Legislature(1995 - 1996)
03/02/1995 02:37 PM House HES
| Audio | Topic |
|---|
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
HOUSE HEALTH, EDUCATION AND SOCIAL SERVICES
STANDING COMMITTEE
March 2, 1995
2:37 p.m.
MEMBERS PRESENT
Representative Cynthia Toohey, Co-Chair
Representative Con Bunde, Co-Chair
Representative Al Vezey
Representative Gary Davis
Representative Norman Rokeberg
Representative Caren Robinson
Representative Tom Brice
MEMBERS ABSENT
None
COMMITTEE CALENDAR
* HB 182: "An Act allowing a dentist to delegate certain duties
to a dental assistant."
HEARD AND HELD
* HB 172: "An Act relating to kindergarten programs and compulsory
education; to identification required upon enrollment in
a public school; to those grades that constitute
elementary, junior, and secondary school; and providing
for an effective date."
HEARD AND HELD
* HB 157: "An Act relating to licensure of dietitians and
nutritionists; and providing for an effective date."
HEARD AND HELD
HB 124: "An Act extending the termination date of the Board of
Nursing Home Administrators; and providing for an
effective date."
PASSED OUT OF COMMITTEE
(* First public hearing.)
WITNESS REGISTER
BEN BROWN, Legislative Aide
Representative Toohey's Office
Room 104, Capitol Building
Juneau, AK 99801
Telephone: (907) 465-4919
POSITION STATEMENT: Testified in support of HB 182.
DR. TOM BORNSTEIN, Dentist and director of dental services
Southeast Alaska Regional Health Consortium
3245 Hospital Drive
Juneau, AK 99801
Telephone: (907) 463-4070
POSITION STATEMENT: Testified in support of HB 182.
JOELLEN TATE RINKER, Legislative Chairperson
Alaska State Dental Hygienists Association
2061 Sturbridge Circle
Anchorage, AK 99507
Telephone: (907) 349-4149
POSITION STATEMENT: Testified against HB 182 via teleconference.
LISA HODSON-SMITH, Dental hygienist, former adjunct clinical
professor, University of Alaska
1830 North Salem Drive
Anchorage, AK 99508
Telephone: (907) 563-7383
POSITION STATEMENT: Testified against HB 182 via teleconference.
DR. KEN CROOKS, Chief of Dental Services
Bristol Bay Area Health Corporation
President, Coastal District Dental Society
P.O. Box 1610
Dillingham, AK 99576
Telephone: (907) 842-5365
POSITION STATEMENT: Testified in favor of HB 182 via
teleconference.
ROBIN STRATTON, Dental hygienist
Bristol Bay Area Health Corporation
P.O. Box 1417
Dillingham, AK 99576
Telephone: (907) 842-4330
POSITION STATEMENT: Testified in favor of HB 182 via
teleconference.
DR. DAN PITTS
Soldotna Dental Clinic
155 Smith Way
Soldotna, AK 99669
Telephone: (907) 262-4989
POSITION STATEMENT: Testified in support of HB 182 via
teleconference.
E.L. WHEELER, DDS
Tanana Chiefs Conference
122 First Avenue, Suite 600
Fairbanks, AK 99701
Telephone: (907) 452-8251
POSITION STATEMENT: Testified in support of HB 182 via
teleconference.
PHYLLIS CAVANAUGH, Dental clinic supervisor
Public Health Service
Tanana Chiefs Conference
122 First Avenue, Suite 600
Fairbanks, AK 99701
Telephone: (907) 452-8251
POSITION STATEMENT: Testified in support of HB 182 via
teleconference.
CECELIA PREZIOSE, Dental hygienist
4858 Canterbury Way
Anchorage, AK 99503
Telephone: (907) 562-7363
POSITION STATEMENT: Testified against HB 182 via teleconference.
CAROL STOLPE, Registered dental hygienist
1741 George Bell
Anchorage, AK 99515
Telephone: (907) 345-0448
POSITION STATEMENT: Testified against HB 182 via teleconference.
JULIE BLEIER, Dental hygienist
Turnagain Dental Clinic
24343 Lilac Court, Apt. D
Anchorage, AK 99507
Telephone: (907) 272-6122
POSITION STATEMENT: Testified against HB 182 via teleconference.
BARBARA O'DONNELL, Dental hygienist
1908 Hillcrest Drive, No. 8
Anchorage, AK 99517
Telephone: (907) 272-9246
POSITION STATEMENT: Testified against HB 182 via teleconference.
KATHLEEN WILLIAMSON, Registered dental hygienist
P.O. Box 33944
Juneau, AK 99803
Telephone: (907) 789-3100
POSITION STATEMENT: Testified against HB 182.
LARRY WIGET, Legislative coordinator
Anchorage School District
4600 DeBarr Road
Anchorage, AK 99510
Telephone: (907) 262-2255
POSITION STATEMENT: Testified in support of HB 172 via
teleconference.
DUANE GUILEY, Director of School Finance
Department of Education
Goldbelt Building
801 W. 10th Street, Second Floor
Juneau, AK 99801
Telephone: (907) 465-8679
POSITION STATEMENT: Testified in support of HB 172.
REPRESENTATIVE BETTYE DAVIS
Alaska State Legislature
Room 430, State Capitol
Juneau, AK 99801
Telephone: (907) 465-3875
POSITION STATEMENT: Testified in support of HB 172.
JOHN WRAY, Incoming president
Alaska Dietetics Association
c/o Bartlett Hospital
3260 Hospital Drive
Juneau, AK 990801
Telephone: (907) 586-2611, ext. 291
POSITION STATEMENT: Testified in support of HB 157.
DAVID OTTOSON, Alaska Representative
National Nutritional Food Association, Northwest Division
200 Seward Street
Juneau, AK 99801
Telephone: (907) 586-6476
POSITION STATEMENT: Testified against HB 157.
CATHERINE REARDON, Director
Division of Occupational Licensing
9th Floor, State Office Building
Juneau, AK 99801
Telephone: (907) 465-2534
POSITION STATEMENT: Provided information for HB 157.
DR. JAMES PIZZADILI, Chiropractor
Alaska State Coordinator, Citizens for Health
3801 McCain Coop
Anchorage, AK 99503
Telephone: (907) 562-6211
POSITION STATEMENT: Testified against HB 157.
JULIANNE MINARIK, Pediatric and neonatal dietitian
Providence Hospital
P.O. Box 126
Girdwood, AK 99587
Telephone: (907) 783-3459
POSITION STATEMENT: Testified via teleconference in support of
HB 157.
FRANCES JAYNES, Registered dietitian
Providence Hospital
2900 Chesapeake Avenue
Anchorage, AK 99516
Telephone: (907) 345-4579
POSITION STATEMENT: Testified in support of HB 157 via
teleconference.
BEVERLY WOOLEY, Legislative network coordinator
Alaska Dietetic Association
2073 Dimond Drive
Anchorage, AK 99507
Telephone: (907) 563-3202
POSITION STATEMENT: Testified via teleconference in favor of
HB 157.
DEBRA MESTAS, WIC nutritionist and certified breast feeding
consultant, Anchorage WIC program;
Renal dietitian, Alaska Kidney Center
8200 Frank Street
Anchorage, AK 99518
Telephone: (907) 349-8835
POSITION STATEMENT: Testified via teleconference in support of
HB 157.
HARLAN KNUDSON, Executive
Alaska State Hospital and Nursing Home Administration
319 Seward Street, Suite 11
Juneau, AK 99801
Telephone: (907) 586-1790
POSITION STATEMENT: Testified in support of HB 124.
PREVIOUS ACTION
BILL: HB 182
SHORT TITLE: DELEGATION OF DUTIES TO DENTAL ASSISTANTS
SPONSOR(S): REPRESENTATIVE(S) TOOHEY,Nicholia
JRN-DATE JRN-PG ACTION
02/15/95 369 (H) READ THE FIRST TIME - REFERRAL(S)
02/15/95 370 (H) HEALTH, EDUCATION & SOCIAL SERVICES
02/23/95 (H) MINUTE(HES)
03/02/95 (H) HES AT 02:30 PM CAPITOL 106
BILL: HB 172
SHORT TITLE: KINDERGARTEN & MISC. EDUC
SPONSOR(S): HEALTH, EDUCATION & SOCIAL SERVICES BY REQUEST
JRN-DATE JRN-PG ACTION
02/10/95 302 (H) READ THE FIRST TIME - REFERRAL(S)
02/10/95 302 (H) HES, FINANCE
03/02/95 (H) HES AT 02:30 PM CAPITOL 106
BILL: HB 157
SHORT TITLE: DIETITIANS AND NUTRITIONISTS
SPONSOR(S): HEALTH, EDUCATION & SOCIAL SERVICES BY REQUEST
JRN-DATE JRN-PG ACTION
02/06/95 252 (H) READ THE FIRST TIME - REFERRAL(S)
02/06/95 253 (H) HES, L&C, FIN
03/02/95 (H) HES AT 02:30 PM CAPITOL 106
BILL: HB 124
SHORT TITLE: BOARD OF NURSING HOME ADMINISTRATORS
SPONSOR(S): REPRESENTATIVE(S) TOOHEY
JRN-DATE JRN-PG ACTION
01/25/95 133 (H) READ THE FIRST TIME - REFERRAL(S)
01/25/95 133 (H) HES
02/09/95 (H) HES AT 03:00 PM CAPITOL 106
02/09/95 (H) MINUTE(HES)
03/02/95 (H) HES AT 02:30 PM CAPITOL 106
ACTION NARRATIVE
TAPE 95-13, SIDE A
Number 000
CO-CHAIR CYNTHIA TOOHEY called the meeting of the House Health,
Education and Social Services standing committee to order at 2:37
p.m. Present at the call to order were Representatives Brice,
Robinson, Vezey, Toohey and Bunde. A quorum was present. Co-Chair
Bunde read the calendar.
HHES - 03/02/95
HB 182 - DELEGATION OF DUTIES TO DENTAL ASSISTANTS
CO-CHAIR CYNTHIA TOOHEY introduced HB 182 and asked her fellow HESS
Committee members to consider it. This is legislation to allow
Alaska's dentists to delegate certain specific duties to their
dental assistants. According to an Attorney General's
interpretation of Alaska statute, dental assistants are not allowed
to perform three procedures: Applying topical preventive agents,
applying prophylactic agents, and applying pit and fissure
sealants.
CO-CHAIR TOOHEY explained that these are nonevasive treatments.
She introduced HB 182 when she became aware of problems which were
arising from the fact that in rural Alaska, it is especially
difficult for a dentist to do his or her job without help. It is
more likely that this help will come from a dental assistant than
from another dentist or from a dental hygienist.
CO-CHAIR TOOHEY said the dentist is responsible for all that
happens in his or her practice, and therefore, must train
assistants to do whatever procedures they are to perform.
