Legislature(1997 - 1998)
04/08/1998 09:08 AM Senate HES
| Audio | Topic |
|---|
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
SB 160 - DENTAL RADIOLOGICAL EQUIPMENT
CHAIRMAN WILKEN informed committee members the version of the bill
being addressed is CSSB 160 as amended in the Senate Labor and
Commerce Committee.
MEL KROGSENG, staff to Senator Taylor, sponsor of the measure, read
Senator Taylor's sponsor statement for the record. She then
summarized the bill as follows. SB 160 changes the procedures for
inspecting and registering dental radiological equipment. Current
DHSS inspections have been erratic and are unnecessary because the
incidence of x-ray overexposure is so insignificant as to be non-
existent. Some states have no such requirement. SB 160 will
transfer those duties to the Board of Dentistry. Inspection
activities will be done by the private sector, and equipment owners
will be required to provide documentation to the board proving that
an inspection was done by a qualified individual within the
previous five years. Trained dental supply company technicians are
far more qualified to perform such inspections than representatives
from DHSS. SB 160 establishes criteria for inspector qualification.
The civil penalty for non-compliance, to be levied by the Board of
Dental Examiners, is a fine not to exceed $5,000 per violation.
MS. KROGSENG explained DHSS was without a technician for several
years delaying some inspections for seven years or more. She noted
Dan Anderson, a technician to Dr. Helmberg (ph), was available on
teleconference to answer technical questions.
Number 394
KATE COLEMAN, Radiological Health Specialist for DHSS, stated she
is one of two such specialists within DHSS. She made the following
comments. This week is national public health week. Alaska could
be diminishing the capacity of public health by diluting the
regulation of dental x-ray. On the international radiation
protection scene, the International Commission of Radiation
Protection would like to lower the exposure to occupationally-
exposed radiation workers. SB 160 will remove government
regulation aimed at keeping that exposure as low as reasonably
achievable. Questions about health effects and risks have been
raised and answers are difficult to quantify, but most people are
concerned about x-ray.
MS. COLEMAN read the following excerpts from a paper by Dr. Stuart
Smith of the UCLA School of Dentistry.
"While the risks from dental radiography is certainly small
compared to other risks that we assume in our daily lives,
such as driving, smoking, and eating fatty foods, there is no
basis to assume that it is zero. Prudence suggests we should
be cautious because of the large number of people that receive
dental x-rays. Recent studies suggest the lifetime cancer
risk from exposure to low levels of ionizing radiation may be
greater than previously estimated. The International
Commission for Radiation Protection data show that estimated
risk has increased four-fold. Cancers other than leukemia
typically start to appear ten years after exposure and remain
in excess for the lifetime of the exposed individuals."
MS. COLEMAN provided the following information. There is an
association with leukemia and radiation, the risk to children being
greatest. Thyroid cancers increase in humans following exposure to
ionizing radiation. About ten percent of individuals with thyroid
cancer die from that disease. A case controlled study has shown an
association between brain cancer and previous medical or dental
radiography. Several studies have shown an association between
salivary gland cancer and dental radiography. As long as there is
a risk, it needs to be monitored. DHSS is responsible for
protecting public health. SB 160 will create an absence of checks
and balances. The credentials of inspectors contained in the bill
are lax and do not address whether these individuals are qualified
to calculate skin dose, film quality, to operate radiation
measuring equipment, and to perform shielding calculations and
scatter radiation measurements. A state certification program for
inspectors should be in place to keep the standards high. She
questioned whether the Board of Dental Examiners will provide the
inspection procedures. The majority of problems in dental x-ray
are a result of film processing and operator error. SB 160 creates
duplicate functions within two state agencies. The type of
organization proposed by SB 160 is unusual by any state's standards
since the expertise of the professional board is so distant from
radiation protection. It is wasteful to establish parallel lines
of expertise in two separate agencies. AS 18.60.475(a)(7)
authorizes DHSS to assist other state agencies in performing
functions that require radiation expertise. This authorization
shows cognizance of the unique qualifications necessary to
understand and implement a responsible radiation control program.
Alaskan citizens will not benefit from the passage of SB 160.
Number 461
CHAIRMAN WILKEN stated he has trouble believing that dentists are
not concerned about risks to people who work for them and would not
take this on as part of their responsibilities. He noted he has
received quite pointed comments from several dentists about how the
current program does not work.
MS. COLEMAN pointed out 25 percent of her job is radiological
equipment testing. Last May, DHSS hired an additional inspector
who inspects full time. She and the other inspector plan to
inspect all of the facilities in the state on a three-year basis.
She noted this is the first time the state has hired two
inspectors, so they have actually just begun this program.
