Legislature(1993 - 1994)

03/01/1994 03:00 PM HES

Audio Topic
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
  HB 472 - REFERRALS INVOLVING DENTAL SERVICES                                 
  CHAIR TOOHEY asked Rep. G. Davis to address the bill.                        
  Number 303                                                                   
  REP. GARY DAVIS stated that HB 472 will prohibit the receipt                 
  of compensation by a dentist for referring a person to                       
  another dentist or dental practice.  He further stated that                  
  the receipt of compensation by a person or advertisement                     
  that refers a dental service is prohibited, unless the                       
  compensation for referral is disclosed at the time of                        
  referral.  He maintained that the proposal would ensure that                 
  patients would be referred to a dentist or a dental practice                 
  as a result of the quality of service.  He said the bill was                 
  before the committee as a result of the American Dental                      
  Association, Principles of Ethics and Professional Code of                   
  Conduct.  He said that it is against their code to solicit                   
  patients in any form through referrals.  He stated that the                  
  legislation would put some of the American Dental                            
  Association's ethics in statute.                                             
  CHAIR TOOHEY asked for questions.                                            
  Number 348                                                                   
  REP. VEZEY asked why the committee was attempting to codify                  
  the ethical standards of any professional organization.                      
  REP. G. DAVIS replied that the initial attempt was made                      
  through a resolution, but Legal Services felt there was room                 
  in statute for the provisions.  He also said Mr. Sam Kito                    
  from the Alaskan Dental Association was present to answer                    
  REP. BUNDE asked if the legislation was inspired by any                      
  specific cases concerning unethical "kickbacks."                             
  Number 338                                                                   
  REP. G. DAVIS said the request was based specifically on the                 
  1-800 number agencies that advertise for referrals.                          
  CHAIR TOOHEY stated that Dr. Dan Pitts from Soldotna was on                  
  line to answer questions.                                                    
  Number 407                                                                   
  DR. DAN PITTS, Former President, Alaska Dental Society,                      
  testified via offnet from Soldotna in support of HB 472.  He                 
  stated that the emphasis of the bill is to protect the                       
  public.  He stated that the code of ethics indicates that it                 
  is unethical for any dentist to make payment to another                      
  person or entity for referral of a patient for professional                  
  services.  He said commercial referral agencies violate that                 
  code.  He said the advertising is false and misleading.  He                  
  explained that most commercial referral services have had no                 
  contact with the Alaska Dental Society to check the                          
  credentials of the dentists they are referring.  He felt                     
  that practice to be very misleading.  He also noted that                     
  only a few dentists are getting referrals from the service                   
  and that the dentists are paying the commercial referral                     
  services for the referrals.  He reiterated that this                         
  practice is unprofessional and unethical.  He said the                       
  legislation is in line with the Alaska Dental Association's                  
  principles of ethics and professional conduct.                               
  Number 497                                                                   
  REP. BUNDE related a situation whereby dentists who utilize                  
  the commercial referral service could possibly pass a                        
  patient around for various dental work to be done only for                   
  the goal of padding their bills.  He indicated that type of                  
  situation to be the only problem he could see.  He further                   
  stated that the notion of the referral service is just a                     
  commercial entity that is selling a product for dentists.                    
  He felt if the dentists are not getting their money's worth,                 
  the dentist should stop buying the product, hence the                        
  services to go out of business.  He saw the issue as two                     
  separate problems.                                                           
  DR. PITTS said the thrust of the bill is to have the                         
  commercial referral service disclose to the patient that                     
  they are paid by dentists for these referrals.  He said                      
  patients are misled because they believe the commercial                      
  referral service is an official referral service that gives                  
  an objective referral.  He stated that the issue is a                        
  nationwide problem and that other states have legislation                    
  that prohibits this particular practice.                                     
  Number 552                                                                   
  REP. BUNDE clarified that the legislation would mandate that                 
  a commercial referral service disclose within conversation                   
  with a potential referral patient that the referral agency                   
  is paid by dentists for their services.                                      
  DR. PITTS agreed.                                                            
  REP. G. DAVIS said that the legislation would include                        
  additional review by the dental boards and indicated the                     
  provision on page 2, line 1.                                                 
  Number 585                                                                   
  REP. BUNDE cited the zero fiscal note and asked if the                       
  professional dental board would be the official policing                     
  agency.  He further questioned if a complaint could be                       
  brought to the board if disclosure is not made.                              