CO-CHAIR TOOHEY explained an oversight in the initial drafting of
this bill left out dentists who are not licensed by Chapter 36 of
Title 8. She asked the committee to consider the amendment
included in the bill packets, so that the ability to delegate these
three tasks to assistants is given to dentists who work for a
branch of the federal government, as well as to the rest of
Alaska's dentists.
Number 207
CO-CHAIR TOOHEY said that in order to enable dentists to do their
jobs in rural Alaska and across the rest of the state, HESS
Committee members should support the amendment and HB 182 as
amended and vote for its passage.
CO-CHAIR BUNDE entertained a motion to adopt the amendment. Co-
Chair Toohey moved that the amendment be adopted.
REPRESENTATIVE TOM BRICE objected for purposes of discussion.
Number 284
CO-CHAIR TOOHEY said the original bill contained a glitch. The
dentists that work for the public health service, the Indian Health
Service (IHS) and the federal government do not need an Alaskan
license. As long as they are licensed by every other state, they
qualify to practice dentistry in the state of Alaska. The
amendment on page 1, line 6, inserts, "or by a dentist exempt from
licensure under AS 08.36.350(a)(2)".
Number 330
REPRESENTATIVE AL VEZEY asked if it was Co-Chair Toohey's
contention that the wording in the current bill specifically
excludes those individuals who are authorized to practice under AS
08.36 that are not specifically licensed by the state.
CO-CHAIR TOOHEY said those dentists can practice in the state.
REPRESENTATIVE VEZEY asked if Co-Chair Toohey was maintaining that
the existing wording specifically excludes those people that will
be included by the amendment.
CO-CHAIR TOOHEY said yes. The amendment is including those people
because they are the ones that normally use dental assistants in
the bush. This amendment will include them into the statute.
Number 410
REPRESENTATIVE VEZEY said he had not read the entire statute. He
would question if these dentists are authorized to practice under
another section in AS 08.36, which they are, if it would not be
redundant to reference certain other subsections of AS 08.36.
CO-CHAIR TOOHEY said apparently, it is not redundant. They are
allowed to practice within the state, as long as they are licensed
in another state in the Union. This is because they are a federal
or IHS employee.
REPRESENTATIVE VEZEY said that is the root of his question. If
they are authorized to practice by virtue of being a federal
officer (because a member of the public health service is an
official officer of the federal government), he wondered if it is
really necessary to include these dentists specifically.
Number 482
CO-CHAIR BUNDE asked on whose advice was the amendment proposed.
CO-CHAIR TOOHEY answered the amendment was proposed because of a
discovery by her staff. She said that a witness in the room would
be able to answer this question.
Number 508
BEN BROWN, legislative aide for Co-Chair Toohey, said the request
to include persons exempted by Section 350 of Chapter 36 came from
the Tanana Chiefs Conference Health Department. Dentists
practicing in rural Alaska are a heterogeneous group. Some of them
are private dentists who are licensed by the state of Alaska under
Chapter 36. Others are employees of the public health service, the
IHS or another agency of the federal government.
MR. BROWN continued that the Tanana Chiefs Conference Health
Department said the bill would not meet their needs as much as they
would like unless the amendment was adopted. This was to make sure
that those exempt from licensure under this chapter were included.
CO-CHAIR BUNDE asked if people employed by the federal government
are not licensed by the state.
MR. BROWN said they were exempt from licensure by the state.
Number 560
CO-CHAIR BUNDE said the question was, is that exemption granted in
Chapter 36.
MR. BROWN said that exemption is granted under the subsection of
Chapter 36 that is cited by this amendment.
Number 590
DR. TOM BORNSTEIN, dentist with the Southeast Alaska Regional
Health Consortium (SEARHC) and director of dental services, said
that dentists who work for the public health service are exempt
from licensure in the state. However, many of those dentists do
have state licenses. The problem is that these dentists are
dealing with the delegation of duties to people who are licensed in
this state.
DR. BORNSTEIN said that in other words, there would be no problem
with a federal dentist delegating authority to perform the duties
in question to a federal dental assistant. The question that Mr.
Brown has tried to clarify is that a dentist who is not under the
purview of the state (not licensed by the state but licensed by the
federal government), delegating responsibility to a dental
assistant who is regulated by the state....
CO-CHAIR BUNDE politely interrupted and said the original question
concerned the ability to practice without being licensed by the
state. He asked if that ability was recognized in statute. He
asked Representative Vezey if that was what he wanted to know.
Number 711
REPRESENTATIVE VEZEY said the state of Alaska cannot regulate the
federal government. The state has medical officers serving in the
public health service and serving in the uniformed services. These
people are not licensed by the state of Alaska. The state cannot
deny them the right to practice. The Alaska statutes may or may
not mention that fact, but it does not change the fact that the
state of Alaska cannot regulate their practice. He asked if we, as
a state, have the right to regulate the public health service in
anything they do.
DR. BORNSTEIN answered that the Native corporations, in many
instances, have hired what are called "direct hire personnel."
There are people that come under the state's laws and specifically,
the health corporations can hire employees who would be under state
statutes but not under federal statutes. In other words, all of
the folks that SEARHC hires that are not federally employed are
under the state's regulation. The amendment is an attempt to avoid
a situation in which a dentist who is not regulated by the state,
(and Representative Vezey is correct, it is irrelevant), is
delegating tasks to a dental assistant who is regulated by the
state. That is the problem.
DR. BORNSTEIN said the amendment is trying to avoid the situation
in which the dentist does not have the authority to delegate this
responsibility even though a private dentist would.
Number 828
REPRESENTATIVE BRICE attempted to clarify Dr. Bornstein's remarks.
He said that currently, private dentists can have dental assistants
apply topical preventive or prophylactic agents.
DR. BORNSTEIN said that if HB 182 passes, that will be the case.
If HB 182 passes without including a provision for the federal
dentists to have those same delegation authorities, a grey area
would exist. The amendment is an attempt to avoid this grey area.
Number 843
REPRESENTATIVE BRICE asked if the amendment is expanding the bill,
not narrowing the bill down. Co-Chair Toohey said yes, somewhat.
The amendment is to allow the federal government to have the same
powers as the private dentist.
CO-CHAIR BUNDE asked if the objection to the motion to adopt the
amendment was still maintained. Representative Brice said no, and
the amendment was passed. The Committee Substitute (CS) for HB 182
was now adopted. The discussion was now open to public testimony.
Number 914
DR. BORNSTEIN spoke in support of HB 182. Dentistry, as well as
medicine, is coming to the realization that prevention of disease
is more humane and cost-effective than treatment of an already
existing condition. This is especially true in regard to dental
caries (tooth decay). Everyone would rather see it prevented.
Among the most cost-effective tools for the prevention of dental
caries is the use of pit and fissure sealants, which is a plastic
coating that goes over the biting surfaces of back teeth; and
topical preventive agents that are applied to teeth, such as
topical fluorides and newly approved fluoride varnishes.
Number 965
DR. BORNSTEIN said that dental sealant use has been a tool of the
dental industry for quite some time. It is a major element of
dental disease prevention. This practice has been in widespread
use for about the last 15 years. SEARHC has had formal sealant
programs for the last several years in conjunction with the schools
in many villages and in the main clinics.
DR. BORNSTEIN said these programs are in place throughout Southeast
Alaska. This is the responsibility of SEARHC and many of the other
Native corporations. These organizations go into the villages and
perform similar sealant programs. SEARHC has a ten-year track
record of providing these types of intensive sealant programs.
During this time, dental assistants have been heavily relied upon
to apply these sealants.
DR. BORNSTEIN said the glitch in the system came when the state
rendered an opinion that SEARHC's direct hire dental assistants
came under the Alaska Dental Practice Act. Up until that time, it
was the widely held assumption that the dental assistants were not
covered by that Act in that they were working in a quasi-federal
system.
DR. BORNSTEIN said that also, it is held by the state that the
federally hired dental assistants are not covered. Therefore, the
situation exists in which a federally hired dental assistant can
work side-by-side with a direct-hire dental assistant and the
federally hired assistant can perform duties that the direct hire
assistant, with the same level of training, cannot.
Number 1075
DR. BORNSTEIN explained that sealants are a safe and relatively
simple procedure. He is not aware, in the ten years that SEARHC
has provided intensive sealant programs utilizing dental
assistants, that there has been any untoward events. He is not
aware of any problems associated with dental assistants applying
the sealants.
DR. BORNSTEIN said the application of dental sealants does not
involve any diagnosis, removal of tooth structure, tooth grinding
or the use of anesthetics or medications on the part of the dental
assistant. In fact, currently the recommendations for teeth that
have incipient carious lesions, which are the very beginnings of
tooth decay, is to seal those lesions over. Microbiological data
suggests that those lesions basically become quiescent and do not
progress because they are cut off from their nutrient source.
Number 1138
DR. BORNSTEIN said these are very effective means of preventing
dental caries. This is a procedure that has been shown to be cost
effective and safe. It is something that the dental assistants are
more than adequately capable of doing. This is also something that
can be done without decreasing the quality of the care that is
provided.
DR. BORNSTEIN has become aware of some of the concerns that have
been raised in regards to allowing dental assistants to apply
sealants. Some information Dr. Bornstein saw circulated
characterized dental assistants as untrained and inexperienced.
Yesterday afternoon, Dr. Bornstein called the other dental clinics
maintained by SEARHC in Juneau, Sitka and Ketchikan. Each of those
clinics employ four dental assistants.
DR. BORNSTEIN asked the dental assistants for their number of years
of experience in their current occupation. In Juneau, the numbers
were 10 years, 15 years, 13 years and 3 years. In Sitka, the
experience levels were 16 years, 32 years, 10 years and 2 years.
In Ketchikan, the numbers were 18 years, 12 years, 1 year and 15
years. This is a random survey taken the day before the HESS
Committee meeting. Some of the newer dental assistants have
replaced people who also worked for a very long time.
Number 1230
DR. BORNSTEIN said these are not folks that are unfamiliar with
dental procedures. In addition, this was not a stacked survey.
Dr. Bornstein asked about every dental assistant in the SEARHC
organization.
DR. BORNSTEIN thinks that many of the corporations and established
dental practices are in the same range as SEARHC. It may be
somewhat of a tainted characterization to say that dental
assistants lack experience.
DR. BORNSTEIN said the nature of the procedure is that it is
relatively easy to perform. The body of knowledge that is required
to go along with the application of dental sealants is really what
the dental assistants are trained for. They know about infection
control and universal precautions, Occupational Safety and Health
Administration (OSHA) regulations, material safety data sheets,
patient safety and instrument use.
DR. BORNSTEIN said that dental assistants learn all those things,
it is their job. Adding the additional responsibility of dental
sealants is a very minor addition to their training.
