Legislature(1995 - 1996)
01/17/1996 09:03 AM Senate HES
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* first hearing in first committee of referral
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= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
SHES - 1/17/96
SB 212 DISCIPLINARY SANCTIONS FOR DENTISTS
Number 001
CHAIRMAN GREEN called the Senate Health, Education and Social
Services (HESS) Committee to order at 9:03 a.m. and introduced
SB 212 as the first order of business before the committee.
MIKE TIBBLES, Staff to Senator Green, read the sponsor statement
which outlines the two main concerns that lead to SB 212. "First,
it insures the rights of dentists to practice the safe dentistry
method of their choice and secondly, by insuring this right, the
bill provides dentists the same level of protection against board
sanctions physicians currently receive under the law." SB 212
would allow dentists to inform patients of safe, alternative
procedures without the concern of sanctions.
SENATOR LEMAN asked if Mr. Tibbles was aware of any challenges
caued by the 1990 law, the State Medical Board--Grounds for
imposition of disciplinary sanctions which is a portion of HB 146.
MIKE TIBBLES was unaware of any such cases.
SENATOR ELLIS asked who had requested the legislation. MIKE
TIBBLES said that an individual had brought the legislation
forward.
Number 065
SCOTT CROWTHER informed the committee that a reform movement had
been initiated in dentistry in 1984 which has resulted in the
documentation by medical scientists of the many health risks
associated with mercury. Mercury leaks out of dental amalgam. Due
to this documentation countries in Western Europe and Canada are
now phasing out the use of mercury based amalgam. Mr. Crowther
believed that a more economical medical and dental system could be
obtained if amalgams were not used. Furthermore, individuals could
reach a higher quality of life and health if amalgams were removed.
In order to achieve these two goals more mercury-free dentists are
needed in Alaska. Mr. Crowther explained that mercury-free
dentists would not knowingly install a mercury-based product in a
patient's teeth. Mercury-free dentists informe patients of the
health risks of amalgams.
Mr. Crowther pointed out that Sweden's socialized medical and
dental system was setting an international standard. In Sweden,
amalgams are not installed and if the patient wishes to remove any
amalgam it is done at the government's expense.
Number 103
Mr. Crowther explained that he was a patient that had experienced
severe health problems due to the leakage of mercury from dental
amalgam. If his amalgams had not been removed four years ago he
doubted his ability to be present at this meeting. Due to mercury
detoxification and body system rebuilding with dietary supplements,
he has experienced many health improvements. He emphasized that
other patients should not repeat his experience. He informed the
committee that one hundred other patients had signed a petition
supporting SB 212.
Mr. Crowther pointed out that mercury-free dentists who have
removed amalgams face the threat of board review since mercury-free
dentists are not following conventional beliefs. He believed that
the passage of SB 212 would protect existing mercury-free dentists
from board review and mercury-free dentistry would grow in Alaska.
Patients would benefit the most from the removal of amalgams.
Number 134
SENATOR LEMAN asked if the protection sought was for cases in which
the removal and replacement of amalgams were performed when no
detrimental health challenges were known. Can dentists currently
remove and replace amalgams that are identified as causing health
challenges? SCOTT CROWTHER explained that, according to the
American Dentists Association Code of Ethics, dentists can remove
and replace amalgams if a physician issues a statement to that
effect. Few physicians have the background and training necessary
to identify mercury poisoning.
DR. BURTON MILLER, a licensed dentist in Anchorage, was in favor of
SB 212. He emphasized that SB 212 would not allow disciplinary
actions to be imposed solely on the grounds that a practice is
unconventional or experimental unless the board could demonstrate
physical harm to the patient. Dr. Miller informed the committee
that he had experienced censorship action due to his philosophy and
practice that noxious and poisonous substances are such.
Therefore, his practice is considered unconventional and
experimental. Dr. Miller was appointed by Governor Hickel to the
Board of Dental Examiners in May 1993 and served 11 months. He
explained that the Alaska State Dental Society, of which the Board
of Dental Examiners comprises the majority, considered his dental
philosophy experimental, unconventional, dangerous, costly and
harmful. The Alaska State Dental Society invested much time and
effort to portray his practice as such without interviewing him or
mentioning his Dental Board work ethics. Therefore, he was
penalized for his unconventional and experimental practice
philosophy. He pointed out that Roger Eichman of Juneau also faced
the same treatment by the Dental Board of Examiners. Other
dentists with similar philosophies in the lower 48 are being
reprimanded and censored as well as disciplinary action and even
license revocation.
