Legislature(1993 - 1994)
03/01/1994 03:00 PM House HES
* first hearing in first committee of referral
= bill was previously heard/scheduled
= bill was previously heard/scheduled
HOUSE HEALTH, EDUCATION AND SOCIAL SERVICES STANDING COMMITTEE March 1, 1994 3:00 p.m. MEMBERS PRESENT Rep. Cynthia Toohey, Co-Chair Rep. Con Bunde, Co-Chair Rep. Gary Davis, Vice Chair Rep. Al Vezey Rep. Pete Kott Rep. Harley Olberg Rep. Irene Nicholia Rep. Tom Brice MEMBERS ABSENT Rep. B. Davis (excused) COMMITTEE CALENDAR HB 267: "An Act increasing elementary and secondary instructional units for certain school districts with 800 or fewer students in average daily membership; and providing for an effective date." PASSED OUT OF COMMITTEE HB 361: "An Act making an appropriation to the Department of Education for support of kindergarten, primary, and secondary education and community schools programs; and providing for an effective date." PASSED OUT OF COMMITTEE *HB 507: "An Act relating to licensure by the State Medical Board and temporary permits for certain optometrists." PASSED OUT OF COMMITTEE *HB 324: "An Act extending the termination date of the Board of Dental Examiners; and providing for an effective date." PASSED OUT OF COMMITTEE HB 320: "An Act relating to public school health personal safety education." PASSED OUT OF COMMITTEE *HB 472: "An Act relating to referrals involving dental services." PASSED OUT OF COMMITTEE (* First public hearing.) WITNESS REGISTER LARRY LABOLLE, Legislative Aid Rep. Richard Foster Alaska State Legislature State Capitol Juneau, Alaska 99801-1182 Phone: (907) 465-3789 Position Statement: Answered questions on HB 267 WANDA COOKSEY, Representative Single School District Consortium P.O. Box 240052 Douglas, Alaska 99824-0052 Phone: (907) 586-9073 Position Statement: Supplied fiscal information on HB 267 to the committee DR. ROY BOX, Optometrist 16185 Lena Loank Rd. Juneau, Alaska 99801 Phone: (907) 789-3175 Position Statement: Answered questions on HB 472 (spoke via teleconference) DR. DAVID MCGUIRE, Chairman Alaska State Medical Board 448 Laurel St., Ste. 202 Anchorage, Alaska 99508 Phone: (907) 562-4142 Position Statement: Answered questions on HB 472 (spoke via offnet) DR. DON LEHMANN, President Alaska State Medical Association 700 Katlian St. #E Sitka, Alaska 99835 Phone: (907) 747-5861 Position Statement: Testified in support of HB 507 DR. DAN PITTS, Former President Alaska Dental Society 155 Smith Way Soldotna, Alaska 99669 Phone: (907) 262-4989 Position Statement: Testified in support of HB 472 (spoke via offnet) PREVIOUS ACTION BILL: HB 267 SHORT TITLE: REVISE FOUNDATION FORMULA, SMALL SCHOOLS SPONSOR(S): REPRESENTATIVE(S) FOSTER,Mackie,Menard,Olberg, Nicholia,B.Davis JRN-DATE JRN-PG ACTION 03/31/93 875 (H) READ THE FIRST TIME/REFERRAL(S) 03/31/93 875 (H) HES, FINANCE 01/31/94 2204 (H) SPONSOR SUBSTITUTE INTRODUCED-REFERRALS 01/31/94 2204 (H) HES, FINANCE 02/02/94 2230 (H) COSPONSOR(S):OLBERG,NICHOLIA, B.DAVIS 02/16/94 (H) HES AT 03:00 PM CAPITOL 106 02/16/94 (H) MINUTE(HES) BILL: HB 361 SHORT TITLE: APPROP: EDUCATION FUNDING FOR FY 95 SPONSOR(S): FINANCE JRN-DATE JRN-PG ACTION 01/11/94 2032 (H) READ THE FIRST TIME/REFERRAL(S) 01/11/94 2033 (H) HES, FINANCE 02/02/94 (H) HES AT 03:00 PM CAPITOL 106 02/14/94 (H) HES AT 03:00 PM CAPITOL 106 02/14/94 (H) MINUTE(HES) BILL: HB 507 SHORT TITLE: LICENSING OF OPTOMETRISTS AND PHYSICIANS SPONSOR(S): HEALTH, EDUCATION AND SOCIAL SERVICES BY REQUEST JRN-DATE JRN-PG ACTION 02/16/94 2416 (H) READ THE FIRST TIME/REFERRAL(S) 02/16/94 2416 (H) HES, LABOR & COMMERCE 03/01/94 (H) HES AT 03:00 PM CAPITOL 106 BILL: HB 324 SHORT TITLE: EXTEND BOARD OF DENTAL EXAMINERS SPONSOR(S): REPRESENTATIVE(S) BUNDE JRN-DATE JRN-PG ACTION 01/03/94 2012 (H) PREFILE RELEASED 01/10/94 2012 (H) READ THE FIRST TIME/REFERRAL(S) 01/10/94 2012 (H) HES, FINANCE 03/01/94 (H) HES AT 