Number 1297
DR. BORNSTEIN said there also may be some confusion as to whether
the bill addresses the polishing of teeth. Dr. Bornstein does not
see where it addresses the polishing of teeth, and is not sure
where this concern comes from. It does not appear to him that the
bill addresses the polishing of teeth.
DR. BORNSTEIN continued that there is also concern that allowing
the dental assistants to perform this procedure will devalue the
services of the dental hygienists. He feels that is an unfair
assumption. The dental hygienists, as any dentist will attest,
undergo extensive training. They are very deserving to be a
profession in their own right.
DR. BORNSTEIN said their main focus is periodontal therapy and
prevention of dental disease. As the practice of dentistry moves
in the direction of the prevention of dental disease, Dr. Bornstein
thinks that the value of dental hygienists will only increase. He
does not think this concern is valid, though he has heard it
expressed.
Number 1366
DR. BORNSTEIN said the issue of certification of dental assistants
to perform these duties has also arisen. He tried to find out
whether certification was feasible and if the process exists for
dental assistants to be able to be certified. He called the
Academy for General Dentistry and reviewed the education materials
put out by the American Dental Association. He called the IHS in
Albuquerque, New Mexico to ascertain whether or not there was a
certification process.
DR. BORNSTEIN explained that in 1991, the Navajo area had planned
to certify dental assistants. They found it was "overkill." They
had gone through the same situation and realized that what they
were netting by coming up with a formal certification process was
not valuable. Essentially, before they are allowed to perform
certain duties, dental assistants receive on-the-job training that
involves inservices in the dental practice, and a certain number of
contact hours with patients. That is how the Navajo area has
proceeded.
Number 1430
CO-CHAIR BUNDE said Dr. Bornstein would be available to answer
questions and announced the order in which comments would be taken
from teleconference sites.
Number 1461
REPRESENTATIVE VEZEY attempted to summarized Dr. Bornstein's
testimony. He said that dental assistants are capable of being
qualified or are qualified to administer prophylactic treatments.
He asked if Mr. Bornstein could make that statement without
reservations.
DR. BORNSTEIN said he has no reservations whatsoever. The dental
assistants have been performing these duties for ten years already.
This is not something that the dental industry in Alaska is asking
to embark on. This is something that has been done already.
REPRESENTATIVE VEZEY commented that Dr. Bornstein did not address
the advantages of using a dental assistant over a dental hygienist.
Representative Vezey said he was just going to assume that using
dental assistants allows the industry to provide health care
service at lower cost.
Number 1509
DR. BORNSTEIN said the dental assistant's salary is generally lower
than the dental hygienist's salary. In addition, it allows for
more efficient staffing configurations. It is better to have a
dentist provide services only they can provide rather than tying
them up with services that a dental assistant could be providing.
REPRESENTATIVE VEZEY thinks the issue that is before the HESS
Committee is providing health care to the public at the lowest cost
without compromising quality. He asked if Dr. Bornstein thought HB
182 would provide this. Dr. Bornstein said absolutely.
Number 1550
CO-CHAIR BUNDE, for the edification of the committee, asked if it
would be fair to say that in level of training, responsibility and
cost, the scale goes dentist, hygienist, assistant. Dr. Bornstein
said yes.
REPRESENTATIVE BRICE asked if Dr. Bornstein said that dental
assistants have been performing the duties in question for the past
ten years.
DR. BORNSTEIN explained that in the programs that the Native health
corporations inherited from the federal government, there was
essentially a grey area as to what was regulated and what was not.
The federal dental assistants were not regulated under the state.
DR. BORNSTEIN said as the corporations accumulated non-federally
hired dental assistants, they were viewed largely by the Native
health corporations to be under the same guidelines that the other
dental assistants were. Therefore, those dental assistants have
been applying dental sealants for years. It is in those programs
that dental assistants have been providing those services.
CO-CHAIR BUNDE announced that Representative Davis joined the
meeting at 3:05 p.m. Representative Rokeberg also joined the
meeting.
Number 1658
JOELLEN TATE RINKER, Legislative Chairperson of the Alaska State
Dental Hygienists Association, testified from Anchorage via
teleconference. She said dental hygienists are health care
providers committed to quality care in public service. In order to
provide this care, they are tested, trained and licensed. The way
HB 182 is written, they feel that the quality of care in the state
of Alaska could be compromised. This would mainly impede the
private sector.
MS. TATE RINKER said the Dental Hygienist Association is opposed to
this bill the way it is written. They are not opposed to
assistants placing sealants or applying topical fluoride. They do
feel that the type of preventative or prophylactic agents is not
well defined in this bill. In addition, in the state of Alaska,
there is no examination for dental assistants. There is no
required certification. This could mean that anyone could be hired
off the street, as a dental assistant, and the next day they could
be applying pit and fissure sealants.
MS. TATE RINKER said she realizes she may be speaking of an extreme
case, however, passing the law as it is written would make that
situation possible. She asked if that is the kind of professional,
quality care that HESS Committee members would want their families
to receive.
Number 1715
MS. TATE RINKER said the big issue that her association has with
the bill is that there are no provisions for any formal
implications regarding procedures which are sensitive and can be
performed on the public. The public is paying for and expecting
quality, professional care from their health care provider. When
this bill insures the public that they are receiving or increasing
quality care, it will be supported. She asked, isn't it important
for all assistants to have a comprehensive training program so the
public can be assured of the professional care it deserves.
MS. TATE RINKER understands that the bill was introduced on behalf
of the Native corporations for their sealant and topical fluoride
programs. These are important programs.
MS. TATE RINKER said she is employed by a Native corporation. She
understands the issue of training and thinks it needs to be in the
bill. She said she is willing to work with the Native
corporations, the Dental Society and the Dental Hygienists Society
to place the language into the statutes that would place an
educational element into the bill.
Number 1773
CO-CHAIR BUNDE asked Ms. Tate Rinker if it would raise her comfort
level with the bill if the bill listed these topical agents
specifically.
MS. TATE RINKER said that would help, but she would still have a
problem with the fact that there are no education requirements for
people who are working in the mouth.
REPRESENTATIVE CAREN ROBINSON said she understands that in the
past, dental hygienists have requested language that basically
says, "...if certified by the board, and under the general
supervision of the licensed dentist."
MS. TATE RINKER said that language was drafted in 1991, and asked
Representative Robinson to notice that language also refers to
other persons. At this point Ms. Tate Rinker thinks that to define
dental assistants would be much more appropriate. She still feels
that we can develop language. It would be important for the three
associations to get together to discuss language and also to confer
with the state on what would be appropriate language that all three
associations would be comfortable with, yet still get the Native
corporations programs that they need.
Number 1838
LISA HODSON-SMITH, dental hygienist and former adjunct clinical
professor at the University of Alaska, also testified from
Anchorage. She said her focus and conviction has been on the
prevention of diseases of Alaska residents to prevent epidemics
such as hepatitis B and AIDS. Anyone who works on a patient
providing care of any kind must have formal training in disease
prevention and microbiology.
MS. HODSON-SMITH believes that competency tests have to be given.
It just takes one virus to spread AIDS. Each individual is
responsible. It may have been tolerated in the past ten years, but
she does not think untrained individuals should be tolerated or
accepted. She thinks that, in fact, hiring people who have no
background in disease transmission through improper cleansing of
themselves and tools will actually promote serious diseases in
Alaska.
MS. HODSON-SMITH said these people need the clinical skills on
sealants, but they also need more formal training in disease
transmission. It will benefit all Alaskans if dental assistants
have that training.
Number 1909
CO-CHAIR BUNDE said he assumes from her testimony that she does not
feel that a dentist who hires a dental assistant necessarily gives
a person the training of which she spoke.
MS. HODSON-SMITH said no. She has observed this many times, and
has worked in many offices in different states. She has seen
dental assistants who do not have training. She has seen improper
dental practices and has had to dismiss herself from the office in
which the improper practices were taking place. She said that
dental assistant training should involve much more than just the
basic skills of sealant placing. She said that she is referring to
the transmission of diseases such as hepatitis B and AIDS.
Number 1945
DR. KEN CROOKS, chief of Dental Services, Bristol Bay Area Health
Corporation; and president of the Coastal District Dental Society,
testified via teleconference from Dillingham. He spoke for his
fellow society members from Dillingham to Barrow. He said that all
in the bush feel that this legislation is vitally important. The
bush has some of the highest instance of dental disease in the
country, and they need to make the best use they can of their
health care resources. He thinks Dr. Bornstein accurately
portrayed the situation. He would try not to repeat Dr. Bornstein.
DR. CROOKS pointed out that in his area, historically they have
dealt with thousands of dental sealants. Statewide, if you count
the times that topical fluoride programs have been administered by
adults without formal training or even by school personnel, Dr.
Crooks can count hundreds of thousands of procedures that have been
performed successfully. Nationally, when studying states with
statutes that permit the application of sealants, more than a
million of these procedures have been performed. The successful
track record for these procedures is undeniable.
DR. CROOKS said he understands people will be concerned, but in his
opinion they are overreacting. It has been demonstrated that the
skill level that is required to perform these services is the same
level of skills or less than many of the other procedures the
dental assistants perform.
DR. CROOKS said the issue of infection control has been brought up.
That is one that the dental profession can point to with pride.
There has been one office with a documented transmission of AIDS in
the country. That was under very unusual circumstances that are
still not clear. Dr. Crooks said these same dental assistants who
are accomplishing this level of quality are the people we are
speaking of in terms of applying dental sealants and topical
prophylactic agents.
DR. CROOKS said that Ms. Rinker brought up polishing agents as
being prophylactic agents. He would refer her back to the statute.
He said to look carefully at Paragraph 1. Clearly, paragraph 1
describes all portions of administering a cleaning of teeth. This
remains unchanged by this legislation and totally in the domain of
dental hygienists. He would offer his reassurance and opinion that
there is no way this will lead to any kind of teeth cleaning by
dental assistants.
Number 2077
REPRESENTATIVE ROBINSON asked if Dr. Crooks had any problem with
working with the Dental Hygienists Association to come up with some
language that either requires some level of training or
certification for dental assistants.
DR. CROOKS said he thought that language would be necessarily very
broad and vague. He said that a dental assistant can be trained to
perform these procedures excellently in less than two hours. If we
were to take the other aspects of dental assistants' jobs, which
require similar levels of training, we could develop a process of
certifying dozens and dozens of procedures that would all have to
strain validity for having a certification.
Number 2121
ROBIN STRATTON, federally employed dental hygienist, Bristol Bay
Area Health Corporation (BBAHC), also testified via teleconference
from Dillingham. She said her practice in Dillingham is somewhat
different than that of the hygienists that have previously spoken.