Number 479
CATHERINE REARDON, Director of the Division of Occupational
Licensing (DOL), indicated that DOL provides staff support to the
Board of Dental Examiners who will be given the responsibility of
ensuring that private inspections of equipment take place under SB
160. She stated from her perspective, she believes this bill
originated as the result of frustration on the part of some
dentists about paying a $50 per year per tube fee to DHSS for its
radiologic inspection program. The frustration was due to the fact
that state officials were not inspecting some dentists'
radiological equipment for significant periods of time. Dentists
have always had the option to hire private inspectors but they
still had to pay the $50 fee. DHSS has not had enough staff to
visit and inspect all dental offices, but it may now have that
ability. Ms. Reardon expressed two concerns. First, she
questioned whether the current system could be improved and stay
within DHSS since the expertise for the inspections is within DHSS.
The Board of Dental Examiners does not have detailed knowledge
about radiologic health issues. The Board opposed the original
version of SB 160 which differed significantly from the committee
substitute in that it would have required the Board to actually do
the inspections. The committee substitute leaves the inspection to
the private sector. Regarding the qualifications of the private
sector inspectors, she stated she was unable to determine whether
the training requirements listed on page 1 of the bill would be
sufficient. She pointed out rural dentists will need to pay the
transportation cost of inspector visits. She indicated the DOL
fiscal note reflects more staff time during the first two years,
with a decline in staff assistance in the following years. She
concluded her testimony by asking again whether it might be better
to improve and fix the existing system.
Number 529
SENATOR GREEN asked how long the current program has been in place.
MS. COLEMAN informed committee members that Sid Heidersdorf
originally came to Alaska in the 1960's as part of the U.S. Public
Health Service and performed this function until he was employed by
the state government in the 1970's.
SENATOR GREEN asked if he worked as a private inspector.
MS. COLEMAN stated he was a government employee who retired in the
early 1990's.
SENATOR GREEN said she would like to confirm whether there have
been no inspections or sporadic inspections during the last 10
years.
Number 542
MS. COLEMAN replied Mr. Heidersdorf was in her position, and spent
about 25 percent of his time doing radiological inspections.
Because he was the only state employee doing this work, he
circulated film to dentists through the mail to be exposed and then
he determined the radiation level. He prioritized which places to
visit depending on the radiation levels, therefore he did not visit
some places more frequently than every seven years.
SENATOR GREEN asked if the same procedure continued after Mr.
Heidersdorf's retirement.
MS. COLEMAN explained there have been gaps in filling the
radiological specialist position because it is difficult to find
people with the appropriate qualifications. She offered to send
committee members the list of DHSS inspections of dental facilities
which is on a data base.
SENATOR GREEN commented it is not too hard to see why a certain
degree of frustration exists among equipment owners.
MS. COLEMAN said yes, but that there is also a big misunderstanding
about DHSS's function versus a repair persons'. DHSS does not do
repairs, service people do. Service people do actual electrical
work on the equipment. DHSS staff are health physicists. They
take measurements with radiation detection equipment from the
operator's point of view and the skin of the patient's point of
view. They look at the film processing to determine where problems
may exist and why a practitioner might have to use higher radiation
levels, which is usually a processing problem. Under CSSB 160,
technicians will not be looking at processing.
CHAIRMAN WILKEN asked how many tubes are located in the state.
MS. COLEMAN replied there are about 250 facilities; the average
facility has three tubes.
CHAIRMAN WILKEN asked if that meant three x-ray units.
MS. COLEMAN said that was correct.
DAN ANDERSON provided the following summary of Dr. Helmberg's
written testimony via teleconference from Fairbanks. The first
paragraph states that dentists themselves have been trained about
radiation dangers which is usually a problem caused by sudden
changes in film density, therefore dentists will not ignore the
problem. Dr. Helmberg also questioned how, if a person can get
cirrhosis of the liver from drinking alcohol, one could calculate
the risk of getting it from drinking one glass of wine every New
Year's Eve. He compared the dental x-ray danger to the person who
drinks one glass of wine per year. As for DHSS's most recent
concern about the financial hardship to remote dental facility
owners, Senator Taylor has already put this concern to rest.
Medical equipment technicians are regularly called upon to serve
other medical and dental equipment in private and government
facilities throughout the state.
There being no further discussion on CSSB 160, SENATOR LEMAN moved
to report CSSB 160 from committee with individual recommendations.
SENATOR ELLIS objected. The motion carried with Senators Green,
Leman, and Wilken voting for the motion, and Senator Ellis voting
against it. CHAIRMAN WILKEN announced CSSB 160(L&C) was moved to
the Senate Finance Committee.
SENATOR ELLIS asked if a fiscal note accompanied the bill.
CHAIRMAN WILKEN stated a fiscal note of about $12,000 was attached.
| Document Name | Date/Time | Subjects |
|---|