03:00 PM CAPITOL 106 BILL: HB 320 SHORT TITLE: PUBLIC SCHOOL HEALTH AND SAFETY EDUCATION SPONSOR(S): REPRESENTATIVE(S) TOOHEY,Hudson,Brice,Bunde, Finkelstein,Nordlund,Olberg,Porter,Sitton,B.Davis JRN-DATE JRN-PG ACTION 01/03/94 2011 (H) PREFILE RELEASED 01/10/94 2011 (H) READ THE FIRST TIME/REFERRAL(S) 01/10/94 2011 (H) HES, FINANCE 01/21/94 2127 (H) COSPONSOR(S):BRICE,BUNDE, FINKELSTEIN 01/21/94 2127 (H) COSPONSOR(S):NORDLUND,OLBERG, PORTER 01/21/94 2127 (H) COSPONSOR(S): SITTON 02/09/94 2328 (H) COSPONSOR(S): B. DAVIS 02/24/94 (H) HES AT 03:00 PM CAPITOL 106 02/24/94 (H) MINUTE(HES) BILL: HB 472 SHORT TITLE: REFERRALS INVOLVING DENTAL SERVICES SPONSOR(S): REPRESENTATIVE(S) G.DAVIS BY REQUEST JRN-DATE JRN-PG ACTION 02/14/94 2375 (H) READ THE FIRST TIME/REFERRAL(S) 02/14/94 2375 (H) HES, JUDICIARY 03/01/94 (H) HES AT 03:00 PM CAPITOL 106 ACTION NARRATIVE TAPE 94-32, SIDE A Number 000 CHAIR BUNDE called the meeting to order at 3:06 p.m., noted members present and announced the calendar. He mentioned that Tanana and Galena were observing the meeting via teleconference. He brought HB 267 to the table. HB 267 - REVISE FOUNDATION FORMULA, SMALL SCHOOLS Number 005 CHAIR BUNDE said that the bill had been discussed previously and that it provides for single site schools to be included in the foundation formula. He asked for further discussion. REP. VEZEY said, "I'd like to know a little more about the basis of these numbers and what these numbers really translate to, into dollars and adjustments." CHAIR BUNDE stated for the record that Rep. Brice arrived at 3:08 p.m. He then asked for clarification of which numbers Rep. Vezey was referring to. REP. VEZEY said "the factors." Number 076 REP. OLBERG offered the assistance of Larry LaBolle. Number 080 LARRY LABOLLE, Legislative Aid to Rep. Richard Foster, Prime Sponsor of HB 267, stated that he did not have a fiscal note included in his bill packet to refer to. REP. OLBERG interjected that the fiscal note exactly matches the amount of last year's appropriation. MR. LABOLLE said the fiscal note dated February 1, 1994, is for $3,372,100 for fiscal year (FY) 1995. Number 143 REP. VEZEY said, "my question was more specifically... the factor 1.12 for schools with membership below 250 and 1.08 for schools with membership below 525 and 1.06 with schools with membership below 800." MR. LABOLLE said those are calculations that were derived by Dr. Cole, who is the author of the foundation formula. He indicated that Dr. Cole came back and did a study of the foundation unit and offered these recommendations when the study was completed. REP. VEZEY asked when the study was done. MR. LABOLLE replied that it was conducted two years ago. Number 173 REP. VEZEY asked if there was anything in the bill packets pertaining to Dr. Cole's study. MR. LABOLLE said that he personally had a copy of the report which showed how those figures were derived. REP. VEZEY said he would appreciate receiving a copy. CHAIR BUNDE asked if there was other information to support those figures. Number 200 WANDA COOKSEY, Representative, Single Site School Consortium, offered fiscal information to Rep. Vezey. REP. OLBERG asked Chair Bunde to identify Wanda Cooksey for the record. Number 229 CHAIR BUNDE said it was his intention to pass HB 267 out of committee and on to the Finance Committee. REP. VEZEY made a motion to pass HB 267 out of committee with individual recommendations and accompanying fiscal note. CHAIR BUNDE, hearing no objections, declared HB 267 was so moved. He then brought HB 361 to the table. HB 361 - APPROPRIATION: EDUCATION FUNDING FOR FY 95 CHAIR BUNDE stated that the HB 361 and a committee substitute (CS) were both addressed previously. He said HB 361 was before the committee. He asked the pleasure of the committee. REP. BRICE clarified that it was the original bill HB 361 that was before