She wanted to speak about her involvement in the dental disease
program in Bristol Bay.
MS. STRATTON said the oral disease prevention program is compliant
of the dental program in Bristol Bay and others like it throughout
the state. Sealant and topical fluoride application performed by
dental assistants has been a tremendous asset to patients there in
the past. The delegation of these duties is an important part of
the coordinated effort to prevent oral disease.
MS. STRATTON thinks that legislation of this nature will serve the
patient population by increasing the availability of these
services. She also believes it is critical to have trained dental
assistants and that those performance standards are monitored by
their employers. Given the amount of training that dental
assistants in the BBAHC receive, and the benefits this legislation
will have to the people that the BBAHC serves, Ms. Stratton
supports HB 182.
Number 2180
REPRESENTATIVE ROBINSON asked how Ms. Stratton is assured that
performance standards are maintained.
MS. STRATTON said they have extensive training programs, inservices
and supervision in the clinic.
Number 2199
DR. DAN PITTS, Soldotna Dental Clinic, testified from Soldotna. He
has practiced in Alaska for the last 20 years, 17 of those 20 years
in Soldotna. He is the past president of the Alaska Dental Society
and currently a council member of the American Dental Association.
For six years, earlier in his practice, he traveled to the villages
of Tetlin, Tok and Northway. He can attest to the fact that dental
decay is in epidemic proportions in the rural areas.
Number 2229
DR. PITTS said that other than a toothbrush, fluorides and pit and
fissure sealants are our best tools to fight this epidemic. He
applauded Representative Toohey for proposing this bill, and he
supports the bill also. Speaking for the Alaska Dental Society, he
wants to assure the HESS Committee members that proper training
through the state OSHA laws are already in the guidelines necessary
for the avoidance of disease transmission. The state OSHA laws
require this.
DR. PITTS added that performance standards are under the direct
supervision of a dentist. The dentist is the one that diagnoses
the need for sealants, and the dentist authorizes either the
assistant or the dental hygienist to place them. The dentist is
the one responsible if they are not done right. This is the way it
should be.
DR. PITTS said that it is all done under the auspices and general
supervision of the dentist. Assistants have previously been able
to place sealants legally in Alaska. It was not until the hygiene
statutes were amended to include sealants that a problem arose.
However, when asked for an intent of legislation, it was shown that
it was not the intent of the legislation which put sealants into
the hygiene statutes to disallow the dental assistants.
Number 2286
DR. PITTS said this has become a point of contention between the
Attorney General and the legislature. Dr. Pitts said he would stay
out of that argument. But he is in favor of HB 182. It is another
line of defense against tooth decay. Dentists in both private and
public practice are both fully qualified to supervise and train the
dental assistants to provide this service.
TAPE 95-13, SIDE B
Number 000
DR. E.L. WHEELER, Tanana Chiefs Conference, testified via
teleconference from Fairbanks. He is presently a commissioned
officer in the public health service. He has served in the public
health service for six years. He is in support of HB 182. He
feels that with the travel that is done to the bush area and other
remote Alaskan areas, it is very important to meet the needs of
patients out in the bush that are unable to walk around the corner
to the dental office.
DR. WHEELER said the public health service has training programs
for the dental assistants and sealant placing and other procedures
that help the dentist. Presently, his office has federally-hired
dental assistants who are placing sealants. These assistants are
trained by the IHS. Also trained are tribal-hire dental assistants
who are paid by the tribe.
DR. WHEELER said the only difference between the federal dental
assistants and the tribal-hired assistants is that they are paid by
different organizations. They are both trained by the IHS, and the
dental assistants do an excellent job and take pride in their work.
Number 128
DR. WHEELER added that, especially with the IHS and the Tanana
Chiefs, allowing the dental assistants to place sealants when out
in the villages lets the assistants that are from those small
village to help their own people. They take pride in this, and do
a high quality job.
REPRESENTATIVE VEZEY asked Dr. Wheeler if, as a commissioned
officer of the public health service, his understanding of the
federal premise is such that the state can regulate him or his
practice, regardless of who Dr. Wheeler uses to help in that
practice.
Number 199
DR. WHEELER answered that as a member of the public health service,
it is basically the same as if he was in the Air Force or Army. He
is not under state jurisdiction. In fact, he does not even need an
Alaska state license to practice for the public health service in
Alaska. He does, however, have an Alaska license and that is why
he is testifying.
DR. WHEELER said that was the point he was trying to make about the
federal employees, as far as federally-hired dental assistants
versus tribal-hired assistants.
REPRESENTATIVE VEZEY asked if the state can regulate those who
assist Dr. Wheeler if they are hired by a non-federal agency.
DR. WHEELER said yes, that was correct.
Number 262
PHYLLIS CAVANAUGH, dental clinic supervisor, Public Health Service,
testified from Fairbanks via teleconference. She has worked for
the Tanana Chiefs Conference for 22 years, and has been an employee
of the United States public health service for 34 years. She has
been working with sealants since their inception. There is
training in the application of these sealants. Also, from her
experience, a trained dental assistant should be applying sealants.
This benefits both the doctor and the patient. The doctor is free
to perform more pressing tasks, and the patients benefit because
they require less visits.
MS. CAVANAUGH explained that sealants applied now can last up to
four years. Therefore, both the state and the individual see a
savings. It is best to do this for children immediately during
their cavity-prone years, instead of putting it off for a year
until a hygienist can come to the village. In this time, large
cavities can develop.
MS. CAVANAUGH said it was proven through a study of Alaska that the
application of sealants is effective. Dental assistants would like
to continue to apply these sealants.
Number 397
CECELIA PREZIOSE, dental hygienist, testified from Anchorage. She
has worked both in the private and public sectors. She does not
think there is anyone in the dental profession that does not agree
that the more educated a dental assistant is the more beneficial it
is to both dentist and patient. No one would dispute that. The
problem lies with the wording of the bill itself.
MS. PREZIOSE said a panel of dentists, hygienists and assistants
should meet and come up with wording that would protect the public.
It would also secure the licenses that are needed for health care
professionals to perform these duties. The problem is the wording
of the bill. It is vague, people will be taking advantage of it,
and people who are not trained will be doing work without proper
knowledge. The bottom line is that the public will suffer.
Number 483
CO-CHAIR TOOHEY read Section 1(d) of HB 182. "This section does
not prohibit a dental assistant from applying topical preventative
or prophylactic agents or pit and fissure sealants when those
duties have been delegated to the assistant by a dentist licensed
under AS 08.36." She asked Ms. Preziose what she found confusing.
MS. PREZIOSE answered that the confusion lies in that the bill does
not specify what qualifications the dental assistant has to have.
Number 617
CAROL STOLPE, registered dental hygienist, also testified from
Anchorage. She said it sounds like everyone is in agreement that
a change would be beneficial to those individuals in the bush and
rural areas that are working with the federal government employees.
These people have a training program, and they are not, as she
understands it, constrained by the laws of the state of Alaska.
MS. STOLPE said that training is the issue, and perhaps some kind
of registration or licensing following that training would solve
the problem. It seems to Ms. Stolpe that it would be wise to
postpone the passage of this bill until the affected parties,
including, of course, the consumer, as well as the dental hygienist
and assistant associations meet to reword the change so it more
directly reflects the intent of the parties involved.
MS. STOLPE concluded by saying that the individual who said the
consumer could have the reassurance that these assistants applying
the agents will be well-trained. She says that is a nice thought,
but that is not necessarily good enough to protect the consumer.
The language in the law should be more clear.
Number 671
JULIE BLEIER, testifying from Anchorage, said that for eight years
she performed as an on-the-job trained dental assistant. Her
training came from various dentists with different teaching skills
and values. The training taught her how to do a specific duty, but
she never fully understood the "why" of performed procedures.
Also, she never fully realized the degree to which some patients'
health was jeopardized.
MS. BLEIER said that when she would ask "why," the answers varied
from, "This is the way I do things," to "This is the way I was
trained." Ms. Bleier provided some examples of health and safety
deviations she witnessed. She once passed an etching material
which is used in pit and fissure sealants over the patient's face.
Some of the material dropped on the patient's forehead. The
material was not wiped off until after the procedure was completed,
about 45 minutes later. If Ms. Bleier had known that the material
contained phosphoric acid, she would never have passed it over the
patient's face.
MS. BLEIER has witnessed dental assistants, whose on-the-job
training did not stress the importance of isolating a completely
dry area to apply sealant material, applying pit and fissure
sealants. Patients are paying good money for sealants to last at
least five years, and the sealants that Ms. Bleier has seen could
not last long enough for the patient to walk out of the office.
MS. BLEIER said that these are very basic, fundamental procedures
that many dentists take for granted, and don't stress to dental
assistants. These fundamentals require formal and professional
education to establish a firm foundation for proper patient care,
and to insure consistency within the dental assistant profession.
MS. BLEIER said that on-the-job training is not the answer.
Dentists simply do not have the time to provide adequate
comprehensive dental assistant training. Time is money, and
training will suffer. Without question, if Ms. Bleier had to "do
it all over," she would have gone to school to be a certified
dental assistant. Due to the high cost of dental care, the patient
expects a high level of competence from the entire dental staff.
She asked the HESS Committee members to please consider these
consequences when making their decision. She asked them to
remember that they are also dental patients.
Number 808
CO-CHAIR TOOHEY asked Ms. Bleier if she knew of a dental assistant
school.
MS. BLEIER answered there is a dental assistant school at the
University of Alaska in Anchorage.
CO-CHAIR TOOHEY asked how long that schooling takes.
MS. BLEIER answered that it takes eight months.
Number 873
BARBARA O'DONNELL testified from Anchorage. She is currently
working toward a degree as a registered dental hygienist. She
testified via teleconference from Anchorage that she has spent two
years in training toward her dental hygienist degree. She has
often engaged in a debate about the histology, the enamel structure
and how pit and fissure sealants and etching materials are applied,
and materials data analysis. This debate has been with many
clinical instructors in classrooms.
MS. O'DONNELL has also received quite a bit of training in how to
apply those agents and the liability and responsibility involved
with that application. She does not see HB 182, as it is proposed
right now, as addressing any of the training that she feels is
required to perform these applications.
Number 951
MS. O'DONNELL will take a national board examination in one month.
She will be questioned on the issues of enamel structure and
materials used in the process of applying these sealants and other
agents. She has spent many hours studying these topics, and she
does not see the provision in HB 128 for any type of training that
covers not only the application but also histology and
understanding of tooth structure and safety considerations.
MS. O'DONNELL said there were also issues of liability. Most
dental hygienists are faced with purchasing liability insurance,
and they assume liability for the procedures that are offered to
the public. She does not know if dental assistants take on this
level of liability for the procedures they perform right now. She
would like to know who is going to assume the responsibility of the
liability of performing these applications.