  REP. G. DAVIS said that the board already has the                            
  responsibility of oversight.                                                 
  REP. BUNDE said that it is also the board's responsibility                   
  to decide on ethics.  He said it would be a breach of dental                 
  ethics to not disclose.  He then said that the referral                      
  services are not dentists, so the board cannot fine someone                  
  who is not a dentist for violation of dental ethics.                         
  REP. G. DAVIS deferred to Dr. Pitts.                                         
  DR. PITTS assumed that the legislation would make it clear                   
  as to how the commercial referral services would have to                     
  operate.  He reiterated the thrust of the proposal to be                     
  that of disclosure to the patient.                                           
  REP. BUNDE clarified that kickbacks between two dentists is                  
  a violation of dental ethics that could be brought up before                 
  the dental board.                                                            
  DR. PITTS said yes.                                                          
  REP. BUNDE asserted that the board has no way of addressing                  
  the ethics issue of commercial referral services because                     
  they are not dentists.  He then asked if there were any                      
  services that were run by dentists.                                          
  Number 646                                                                   
  DR. PITTS said no referral services are run by dentists.  He                 
  felt for a commercial referral service to refer a patient                    
  would be "pretty close to practicing dentistry."                             
  REP. BUNDE said the commercial referral agencies are                         
  currently doing just that.  He commented that the issue                      
  could also be raised if he was to tell his friends that he                   
  needs a route canal and his friends suggest a dentist.                       
  DR. PITTS said that a commercial entity would be practicing                  
  dentistry by referring the patient to a dentist.                             
  REP. BUNDE stated that the difference may be his friends                     
  would not get paid for the referral.                                         
  CHAIR TOOHEY asked for further questions.                                    
  Number 674                                                                   
  REP. VEZEY asked Dr. Pitts if the adherence to the                           
  professional ethics standards is a condition of licensure.                   
  DR. PITTS said yes.  He said the proposal focuses on the                     
  commercial referral services, not on dentists.                               
  REP. VEZEY indicated that under Title 836.315 there is no                    
  provision made for the adherence to the professional ethics                  
  standards as being a requirement of licensure or grounds for                 
  DR. PITTS said the a definition of the board's purpose is to                 
  pass judgement on the ethical standards of the profession.                   
  Number 724                                                                   
  REP. VEZEY said he felt the added wording was really                         
  unnecessary, and further stated that he thinks the board                     
  does not have the authority to revoke a license for                          
  unethical behavior.  He said he knew the board to have the                   
  authority to revoke licensure on the grounds of professional                 
  incompetence, but not for unethical behavior.                                
  REP. BUNDE interjected and said the sponsor statement                        
  indicates that the Board of Dental Examiners is charged with                 
  developing ethics policy.                                                    
  REP. VEZEY said the sponsor statement is not codified in                     
  REP. BUNDE agreed that Rep. Vezey brought up an interesting                  
  REP. VEZEY suggested that Dr. Pitts look at the board's                      
  statutory authority, because he did not believe the board                    
  has any authority in enforcing ethics.  He stated that the                   
  board only had authority to enforce professional standards.                  
  Number 759                                                                   
  DR. PITTS questioned if professional standards are the same                  
  as ethics.                                                                   
  REP. VEZEY stated that professional competence implies                       
  technical competence.                                                        
  DR. PITTS reiterated that the bill specifically addresses                    
  disclosure by the commercial referral services.                              
  REP. VEZEY said Dr. Pitts was referring to Section 2 that                    
  amends Title 45, which is a chapter on unfair trade                          
  practices.  He further stated that the section dealing with                  
  the authority of the board of licensing is in Title 8.  He                   
  again stated that he did not believe the board has the                       
  authority to revoke a license for unethical behavior.  He                    
  suggested Dr. Pitts look into the matter.                                    
  DR. PITTS said that he is not a board member and would have                  
  to talk with a board member.  He said he had always assumed                  
  that the dental board has the authority to revoke a license                  
  for unethical behavior.                                                      
  CHAIR TOOHEY asked the pleasure of the committee.                            
  REP. VEZEY said he answered his own question.                                
  Number 829                                                                   
  CHAIR TOOHEY asked again the pleasure of the committee.                      
  REP. VEZEY made a motion to pass HB 472 out of committee                     
  with individual recommendations.                                             
  CHAIR TOOHEY, hearing no objections, declared HB 472 so                      
  Seeing no further business before the committee CHAIR TOOHEY                 
  ADJOURNED the meeting at 4:15 p.m.                                           

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