Legislature(2007 - 2008)CAPITOL 17
03/19/2007 03:00 PM House LABOR & COMMERCE
| Audio | Topic |
|---|---|
| Start | |
| Confirmation Hearing(s)|| Commissioner, Department of Labor & Workforce Development|| Commissioner, Department of Commerce, Community, & Economic Development | |
| HB182 | |
| HB136 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| + | HB 136 | TELECONFERENCED | |
| *+ | HB 182 | TELECONFERENCED | |
| + | TELECONFERENCED |
HB 136-DENTAL HYGIENISTS CHAIR OLSON announced that the final order of business would be HOUSE BILL NO. 136, "An Act relating to dental hygienists." 3:35:24 PM REPRESENTATIVE STOLTZE explained that HB 136 is intended to bring additional healthcare access to under-served communities. The House Health, Education and Social Services Standing Committee considered this bill and addressed several health related concerns. He opined that this is an important issue, noting that many healthcare professionals have been willing to testify. 3:38:18 PM REPRESENTATIVE GARDNER opined that this is a good bill. The state has experienced a shortage of healthcare practitioners in a range of fields, and needs to explore alternative ways of providing healthcare, particularly in rural areas. She questioned whether the implementation would be different in rural areas versus urban areas. REPRESENTATIVE STOLTZE speculated that the implementation would have a broader application in rural areas of the state. REPRESENTATIVE NEUMAN inquired as to the definition of "direct supervision." 3:40:03 PM BEN MULLIGAN, Staff to Representative Bill Stoltze, Alaska State Legislature, sponsor, explained that "direct supervision" means the dentist is in the same room, "indirect supervision" means the dentist is in the same facility, and "general supervision" means the dentist has authorized the procedure and may not be on the premises. REPRESENTATIVE STOLTZE, in response to a question from Representative Neuman, explained that the dental hygienist performs basic preventative oral care. 3:42:35 PM REPRESENTATIVE RAMRAS relayed a request to include dental assistants in HB 136, and inquired as to the difference between a "dental hygienist" and a "dental assistant." REPRESENTATIVE STOLTZE explained that a "dental hygienist" is licensed, while "dental assistants" do not have a defined status in statute. REPRESENTATIVE RAMRAS expressed further confusion between the difference between "dental hygienist" and "dental assistant." He noted that the bill requires 4,000 hours of practice prior to a dental hygienist being authorized for general supervision. He surmised, then, that a dental assistant is "well below" a dental hygienist in regard to education. He opined that empowering a dental assistant to perform certain activities currently performed by dental hygienists [is not wise]. REPRESENTATIVE STOLTZE replied that while he does not wish to compare the two, there are defined qualification requirements for dental hygienists, which he does not believe exist for dental assistants. MR. MULLIGAN explained that dental assistants are not required to be licensed. Classes are offered, but are not required. Dental assistants are not covered in statute. REPRESENTATIVE RAMRAS commented that dental hygienists have a defined licensing requirement. REPRESENTATIVE GATTO shared his understanding that the dental hygienist can offer certain services while the dentist is away, while the dental assistant simply assists the dentist during the procedure. 3:47:42 PM GAIL WALDEN, Dental Hygienist, Member, Alaska State Dental Hygienists' Association (ASDHA), stated that she is in support of HB 136. She said that the needs of Alaskans are not being met by the current oral healthcare delivery system. Current statute prevents dental hygienists from providing oral healthcare in non-traditional settings. She explained that dental hygienists receive a comprehensive education, are licensed and regulated by the state, and must meet continuing education and cardiopulmonary resuscitation (CPR) requirements. She opined that dental hygienists are not being utilized to full potential. The Alaska State Board of Dental Examiners ("the Board") is in support of HB 136, and has concluded that the proposed changes are consistent with its vision of ensuring that all Alaskans receive the best possible care. She pointed out that HB 136 has received support from numerous members of the Oral Health Coalition, including the Alaska Primary Care Association, and AARP. MS. WALDEN, referring to Section 1 of HB 136, stated that the restorative function license endorsement creates an efficient healthcare delivery system that increases the number of patients seen. If the dentist is able to bring a dental hygienist and a dental assistant when traveling to rural areas, this would allow more procedures to be completed in the time available. The procedures would be performed under the direct supervision of a licensed dentist, and the dental hygienist would be trained in these procedures. This endorsement would require separate licensing. She pointed out that the curriculum, examining, and licensing for restorative functions for dental hygienists has been established in other states, including Washington State. MS. WALDEN then referred to Section 2 of HB 136, explaining that this allows dental hygienists to administer local