Legislature(1995 - 1996)

03/02/1995 02:37 PM HES

Audio Topic
* first hearing in first committee of referral
+ 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                                                                
 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                          
 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                          
 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                        
 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                        
 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                        
 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                        
 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                        
 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                                                               
 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                                        
 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                                     
 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                                                                
 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                    
 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              
 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                
 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                
 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                  
 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                 
 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                   
 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                 
 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                   
 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                
 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                  
 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            
 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                   
 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                
 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                                                               
 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           
 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"             
 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             
 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             
 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                     
 "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                      
 "HB 157 will provide the people of Alaska with the following                 
 "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                    
 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            
 "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                   
 "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                 
 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                     
 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                  
 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                    
 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                     
 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              
 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             
 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             
 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             
 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            
 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                                                               
 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                   
 "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.                          
 The meeting was adjourned at 4:53 p.m.                                        

Document Name Date/Time Subjects