Legislature(2001 - 2002)

02/28/2001 03:20 PM L&C

Audio Topic
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
HB  81-EXTENDING BOARD OF DENTAL EXAMINERS                                                                                    
CHAIR MURKOWSKI announced  that the next order  of business would                                                               
be HOUSE BILL  NO. 81, "An Act extending the  termination date of                                                               
the Board of Dental Examiners."                                                                                                 
Number 2307                                                                                                                     
REPRESENTATIVE HUGH FATE, Alaska  State Legislature, testified as                                                               
the sponsor  of HB  81.  Representative  Fate offered  a proposed                                                               
committee substitute (CS) for the committee's consideration.                                                                    
REPRESENTATIVE  ROKEBERG  moved to  adopt  CSHB  81, Version  22-                                                               
LS0375\O,  Lauterbach, 2/26/01,  as the  working document  before                                                               
the committee.   There being  no objection, Version O  was before                                                               
the committee.                                                                                                                  
REPRESENTATIVE  FATE  informed  the   committee  of  the  changes                                                               
encompassed in  Version O.   It extends the termination  date for                                                               
the  Board of  Dental Examiners  to the  year 2005.   On  page 2,                                                               
lines 1 and 11, it removes  the word "prophylactic" and keeps the                                                               
word "preventive"  since both  words have the  same meaning.   In                                                               
Section 4, language will be  added that says, "The governor, when                                                               
making  appointments, will  consider licensed  dentists nominated                                                               
by  the  Alaska Dental  Society  and  licensed dental  hygienists                                                               
nominated by  the Dental Hygienists' Association."   He clarified                                                               
that  this  is  not  mandatory,  but conveys  the  need  for  the                                                               
governor  to   review  the  list   supplied  by   the  respective                                                               
REPRESENTATIVE HALCRO  asked if  that has been  a problem  in the                                                               
REPRESENTATIVE FATE  answered, "It seems  to have been  a problem                                                               
in the  past.  How  large a problem, I  can't say."   He informed                                                               
the committee  that these  were recommendations  by the  Board of                                                               
Dental Examiners  or the Alaska  State Dental Society.   He noted                                                               
that  when  he was  on  the  Board  [of Dental  Examiners],  they                                                               
discussed this.   He  didn't believe  it was  a problem  of great                                                               
magnitude, although it  did exist from time to  time.  Therefore,                                                               
there were  appointments to  the Board  of Dental  Examiners that                                                               
didn't  carry the  respect  of  the full  Dental  Society or  the                                                               
present board.                                                                                                                  
REPRESENTATIVE  HAYES asked  if  this language  is merely  intent                                                               
language since the governor can choose whomever he wants.                                                                       
REPRESENTATIVE  FATE  noted  that  this had  been  reviewed  with                                                               
Catherine Reardon, Director,  Division of Occupational Licensing,                                                               
Department of  Commerce & Economic  Development, and  no conflict                                                               
was seen because  the language only asks the governor  to look at                                                               
the list.                                                                                                                       
Number 2473                                                                                                                     
REPRESENTATIVE FATE  continued reviewing the  changes encompassed                                                               
in Version  O.  He  referred to page  2, line 22,  which requires                                                               
the president of  the Board of Dental Examiners to  be a licensed                                                               
dentist.    He  explained  that   this  [requirement  was  deemed                                                               
necessary]  because  being  president  of  the  Board  of  Dental                                                               
Examiners  involves  more  than  administrative  duties.    Under                                                               
Section 6, it  refers to radiology [equipment]  and the placement                                                               
of the seal.                                                                                                                    
TAPE 01-26, SIDE B                                                                                                              
REPRESENTATIVE FATE explained that  currently, upon completion of                                                               
the  examination  [of  the dental  radiological  equipment],  the                                                               
examiner would take the fee directly  from the dentist.  Then the                                                               
examiner  is required  to  send a  report  to central  licensing,                                                               
which  would  issue the  seal  to  the  dentist.   This  language                                                               
attempts to simplify  the process.  This was  also discussed with                                                               
the Division  of Occupational Licensing.   He explained  the [new                                                               
