Legislature(2007 - 2008)BELTZ 211
05/01/2007 01:30 PM Senate LABOR & COMMERCE
Audio | Topic |
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Start | |
HB121 | |
SB118 | |
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 | ||
+= | SB 155 | TELECONFERENCED | |
+= | SB 118 | TELECONFERENCED | |
+= | HB 121 | TELECONFERENCED | |
CSHB 136(FIN)(title am)-DENTAL HYGIENISTS 2:22:52 PM CHAIR ELLIS announced CSHB 136(FIN)(title am) to be up for consideration. BEN MULLIGAN, staff to Representative Stoltzee, explained that this bill is meant to improve access to oral health care in Alaska by expanding the duties of dental hygienists. This entails establishing restorative function license endorsements, which translates into dental hygienists being able to replace filings and do contouring under the direct supervision of a dentist who would actually prepare the filling. The hygienist would place it and make sure it fit right and then the dentist would come back in a make sure everything was correct. He said the second thing would be to allow dental hygienists to give local anesthesia under general supervision. Right now dental hygienists have the authority to do direct and indirect deliverance of local anesthesia and have since 1981. Lastly, it would allow dentists and dental hygienists to enter into collaborative agreements with the additional requirement that they be approved by the Board of Dental Examiners. MR. MULLIGAN said the bill lists criteria that a dentist and hygienist could agree that the hygienist could perform under the general supervision away from the setting of a dental facility. They can perform one of those or multiple variations of them. The bill has received many letters of support from dentists, anesthesiologists, hygienists, some primary care groups and some local municipality groups throughout the process. 2:25:55 PM SENATOR BUNDE said that a controversial program began last year where technicians were trained in New Zealand to work in the bush and asked if this was a step in that direction. MR. MULLIGAN replied that the University of Washington was developing a program involving going to New Zealand. He explained that the hygienists go to an accredited school and have to take tests, get an endorsement and are regulated. SENATOR BUNDE asked how the procedures would differ for hygienists and technicians. MR. MULLIGAN replied that he didn't think HB 136 allows dental hygienists to do procedures differently, but it was giving another option to consumers for that access to occur. 2:26:29 PM SENATOR STEVENS said he is confused about the collaborative agreements. His district often has dental hygienists going to the small villages without a dentist and he asked if this allows them to do the work even though a dentist isn't in the building. MR. MULLIGAN replied yes, if it is stipulated in the collaborative agreement. 2:27:19 PM JIM TOWLE, Executive Director, Alaska Dental Society, said he supported the concept and intent of HB 136, but the society had two areas of concern. One deals with the administration of local anesthesia under general supervision. They support that concept with a collaborative agreement where it is balanced and allows hygienist working outside of the traditional dental office in rural areas to do that, but had reservations about general supervision in all cases. Secondly, under the collaborative agreement, he wanted an amendment that would make sure the patient is seen within a year for a diagnosis and examination by a dentist. He went back to Senator Bunde's question about the difference between a dental health aid therapist and hygienist and said there is a critical difference. Hygienists would not be in a position to actually prepare a cavity by taking a hand piece and drill and removing the decayed material. This simply allows the hygienist to "pack and carve" - place the filling material and put it in. MARIE DARLIN, AARP Capital City Task Force, supported this bill because there is a need for a lot of these things that are now pertaining to all health care issues. STEVEN BERTRAND said a dental hygienist friend of his, Vicki Haas, asked him to address the committee today. He is a Licensed Paramedic Firefighter in Anchorage and has also been certified at all levels of EMT. He has been working under standard protocols and medical operating orders since 1983. With regard to general orders, he is allowed to give everything to and including a paralytic to paralyze someone to incubate them in the field without any direct supervision of a doctor. Everything that he does is documented and certified on a biannual basis by the State of Alaska. 2:32:02 PM ROYANNE ROYER said she had worked as a dental hygienist for 29 years in both private practice and public health; she has been an instructor for 20 years in the UAA dental program. She is a member of the State Oral Health Coalition that also supports this bill. She wanted to address three things; the first being anesthesia. Dental hygienists have been giving local anesthesia in Alaska since 1981. For a hygienist to receive a license to administer local anesthesia requires a separate written and clinical examination by a national examining board after being educated separate from dental hygienist license in the State of Alaska. Dental hygiene curriculum for local anesthesia is established and competency requirements are enforced by the American Dental Association. There has never been a disciplinary action against a dental hygienist for administration of local anesthesia under the current statute and, obviously, no fatalities. Forty states allow dental hygienists to administer local anesthesia; Idaho and Oregon require local anesthesia under general supervision. Oregon has had this for over 20 years. 