anesthesia under general supervision of a licensed dentist. She stated that dental hygienists have been administering local anesthesia under direct or in-direct supervision since 1981. Local anesthesia is used to reduce stress and provide pain control in the treatment of moderate to advanced gum disease. She explained that under general supervision, the dentist must still diagnose and provide a plan for treatment, but would not need to be present in the facility during the treatment. Idaho and Oregon currently allow dental hygienists to deliver local anesthesia under general supervision. No disciplinary action has been taken against these hygienists. MS. WALDEN then moved on to Section 4, stating that this section has the potential to provide the greatest impact to Alaskan communities. Experienced dental hygienists may enter into a written agreement with a dentist. This agreement would allow the dental hygienist to provide services listed under the agreement without supervision, and would allow access to nursing homes, schools, and Headstart programs, among others. This agreement must be approved by the Board. This is intended to reach individuals that are not receiving care and to provide preventative services to increase oral health, in addition to increasing general health and well-being. She stated that the changes made by HB 136 have been implemented in other states, and have proven to be safe and effective. She opined that the statutes show dental hygienists' continued professional commitment to working with dentists to provide service to the public. 3:52:02 PM IVONNE MILLEA, President, Alaska State Dental Hygienists' Association (ASHDA), gave a brief history of her experience as a licensed dental hygienist in Alaska, and stated that she is in support of HB 136. 3:53:02 PM JENNIFER MCELROY, Dental Hygienist, President, Kenai Peninsula Dental Hygiene Association, stated that she strongly supports HB 136. She has seen a need for increased access to oral healthcare. In regard to senior dental care, she has seen a complete lack of access. She explained that dentists do not visit nursing or group homes, and residents of these facilities may be unable to travel to an office for preventative care or necessary healthcare screenings. She opined that licensed dental hygienists are the key oral health professionals to deliver care in this type of setting. Screenings performed by licensed dental hygienists can identify oral health care issues that may affect overall health. Many villages have a need for oral healthcare, and residents travel once per year to see a dentist. 3:54:35 PM GLENN MARTIN, DDS, stated that he is a practicing public health dentist, a member of the American Dental Association (ADA) and a fellow of the Academy of General Dentistry. He gave a brief history of his work experience in Alaska, which includes time spent traveling to villages and providing dental care. During the past 15 years, he has traveled to 62 villages, and has 128 weeks of experience practicing dentistry in rural Alaska. He is currently working in Anchorage, where he is the director of village travel for Southcentral Foundation Village Clinic. He stated that he strongly supports HB 136, which would enable him to provide healthcare to more patients. The collaborative agreement portion of the bill would greatly increase sufficiency by allowing dental hygienists to travel to villages prior to the arrival of the dentist, in order to evaluate school-age children and perform x-rays and oral screenings to identify needs. He explained that initial screenings and preventative treatments take 1-6 days, depending on village size. Allowing the dental hygienists to perform these procedures would allow the dentist to perform restorative and emergent needs. This would decrease the time needed to complete children's dental needs and increase the time available to address adult dental needs. He stated that HB 136 would make a measurable impact on access to care, and urged the passage of this bill. REPRESENTATIVE NEUMAN asked if dental hygienists are included in the Washington, Wyoming, Alaska, Montana, Idaho Medical Education Program (WWAMI). DR. MARTIN replied no. REPRESENTATIVE GATTO thanked Dr. Martin for his service. He shared his belief that Dr. Martin's presence in the villages was beneficial to individuals that would not have enjoyed the "pleasure of good health" without these efforts. 3:57:57 PM ROYANN ROYER, Dental Hygienist, began by giving a brief history of her experience as a dental hygienist, and stated that she is a member of the Oral Health Coalition, which is in support of HB 136. She informed the members that she worked as a restorative dental hygienist for two years in Washington State, and therefore has first-hand knowledge of the effectiveness this expanded function can provide. She explained that if passed, HB 136 would significantly increase the number of patients that can be seen during a typical village visit. She agreed with earlier testimony that these visits currently take one week. Allowing the dental hygienists to do the initial screenings and preventative procedures, the dentist would have more time to perform restorative procedures. As an educator, she opined that the collaborative agreement function could be incorporated into the curriculum, and emphasis