Number 209
In an article last year, The Journal of the American Medical
Association stated that 40 percent of the population is seeking
alternative medical care. Dr. Miller said that the same
information that pushed 40 percent of the population towards
alternative medical care is the same information that the American
Dental Association (ADA) does not circulate to its members.
Information regarding the issue of mercury vapor from mercury
amalgam can be found in reputable, prestigious scientific journals.
Due to this information many dentists are practicing mercury-free,
biological dentistry in secret.
Dr. Miller said that SB 212 would encourage health centered
dentistry without the fear of reprisal. Dr. Miller supported the
passage of SB 212.
SENATOR LEMAN asked if the examination or training to become and
continue to remain a dentist included the capability of installing
mercury amalgam filling. DR. BURTON MILLER was fairly sure that
mercury amalgam filling was still part of the curriculum as when he
attended school. Dr. Miller added that when he attended school the
toxicity of mercury was not mentioned. Today mercury is known to
be more toxic than lead cadmium or arsenic.
Number 250
DR. MICHAEL ZIFF, Executive Director of the International Academy
of Oral Medicine and Toxicology (IAOMT), stated that the scientific
evidence against the use of mercury amalgam has compelled many
governments to end the use of mercury amalgam. In 1994, the United
States' Public Health Service stated that mercury exposure from
amalgam dental fillings exceeded the minimum risk level therefore,
creating a potential health risk to patients. Even so, the dental
profession declares that mercury exposure from dental amalgam is
not harmful to patients merely because dental amalgams have been
used for over 150 years.
Dr. Ziff informed the committee that the ADA amended its Code of
Ethics in 1986 in order to state that the removal of dental
amalgams was unethical while encouraging boards of dentistry to
discipline dentists who performed the removal of dental amalgams.
Following the amendment, four dentists in the United States have
lost their license for this. This is a restriction on trade as
well as a disservice to the public health. Dr. Ziff emphasized
that state board's must inform their citizens of dental procedures
that prevent risk to the patient. The IAOMT has informed the
Alaska Board of Dentistry of their duty to inform the public of the
potential risk of dental amalgam. Furthermore, the IAOMT informed
the Alaska Board of Dentistry to end the disciplinary actions
against those fulfilling their obligation to public health.
In response to Senator Salo, Dr. Ziff explained that he had been in
dentistry for 35 years and currently practiced one half day a week.
Dr. Ziff sold his practice in 1988 in order to dedicate his time to
scientific investigation.
Number 298
SENATOR SALO asked if there had been any successful litigations
against dentists regarding amalgam fillings. DR. MICHAEL ZIFF was
unaware of any such cases. He informed the committee of a case in
progress in which the ADA's attorneys declared that the ADA did not
have any responsibility to protect the public from allegedly
dangerous materials in dentistry.
DR. ROGER EICHMAN, 25 year Dentist, noted that he had replaced Dr.
Miller on the Alaska Board of Dentistry until he too was not
confirmed. He said that he was one of the pioneers in composite
fillings in the United States. Composite fillings have improved
from a material point of view such that there is no reason to use
an amalgam filling. Amalgam fillings expand, break teeth, give out
electrical action and are toxic.
Dr. Eichman informed the committee that he is the president of the
Juneau Mining District and is very well versed in field geology.
There is a field geology test for mercury which illustrates how
mercury vaporizes off of the silver amalgam. This happens every
time a person with such a filling chews or polishes a tooth not to
mention when an amalgam is placed or replaced. An amalgam filling
contains 50 percent mercury when placed in the tooth however when
assayed after 10 years, only half of the mercury remains. Dr.
Eichman said that the mercury is absorbed. After 20-30 years, an
allergy to the metal is developed which leads to a discussion of
symptoms such as multiple sclerosis, lupus, and other debilitating
diseases. He acknowledged that mercury has not been said to cause
these diseases, but in order to receive treatment for these
disorders it seems necessary to remove the mercury load from the
body.
