Legislature(1997 - 1998)

03/21/1997 03:19 PM L&C

Audio Topic
* first hearing in first committee of referral
+ teleconferenced
= 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              
 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"               
 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                
 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.                          

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