Legislature(2007 - 2008)BELTZ 211
05/01/2007 01:30 PM Senate LABOR & COMMERCE
| Audio | Topic |
|---|---|
| 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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