CO-CHAIR BUNDE said that he would assume that the liability would
fall upon the dentist.
Number 1049
KATHLEEN WILLIAMSON, registered dental hygienist, was educated in
Alaska and took both her national and state board exams. She has
been working mostly in a private clinical setting for 11 years now.
She has been trying to remember exactly how many hours of her
training was dedicated to pit and fissure sealants, and she cannot.
This has already been covered, but it is true that although the
main tools used are an explorer and a mirror, there are a lot of
other things that happen.
MS. WILLIAMSON said that in her experience, anyone can be taught to
do a number of things. What an education does is teach you what
can go wrong with those things, so you can make decisions about
how, why, and when a procedure takes place. She also took a
separate course that licenses her to administer local anesthetic.
A dentist could teach her how to do this, but she does not know
that he would teach her all the things that could go wrong if she
did it wrong.
Number 1102
MS. WILLIAMSON thought that was the crux of the contention, that
the bill allows the dentist to teach the assistant how to perform
duties. Therefore, the wording is just not there that tells
exactly what the dentist is going to teach the assistant.
MS. WILLIAMSON wondered if dental assistants are aware that
polishing agents are coded according to color. The color tells you
if the agent is coarse or finer. There are many little things that
she went to school to learn, and the dentist did too. She thinks
some sort of formal education should be a requirement.
MS. WILLIAMSON said she has also worked for SEARHC in the bush.
She said that one of the limitations that exist in the bush is that
there is typically only one chair. If there is only one chair, she
would assume the dentist is present. If the dentist is there, then
he can do these procedures. He probably does not want to be
present during lunch, so is that the time when the assistant will
place the sealants?
Number 1166
MS. WILLIAMSON asked if the assistant would go to the bush on a
different day, when the dentist is not present because the
assistant lives in that village. When Ms. Williamson worked in the
bush, there was only one chair, and she was the hygienist.
Therefore, she went and performed, under general supervision, those
duties that the law allowed her to do.
MS. WILLIAMSON asked if there is already two chairs, would there be
a dentist working in one chair, and a dental assistant working the
other chair, but no dental hygienist. She asked if this was the
plan to save money. The other chair will be operating, but the
operator will not have to be paid as much.
Number 1198
CO-CHAIR TOOHEY asked about the average salary for a dental
hygienist.
MS. WILLIAMSON said the average was about $200 per day, or $30 to
$35 per hour.
CO-CHAIR TOOHEY asked how much the salary of a dental assistant is.
Dr. Bornstein answered that dental assistants probably make,
depending on experience, between $12 and $20 per hour. Co-Chair
Toohey stated she thinks that is probably one of the major reasons
for the delegation.
MS. WILLIAMSON said she thinks that bush dentists and public health
service dentists are trying to push this bill through, but the one
who will most benefit is the urban dentist. The procedures in
question are commonly done. Counting fluoride treatments and
cleaning, these account for probably 20 procedures every day in a
regular office.
MS. WILLIAMSON said that probably what will happen is the regular
dentist will be scheduling these treatments and applications, and
the child will walk out with sealants and the process will be over
in no time at all.
CO-CHAIR TOOHEY said that will happen anyway, whether they are
licensed or not. If they are licensed that will still happen. Co-
Chair Toohey said that she is a nurse. They are now training
nursing assistants because nurses have become so well-recognized
with a high pay scale that has become a problem. Whatever happens,
the cost of treatment must be lowered. We are obliged to lower the
cost of treatment in this country. Whether they are licensed or
not, they will still be doing whatever it takes to keep those
cavities from coming. The job of the dental hygienist will never
be excluded, but some of the jobs may be usurped.
Number 1309
MS. WILLIAMSON said that was fine. As a matter of fact, that is
why dental hygienists were created in the first place, because
dentists don't want to do what hygienists do. Dentists are trained
to perform those duties, but they don't want to do them.
MS. WILLIAMSON said however, the hygienists went to school to learn
their trade and what could go wrong and what might not be a good
idea to do.
Number 1329
REPRESENTATIVE DAVIS said it has been indicated there is a dental
assistant school. He asked how many dental assistants currently in
the field have gone to school. He asked if someone could be hired
without going to school; and if someone could be hired, trained,
and called a dental assistant.
MS. WILLIAMSON said that someone could be trained on the job and
called a dental assistant. She said that was where the contention
was. In Alaska, no formal education is needed for a dental
assistant position. Some states require this formal education, but
Alaska and some other states do not. There is a dental assistant
school in Alaska, but it is not required that a person attend that
school in order to be a dental assistant. Many dental assistants
are trained on the job. This is not to say that they do not do a
good job, but it depends on what the dentist said was important.
CO-CHAIR BUNDE announced the end of public testimony, and opened
discussion for the committee.
Number 1396
REPRESENTATIVE ROBINSON said she was strongly in favor of this
approach to dental care across the state, and wants to see this
bill passed. She wondered if the issue could be placed into a
subcommittee. It appears that everyone seems to be in favor of the
essence of the bill. She has not heard that the dental hygienists
are adamantly opposed to the bill, but the contention lies in the
semantics of whether or not the bill clearly has the necessary
safeguards.
REPRESENTATIVE ROBINSON said everyone wants to make sure that every
child in all areas of the state receives appropriate and quality
dental care. She asked if the sponsor of the bill would be willing
to form a subcommittee. Representative Robinson said she would be
happy to work with the sponsor of the bill (Representative Toohey),
dental hygienists and dentists to see if a solution can be found.
REPRESENTATIVE ROBINSON said a solution may not be possible.
However, it would benefit everyone to try and find language that
assures quality control. This bill does not have another committee
to go to, so this is the committee to take on that responsibility.
Number 1465
CO-CHAIR TOOHEY said the bill was amenable, and said if Dr.
Bornstein would be willing to work with herself and Representative
Robinson, a solution may be possible.
REPRESENTATIVE VEZEY said he would be opposed to trying to add
verbiage to this statute. He thought if Title 8 was studied, it
would be found that dentists are licensed by the dental licensing
board. They are charged with maintaining the standards of the
American Dental Association or the Alaska Dental Association.
There is an extremely high standard that is already enacted in the
statute. It is not enacted verbatim, it is adopted from
professional standards.
REPRESENTATIVE VEZEY continued that by virtue of the fact that this
is the dentist's practice, the dentist is obligated to maintain
these standards in order to keep his license. Not to mention the
fact that the dentist is required to maintain the malpractice
insurance and has full liability. Representative Vezey thought
that no matter how hard the HESS Committee members try, they cannot
codify good dental practice. It is simply beyond the means of this
legislature to do so. That is why there is a dental board.
Number 1530
REPRESENTATIVE ROKEBERG said he was looking at the statute under
Title 8. The statute which would be amended by the bill is the
dental hygienists statute, not the dentist's statute. The dental
hygienist statute is nine pages long. From listening to testimony
and Representative Robinson, he believes that if we are looking
toward the certification of dental assistants, another nine pages
will have to be drafted.
CO-CHAIR BUNDE said that, as chair, he would make a command
decision. He said the bill would be held and asked that
Representatives Toohey, Vezey and Robinson bring the bill back to
the committee next week, either in its original form, or whatever
their research may come up with.
HHES - 03/02/95
HB 172 - KINDERGARTEN AND MISCELLANEOUS EDUCATION
Number 1596
CO-CHAIR BUNDE said he was the sponsor of this bill. He said that,
in a nutshell, the bill mandates kindergarten. In previous
legislation, the required schooling began at first grade. The bill
was requested by a number of school districts. The bill also
expands a concept of middle school. There are currently school
districts that operate under a middle school concept. HB 172
legitimizes some current practices, and allows others to look into
these options.
CO-CHAIR BUNDE said that Duane Guiley, from the Department of
Education (DOE) is present to answer questions about the bill. He
said he did not intend to move the bill out of committee today,
because he was going to have to leave the HESS Committee in a few
minutes. However, he would like to begin discussion of the bill.
REPRESENTATIVE ROBINSON said that Co-Chair Bunde said the bill
mandates kindergarten. She was under the impression the bill made
kindergarten an option, and parents have the right to determine if
their child will attend kindergarten or not.
CO-CHAIR BUNDE said that the parents have the right to determine
attendance, but the district must offer kindergarten.
Number 1668
LARRY WIGET, Legislative coordinator, Anchorage School District, is
in support of HB 172. Research indicates that kindergarten is an
important part of public school education. In fact, it appears
that earlier childhood education is most beneficial to future
success. In addition, 35 states have already mandated that
kindergarten be offered. All school districts in Alaska are
already providing kindergarten education. HB 172 recognizes the
importance of kindergarten as part of the instructional program,
and Mr. Wiget is certain that all school districts will continue to
offer kindergarten in the future.
MR. WIGET said that under current law, secondary schools are
comprised of grades 7 through 12, or any appropriate combination of
grades in this range. Junior high school might be comprised of any
combination of appropriate grades between seven and ten. Enacting
this piece of legislation would add "middle school" to the
definition of secondary school, and allow the sixth grade to be
considered part of junior high school or middle school.
MR. WIGET continued that research has also indicated that those
schools are a positive experience, and the Anchorage School
District is working toward the middle school level. This will
allow the schools to work with districts to make middle schools
accommodating to grades beyond the normal high school definition.
Also, it will allow them to add middle schools.
Number 1732
MR. WIGET said according to the 1990 state education indicators, 27
states currently mandate the minimum age of schooling as age six or
less. In 43 states, including Alaska, children generally enter
school at age five. The Anchorage School District supports
changing the compulsory school age in Alaska from seven to six.
MR. WIGET said the last part of the bill he would like to address
is that the Anchorage School District does currently require that
a person who enrolls their child in a public school provide a copy
to the district of the child's birth certificate or other proof of
the child's identity if the child has not previously been enrolled
in a public school.
MR. WIGET said the Anchorage School District supports this practice
statewide.
Number 1761
CO-CHAIR BUNDE asked Mr. Wiget if he thought sixth graders were too
young to be included with seventh and eighth graders in a middle
school setting.
MR. WIGET said there would probably be some argument on this topic.
He did an internship at an elementary school, and taught junior
high school and high school. Through personal experience, he sees
sixth grade as almost an transition age. He does not see that as
a problem.
REPRESENTATIVE VEZEY asked why we need this statute.
Number 1801
CO-CHAIR BUNDE explained that kindergarten is not mandatory at this
point. Budgets are going down, districts are concerned that,
rather than cutting out administration, or fat, or the basketball
team, that schools will cut out kindergarten to save money because
it is not mandatory.
REPRESENTATIVE VEZEY asked if the districts were not the "bosses"
anyway.
REPRESENTATIVE BRICE said the school boards are in charge.