the committee. REP. TOOHEY made a motion to pass HB 361 out of committee with individual recommendations and accompanying fiscal note. Number 278 CHAIR BUNDE clarified and said there is no fiscal note because it is an appropriation. Hearing no objections, CHAIR BUNDE stated that HB 361 was so moved. CHAIR BUNDE then asked for a subcommittee report from Rep. G. Davis and Rep. Vezey regarding HB 362. REP. VEZEY said that Rep. G. Davis and he had not gotten together for that subcommittee meeting and questioned the date that Chair Bunde had asked for them to produce their recommendations. CHAIR BUNDE asked if the committee could have an update by Friday. CHAIR BUNDE then brought HB 507 before the committee. HB 507 - LICENSING OF OPTOMETRISTS & PHYSICIANS Number 340 REP. TOOHEY stated that Section 1 of the bill addresses the concerns of the State Medical Board to interview an applicant for licensure in person. She indicated that the board would like the section to be expanded to include a designated representative. She said because of the large geographical area of the state and the expense involved in traveling, the change would be prudent. She said the provision would allow actively licensed physicians who have been previously approved by the board to interview applicants. She further stated that Section 2 deals with granting temporary permits for locum tenens for the purpose of providing temporary medical coverage for an unserved area as approved by the board. She said the board wishes to amend that section of statute to allow locum tenens physicians to practice for limited periods of time. Locum tenens licenses would serve as 60 day permits in remote areas with the knowledge and scrutiny of the board. She said under current status locum tenens permits may only be issued to physicians who are substituting for an absent physician. She said the legislation would allow for a temporary permit to be issued to a physician who would be practicing in an area that does not have a residing physician. She said the same requirements for a full license are expected for temporary licensure. REP. TOOHEY indicated those requirements as being: proof of education, residency or internship, Federation of State Medical Board approval, and at least one verification from another state where the physician is licensed. She further stated that in Section 3 of the bill, the locum tenens permit may be issued to a nonresident optometrist for the purpose of assisting or substituting for an optometrist licensed under AS 08.72.172. She said if a practitioner in a remote area of Alaska becomes seriously ill or injured and must leave temporarily, presently the physician must close down the clinic. She said the proposal would allow a specialist, perhaps in the area of subnormal vision and visual therapy, to be scheduled to assist local doctors where specialist care does not exist now. REP. TOOHEY said Dr. David McGuire, Chairman of the Alaska State Medical Board, was on line to answer any questions pertaining to Sections 1 and 2 of the bill. She also said that Dr. Roy Box was available via teleconference from Wrangell to discuss Section 3. She said there were others in the audience from the Alaska Medical Association who could assist with questions. CHAIR BUNDE explained that Dr. McGuire was in the process of connecting with offnet. He asked Rep. Toohey if she had further testimony. CHAIR TOOHEY said she was finished. CHAIR BUNDE asked for Dr. Roy Box to testify. Number 468 DR. ROY BOX, Optometrist, stated that the problem is that there is a limited number of doctors and all have established offices, so if an optometrist needs to leave his office, it's almost impossible to get someone to fill in. He said if there was a broader selection of licensed doctors from other parts of the country, it would be easier to maintain uniform care for patients. He