process] as  follows.  After  the dentist gives the  examiner the                                                               
required  fee,  the [examiner]  may  give  the dentist,  who  has                                                               
passed the  inspection, the  seal that specifies  a date  for the                                                               
next inspection.   This  is not  really a state  seal.   Then the                                                               
examiner  would send  one copy  to the  Division of  Occupational                                                               
Licensing  and the  other to  the dentist.   Therefore,  there is                                                               
accountability from  the dentist  who has  received the  seal and                                                               
the examination  because the licensing  agency knows that  it has                                                               
been  performed and  [the equipment]  has passed  or failed.   If                                                               
[the equipment]  fails, there is  another date  automatically set                                                               
by the inspector,  because the equipment can't be  operated if it                                                               
hasn't passed inspection.                                                                                                       
REPRESENTATIVE FATE pointed out that  Section 7 of the Version O,                                                               
as discussed  in the sectional  analysis, "makes a  passing score                                                               
on a clinical  exam given by the Central  Regional Dental Testing                                                               
Service, Inc.  an acceptable alternative to  the Western Regional                                                               
Examining  Board examination."   He  clarified that  the standard                                                               
won't  be   reduced  with  this  because   the  Western  Regional                                                               
Examining Board  and the Central Regional  Dental Testing Service                                                               
have the  same sort  of standards.   He  noted that  the language                                                               
"provided the examination was taken  on or after January 1, 1987"                                                               
is deleted because  the new examining board  makes that provision                                                               
moot.   On  page 3,  line 31,  the language  "has been"  has been                                                               
replaced with "is",  and on page 4, line 1,  "a" is replaced with                                                               
the  word "that".   Both  of those  changes merely  clean up  the                                                               
language.  On page 4, line  2, the language "in which the dentist                                                           
is licensed" has been inserted so  that a dentist can be licensed                                                           
in Alaska through credentialing.                                                                                                
REPRESENTATIVE  FATE  pointed out  that  the  bill increases  the                                                               
civil fine [for dentists] and  specifies that the fine be $25,000                                                               
for each violation.   This is an increase from  $5,000.  Finally,                                                               
Version O includes  new language regarding the  definition of the                                                               
practice of dentistry.   He referred to page 6,  line 26, through                                                               
page 7, line 2.  The  definition of the practice of dentistry has                                                               
been expanded to include new concepts of treatment and learning.                                                                
REPRESENTATIVE  ROKEBERG asked  if this  would allow  dentists to                                                               
perform plastic surgery.                                                                                                        
REPRESENTATIVE FATE replied no.                                                                                                 
Number 2270                                                                                                                     
CHAIR MURKOWSKI pointed out that  the original bill was merely an                                                               
extension of  the sunset date.   Therefore,  she asked if  any of                                                               
the expansions  of the bill  would result  in an increase  to the                                                               
fiscal note, which was a zero fiscal note.                                                                                      
REPRESENTATIVE  FATE answered  that the  fiscal note  will remain                                                               
REPRESENTATIVE ROKEBERG  asked if  "we" don't like  dentists from                                                               
the East Coast.                                                                                                                 
REPRESENTATIVE  FATE said  that he  sat  on the  Board of  Dental                                                               
Examiners when  perhaps that was  true.  However,  now everything                                                               
is  done with  regional  examinations.   Many  of these  regional                                                               
examinations  have  reciprocity  between examining  boards.    He                                                               
said,  "Standards  have  come  up  to where  ...  the  boards  of                                                               
examiners who  go over those  standards basically, now,  are very                                                               
close  to the  same."    Therefore, the  basic  training is  very                                                               
standardized throughout the U.S.                                                                                                
Number 2177                                                                                                                     
CATHERINE REARDON, Director,  Division of Occupational Licensing,                                                               
Department  of  Commerce  & Economic  Development,  informed  the                                                               
committee that  the division  provides the  staff support  to the                                                               
Board of  Dental Examiners.   In regard  to the fiscal  note, Ms.                                                               