CO-CHAIR BUNDE said that school boards are the "boss" and districts
are afraid there would be pressure to cut out the nonmandatory
program, rather than adjust the other mandatory programs.
REPRESENTATIVE VEZEY asked if the decision would have to be made by
a school board that is duly elected.
CO-CHAIR BUNDE said if kindergarten is mandatory, the decision is
not the school board's to make. However, Co-Chair Bunde is
speaking about cuts to school programs would be made by elected
school board officials. All districts currently have kindergarten,
but it is not mandated.
DUANE GUILEY, Director of School Finance, DOE, said he would be
pleased to answer any questions.
Number 1871
REPRESENTATIVE ROBINSON asked if any of the past education boards
have looked at this issue and if mandating kindergarten is a
recommendation from them.
MR. GUILEY said the Governor has a made a very strong statement in
support of early childhood education. The new commissioner of the
DOE, Dr. Shirley Holloway, is very supportive of early childhood
education. However, neither has taken a specific position on this
piece of legislature. The first school board meeting was yesterday
with the new board members. They have not had an opportunity to
take a position on any legislation. However, this is an issue they
will be looking at.
MR. GUILEY said this bill does not make kindergarten mandatory, it
only makes it mandatory that a district offer kindergarten. It
still appears to make kindergarten optional by lowering the
compulsory school age to age six. This would indicate it is not
mandatory that a parent enroll their child in kindergarten, but by
the time the child turns six, it is mandatory that a child be
enrolled in a schooling program.
CO-CHAIR BUNDE acknowledged the presence of Representative Bettye
Davis.
Number 1933
REPRESENTATIVE BETTYE DAVIS said she wished that she could have
heard some previous comments.
CO-CHAIR BUNDE said there was a comment from a school administrator
in Anchorage who did not feel that sixth graders in a middle school
would be a problem.
REPRESENTATIVE B. DAVIS said she was glad the committee introduced
the bill to make kindergarten mandatory. She believes that
children at that age can learn. That has been demonstrated. There
are many schools in the Anchorage School District, and other parts
of the state that have full-day kindergarten. Alaska is only
fortunate enough to have a few schools that offer this. This goes
over very well and there is a long waiting list. This is not for
babysitting purposes, it is for learning.
REPRESENTATIVE B. DAVIS believes that people want to make it a
statute that children enter school at age five, because as we begin
to downsize the state dollars, if programs are not mandated they
will not be paid for. For that reason, she is supportive of this
mandate also. She has always been supportive of the fact that she
believes it should be mandatory.
Number 1970
REPRESENTATIVE B. DAVIS said she sees many children enter school at
age six and experience disadvantages because they did not have an
opportunity to go to kindergarten. Those children who have an
opportunity to go, even for just two and one-half hours every day,
learn many things that need to be learned. First grade teachers do
not have time to teach children how to tie their shoes, where to
put their coats and how to stand in a line. Many of these children
don't know how to write their names. Some children are as old as
seven before they enter a school. Those children are really at a
disadvantage.
REPRESENTATIVE B. DAVIS supports the middle school or junior high
concept. However, she does not support grades six, seven and eight
being in a junior high setting together. She does not believe it
is appropriate for sixth graders to be in a school setting with
seventh and eighth graders. Sixth graders are a unique group,
through psychological, physiological and sociological factors.
They need to be separate.
REPRESENTATIVE B. DAVIS said there are those who believe kids age
seven and eight need to have an opportunity to explore and find
themselves, and not do much academically. She does not ascribe to
this. She does believe that sixth graders function better in a
kindergarten through sixth (K-6) grade setting.
REPRESENTATIVE B. DAVIS does not believe this must be in statute.
She was looking for information concerning how many states
currently mandate this. The way she understands HB 172, it would
make grades six through twelve secondary. In Anchorage, grades
nine through twelve are high school. Grades seven and eight are
junior high, which is also secondary. If sixth graders are
included, they would no longer be under the K-6 concept.
Number 2052
REPRESENTATIVE B. DAVIS said there has already been a bad
experience from putting grades seven through twelve in one complex.
This did not work, the schools were too large, and the seventh and
eighth graders did not get all the attention they needed. From
this, they moved to junior high schools which contained only
seventh and eighth graders.
REPRESENTATIVE B. DAVIS hopes this bill is passed. She has also
introduced a piece of legislation for mandatory kindergarten. She
wanted to hear what other people, including HESS Committee members,
had to say about sixth graders going into high school.
Number 2075
CO-CHAIR BUNDE said the way he reads page 2, section 4 of HB 172,
grades six through ten could be organized as a junior high or a
middle school. He does not believe middle schools are classified
as secondary.
REPRESENTATIVE B. DAVIS said she would like someone to speak to
that, because the way she reads the bill, you may have any
combination of sixth through tenth grades. This means you can put
sixth graders in any of those combinations. She does not see why
this cannot be done now. She does not know if a statute is
necessary to accomplish this. She knows that most schools do not
put sixth graders in this setting.
REPRESENTATIVE B. DAVIS said she checked with the DOE that day, and
the DOE said they are already placing sixth graders in a middle
school setting in Alaska. No statute is necessary. If the statute
is there, more school districts will take it into consideration,
and begin to implement the statute. She asked if the mandate was
to downsize the classes to provide more class space, or to enable
children to learn better. She said that learning must be the
focus, and not necessarily finding space.
Number 2126
MR. WIGET said he appreciates the testimony of Representative
Bettye Davis, as she is a former school board member from
Anchorage. She has a broad base of experience in a variety of
issues dealing with the organization of schools and education.
MR. WIGET said the Anchorage School District's sense of the bill is
that currently, the district does not have junior high schools with
sixth grade included. The intent of the bill is to allow the
inclusion if it was the will of the board to make a sixth-through-
eighth grade middle school.
TAPE 95-14, SIDE A
Number 000
MR. WIGET said that Representative B. Davis stressed, as a member
of the Anchorage School Board, that this inclusion would not happen
in a district when she was a board member. Mr. Wiget said that
decision would be up to the individual boards.
REPRESENTATIVE B. DAVIS asked Mr. Wiget how many states have such
a concept as this.
MR. WIGET does not have that information.
Number 042
REPRESENTATIVE BRICE asked what has been heard from other school
districts around the state, outside of Anchorage.
CO-CHAIR BUNDE said he has only been in communication with
Anchorage. It is his understanding that there are other areas,
particularly the Mat-Su Valley, that have middle schools currently
in operation without statutes.
REPRESENTATIVE B. DAVIS asked to go on record saying that she
supports the middle school concept, and she definitely supports
junior high, seventh and eighth grades. She is certain that the
middle school concept is in place in several Anchorage school
districts. She likes the way the children are divided, and the
teachers like it too. There is nothing to keep the school
districts from including sixth grade in a middle school setting.
REPRESENTATIVE B. DAVIS is not saying she disapproves of the middle
school concept. She would like to see it in statute, because she
thinks that more districts would implement the statute. But she
does not think that sixth grade students should be placed in a high
school setting. This is what the bill allows for.
Number 149
REPRESENTATIVE G. DAVIS said he would have to leave the meeting
soon, so he wanted to comment. Kindergartens are already in
existence, and he does not see a reason to mandate them. He is in
favor of early childhood education. He did not go to kindergarten
and feels he missed out. However, good quality education is
provided even before kindergarten, in preschools. As far as middle
schools, he thinks that a secondary certificate is necessary for
middle schools, seventh and eighth grades.
REPRESENTATIVE G. DAVIS said he does not see a problem with
including sixth grade with junior high.
CO-CHAIR BUNDE reminded the HESS Committee members that the bill
was not going to be moved today. He is going to discuss the issues
with other school districts, and see what their concerns are. The
bill will be heard before the committee at a future date.
CO-CHAIR BUNDE passed the gavel to Co-Chair Toohey. She chaired
the remainder of the meeting.
HHES - 03/02/95
HB 157 - DIETITIANS AND NUTRITIONISTS
JOHN WRAY, incoming president, Alaska Dietetics Association,
practicing registered dietitian, spoke in support of HB 157.
"Nutrition and dietetics is the integration and application of
the principles derived from the sciences of nutrition,
biochemistry, physiology, food management, behavioral and
social sciences. The primary emphasis is to achieve and
maintain the health of the public. All dietitians are
nutritionists. Dietitians use the terms interchangeably, like
physicians and doctors, or attorneys and lawyers. However,
not all nutritionists are dietitians. Nutritionist is a
broader, generic term, and therefore in HB 157 provisions are
made to ensure that individuals with nutrition practice
experience and bachelor's, master's, or doctoral degrees from
accredited universities may be recognized as the experts that
they are, whether they are dietitians or nutritionists.
"Anyone presently can call himself or herself a nutritionist.
They sometimes offer expensive and sometimes inappropriate
advice and unproven therapies, unless the state government has
a law that requires nutritionist licensing. The largest
professional organization for nutritionists in the United
States, with over 64,000 members, is the American Dietetic
Association (ADA).
"The 64,000 members meet academic and experience requirements.
Eighty percent of ADA members are registered dietitians (RDs),
who, after achieving their degree, complete internships and
must pass an examination. They must maintain continuing
education credits to continue their RD designation. Many Rds
have obtained advance degrees beyond their baccalaureate.
"The ADA is also recognized as the accrediting agency of the
university undergraduate programs in dietetics and nutrition,
by the Council of Postsecondary Accreditation and by the U.S.
Department of Education. While the ADA has existed since
1917, there are other private accreditation organizations such
as the American College of Nutrition, who provide standards
with which nutrition professionals can gain membership.
Number 684
"However, there are other self-styled nutritionists who
provide unproven therapies and counseling to the public. In
teleconference testimony, it is hoped that other members will
provide anecdotal accounts of clients in Alaska who have been
influenced by such individuals.
"Nutrition is a relatively young science. Human studies with
nutrition is a highly regulated field. Thus nutrition fraud
is very widespread. So widespread that a long-term health
subcommittee found that health care fraud in the United States
cost Americans between $25 billion and $50 billion a year,
with nutrition fraud the most common type of health fraud
seen.
"In Alaska, there are over 120 Rds and nutritionists working
in a broad range of settings all over the state, from
Ketchikan to Nome. In Alaska, Rds and nutritionists are
represented by the Alaska Dietetics Association (AKDA), which
is a state affiliate of the ADA. Registered dietitians and
nutritionists are a vital component of medical treatment teams
at all hospitals in the state. In fact, the joint commission
of Accreditation of Health Care Organization and Medicare
mandate that nutrition services be provided by Rds in
hospitals and nursing facilities.
Number 785
MR. WRAY continued his testimony.
"In addition, Rds work in a variety of outpatient clinics.