further stated that his profession is emerging into specialty areas; i.e., subnormal vision; and those practitioners are often located in the larger metropolitan areas in other states. CHAIR BUNDE asked for questions. There were none. He then went to Dr. McGuire in Anchorage. Number 523 DR. DAVID MCGUIRE, Chairman, Alaska State Medical Board, testified via offnet on HB 507. He stated that existing statute requires the board to interview all applicants for permanent and temporary licenses. He said the board suggested having designated reviewers. He felt that having designated examiners would ease the burden of travel for physicians coming to Alaska to be licensed. He urged the passage of HB 507 to allow for designated reviewers. Number 603 CHAIR BUNDE encouraged Dr. McGuire in his endeavors. REP. OLBERG read the definition of locum tenens from the dictionary. Locum tenens: a person, especially a physician or member of the clergy, who substitutes for another. Number 630 CHAIR BUNDE asked if there were any further questions or comments. Number 633 DR. LEHMANN, President, Alaska State Medical Association, testified in Juneau in support of HB 507. He stated that the proposal was a good start and could be made even better. He said the current system of licensure was unnecessarily cumbersome because of the interview. He asserted that the problem, especially in rural areas, of obtaining licensure is that it is unduly expensive, cumbersome, and sometimes precludes having adequate physician coverage in various parts of the state. He offered that his interview for licensure took no longer than two minutes and he felt that the interview itself does not accomplish much. He explained that he informally interviewed 30 physicians and only one said that he had a meaningful interview. DR. LEHMANN related an incidence where a doctor from the Virginia Mason Clinic in Washington came to conduct a specialty clinic in Sitka. The doctor had to fly from Sitka to Anchorage, drive a rental car to Wasilla, and interview with a layperson of the board, who did not have his interview material with him. Dr. Lehmann lamented that the interview consisted of, "Hi. How are you?" He said the process seems ineffective. DR. LEHMANN indicated that on line 5, under Section 1, if the word "shall" could be changed to "may" it would allow the board to interview everybody at their discretion, including the option of eliminating the interview process completely. The proposed amendment would allow the board to interview anyone they so choose, and consequently the board would be able to spend more time hunting down "nefarious characters." Number 734 REP. VEZEY suggested that the words "in person" be deleted from Section 1, instead of adding the word "may," indicating that in this age of technology, telecommunications and audiovisual communication is becoming more acceptable. DR. LEHMANN said he was unsure what a telephonic interview would accomplish. REP. VEZEY asked what an in person interview would accomplish. DR. LEHMANN maintained that if the interviewer has serious concerns regarding the applicant, it is important to conduct the interview in person. REP. VEZEY disagreed due to the factors of the time, money, and travel that are involved. He said because of the geographical expanse of Alaska, the state is forced to look to other means of communication. He reiterated that he had no problem changing the word "may" to "shall," but he felt that the words "in person" were too restrictive for the board. DR. LEHMANN said that he would have no problems adding the words or telephonically to interview the person. REP. VEZEY stated that it would be redundant. He also said that interactive video is an option. Number 791 DR. LEHMANN said, "I did not want to step on any toes from the state medical board. And this way, they would still have their option to