Legislature(1997 - 1998)
03/21/1997 03:19 PM L&C
* first hearing in first committee of referral
= bill was previously heard/scheduled
= bill was previously heard/scheduled
HB 135 - DENTISTS: LICENSING & EXTEND EXAMINING BD Number 137 CHAIRMAN ROKEBERG announced the first order of business would be HB 135, "An Act relating to dental licensing; extending the termination date of the Board of Dental Examiners; and providing for an effective date." Number 168 CATHERINE REARDON, Director, Division of Occupational Licensing, Department of Commerce and Economic Development, was first to come before the committee. She said the bill was introduced by the Legislative Budget and Audit Committee (LB&A). She explained all the bills the committee would deal with today contain elements of legislative audit recommendations in addition to the extension of the board's sunset dates. She said while the department agrees with most of the suggested changes, the ideas were brought forward from LB&A rather than initiated by the Department of Commerce and Economic Development. She said HB 135 extends the sunset date to 2003, but it is her understanding that four years is what is probably considered more appropriate by the Senate. MS. REARDON informed the committee members that Section 2 increases the number of public members on the board and decreases the number of dentists. This was a recommendation of the legislative audit, as Mr. Welker testified to in the Senate the previous week. The purpose was that with a nine member board, it was the feeling of the auditor that two members might bring a more effective public voice to the board and that perhaps in other times in history they might have benefited from more public voice. She said currently there are six dentists, two hygienists and one public member on the board. The bill would make it five dentists, two hygienists and two public members. Number 358 MS. REARDON referred to Section 3 and said it removes a requirement that the photograph submitted with an application be autographed. She said it is good idea to remove that requirement since the application forms are signed anyway. MS. REARDON referred to Section 4 and said it gives the board more leeway in allowing dentists to come in by credentials, these are people who are licensed in other states as dentists. The current law says that the other state in which the person is licensed has to have licensing requirements, that are generally equivalent to those of this state. She said the issue has come up that Alaska is part of the Western Regional Examining Board, they give what is called the "WREB" dental exam. There are also several other regional exams in the country that are not identical. She said she believes California has its own exam. When it comes to determining what is equivalent, there are occasions where someone may be coming from another state and the test they took doesn't have the same elements as the WREB that Alaska uses, and therefore, the person isn't eligible for coming in by credentialing. The new language on page 2, starting on line 20, says that if the reason that the licensing requirements aren't equivalent because something was missing on the other state's test that the board may allow the person to come in for licensure if they demonstrate that they've had continuing education or hold specialty certification or provide proof of successful practice in those areas, so as to not exclude people from practice in Alaska unnecessarily. Ms. Reardon explained the board currently has a regulation out for public notice which would give some leeway to the situation. She noted the public comment period ends June 6. Number 517 MS. REARDON said Section 5 is a transition section which deals with the replacement of one of the dentists by a public member. The transition section says that the next dentist whose term expires will be replaced by a public member instead of kicking someone off the board for immediate replacement. Ms. Reardon informed the committee the bill has a zero fiscal note and was done slightly different than in the past for board sunset extensions due to a request from the Senate. She said the department used to show the ongoing costs of programs. There were usually positive fiscal notes that showed the money was already in the budget, but was leading to the necessity of Finance Committee referrals. The department is doing fiscal notes and it is shown in the analysis that there is an ongoing cost of regulating dentists which is already in the budget. Ms. Reardon said in this case, the department is saying the cost is about $163,200 a year for licensing dentists. Number 592 REPRESENTATIVE JOE RYAN asked if dental hygienists are licensed. MS. REARDON indicated dental hygienists are licensed under the Board of Dental Examiners. REPRESENTATIVE RYAN asked if they have to meet national criteria. MS. REARDON explained there is a national exam. The licensing is similar to the one set up for real estate or dentists where in statute there are qualifications for training and examination. It is very similar to all of their licensing sections. REPRESENTATIVE RYAN explained the reason he is asking is he has some friends that are dentists and a circumstance he has heard is that they were having to pay a lot of people a lot of money who they didn't feel were qualified to do the job. They wanted more qualifications and expertise. REPRESENTATIVE RYAN said a common complaint from people in Alaska was that there weren't enough dentists or enough competition and the prices are very high. A lot of people go to Whitehorse or Seattle. The board is very restrictive in allowing other people to come into the state. Representative Ryan noted a friend of his in Fairbanks, Dr. Helmbrick, after six or seven times of taking the exam before he could qualify, graduated from an accredited school. He felt it was a case of an old Alaskan tradition, "I'm here, close the door, don't let anybody else in." He asked if there has been anything to eliminate that. MS. REARDON said she wasn't sure what time period Representative Ryan's friend was having this difficulty. She said she believes the committee would see in some previous audits and legislative committee hearings regarding credentialing or licensure that there have been similar concerns expressed. She said she thinks that some of the board members, who are on-line, would say that is not their perspective or way of behaving and that they have been trying to find ways within their