Legislature(1995 - 1996)
05/04/1995 09:10 AM Senate HES
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SENATE HEALTH, EDUCATION AND SOCIAL SERVICES COMMITTEE
May 4, 1995
9:10 a.m.
MEMBERS PRESENT
Senator Lyda Green, Chairman
Senator Loren Leman, Vice-Chairman
Senator Mike Miller
Senator Judy Salo
MEMBERS ABSENT
Senator Johnny Ellis
COMMITTEE CALENDAR
CS FOR HOUSE BILL NO. 182(HES)
"An Act allowing a dentist to delegate certain duties to a dental
assistant."
PREVIOUS SENATE COMMITTEE ACTION
HB 182 - No previous action to record.
WITNESS REGISTER
Benjamin Brown, Staff
Representative Cynthia Toohey
State Capitol
Juneau, Alaska 99801-1182
POSITION STATEMENT: Discussed HB 182.
Tom Bornstein
Southeast Alaska Regional Health Consortium
1020 Otter Run
Juneau, Alaska 99801
POSITION STATEMENT: Supported HB 182.
Catherine Reardon, Director
Division of Occupational Licensing
Department of Commerce
PO Box 110806
Juneau, Alaska 99811-0806
POSITION STATEMENT: Stated that the division did not have any
objections to HB 182.
ACTION NARRATIVE
TAPE 95-35, SIDE A
HB 182 DELEGATION OF DUTIES TO DENTAL ASSISTANTS
Number 002
CHAIRMAN GREEN called the Senate Health, Education and Social
Services (HESS) Committee work session to order at 9:10 a.m. and
introduced HB 182 as the only order of business.
BENJAMIN BROWN, staff to Representative Toohey, explained that
HB 182 was made necessary by a 1988 Attorney General determination.
The dental hygienist statute specifies that dental hygienists can
perform the application of preventive agents and pit and fissure
sealants, therefore, it was determined that no one else can do this
but dentists. That determination changed the long-standing dental
practice in Alaska which created a critical need, especially in
rural Alaska; itinerant dentists cannot carry a hygienist along
with them. Itinerant dentists have the option of performing those
procedures themselves, getting a hygienist to perform those
procedures - which is prohibitively expensive, or those procedures
are just not performed. The Dental Society is unanimously in
support of HB 182 as well as many of the nonprofit regional Native
health cooperations.
TOM BORNSTEIN, Director of Dental Services for the Southeast Alaska
Regional Health Consortium (SEARHC), supported HB 182 which allows
dentists to delegate the responsibility of the application of pit
and fissure sealants to dental assistants. He informed the
committee that he had earned a BA, a BS, a DDS, and a two year
advanced general practice residency after his DDS degree. The
consortium is in favor of getting sealants on teeth in the most
cost effective manner possible. He said that dental assistants can
provide this service in a quality manner. Dental sealants have
been in wide spread use over the past 20 years. SEARHC has used
sealants extensively in the last 10 years. Dental assistants have
been applying these sealants for the last 10 years.
Number 078
CHAIRMAN GREEN noted that a quorum had arrived and that a formal
meeting was called to order.
TOM BORNSTEIN said that he was not aware of any problems with
allowing dental assistants to apply these sealants. He explained
that the problem occurred when the Attorney General's Office of
Alaska notified SEARHC that dental assistants were not allowed
under the State Dental Practice Act to apply dental sealants.
However, the Attorney General's Office also informed SEARHC that
federally hired dental assistants are not under the purview of the
State Dental Practice Act and can therefore, continue to apply
dental sealants. Both directly hired dental assistants and
federally hired dental assistants work side by side with the same
training.
Mr. Bornstein dismissed the characterization of dental assistants
as untrained people. Of the 16 dental assistants working for
SEARHC, 14 have more than 10 years experience as dental assistants.
Under Occupational Safety and Health Association (OSHA) guidelines
dentists are required to provide certain written policies and
procedures that dental assistants must follow in order to protect
themselves and the patient. Mr. Bornstein said that technically
sealants are an easy procedure to perform. The scope of knowledge
necessary for a dental assistant to perform this procedure is well
within their level of training.
Number 154
With regards to the notion that allowing a dental assistant to
perform sealants would decrease the importance or the role of the
dental hygienist, dental sealants are a minor portion of what
dental hygienist does. Delegating this procedure to dental
assistants would not devalue the hygienist's role. He noted that
SEARHC has difficulty in filling hygienist positions. Allowing
dental hygienists to perform procedures for which they were
specifically trained would ensure the value of the hygienist.