Reardon agreed  that the proposed  CS will not impact  the fiscal                                                               
note.   However,  she pointed  out  that the  [House and  Senate]                                                               
Finance  Committees  as  well  as  the  presiding  officers  have                                                               
requested  that the  administration change  the way  fiscal notes                                                               
for  board sunset  extensions are  presented.   In the  past such                                                               
fiscal  notes were  presented as  zero fiscal  notes with  a note                                                               
regarding the  prior year's  costs that  were anticipated  in the                                                               
governor's  budget.   Now,  such fiscal  notes  will be  positive                                                               
fiscal notes that  show the costs, with a comment  that the money                                                               
is already in the budget.                                                                                                       
Number 2055                                                                                                                     
REPRESENTATIVE  ROKEBERG asked  if  the desire  was  to show  the                                                               
fiscal note as positive because the money is in hand.                                                                           
MS. REARDON related her understanding  "that the request has been                                                               
made that  we prepare the fiscal  notes keeping in mind  the fact                                                               
that if  the board was not  extended, there would be  a reduction                                                               
in  state  expenditures."   Therefore,  the  fiscal  note  should                                                               
indicate  that  there is  a  cost  to passing  this  legislation.                                                               
Thus, costs are being shown for  years 2003-2007, not for 2002 or                                                               
2008, because the latter are wind-down years.                                                                                   
REPRESENTATIVE  ROKEBERG inquired  as to  where that  would leave                                                               
[proposed CS] 418.                                                                                                              
MS. REARDON  responded that she  didn't feel that would  have any                                                               
impact on  the final result, but  rather it is a  [difference] in                                                               
how the same  reality is shown.  She explained  that the money is                                                               
still  receipt-supported services  and  no  increments are  being                                                               
requested.   She  highlighted that  this change  in fiscal  notes                                                               
will  not impact  how  "our" expenditures  are  reflected in  the                                                               
state budget.                                                                                                                   
MS. REARDON thanked Representative  Fate for discussing the ideas                                                               
with her  and taking into  account her  comments.  She  said that                                                               
the division  and the board  would like  for the Board  of Dental                                                               
Examiners to be  extended to 2005.  She expressed  the need to be                                                               
clear regarding  which items  the Board  of Dental  Examiners has                                                               
taken a position  on because sometimes people refer  to the Board                                                               
of the Dental Society as the Board [of Dental Examiners].                                                                       
Number 1970                                                                                                                     
MS.  REARDON informed  the  committee that  the  Board of  Dental                                                               
Examiners  supports the  removal  of the  word "prophylactic"  in                                                               
Section 3, which would clarify  that dental assistants are not to                                                               
do  "prophies"   that  relate  to  cleaning.     Instead,  dental                                                               
assistants  are  permitted to  do  the  preparation for  pit  and                                                               
fissure sealants.   This is not a change in  policy but rather is                                                               
an  attempt to  offer  clarity.   In  regard  to  Section 4,  Ms.                                                               
Reardon  noted  that she  had  communicated  with the  governor's                                                               
office  regarding   the  need   to  consider   licensed  dentists                                                               
nominated by the two groups.   She related her understanding that                                                               
this  language in  Section 4  is acceptable  and doesn't  seem to                                                               
present any  constitutional concerns  because the  requirement is                                                               
that  they  merely  be  considered.     She  mentioned  that  the                                                               
governor's office feels  that it has always  considered the names                                                               
brought forward by  the Dental Hygienists and  the Dental Society                                                               
and welcomes anyone's suggestion.                                                                                               
MR. REARDON  turned to Section  5, with which  the administration                                                               
has concerns.   The Dental Board  has not taken a  board position                                                               
on Section 5  or Section 4.   She noted that her  staff had faxed                                                               
the most recent version of the  proposed CS to the members of the                                                               
Dental Board.   Although the board  has not had a  public meeting                                                               