placed on utilizing this function for servicing patients in nursing homes, and disabled, home- bound patients. She stated that externships would most likely be developed with practitioners working in these facilities, and students would be mentored into these positions. She opined that while some hygienists do not want to work full-time, there are many who would utilize this expanded function to visit limited-access areas for a few hours during the day to provide services. She pointed out that HB 136 can be put into practice immediately. The restorative aspect would require additional training; however, the University of Alaska Anchorage (UAA) is ready to develop and implement restorative courses as soon as the legislation is passed. The initial courses would be presented in a condensed format, to allow currently licensed hygienists to receive this training in a short amount of time. 4:01:49 PM DAVID LOGAN, DDS, Member, Alaska Dental Society (ADS). The ADS would like to see the scope of HB 136 broadened to help increase access to dental care in under-served areas. The ADS is concerned that if this is limited only to dental hygienists, this would restrict the use of other dental auxiliaries in the aforementioned areas. He explained that the ADS formed a non- profit in order to provide volunteer treatment in rural areas. There is limited equipment available, and the plan involves bringing dental assistants rather than hygienists. Allowing assistants to perform expanded functions would provide a valuable asset. He pointed out that 17 other states allow auxiliaries to perform additional functions, adding that Washington State is the only one to limit this to hygienists. Additionally, the ADS would like to see additional training allowed. The American Dental Association (ADA) is bringing pilot programs into different states, and the ADS would like to be involved in this. Legislation is needed to authorize this. CHAIR OLSON asked whether the ADS considered an additional piece of legislation for this. He opined that because dental assistants are not regulated, this might slow the passage of the bill. DR. LOGAN replied that this has been considered; however, the ADS believes that assistants and hygienists need to be held to the same standards, therefore it is appropriate to address this within the same legislation. CHAIR OLSON reiterated that this might have a negative affect on the passage of HB 136. REPRESENTATIVE RAMRAS restated his earlier question regarding the difference between a dental assistant and dental hygienist. DR. LOGAN explained that dental assistants are not regulated, and are "loosely defined" as a person who works with a dentist. Dental assistants provide the following auxiliary functions: placement of rubber dams, handing tools to the dentist, and performing some impressions. REPRESENTATIVE RAMRAS commented that a dental assistant is not very well defined. He stated that he does not want to slow down the aid to villages in need of dental healthcare while attempting to incorporate a "loosely defined" group. DR. LOGAN replied that dental assistants are loosely defined as a result of limited access to training. While some states have decided to certify dental assistants, others have not. Alaska has elected to not require this certification. If all dental assistants were required to receive certification, it would be difficult for smaller communities to meet these requirements. REPRESENTATIVE RAMRAS opined that these issues need to be addressed prior to allowing dental assistants to perform these expanded functions. While he is in favor of increasing the number of dental professionals working in rural communities, he is not comfortable with expanding the role of dental assistants at this time. 4:09:13 PM REPRESENTATIVE NEUMAN inquired as to whether Dr. Logan had previously stated that dental hygienists should be independently licensed. DR. LOGAN replied no. REPRESENTATIVE NEUMAN asked whether states currently allow the independent licensing of dental hygienists, thus allowing them to work independently from a dentist's office. DR. LOGAN shared his understanding that this is allowed in Colorado. REPRESENTATIVE NEUMAN asked whether Dr. Logan would support this in Alaska, considering the previous testimony. DR. LOGAN replied that conceptually, parts of this "make sense." However, he is unable to give an endorsement to something that he is unable to see or examine. REPRESENTATIVE LEDOUX asked whether Dr. Logan sees a downside to allowing dental hygienists to perform the additional functions included in the bill. DR. LOGAN replied that he has no problems with the restorative functions. In regard to the collaborative agreement, he said that there is some concern with certain procedures allowed, in addition to allowing dental hygienists to render a diagnosis. Allowing general supervision for administering local anesthesia "has its merits." REPRESENTATIVE LEDOUX asked whether there are any specific concerns. DR. LOGAN replied that the largest concern is with collaborative agreement, which allows the dental hygienist to render a diagnosis. REPRESENTATIVE LEDOUX asked whether dental assistants should be allowed to do this. DR. LOGAN replied no, adding that this would "certainly not be appropriate." CHAIR OLSON asked whether the House Health, Education