statute to let in qualified people. Ms. Reardon said if the test his friend was taking was the Western Regional exam, that is a test that involves not just Alaska, but is written for all states. She noted the Dental Board members participate in meetings and examinations by the Western Regional and are familiar with how the test is written. Number 847 KENNETH L. CROOKS, DDS, Chairman, Board of Dental Examiners, testified via teleconference. Dr. Crooks informed the committee members he has been practicing dentistry since 1971. He said he left private practice in California in 1977. He then moved to Alaska and has spent the last 20 years with the Indian Health Care, Bristol Bay Health Corporation, Dillingham. He was appointed to the Board of Dental Examiners in February, 1995, and was elected chairman in December, 1996. Dr. Crooks referred to HB 135 regarding the addition of a second public member and said the board has discussed this and they are in favor of the idea. He noted the board has experienced problems with the single public member not being able to attend all of the meetings. Prior to that person's resignation, she had difficulty making it to half of the meetings. Dr. Crooks said personally, he was not aware of reducing the number of dentists on the board in order to add a second public member and he doesn't believe that any of the current board members realize that was even a possibility. Dr. Crooks suggested an additional position be created in order to add a second public member. He said he would further suggest that in the last two years, they have had a budgetary (indisc.) which would make this possible without any additional funding. He said he knows there was a fee reduction this year which Catherine Reardon could speak to. Dr. Crooks said he believes that even with the fee reduction, they could still (indisc.) being able to pay the travel costs or whatever is involved with an additional board member. DR. CROOKS said as far as the second change to the statute dealing with the problem of the definition of "generally equivalent" in offering statutory relief from some dilemmas they've had he feels the current board would embrace this change. It is sympathetic or symbiotic with the regulation change that they proposed at their December board meeting. He said, "I think they're fully compatible and are designed to accomplish the same purpose which is to get out of a situation where we have had to actually -- within the last year we have tabled applications from at couple of dentists, at least two, because we felt that by all our standards and our background check that these were qualified dentists, eligible for licensure by credential, but because of the language of the statutes and regulations, we were not able to grant licensure. We've tabled those licenses rather than deny them in the hope that changes could be made. We envisioned it through regulation in order to all them to get licensure." Number 1124 CHAIRMAN ROKEBERG asked if the change would satisfy the problem. DR. CROOKS indicated he would like to see both things happen. He said he thinks the statute would certainly help, but if the regulation change goes through it would make more things black and white where it wouldn't be up to the board to make value judgements. He said, "The language where (indisc.) demonstration of continuing education or proof of satisfactory successful practice involved, no matter how you look at it that calls for subjective judgement." Number 1192 CHAIRMAN ROKEBERG said there has been some discussion of prohibiting the use of amalgam fillings. He asked Dr. Crooks to comment. DR. CROOKS said the board has not had discussion about prohibiting the use of amalgam fillings, but would be confident that the board would be unanimously against any idea like that. It is the best material available for a lot of common dental restoration needs. Number 1254 REPRESENTATIVE RYAN said a couple of dentists have felt that the qualifications of dental hygienists weren't up to speed for what they were having to pay them in that they weren't professional enough. They felt though there should be some stricter standards set for hygienist's educational background. DR. CROOKS said the licensure for hygienists in Alaska is very similar in process to the licensure for dentists, including the fact that they use a component of the Western Regional Examination Board for testing of hygienists. He said if the dentists have questions about the standards of the exams or reviewing, he would like to hear from them. Dr. Crooks said as far as the specifics of the Western Regional exam, Dr. Warren who is also on-line, is much more familiar with the make-up of that exam. Number 1338 REPRESENTATIVE RYAN said it was a concern that was expressed to him and he wanted to bring it to Dr. Crooks' attention. He noted he doesn't know that much about the profession. Representative Ryan informed the committee he has received complaints from the public that it is extremely difficult for people who want to come to Alaska and practice to get licensed. The public opinion is that there is an "old boy network," kind of protecting the territory. He said he knows a lot of people in Alaska who have gone somewhere else where the fee for service was tremendously less expensive than it is in Alaska. DR. CROOKS said, "This board, and I'm speaking of the people who have been there the last two years, were appointed, most of them anyway, were appointed by the current governor, with the understanding that the law is -- we could expect (indisc.) to follow it as closely as possible and the credentialing was a process that we were encouraged to develop. And as I heard you say, we have tabled two licensure applications purely because we could not find it in ourselves to deny licenses to these people who have appeared qualified. I do not believe that there is any sort of protection being exercised by the Board of Dental Examiners in the state." Number 1455 ROBERT WARREN, DDS, testified via teleconference from Anchorage. He said he is a practicing dentist and has been in practice for 21 years. He was appointed, under the Sheffield Administration, to the Board of Dental Examiners in 1981, to fill an unexpired term and then was reappointed for two additional terms. He noted his last term expired in 1991. Dr. Warren said he was chairman of the board in 1987, when Alaska joined the Western Regional Examining Board. Recently, he has been involved in the American Association