Mr. Bornstein noted that there had been some information
circulating regarding the possible certification of dental
assistants to do sealants. At one time, there was a program in
which the Indian Health Services West was preparing to certify
dental assistants. The IHS determined that there was no need to
certify dental assistants in this procedure. He said that the
certification process was more cumbersome than the training of the
dental assistants who apply sealants. Mr. Bornstein explained that
the knowledge necessary is already required by OSHA.
SENATOR LEMAN asked if those hygienists that had worked more than
30 years were highly stressed. TOM BORNSTEIN informed the
committee of a dental hygienist in Sitka who has been working for
32 years and seems to be more enthusiastic.
Number 218
SENATOR LEMAN inquired as to the material used in these sealants.
TOM BORNSTEIN said that it is an unfilled resin material, a
composite resin that is unfilled. The material is similar to that
used in fillings. Mr. Bornstein explained that sealants attempt to
cover the grooves with a thin coat. The material is soft and
people eventually wear the thin coat off except in the grooves
which affords a smoother service for easier cleansing.
SENATOR LEMAN asked if the material was a silver, mercury amalgam.
TOM BORNSTEIN specified that there is no metal at all in sealants.
In response to Senator Leman, Mr. Bornstein said that the
opposition he had discussed earlier was in response to a letter
from a dental hygienist's concerns that he had read.
CHAIRMAN GREEN commented that she had received much opposition to
this from dental hygienists. She said that she did not want to
offend dental hygienists; professions do have territories. She
wanted to ensure that there was a mechanism in place in order to
eliminate the possibility that hygienists are dismissed.
TOM BORNSTEIN informed the committee that a Juneau office had been
actively recruiting for a dental hygienist for a year and a half.
He said that this legislation would not undervalue the services of
the dental hygienist. Another concern raised in the letter from
the Hygiene Organization to hygienists was that this legislation
would allow dental assistants to polish teeth. That function is
clearly delineated in the Dental Practice Act that policing teeth
is a hygiene function. A lot of the hygienists who are opposed to
this legislation have been given some misinformation.
Number 268
SENATOR SALO inquired as to what would happen if there was a
mistake in the application of the sealant.
TOM BORNSTEIN explained that the most common problem in the
application of a dental sealant is that the area where the sealant
is being applied does not remain dry. If the area becomes moist
with the patient's saliva or water, the sealant does not adhere.
The etching solution that creates a porous surface for the sealant
to adhere to would also be problematic if the area does not remain
dry. Mr. Bornstein said that another reason for dental assistants
to be allowed to help with this procedure is due to the need for
two persons to be working on the sealant in order to keep things
dry. The worst scenario with sealants would be that it did not
work. He noted that the instruments used could be a danger, but
those instruments are used everyday.
CHAIRMAN GREEN asked if the dentist under which the assistant works
would be ultimately liable for any problems. TOM BORNSTEIN said
yes. The dentists and dental assistants in the federal or IHS
programs are usually covered under the Federal Torts Malpractice.
All dentists are required to have malpractice insurance while
dental assistants are not. Mr. Bornstein pointed out that dentists
are required to insure their employees, therefore the dentist would
be ultimately held liable.
CHAIRMAN GREEN inquired as to if the IHS training program was in
place and active. TOM BORNSTEIN indicated that the IHS was
interested in certifying dental assistants to perform dental
sealants. IHS determined that certification was not necessary. In
speaking for most of the dental programs for the Native
corporations, the corporations ensure that dental assistants
performing sealants go through training. However, there is not a
formal training mechanism in the state. In some states, dental
assistants who go through a training program would receive
information regarding sealants; not all dental assistants go
through this dental assisting program. All of the dental
assistants at the corporations are trained before they are allowed
to practice.
Number 338
CATHERINE REARDON, Director of the Division of Occupational
Licensing, informed the committee that she was present in order to
answer questions regarding licensing or anything that affected her
division. She said that the division does not have any objections
to this legislation.
SENATOR LEMAN inquired as to the meaning of the division not having
any objections.
CATHERINE REARDON explained that the Dental Board has not taken a
formal position on this bill. The division's position is
officially neutral. At this time, the division would not be
involved in the delegation of authority.
SENATOR LEMAN expressed concern with how his vote on this would be
interpreted with respect to other areas such as engineering.
Number 359
SENATOR LEMAN moved that CSHB 182(HES) be forwarded out of
committee with individual recommendations. Hearing no objection,
it was so ordered.
There being no further business before the committee, the meeting
adjourned at 9:34 a.m.
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