at  which  it  could  vote, individual  members  have  commented.                                                               
Several  board members  say that  they like  the bill  as it  is,                                                               
while  several   took  issue   with  Section   5,  as   does  the                                                               
administration because  there could be  a situation in  which the                                                               
hygienist member or public member would  be the best person to be                                                               
chair.    She said,  "It's  unclear  why  that option  should  be                                                               
foreclosed."   She informed the  committee that at one  point the                                                               
Medical Board had  the public member, an attorney,  as the chair.                                                               
She  also pointed  out  that  the current  public  member of  the                                                               
Dental Board,  although not interested  in serving as  chair, has                                                               
chaired the Board  of Providence Health System for  the past five                                                               
years.     That   position   included   the  responsibility   for                                                               
credentialing physicians  for each medical facility.   Therefore,                                                               
perhaps  a public  member  could  be qualified  to  serve in  the                                                               
capacity of the chair.                                                                                                          
Number 1813                                                                                                                     
MS. REARDON referred  to the language change in  Section 6, which                                                               
seems fine to  her.  She noted that the  program was administered                                                               
per  the existing  statute.   Although the  Dental Board  has not                                                               
taken a position on Section  6, she didn't anticipate there being                                                               
a problem.  In regard to Section  7, the Dental Board has taken a                                                               
position in support  of accepting the [passing score]  of an exam                                                               
given  by the  Central Regional  Dental Testing  Service.   These                                                               
regional  exams  are,  in  lay  terms,  a  practical  exam.    As                                                               
mentioned  earlier, the  Central and  Western regions  agree that                                                               
their tests are comparable, and  there is statistical information                                                               
to support  that claim.   Ms.  Reardon said, "I  think this  is a                                                               
good move because I believe it  benefits Alaska when it is easier                                                               
for dentists from other states  to relocate here."  She explained                                                               
that  the dentists  in Alaska  are  becoming older  and thus  the                                                               
state may soon  face a difficulty with having  an adequate number                                                               
of dentists.  Ms. Reardon noted  her support of Section 8 because                                                               
it removes one  of the possible stumbling blocks  to dentists who                                                               
are coming in from other states.                                                                                                
MS. REARDON pointed  out that the Dental  Board strongly supports                                                               
the civil  fine authority increase,  which parallels  an increase                                                               
that is included  in separate legislation for  the Medical Board.                                                               
The  Dental  Board did  recommend  adopting  the American  Dental                                                               
Association (ADA)  definition of  dentistry, which appears  to be                                                               
what is  included in  HB 81.   Therefore, the  board would  be on                                                               
record  as   supporting  that.     In  conclusion,   Ms.  Reardon                                                               
reiterated that the  Dental Board and the  division would support                                                               
this  legislation with  some  concerns  regarding the  presidency                                                               
Number 1656                                                                                                                     
REPRESENTATIVE  HALCRO  surmised that  Section  5  is more  of  a                                                               
territorial  disagreement  than  a  practical  one.    He  asked,                                                               
"Wouldn't it  be safe to assume  that the president of  the board                                                               
should be a licensed dentist?"                                                                                                  
MS. REARDON remarked, "I guess  that that's the issue that maybe-                                                               
-no, perhaps it's not safe to  assume it should be."  She pointed                                                               
out  that  there are  three  people  on  the  board who  are  not                                                               
dentists:    the two  hygienists  and  the  public member.    She                                                               
acknowledged that since  the majority of the  board are dentists,                                                               
they  could,  if  they  united,  have a  majority  vote  for  the                                                               
president.    However, it  doesn't  seem  necessary to  thwart  a                                                               
future  situation  in  which  the   board  would  feel  that  its                                                               
hygienist  member or  public member  would best  serve as  chair.                                                               
She  informed  the  committee that  with  occupational  licensing                                                               
boards,  all the  members  vote  unless there  is  a conflict  of                                                               