of Dental Examiners which is the national organization that Alaska's board queries when there are disciplinary questions about credentialing candidate for licensure. He noted he is the president-elect. He said the national organization was the clearinghouse for disciplinary information as it is the agency that all licensing agencies in the United States report to. Dr. Warren said he is in favor of the legislature extending the termination date for the board, but would strongly suggest that if the numbers on the board have to be changed to make room for a public member that the board be increased by a member rather than eliminating an existing dentist position. Dr. Warren explained he was the president of the board when Alaska joined Western Regional. The legislative audit report of 1986 and 1987 strongly urged that Alaska stop giving their own state licensing exam which they had done for a decade before statehood and since statehood. He said he believes that is where the Dental Board got "the good old boys" reputation. DR. WARREN explained that to affiliate the Dental Board with the Western Regional Examining Board took statutory changes. Representative Curt Menard, a dentist from Wasilla, was in the House at the time and his staff and Dr. Warren helped write the current statute. He explained what they elected to do, aside from putting the WREB language in the statute, was to increase the board of seven members, five dentists, one hygienist and one public member, to nine members adding another dentist and hygienist. Dr. Warren said, "The reason for it at the time was in the past we'd given the examination here in Anchorage. Now our members, because we are a member of Western Regional, were being asked to be in the WREB examining pool. And by that, what I mean is at the time the members of WREB were Arizona, Utah, Montana, Idaho and then also Alaska, and then New Mexico joined. And at the time, there were six states and none of these states had dental schools, so the board members were asked to give the examination on a rotating basis. Frequently, these exams are two to three days from the day of travel so it meant as much as a week out of the office, out of your productive time in your office, if you volunteer to give these exams out of state. They were frequently given in states that had dental schools like Loma (Indisc.) in Southern California or University of Oregon. And so we felt the time constraints on the Dental Board members, be the hygienists, who also had to get exams out of state or dentists who (indisc.) out of state. We needed a few more people to kind of spread that load a little bit more equally. I think it has served the public well and the citizens of the state well for a decade and I can see no reason why to change it at this time." DR. WARREN informed the committee that WREB has now expanded to ten states. Several years ago Oregon rejoined. The state of Washington is currently a member of WREB. The latest states that have joined are Texas and Oklahoma which almost doubled the amount of candidates. Dr. Warren said in response to Representative Ryan's question, this year the WREB is going to examine 1,000 candidates in 12 different exams meaning that if 1,000 pass, they will be eligible to apply for a new license in Alaska. Dr. Warren explained Dr. Crooks has been involved in the credentialing process longer than he has. He said they were just transitioning into the process when the original statute was written. Number 1747 REPRESENTATIVE RYAN indicated that he is having his amalgam fillings replaced with plastic as he has read several articles discussing different diseases that amalgam fillings can cause. He said a few years ago he can remember an appointment to the board when Representative Menard was in the House and this person thought along the same lines as he does. There was opposition to this person's appointment because he dared breach the orthodoxy at the time. He asked Dr. Warren if there is going to be a move again to chastise people who want an alternative replacement rather than using a mercury based product in their mouth. DR. WARREN explained that one of the originators of this philosophy was a Dr. Hal Hungens from Colorado. He said this past year, Dr. Hungens' license was revoked by the state of Colorado and after that the Colorado State Medical Board of Examiners filed a complaint against a physician (indisc.) and she voluntarily surrendered her medical license and moved to Alaska. There has also been a revocation of a license of a dentist in Minnesota doing the same thing. Dr. Warren said that there has been historical judgement in California where a California superior court judge would not receive any testimony portraying that dental amalgam was a serious health threat. A researcher at the University of Nebraska has found that there is no evidence to link Alzheimer's disease to amalgam. He said there is a lot of anecdotal evidence out there regarding amalgam fillings. Number 1895 REPRESENTATIVE RYAN said, "My concern is that I would like to see an individual option be allowed and I would hate to see that anyone who is practicing and offered this service to the public that there would be people ganging up on them." Number 1920 CHAIRMAN ROKEBERG asked Dr. Warren if he would prefer that the committee amend the bill to the year 2001, for a four year cycle and then return to the six licensed dentists and one public member. DR. WARREN said he would recommend that. Number 1993 RICHARD COOK, Dentist, President of the Juneau Dental Society, said he thinks most dentists, in general, support the bill as written or with the modifications. He said he personally doesn't have strong feelings if another public member is added or not. Number 2026 CHAIRMAN ROKEBERG closed the public hearing on HB 135. He said he would like to make an amendment to change the date of 2003 back to 2001. He said he would also like to maintain the six dental members because of the importance of them being in the (indisc.) for the actual examination process and maintain the one public member. REPRESENTATIVE COWDERY moved the amendment. CHAIRMAN ROKEBERG asked if there was an objection to the amendment. Hearing none, the amendment was adopted. Number 2075 REPRESENTATIVE HUDSON moved and asked unanimous consent to move HB 135, as amended, out of committee with individual recommendations and a zero fiscal note. Hearing no objection, CSHB 135(L&C) was moved out of the House Labor and Commerce Committee.