Number 366
Dr. Eichman said that it would be unethical for him to recommend
amalgam removal or to influence the patient in any manner. It is
not unethical if a patient requests, unprompted, the replacement of
their amalgam fillings. He emphasized that he could not determine
if a patient with an amalgam filling had a problem or would later
on. Furthermore, Dr. Eichman did not know anyone who could
diagnose this problem with any assuridty, moreover the tests used
are expensive. Removing the amalgam is the cheapest manner in
which to deal with this issue. He noted that merely this
discussion with the committee could put his practice in jeopardy
although, he expressed more concern for the upcoming generation of
dentists with regard to the debate over amalgams versus composites.
Discussion of this debate and the related cases is necessary in
order to learn and treat future cases.
CHAIRMAN GREEN asked Dr. Eichman if SB 212 addresses the concerns.
In response to Chairman Green, DR. EICHMAN said that the bill moves
toward helping. Dr. Eichman did not believe that SB 212 placed
anyone in a position of harm. SB 212 opens communication, but does
not change practice.
Number 415
SENATOR ELLIS inquired as to the average cost of the removal of an
amalgam filling and the replacement with the composite filling.
DR. EICHMAN estimated that such a procedure would cost $80-$125 a
filling depending upon the size of the filling. The cost of
amalgam fillings in Juneau are higher than the above estimate.
ELMER LINDSTROM, Special Assistant in the Department of Health &
Social Services (DHSS), explained that early this year Dr. Crowther
had offered to provide the department with information regarding
amalgam fillings and mercury toxicity. Mr. Lindstrom provided the
information to the Division of Public Health in order to receive
the division's opinion on this issue. The Section of Epidemiology
in the Division of Public Health reported that the scientific
literature did not support the suggestion that these fillings were
a public health issue or a public health risk. The position by the
Section of Epidemiology remains the same.
The Division of Public Health identified SB 212 as related to the
amalgam filling issue although, the bill does not mention this
issue. Mr. Lindstrom related the Division of Public Health's
concern that SB 212 goes beyond that issue and could include other
unconventional or experimental practices in the future. The
Division of Public Health suggested that the issue of amalgam
fillings should be stated in SB 212 to eliminate the broadness of
this statute. This statute would limit the ability of the board.
Mr. Lindstrom said that the interest of the Division of Public
Health is the impact on the consumer.
In conclusion, Mr. Lindstrom proposed the question: is the removal
of amalgam fillings necessary in the instance when there is no
demonstrable physical harm from the removal of the fillings?
According to the Division of Public Health's perspective on the
scientific literature, the removal of amalgam fillings is not
necessary and can be an expensive procedure.
Number 466
SENATOR LEMAN pointed out that comparable wording to that in SB 212
is used in statutes referring to medical doctors; this language has
been in place for approximately six years. In response to Senator
Leman, ELMER LINDSTROM was unaware of any problems related to the
medical statutes. Mr. Lindstrom speculated that the Division of
Public Health would have had the same testimony on the medical bill
as today.
CATHERINE REARDON, Director of the Division of Occupational
Licensing in the Department of Commerce & Economic Development,
explained that the division issues dental licenses and interacts
with the board in disciplining dentists and dental hygienists who
prove to be incompetent or unethical in their practice. She
reiterated the concern that SB 212 encompasses more than amalgam
fillings. Ms. Reardon expressed concern with the effect of the
medical statutes, which contain language similar to that in SB 212,
have had on investigations and enforcement. Ms. Reardon suggested
that SB 212 be limited to the amalgam issue. She discussed the
investigative procedure in which demonstrable harm must be
determined and classified in order to move forward with the
allegations.
CHAIRMAN GREEN did not believe that SB 212 repealed or took any
powers from the division. SB 212 does not have any correlation to
any unprofessional conduct. SENATOR ELLIS commented that the bill
changed the standard.
Number 528
CATHERINE REARDON explained that under SB 212, the division would
be required to prove that a dental practice was not only
unconventional practice, but that the practice also harms the
person. The harm would also have to be well documented. Ms.
Reardon said that this creates the concern regarding the broadness
of SB 212. Limiting SB 212 to the amalgam fillings would narrow
the conditions under which the division would investigate
accusations against a practitioner.
