Legislature(2001 - 2002)
02/28/2001 03:20 PM L&C
* first hearing in first committee of referral
= bill was previously heard/scheduled
= 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 associations. REPRESENTATIVE HALCRO asked if that has been a problem in the past. 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 zero. 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 issue. 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. Shaffer. 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 follows: 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.