They provide nutritional teaching to diabetics; substance
abuse clients; patients with heart disease, kidney failure,
digestive disorders, eating disorders, high risk pregnancies,
strokes, AIDS, and cancer treatment. In addition, Rds and
nutritionists can be found in Women, Infants and Children
(WIC) clinics and the public health sector at the University
of Alaska Anchorage, the school lunch program and sports
medicine.
"HB 157 will provide the people of Alaska with the following
benefits:
"One, it will protect Alaskans from potential harm caused by
untrained individuals. The citizens of Alaska will know where
to find quality nutrition services;
Number 808
"Two, it will provide increased protection from the health and
economic costs of nutrition fraud;
"Three, it will enable the Alaskan consumer to distinguish
between qualified and unqualified care providers. The bill
does not restrict any one person from offering nutrition
information or products, and the people of Alaska should
decide who is the expert. With licensure, the state of Alaska
is giving the public standards so they can make an educated
choice of who they wish to have as their provider;
"Four, it will increase the availability of nutrition services
to Alaskans by providing for consumers the means to recognize
qualified nutrition experts.
"HB 157, Dietitians and Nutritionists, will not increase
health care costs. When the bill was introduced, included in
the HESS Committee members' bill packet was a copy of the
document with cost savings of medical and nutrition therapy in
Alaska. It shows that dietitians reduce health care costs.
They are cost effective. Rds can avert the cost of lifetime
care of mentally and physically retarded persons due to low
infant birth rate through improved nutritional care during
pregnancy.
Number 880
MR. WRAY continued.
"Proper nutrition reduces the frequency and length of hospital
stays for those individuals with chronic diseases. Also,
proper nutrition decreases the length of the hospital stay
through appropriate nutritional support for those patients
with surgery or cancer treatment. It also helps speed the
healing of wounds.
"It is important to note that HB 157 in no way excludes
individuals or professions from practicing nutrition. Page 4
of the bill begins a list of 13 exemptions of groups and/or
individuals. Specifically, exemption number 8, on page 5,
line 22, makes it quite clear that the AKDA does not wish to
stop, restrict or limit efforts of any health food stores, or
a provider of natural products.
"In a letter received from the National Nutritional Food
Association (NNFA) voicing their strong opposition to HB 157,
the ADA wonders if the letter would have been sent if the
number 8 exemption had been clearly read. Their activities
are in no way restricted. If the bill becomes law, it will be
business as usual for them.
"In the same letter, the NNFA questions why licensure is
needed. That question was answered in the testimony already
given. They question that the real purpose is money. HB 157
does not create an unfair corner on the nutrition dollar in
Alaska. Rds certainly wish to make a living. However, they
believe that everyone else who wants to practice nutrition
have the right to do so. Rds will not get rich as a result of
HB 157.
"The letter from the NNFA states that under HB 157 Rds will
have a monopoly, which limits freedom of speech. We refer
them to the 13 exemptions listed in the bill. Thirty-two
other states currently have licensure or certification for Rds
and nutritionists. The wording in HB 157 is taken from many
of the laws in those 32 states.
Number 990
"In the same letter from the NNFA, there are inaccuracies in
their attempt to show the action in other states. They list
ten states as having defeated licensure in 1992 and 1993.
Please note that eight of those states passed licensure in
1994 for dietitians and nutritionists.
"The primary opposition in the past for other states with
licensure has been that other state affiliates have tried to
exclude other people from practicing nutrition. One of the
purposes of presenting this bill was to not exclude people
from practicing nutrition. It says if they wish to provide
nutritional services and label themselves as a dietitian or
nutritionist that they are to be licensed by the state, and
have the qualifications.
MR. WRAY continued his testimony on behalf of the Alaska Dietetics
Association.
"The ADA is going to present some technical amendments that
have come under their attention from discussions with the
Division of Occupational Licensing. Most of them are small
oversights on the part of the ADA. This language was culled
from legislation passed in other states. These amendments are
listed number one through five.
"There are three changes which the Division of Occupational
Licensing wanted addressed. One would allow the division to
draft and implement regulations, one would list the
authorization of licensing of dietitians and nutritionists to
two other appropriate places in the statute Title 8, and the
final change would eliminate some excessive wording regarding
the qualifications of dietitians for licensure.
"Hopefully these can be addressed conceptually, and not hold
up the passage of this legislation to its next committee of
referral.
"In addition, in response to a letter received from the
Shackley Corporation, a proposed amendment number 6 in the
bill packet changes the wording slightly. The Alaska
Dietitians Association also supports this amendment.
"The seventh amendment comes from a letter from the American
College of Nutrition . This clarifies the language for
nutritionists. This is also supported by the AKDA.
Number 1109
"In closing, the AKDA wishes to provide the people of Alaska
the knowledge for an educated choice when searching for valid,
accurate nutrition information from highly skilled motivated
professionals. The support of the HESS Committee members is
greatly appreciated."
DAVID OTTOSON, Alaska Representative for the National Nutritional
Food Association, Northwest Division, said that the letter from his
organization indicates their opposition to the legislation because
it is unnecessary. It does impinge upon freedom of speech with
respect to nutritional issues. It gives dietitians and
nutritionists a monopoly on information concerning scientific
nutrition.
MR. OTTOSON said that Mr. Wray responded to the letter from the
NNFA by saying there is a need to protect the public from potential
harm. Mr. Ottoson was unclear as to where the harm lay. He said
that food is what is being discussed. Mr. Ottoson has not heard
anybody, other than dietitians, say that there is a serious health
problem which exists because of nutritional advice given by someone
other than a licensed dietitian.
Number 1201
MR. OTTOSON asked if there was any documented examples of harm in
the state of Alaska, and what occurred. Mr. Ottoson said that the
cost of fraud, discussed by Mr. Wray, is also undocumented. Mr.
Ottoson reiterated that Mr. Wray also said that HB 157 will allow
the consumer to discern between qualified and unqualified
practitioners.
MR. OTTOSON thinks the consumer is smart enough to do that without
the legislature passing a law to license dietitians. It seems to
Mr. Ottoson another example of the government assuming that people
are not smart enough to make their own decisions with respect to
something that is fairly basic, considering that everyone eats.
MR. OTTOSON said the NNFA still remains opposed to the legislation.
Mr. Ottoson reminded HESS Committee members about when Mr. Wray
discussed the exemptions included in the bill. Mr. Ottoson said
the bill regulates nutrition information, yet there are 13
exemptions included in the bill. He finds it ridiculous to have
this type of regulation if it requires 13 exemptions in an attempt
to think of every situation.
Number 1260
MR. OTTOSON said that under this legislation, it is a misdemeanor,
punishable by a year in prison or a $1,000 fine to engage in
dietetics or nutrition practice. He asked how the bill defines
engaging in dietetic or nutrition practice. Dietetics or nutrition
practice means the integration or application of scientific
principles of food nutrition, biochemistry, physiology, food
management, and behavioral and social science to achieve and
maintain human health.
MR. OTTOSON said therefore, he is exempted when he is talking to
people in his health food store about nutrition and nutrition
products. So are his employees. But if one of his employees goes
home and speaks to a friend about nutrition and recommends a
product, under HB 157, this would be technically illegal and
punishable.
MR. OTTOSON said he just heard about the bill yesterday, and the
reason the HESS Committee members had not heard from their
constituents about it is because they have not yet heard about the
bill. However, Mr. Ottoson assured HESS Committee members that
they would be hearing from people about this.
Number 1346
CATHERINE REARDON, Director, Division of Occupational Licensing
(DOL), introduced herself.
CO-CHAIR BUNDE asked her to comment on the fiscal note for HB 157.
He asked how many people she thought would apply for the license,
and if the fees would cause the program to be self-sustaining.
MS. REARDON said the second page of the fiscal note outlines how
the DOL reached the cost figures. The DOL is asking for 25 percent
of a licensing examiner I for the first two years. A licensing
examiner I is the position that provides the staff support for
licensing. After two years, the DOL asks that the percentage drop
to 10 percent of a licensing examiner I. The reason for that is
the first two years is when the bulk of new licensees come into the
system. After that, it will just be a matter of re-licensing
individuals every two years.
MS. REARDON continued that small amounts in the fiscal note were
allotted for printing, postage and supplies. These figures were
reached based on approximately 120 licensees, as indicated at the
bottom of the second page of the fiscal note under "Revenue and
Fund Source." It was intended in compliance with the statute that
these would cover 100 percent of the costs associated with
licensing.
MS. REARDON said obviously the DOL estimated what licensing will
cost, and, after the first two years, the licensing is reevaluated
whether the fees are too high or not high enough to cover costs.
The fees are then adjusted for the future.
Number 1444
CO-CHAIR BUNDE asked if Ms. Reardon anticipated the initial license
will be $280.
MS. REARDON said it would cost $280 for two years, if there are 120
licensees. If there are fewer licensees, the cost would need to be
higher; if there were more, costs would be lower.
CO-CHAIR BUNDE asked if Ms. Reardon anticipated the formation of
another board to oversee this process; or if this would simply need
a technician, or someone with the appropriate degrees, to
supervise.
MS. REARDON said this bill does not set up a new board, it allows
the division to administer this program directly. The DOL has that
power for several other types of professions. In addition to
licensing, the DOL would also be handling disciplinary actions and
the revocation of licensing. There are additional costs that
sometimes come about in terms of the attorney general costs and
hearings. All of this would still be possible.
Number 1495
CO-CHAIR BUNDE announced at 4:35 p.m. that he and Representative
Gary Davis were needed to make a quorum at another meeting.
CO-CHAIR TOOHEY announced that a quorum was still present. No
action would be taken on this bill today, but the rest of the
public testimony would be taken.
MS. REARDON said that the division has several suggestions for
improvements to the bill, some of which are incorporated into the
amendments which have already been offered, and some of which are
not. Ms. Reardon said the DOL will be working with the committee
and the sponsors. At the next meeting they may have some comments
to make at that time.
Number 1555
DR. PIZZADILI, Anchorage chiropractor and Alaska state coordinator
for Citizens for Health (CEH), testified via teleconference from
Anchorage. He explained that CEH is a national, nonprofit consumer
health advocacy organization, with members in 11 countries and all
50 states. They are strongly opposed to HB 157, because it
unnecessarily and unreasonably creates a monopoly over the practice
of nutritional advice-giving.
DR. PIZZADILI said an assumption is that without regulation, the
public will be exposed to poor nutritional advice. We must
remember that some amount of poor advice will occur no matter how
well-trained the practitioners are. This is because even the most
accomplished professionals are human. As a result, they make
mistakes or fail to make themselves completely understood.
DR. PIZZADILI said for instance, we might expect that even the
best-trained professional will make a serious mistake one-in-every-
1000 patient visits. The issue is not whether poor advice is
given, but how often it is given. Without some comparative
statistical evidence to substantiate a claim for poor advice-
giving, the purpose for which this bill exists is null and void.