and Social Services Standing Committee was asked to incorporate dental assistants into the bill. DR. LOGAN replied yes. In response to an additional question, he stated that the request was denied, although he does not remember hearing a specific reason for this. 4:14:38 PM MARY CERNEY, Dental Hygienist, gave a brief history of her work experience. She stated that she previously served as president of the Alaska State Dental Hygienists' Association (ASDHA), and served eight years on the Board of Dental Examiners. She stated strong support of HB 136. She agreed that dental assistants are not regulated. Dental hygienists receive a formal education in programs that are accredited by the American Dental Association's (ADA) Council on Dental Accreditation. Dental hygienists must pass a national board exam, and must prove competency on an independently administered clinical exam, in order to practice in all 50 states. She explained that she is an examining hygienist with the Western Regional Examining Board. The education received by dental hygienists is usually two years of college prerequisites, and two academic years integrated with clinical instruction. Faculty is also subject to standards and qualifications. MS. CERNEY went on to say that dental hygienists must maintain good standing, and complete continuing education requirements. This sets a baseline of education and qualifications for all hygienists. The Western Regional Examining Board gives a specific exam for the restorative clinical skills. Any hygienist performing these functions would be required to take this exam. She stated that the idea of expanding the setting in which the local anesthetic is administered was proposed by Dr. Logan when he was president of the Board of Dental Examiners. She explained the situations in which this might occur, pointing out that the dentist is not required to allow this. In summation, she commented that the proposed changes improve the healthcare delivery to residents of Alaska, help maintain education standards currently in place, assure the competency by requiring clinic exams, and mandate accountability. In regard to administering anesthetic, she stated that the dentist has recommended this treatment. The collaborative care agreement gives the authorization by the dentist with whom the agreement is initiated, and must be approved by the Board. She explained that this does not allow the hygienist to diagnose or offer treatment plans. The hygienist would simply be allowed to perform the hygiene portion of what is normally done, without the dentist providing a prior diagnosis. This is "just ... flipping the order of things a little bit." MS. CERNEY offered her understanding that proposed regulations would require the hygienist to have additional training in emergency medical procedures. She supports the requirement that hygienists have at least 4,000 hours of documented clinical experience prior to being allowed to enter into a collaborative agreement. Referring to a program to open in Fairbanks, she stated that the intent is to graduate hygienists with a strong emphasis in a variety of health settings, and to encourage treatment in communities that do not receive a broad scope of dental treatment. She shared her experience volunteering at the Salvation Army Clinic in Fairbanks, and expressed frustration that she has been unable to administer local anesthetic to make patients comfortable. She opined that many of these patient have experienced neglect and need more thorough treatment than the patients seen at a highly established practice. If dental hygienists were able to administer local anesthetic under general supervision, the patients could be seen regardless of whether a dentist was willing to volunteer on a particular day. 4:23:23 PM MARIE DARLIN, Coordinator, Capital City Task Force, Alaska AARP, expressed support for HB 136. The AARP believes that all Alaskans should have access to high quality, affordable healthcare, including oral health. The AARP also believes that HB 136 would help reduce dental costs, as well as improve accessibility. CHAIR OLSON stated that he had planned to hold the bill over until the next committee hearing; however, he has not heard any significant concerns. 4:25:13 PM REPRESENTATIVE BUCH stated that if the dental community is in support of the legislation, he is in support, and does not see any reason to hold it over. CHAIR OLSON stated that while he would be willing to help draft legislation to address specific concerns, he is not supportive of any additions to HB 136. He opined that this would be "counter productive." REPRESENTATIVE RAMRAS stated that he would like to see more people capable of providing dental healthcare to rural communities, adding that he would look forward to assisting the dental community in broadening this at a later date. 4:27:12 PM REPRESENTATIVE NEUMAN suggested that independent licensing of dental hygienists be considered. He surmised that this would promote competition and better rates for preventative care. 4:28:41 PM REPRESENTATIVE LEDOUX moved to report HB 136 out of committee with individual recommendations and the accompanying fiscal notes. There being no objection, HB 136 was reported from the House Labor and Commerce Standing Committee.
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