Legislature(1997 - 1998)
04/02/1998 01:40 PM Senate L&C
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* first hearing in first committee of referral
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SB 160 - DENTAL RADIOLOGICAL EQUIPMENT
CHAIRMAN LEMAN announced SB 160 to be up for consideration.
MS. KREITZER explained the changes in the committee substitute that
answer concerns brought up in a previous meeting: deleting Section
1 relating to the Alaska Dental Society making nominations for
appointments to the Dental Board. References to inspecting the
control panel were changed to say the inspection is of dental
radiological equipment and a definition of inspectors was added.
Language was changed to allow the Board to adopt federal standards
and to include a person working under a dentist's supervision in
the sections relating to the use of uninspected or registered
equipment. "Owners of equipment" was expanded to include lessees.
The intent of the previous version was that an inspection occur
once every five years and that the inspection seal has an
expiration date on it, has all been clarified, in the CS.
MS. KREITZER said one point remains to be resolved by the Committee
on page 4, line 12 in the transitional provisions. There is a
phrase that says, "records, equipment, and other property of
agencies of the State whose functions are transferred under this
Act shall be transferred commensurate with the provisions of this
Act." After speaking with the Department of Health and Social
Services, she thought the board only needs records of agencies of
the State. There is no other equipment or property and this
wording might set up the expectation that there is.
Number 170
SENATOR MILLER moved to adopt the committee substitute to SB 160.
There were no objections and it was so ordered.
DR. PETER NAKAMURA, Director, Division of Public Health, said most
of the changes in the CS are very positive and he supports them,
but he still has some significant concerns. In Section 1 he has a
problem with the fees which are defined to be for certification of
any equipment and its inspection. The problem is that there are a
lot of radiation devices in distant, rural communities and it costs
a lot of money to go out there, even every five years, to inspect
and certify the equipment. The fee is low for someone in an urban
community where an inspector resides, but the costs of traveling to
a rural area would make the fee much more significant to an
individual owning that radiation device. Also, once an individual
gets out there, he can be weathered in for two or three days adding
to the cost.
There is also a problem with the training standards which are set
by the manufacturer. If all you're going to do is look at the
medical device, that's fine; but in terms of public health safety,
frequently of greater concern is who is operating the equipment and
what kind of training they have. Do they have the appropriate
policies and procedures and are those posted? Are they following
them and is someone looking at the x-ray films to see if they have
been taken appropriately. None of that is involved in this
certification or inspection process. It's all presently done by
inspections performed by the Department of Health and Social
Services. Once this responsibility is transferred, he would not
have the resources to continue any kind of certification evaluation
of the practitioners or the quality of the film device.
He said that the Dental Board will now assume responsibility for
the safety of the devices or procedures. According to his
radiation specialist, they measure scatter radiation around the
room, check the kilovolt peak from the tube housing and check the
dose to the patients and the staff involved which would not be done
under this new procedure. Other materials involved are computers
for reports, records, and letters. The Department would not be
able to release this equipment, since it is used for other
responsibilities regarding radiation and medical devices. If this
change takes place, there will be no assurance of dental radiation
safety as practiced in a dentist's office. No one will provide any
oversight or assurance of training.
CHAIRMAN LEMAN asked what he thought about deleting "equipment and
other property" on page 4, line 12.
DR. NAKAMURA answered they are more than willing to transfer the
records if the responsibility is transferred. He said the
equipment and property exists for his department, but does not
exist for the Dental Board.
SENATOR MILLER moved to delete that language. There were no
objections and it was so ordered.
Number 281
MS. CATHERINE REARDON, Director, Division of Occupational
Licensing, said the amendment deleting the equipment was fine with
her, because the Dental Board, itself, will not be doing
inspections, so it doesn't need any equipment or property. That
responsibility will go to the private sector that is going to be
hired by the dentists. If there are complaints from the public or
anyone saying that they think the radiological equipment is not
functioning properly, the Dental Board will not be going out to
check the equipment and HESS wouldn't be responsible for that
anymore, either. The statute says what's required of an owner of
radiological equipment is to provide evidence to the Dental Board
that they have had it inspected every five years. There is no
responsibility to spot check to make sure the equipment really is
working properly.
SENATOR KELLY said he didn't think anyone could complain because
they couldn't tell if the equipment was working well or not.
DR. ELLENBERG said they were told by the Department that the
inspector's job was just more than measuring kdp, that when the
inspector is onsite, he is involved in educating the staff on the
taking and developing of x-rays and that dentist's pay a
registration fee so they aren't disappointed when 10 years elapse
and there's no inspection. He asked how much education could the
Department give his staff when they don't come to his office. He
also asked who took the dentist out of the equation, because they,
as owners of the equipment, are the best suited to train staff and
are with them every day, not just a couple of hours every seven to
10 years. The best person to inspect an x-ray unit would be a
qualified technician, since he has the technical capabilities to
calibrate the equipment at the same time and SB 160 mandates this
to be done every five years.
The Department also testified that you can't say there is no risk
in dental radiography which is true, but no one can prove that
there is a risk in such low doses. Most investigators agree that
there is probably some threshold level of radiation that our bodies
deal with, or possibly need. Today, we cannot directly attribute
any diagnosed cancer or genetic change to dental radiography.
Academically, we can calculate a risk factor, if we make some
assumptions which haven't been proven. The only way to calculate
this risk is through extrapolation from high dose data such as in
post-war Japan. No one can estimate the risk of liver cirrhosis in
a person who drinks on New Year's Eve. If we can extrapolate a
risk, the cancer risk from dental x-rays is approximately the same
as the cancer risk from drinking 30 cans of diet soda.
Furthermore, recent studies suggest that our bodies actually need
low-dose radiation to synthesize certain proteins. To be on the
safe side, dentistry has to assume that there may be some risk and
has done a remarkable job to lessen patient exposure by using high
speed films, sensitive screens, and lead protective aprons. SB 160
would provide another layer of protection by having the x-ray unit
fine-tuned to manufacturer's specifications once every five years.
A State registration fee, on the other hand, does nothing to
protect anyone.
MR. TIM WOLLER, President, Alaska Dental Society, supported the
committee substitute to SB 160.
MR. LYNN LEVENGOOD, private citizen, supported CSSB 160 because it
provides additional protection for individual citizens of Alaska.
Number 378
SENATOR KELLY said he would support this bill, but this legislation
is not on the books in the face of a vacuum. "There is danger in
radiology that has been known since at least the second world war
and he wasn't certain how much risk there is in dental equipment.
One of the fundamental reasons for the Legislature to be here is to
protect the public health and safety and I'm not certain we are
doing that by totally eliminating any oversight by the Department."
SENATOR MILLER moved CSSB 160(L&C) out of Committee with individual
recommendations. There were no objections and it was so ordered.
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