DR. PIZZADILI said in some matters of serious concern to the
public, experts, and those choosing to maintain exclusive rights to
advising the public on nutrition-related matters, have been
remarkably incorrect in giving the public advice.
DR. PIZZADILI continued that for nearly 50 years, dietitians and
home economists have advised the public to substitute margarine for
butter, despite a 1942 study in rats that demonstrated that
margarine increased cholesterol levels and contributed to processes
which in turn contributed to arterial sclerosis. Suddenly, many
reports in medical literature cautiously advises the public that
maybe they have been in error for 50 years.
Number 1653
DR. PIZZADILI added that it was only 15 years ago that dietitians
called anyone a charlatan or a quack if they purported synthetic
food additives might adversely affect behavior. This bill
restricts the practice of exchanging information on nutrition to a
very small group. Thirty-four states have legislation, but only 14
have mandatory licensing. Two of these states require no formal
training.
Number 1694
JULIANNE MINARIK, dietitian, Providence Hospital, testified from
Anchorage. She said that everyone can be a nutritionist, because
everyone eats. Not everyone, however, can be a dietitian because
they go to school for a long period of time to learn about
nutrition, nutrition aspects within states of disease, etc., etc.
Ms. Minarik sees less insurance of critical issues protecting some
of the most vulnerable citizens, especially children and pregnant
women.
MS. MINARIK said she is a dietitian assigned to the prenatal unit,
pediatric unit, pediatric intensive care unit, and the neonatal
intensive care unit in Providence Hospital. Providence Hospital
acts as a referral center for the state of Alaska. Inappropriate
nutrition advice to pregnant women can and has led to premature
delivery of infants. In many cases, these infants are critically
ill.
MS. MINARIK said that poor nutritional advice can lead a pregnant
woman to deliver a newborn who is below the gestational age.
Prematurity means many months, perhaps a very long time in the
newborn intensive care unit. These costs are both financial and
emotional. Nutrition counseling and intervention by a professional
can make the difference between a healthy baby and one which will
be born too soon and may never fully recover. Also, the dietitian
functions as a part of the health care team in the treatment of
premature infants and babies.
MS. MINARIK explained that feeding for a newborn infant can start
out with one to two drops and can go up after that. Needless to
say, the smallest error in the formulation for these tiny patients
can be disastrous.
FRANCES JAYNES, registered dietitian, Providence Hospital, also
testified from Anchorage. She said that asking for licensure of
dietitians in the state of Alaska is a means to assure that
nutrition counseling and medical nutritional therapy is provided by
qualified individuals only. Dietitians have a minimum of a
bachelor's degree from an accredited university. Many have
master's degrees or doctorates. In addition, dietitians receive
postgraduate training from an accredited program.
MS. JAYNES said once this basic training is completed, competency
is further checked through a national registration examination. A
person who passes this examination must then maintain continuing
education to stay registered. This process assures the consumer of
the competency of the dietitian.
MS. JAYNES continued that according to the Surgeon General's report
on nutrition and health, eight out of ten leading causes of death,
including heart disease, stroke, some types of cancer and diabetes
are related to diet and alcohol. Appropriate intervention from
qualified, well-trained health care professionals such as
dietitians can make a very positive impact.
Number 1848
MS. JAYNES said her main clinical functions at Providence Hospital
involve nutrition support of critically ill and injured adults, and
nutrition education of cardiac patients. Nutrition support
involves appropriate promotion of nutrition products taken in a
specific manner over a period of weeks. Additionally, these
patients usually have specific metabolic needs, which must be met
in order to facilitate recovery. Incorrect or inappropriate
nutrition support can cost not only time and money, but also the
patient's life.
MS. JAYNES said the cardiac patients are educated to change their
lifestyle, including diet, in order to recover and prevent the need
for further intervention such as coronary artery bypass surgery.
Without proper care, even newly grafted coronary arteries may not
last more than eight years. Since there are many patients in their
50s, 40s and even 30s, appropriate counseling is essential for
long-term survival.
MS. JAYNES urged the HESS Committee members to support licensing
dietitians as a means of consumer protection from a multi-billion
dollar diet industry.
Number 1915
BEVERLY WOOLEY, Legislative Network Coordinator, Alaska Dietetic
Association, testified via teleconference from Anchorage in support
of HB 157.
MS. WOOLEY a nutritionist currently working for the municipality of
Anchorage, Department of Health and Human Services. One of the
missions of the state and local health agencies is to protect and
promote health, and prevent disease and injury. One of the core
public health functions that have been put forth and is essential
to this mission is the assurance to clients that they can get the
necessary high-quality effective health services available to the
public.
MS. WOOLEY said there is a quality assurance issue at stake here.
An effective means of insuring quality is through licensing of
health professionals including dietitians. Most other health care
providers are licensed. Even hair stylists are licensed in Alaska.
Presently, anyone in Alaska can call him or herself a dietitian or
nutritionist and offer sometimes expensive, sometimes dangerous
advice to clients.
MS. WOOLEY continued that passage of HB 157 and thereby licensing
dietitians and nutritionists would enable the public to identify
individuals who are qualified by education, experience and
examination to provide quality nutrition care services and would
also provide increased protection to the public from the health and
economic costs of nutrition fraud.
MS. WOOLEY said that she previously taught at Anchorage Community
College and one day, after a giving a lecture on nutrition during
pregnancy, a young student approached her in tears. This normal-
weight, pregnant student informed Ms. Wooley that she and her
husband had been told by a "nutritionist" that she was overweight
and needed to lose weight immediately to insure the health of her
unborn baby. This information was not only inaccurate but
dangerous. It was given to her by an untrained individual who had
presented him or herself as a nutritionist.
CO-CHAIR TOOHEY asked if Ms. Wooley had written this testimony and
sent it to the HESS Committee members. Ms. Wooley said that parts
of it had been sent to committee members, but she was also
currently providing new testimony.
Number 2024
MS. WOOLEY reminded the HESS Committee members that many consumers
currently have mistakenly sought advice from unqualified persons
because they were not aware that the profession was not licensed.
Testimony was heard earlier that people should have the
intelligence to judge for themselves. People do not realize it is
not a licensed profession. They have called Ms. Wooley when they
are caught off-guard and asked, why are they allowed to do this,
doesn't the government protect the public. Most people, at this
point, do not know that dietitians are not licensed.
MS. WOOLEY said it is the position of the American Dietetics
Association as well as the Alaska Dietetics Association that
licensure of dietitians and nutritionists is important for
protecting the health and the welfare of the citizens of Alaska.
Number 2060
DEBRA MESTAS, WIC nutritionist and certified breast feeding
consultant, Anchorage WIC program; and renal dietitian at the
Alaska Kidney Center, testified via teleconference from Anchorage
that she is in charge of thousands of critically ill patients who
rely, daily, on what they eat.
MS. MESTAS explained that kidney patients can live or die within
hours according to what they eat or drink. Much of this is not
known by other people who have no physiological knowledge of kidney
function or medication use. These people are at risk of becoming
hospitalized and permanently damaged. They can also die from
inaccurate dietary advice. You will not hear this from untrained
people because they do not know how the kidney works.
MS. MESTAS said this is also the case with people who have no
training in cardiac functions or diabetes. She would encourage the
HESS Committee members to pass HB 157 because of all the problems
she has seen with patients coming to her with advanced renal
failure from inappropriate nutritional advice and supplements that
were "prescribed" by untrained individuals who had no business
treating these patients because they had no knowledge of their
physiological problems.
MS. MESTAS added these untrained professionals are usually not in
contact with any medical professionals. They do not know the
medications the client is on. They do not know the interactions of
their pills or gimmicks that are occurring in the patient's body.
The public is being put at severe risk when they have these severe
diseases.
MS. MESTAS also sees infants who are malnourished from
inappropriate nutritional advice, and their parents have been
encouraged to not give formula or breast milk within the first
year. These patients sometimes die or fail to thrive. She thanked
HESS Committee members for considering the importance of HB 157.
CO-CHAIR TOOHEY closed HB 157 to public testimony. HB 157 would
stay in the HESS Committee for an undetermined amount of time.
HHES - 03/02/95
HB 124 - EXTEND BOARD OF NURSING HOME ADMINISTRATORS
Number 2151
CO-CHAIR TOOHEY handed the gavel to HESS Committee Vice-Chair
Rokeberg and discussed the sponsor statement.
"This bill eliminates the State Board of Nursing Home
Administrators and transfers its legal duties to license and
regulate to the Division of Occupational Licensing in the
Department of Commerce. Federal regulations require that a
nursing home administrator be licensed by the state in order
for that state to receive Medicaid funding from the federal
government.
"This licensing can be done either by a board or by the
executive branch agency. The Division of Occupational
Licensing is ready to take on the licensing duties. The
Department of Health approves of the transfer, and the
Hospital and Nursing Home Association supports eliminating the
board and transferring these duties to Occupational Licensing.
"Eliminating the board will also save money because travel
costs will no longer be incurred by the board."
CO-CHAIR TOOHEY said that Catherine Reardon, Director of the
Division of Occupational Licensing, was present.
REPRESENTATIVE ROKEBERG asked for public testimony on the bill.
Number 2214
HARLAN KNUDSON, executive, Alaska State Hospital and Nursing Home
Administration (ASHNHA), spoke in support of the HESS Committee
Substitute (CS) for HB 124. He said the state needs to continue
the licensing of nursing home administrators, not only for the
Medicaid program, but it is also good for quality care.
MR. KNUDSON said in addition, the Department of Commerce is able to
handle the two main roles of licensure. One, there is an excellent
national exam of which the administrators of this state participate
in drafting, and there is a good exam, so the state does qualify
the people to come in, and there are regulations pending that will
require continuing education.
MR. KNUDSON urged the support of the HESS Committee members.
Number 2245
CO-CHAIR TOOHEY asked Mr. Knudson approximately how many licensed
administrators that hold an Alaska license were in the state.
MR. KNUDSON answered about 80.
REPRESENTATIVE BRICE moved to adopt the HESS Committee Substitute
for HB 124 for purposes of discussion. The motion passed.
CO-CHAIR TOOHEY clarified the difference between the CS and the
original bill. The CS eliminates the sunset date. The original
bill provided for a sunset date. There was also a change between
the licensed administrators and they decided to eliminate the
board's responsibility and go to the Department of Commerce.
REPRESENTATIVE BRICE moved that the CSHB 124(HESS) be passed with
individual recommendations and accompanying fiscal notes.
REPRESENTATIVE VEZEY objected, and a roll call vote was taken.
Voting yes were Representatives Rokeberg, Brice, Robinson and
Toohey. Voting no was Representative Vezey. Absent were
Representatives Bunde and Davis. The motion passed.
ADJOURNMENT
The meeting was adjourned at 4:53 p.m.
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