interest.   Therefore,  any one  of  the board  members could  be                                                               
perceived as  the tie-breaking  vote and  thus the  chair doesn't                                                               
have  any special  power in  that regard.   Ms.  Reardon expected                                                               
that  in cases  of participating  in things  such as  the Western                                                               
Regional Examining  Board, a dentist  member of the  Dental Board                                                               
would be requested to participate.                                                                                              
REPRESENTATIVE  HALCRO  inquired   as  to  Representative  Fate's                                                               
contention that the  president of the Dental  Board will interact                                                               
with   other  presidents   of  other   boards  and   professional                                                               
organizations and  thus should  have a  background as  a licensed                                                               
dentist in order "to talk the talk."                                                                                            
MS. REARDON indicated  that if the chair was not  a dentist, that                                                               
person could note that  he or she is not a  dentist.  She pointed                                                               
out that  since she  has been director,  the chair  hasn't always                                                               
been  the person  participating in  national meetings.   For  the                                                               
past  several years  it was  common for  a member  who is  a past                                                               
president of  the board  to be involved  with the  Western Region                                                               
Examining Board interactions for the board.                                                                                     
Number 1475                                                                                                                     
GEORGE SHAFFER, DMD, Licensed Dentist  in Ketchikan, informed the                                                               
committee that  he is  a past  member and  past president  of the                                                               
licensing  board.   He  said  that he  agrees  with  most of  the                                                               
comments  that he  has heard  regarding the  changes.   He stated                                                               
that he  would like this  bill to  pass as presented  [Version O]                                                               
with  one  amendment.    He  explained that  the  board  has  the                                                               
following three purposes:  to  issue a license, to discipline the                                                               
licensee  after issuance  of the  license if  there are  problems                                                               
with the practitioner, and to  establish the minimum standards of                                                               
competency that would allow people to practice in Alaska.                                                                       
MR.  SHAFFER related  his  belief that  the  minimum standard  of                                                               
competency is  the crux of the  problem in regard to  who sits as                                                               
the  chair  of   the  board.    Sometimes  it   is  difficult  to                                                               
communicate  without  using  technical  dental  language  between                                                               
boards.   He pointed out  that the inclusion of  another regional                                                               
exam  would result  in more  communication between  the licensing                                                               
boards.  Dr.  Shaffer informed the committee that when  he was on                                                               
the  board,  a licensed  Alaskan  dentist  was present  at  every                                                               
examination  given  by  the  Western  Regional  Examining  Board,                                                               
although  he  understands  that  is  not  the  current  practice.                                                               
Therefore,  adding  the  Central Regional  Testing  Service  will                                                               
include  more exams  and create  difficulty  in finding  licensed                                                               
personnel  from Alaska  who would  be  willing to  travel to  the                                                               
location of [these  exams] when they are given.   So, he surmised                                                               
that  there   would  be  more  communication   necessary  between                                                               
Alaska's Dental Board president and the licensing entities.                                                                     
DR.  SHAFFER specified  that his  amendment would  be on  page 3,                                                               
line  16,  after  "or  by the  Central  Regional  Dental  Testing                                                           
Service, Inc.",  to insert  "taken after January  1, 2001,".   He                                                           
explained  that he  wanted  this language  because  Section 7  of                                                               
Version  O deletes  the language  "taken on  or after  January 1,                                                               
1987",  which  defined  the  moment  in  time  when  the  Western                                                               
Regional [exam] was  accepted as meeting Alaska's  standards.  If                                                               
this is  left without  a starting  date, he  said there  would be                                                               
potential problems for  the legal system to define  at what point                                                               
the exams,  the Western Regional  and the Central  Regional, were                                                               
comparable.   In July 2000  the Western Regional [Board]  and the                                                               
Central Regional [Board] agreed  that both exams were comparable.                                                               
Therefore, he  was uncomfortable  with accepting a  regional exam                                                               
without a starting date.                                                                                                        