2:34:22 PM The restorative procedures would be done under the direct supervision of a licensed dentist. The dental hygienist would not be prepping the filling, but only filling them. Dental hygienists would be educated and licensed to provide these additional services. The curriculum for examining and licensing for restorative function by dental hygienists have already been established in many states, such as Washington, which has had this expanded function for over three decades. MS. ROYER said she was educated in Washington and worked there as a restorative dental hygienist for two years before coming to Alaska. That experience provided her knowledge of how effective and efficient this expanded function can be for increasing the number of services that can be done in one day. 2:35:17 PM MS. ROYER said collaborative agreements have the biggest potential to provide the greatest impacts to Alaskan communities. It allows hygienists with experience to enter a written agreement with a dentist; this is not independent practice at all. It must be approved by the Board of Dental Examiners and the hygienist would be able to provide the services agreed upon prior to the dentist seeing the patient. Collaborative agreements could be used in rural areas, nursing homes, with disabled and homebound patients and many areas that are currently lacking access. She said that all of these dental hygiene statute changes have been implemented in other states and they have been proven to be safe and effective. She summarized: This is a team effort, not independent practice by dental hygienists. The goal for everyone here I hope is to provide quality access to care and I think we could do this right now, not five years from now, not a year, but right now if you would pass HB 136. SENATOR STEVENS asked if she was saying that dental hygienists go out to a village and perform these services without direct supervision of a dentist and also without the patient seeing a dentist. MR. ROYER replied no; she was saying prior to seeing a dentist. For instance, she would be able to take X-rays and do simple cleaning before a dentist would see the client. These are all things the hygienist would collaborate on with a dentist who was knowledgeable about his or her skill level. GLENN MARTIN said he is a member of the American Dental Association and a fellow at the Academy of General Dentistry. He practiced in Bethel and Southeast Alaska from 1992 to 2001. He currently lives and works in Anchorage where he is director of Village Travel for Southcentral Foundation. He has traveled to 62 villages and has 128 weeks of experience practicing dentistry in rural Alaska. He supported HB 136. He said today there are 24 public health dentist vacancies in Alaska. If passed, this bill would greatly increase the number of patients he could provide health care to. Utilizing the collaborative agreement portion of the bill would increase efficiency. A dental hygienist could travel to the village prior to his scheduled trip and provide X-rays and oral screenings. He could use his time for restorative and emergent needs. Passing HB 136 makes a measurable impact on access to care. 2:39:27 PM MARY CERNEY said she has been a practicing hygienist in Alaska for 32 years. She had just completed her second term on the Board of Dental Examiners and she is currently serving with the Western Regional Examining Board which administers licensing exams to dental hygienists with traditional hygiene duties restorative procedures and anesthesia. She wanted to add that under the collaborative agreement, hygienists would be doing only the procedures they do day in and day out. The only difference is that they would be done in a slightly expanded setting, so dental hygienists can go out into a community health situation that isn't regularly staffed by a dentist and do a little bit of pre-treatment like taking X-rays, cleaning and getting education going so people have some knowledge of their oral health. It's not in any way in lieu of dental treatment. 2:41:14 PM MS. CERNEY said that general supervision means that presently a dentist must be in the facility if a hygienist is giving local anesthesia to numb even a single tooth. The definition in Chapter 32 says that general supervision means "the dentist has authorized the procedures and they are being carried out in accordance with the dentist's diagnosis and treatment plan." So, regardless of the situation, it means that the dentist has already looked at the medical history, doesn't have a problem with it and is also comfortable with that dental hygienist's ability to do the procedure. The dental hygienist is still employed by the dentist and would be working at his direction, be it private practice or in a collaborative agreement. When there is a decision to do local anesthesia under general supervision that merely means that the dentist stepped out to lunch or if the dentist is away for a week or two the hygienist can continue seeing the same patients - because there are many patients who benefit from just a single tooth being numbed or a couple of teeth that are sensitive or doing deep scaling on it. "It just frees us up to do what we do every day and have been doing every day since 1981." 2:43:28 PM RENA BOWER said she had served on the Board of Dental Examiners for seven years. She is currently an instructor at the new dental hygiene program at the University of Fairbanks Tanana Valley Campus and has been a certified dental assistant licensed in Alaska for 15 years and is able to give local anesthetic. She couldn't add anything to previous testimony other than HB 136 would greatly enhanced care and expedite the care that can be given into the rural areas and the underserved population. She emphasized that the dentist always has the authority, even after diagnosing and prescribing the treatment, to say he isn't comfortable with having his dental hygienist administer anesthetic or whatever. DON CHILES, oral maxilla-facial surgeon, said he is currently employed at the Native Medical Center. He has practiced for 40 years in both Bush Alaska and in private practice. He supported HB 136. When he taught at Baylor, he taught both dental hygienist students and dental students the very same CPR course relative to emergencies and dental treatment. In private practice, he employed a dental hygienist who worked with him as a surgical assistant. He had first-hand knowledge of her training and he was in total support of having collaborative agreements for doing treatments in the bush. It would enhance treatment for patients and his experience is that dental hygienists do thorough exams. CHAIR ELLIS noted that HB 136 would be held for another hearing in the near future.
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