SENATOR SALO expressed concern that if SB 212 specifically
addresses amalgam fillings, the division may be left protecting
mainstream dentistry if amalgam is later found to be harmful.
CATHERINE REARDON acknowledged Senator Salo's concern, but feared
that the language limited the board's ability to outline what is
considered a safe practice. She felt that if metal fillings were
found to be harmful under the amalgam language, the division would
also have problems because that practice would then be considered
unconventional or experimental.
SENATOR SALO preferred protection from those practices that
illustrated demonstrable harm or useless economic waste over making
the language specific to amalgams.
CATHERINE REARDON mentioned that the Dental Board had adopted the
1995 ADA Code of Ethics through regulation. The 1995 ADA Code of
Ethics refers to amalgams only in general terms regarding the
quality of care.
TAPE 96-1, SIDE B
According to the investigative unit, no one has been disciplined
nor could the unit recall any complaint investigations which were
based on amalgams versus composites.
SENATOR MILLER asked if composite fillings conformed to the minimum
standards of professional dentistry. In response, CATHERINE
REARDON said that he had hit on the issue - there is not a book of
dos and don'ts.
SENATOR MILLER inquired as to what portion of the statutes were
being used to justify that composites cannot be used if the
composites do in fact conform to the minimum standards. CATHERINE
REARDON stated that the board and the division are not disciplining
dentists who use composite fillings. Ms. Reardon further clarified
that there is a debate within the dental community regarding
whether composite fillings are part of the standard.
There was discussion about Dr. Miller's testimony which Senator
Miller had understood that Dr. Miller had received disciplinary
action for using composites.
SENATOR LEMAN clarified that Dr. Miller was referring to his not
being confirmed on the board as his disciplinary action. Senator
Leman recalled that during the confirmation hearings for Dr. Miller
his use of composites was brought forth.
Number 544
DR. EICHMAN said that the entire dental community is moving toward
composite fillings. The problem rises when a dentist recommends
composites to a patient; the dentist is considered unethical.
However, it would not be unethical for a dentist to place
composites, if a patient requested so with no suggestions from the
dentist. Dr. Eichman pointed out that this is a communication
problem. He further noted that a dentist could be censored if they
spoke out against the ADA, moreover the dentist could be placed
before the board. The ADA considers it unethical to speak out
about a dental problem.
SAM KITO, Alaska Dental Society, explained that the amalgam debate
surfaced after the legislature and the administration had passed
the Dental Practices Act. The Dental Practices Act allows the
Dental Board to be able to discipline themselves. The board
determines whether a dentist is performing up to a certain
standard. He said that the debate is over a dentist recommending
composites to a patient that has amalgam filling.
Mr. Kito did not believe there would be any argument that amalgam
lasts longer than composites. The argument is about the presence
of scientific proof that amalgam is safe. The studies indicate to
the Dental Association and the majority of Alaskan dentists that
amalgam is not harmful. If amalgam was harmful a determination
would have been made; there has not been a determination.
Number 495
Mr. Kito passed out the ADA's Code of Ethics and Professional
Conduct. He agreed that this was an internal argument. He
explained that the Dental Board and the Dental Association had
difficulties in the past regarding whether the Division of
Occupational Licensing would take an issue disciplining a dentist.
The division indicated that there was much work involved and the
standards were not set at that level. Mr. Kito suggested that
dentists mediating amongst themselves would be a better option. He
informed the committee that the Attorney General would not get
involved unless a crime had been committed. The Dental Association
of Alaska has indicated that they would like to work with the
process that has been put in place.
SENATOR SALO asked if the Dental Association would agree that they
are moving toward composites. SAM KITO replied, no. That issue
should be debated within the professional ranks and is being
debated. The majority of dentists believe that dental amalgam is
not harmful. Mr. Kito reiterated Ms. Reardon's point that the
Division of Occupational Licensing is not charging, prosecuting, or
reviewing any dentist that installs composites. Mr. Kito said that
it is a matter of the conduct in the movement from amalgams to
composites.
CHAIRMAN GREEN asked for the pleasure of the committee.
SENATOR LEMAN moved that SB 212 be moved out of committee with
individual recommendations. Hearing no objection, it was so
ordered.
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