Number 1228                                                                                                                     
DR. TOM  HIPSHER, President, Alaska Dental  Society, informed the                                                               
committee  that  the  Alaska Dental  Society  recently  held  its                                                               
executive council  meeting, during which this  bill was reviewed.                                                               
Basically, the  [executive council of the  Alaska Dental Society]                                                               
unanimously  passed  this bill  as  written,  as amended  by  Dr.                                                               
REPRESENTATIVE  FATE  offered  Dr. Shaffer's  amendment  for  the                                                               
committee's consideration.                                                                                                      
MS.  REARDON mentioned  that she  hasn't spoken  with the  Dental                                                               
Board  on this  amendment.   Speaking on  behalf of  herself, she                                                               
related her belief  that even with the amendment  this bill would                                                               
be a  good step  toward making  Alaska available  as a  place for                                                               
dentists  to practice.   However,  inserting  that specific  date                                                               
will  remove part  of  that  gain because  those  who passed  the                                                               
[Central Regional  Testing Service]  exam earlier would  be faced                                                               
with  the need  to take  the [Western  Regional Examining  Board]                                                               
exam, even if the individual had  been practicing for a number of                                                               
years in  another state without disciplinary  action.  Therefore,                                                               
Ms.  Reardon  was concerned  with  the  "difficulty and  cost  of                                                               
coming  in for  a 'licensed  by credentials'  into Alaska."   She                                                               
pointed  out that  an  individual who  didn't  take the  [Western                                                               
Regional Examining Board]  exam would have to  have practiced for                                                               
the past  five years and then  would be faced with  taking a test                                                               
that is  not easy to  do after being out  of school for  a while.                                                               
Furthermore, it  has its own  substantial costs.   Therefore, she                                                               
said, "We'll be  putting off the date at which  we can accept ...                                                               
people just  on the face  of that passage  of the test,  but it's                                                               
still better than not accepting those people at all."                                                                           
Number 1018                                                                                                                     
CHAIR  MURKOWSKI  clarified  that  the amendment  would  read  as                                                               
     Page 3, line 13, after "Inc."                                                                                          
          Insert "taken after January 1, 2001"                                                                                  
REPRESENTATIVE  FATE  asked  if  this  amendment  would  preclude                                                               
anyone who  has taken the  Western Regional exam after  a certain                                                               
date or  if the  amendment is  specific to  the date  the Central                                                               
Regional Testing Service exam was  given parity of standards with                                                               
the Western Regional [Examining Board] exam.                                                                                    
DR. SHAFFER answered,  "We would not want to restrict  the use of                                                               
the Western  Regional Board,  but we  would like  to put  a clean                                                               
start  date for  the acceptance  of the  Central Regional  Board.                                                               
And if it  takes more [work on the language]  to make that clear,                                                               
then I would be in favor of that as well."                                                                                      
REPRESENTATIVE FATE said, "Basically,  what you're saying is that                                                               
nobody has taken the ... Central  Testing ... dental exam to even                                                               
become licensed in the state and  they can now, but ... the clock                                                               
will begin to tick January 1, 2001.  Is that correct?"                                                                          
DR. SHAFFER answered in the affirmative.                                                                                        
Number 0862                                                                                                                     
CHAIR MURKOWSKI  asked if there  was a motion from  the committee                                                               
members to  adopt the  aforementioned amendment.   [There  was no                                                               
audible  motion  from any  committee  member.]   Chair  Murkowski                                                               
announced that  there were no  objections and thus  the amendment                                                               
was adopted.                                                                                                                    
REPRESENTATIVE  HAYES moved  to report  CSHB 81,  Version O  [22-                                                               
LS0375\O, Lauterbach, 2/26/01], as  amended out of committee with                                                               
individual  recommendations  and  the  accompanying  zero  fiscal                                                               
note.  There  being no objection, CSHB 81(L&C)  was reported from                                                               
the House Labor and Commerce Standing Committee.                                                                                

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