interview anybody they chose." CHAIR BUNDE asked Dr. McGuire's reaction to the issue being addressed. DR. MCGUIRE asserted that the medical board is held to a high standard. He related a story of an interviewee who appeared for his licensure review and was noticeably psychotic. He said that another interviewee was granted licensure and sometime later the interviewee showed obvious signs of psychosis. He indicated that in those instances a telephonic interview would not have sufficed. He felt that there were legal implications as to the interviewees that are asked to interview in person and those who are not. He said the board's approach is to have everybody interviewed so as to avoid legal problems. Number 856 CHAIR BUNDE stated for the record that Reps. Brice, Nicholia, Olberg, Kott, Vezey, Toohey and Bunde were present. He then said that he values the interpersonal, in person, visual, and nonverbal aspects of an interview. He felt that substituting the word "may" with "shall" would only invite litigation. REP. VEZEY said there is no substitute for a credentials and reference check. He said he found the interview process the least useful tool in selecting qualified personnel. He reiterated that in person interviews are very archaic. Number 900 CHAIR TOOHEY maintained that the issue should be decided by the medical community. Number 905 CHAIR BUNDE took an informal poll as to those in favor of the word remaining "shall" and those who would prefer the word to be "may." The poll unanimously favored using the word "may." He polled again, asking if the words "in person" should be deleted or if the word "telephonically" should be added. CHAIR TOOHEY interjected and said she would accept a friendly amendment that indicates in person or by telephone. CHAIR BUNDE asked if Rep. Toohey was proposing an amendment. CHAIR TOOHEY said she would make the proposal at the pleasure of the committee. CHAIR BUNDE told Rep. Toohey to address the proposal and the committee would vote. Number 942 REP. BRICE said it was his understanding that there was still concerns regarding the word telephonically. CHAIR BUNDE asked for the amendment so the committee could further discuss the issue. REP. OLBERG asked if it was Rep. Vezey who suggested deleting the words "in person." CHAIR BUNDE said yes. Number 954 REP. VEZEY made a motion to amend HB 507, Section 1, line 5, to change the word "shall" to "may." CHAIR BUNDE asked for discussion. He then expressed his opposition to the amendment. He reiterated his concerns pertaining to legal problems that could be inherent by changing the word to "may." He called for a vote. Reps. Toohey, Vezey, Olberg, Nicholia, and Brice voted "yea" and Reps. Kott and Bunde voted "nay." CHAIR BUNDE stated that HB 507 as amended was before the committee. He then asked for further discussion. Number 012 REP. VEZEY made a motion to amend HB 507, Section 1, line 6, by deleting the words "in person." CHAIR BUNDE stated that the committee had heard the amendment and asked for further discussion. There was none. REP. OLBERG asked, "does the use of the word `may' mean allow for `may not'?" REP. BRICE said yes. CHAIR BUNDE said that word "may" would allow for an interviewee to be interviewed in person, not in person, or not at all. He asked Rep. Vezey if that was his interpretation. REP. VEZEY said yes. He felt that in person is unduly restrictive and felt that its deletion would not invite litigation. CHAIR BUNDE asked if Rep. Vezey still preferred to delete the words "in person" as opposed to having the line read "may be interviewed in person." REP. VEZEY said once the words have been changed from "shall" to "may," the sentence becomes permissive, and leaving the words "in person" becomes redundant. REP. OLBERG suggested going back to the use of the word "shall" and then deleting the words "in person." He then read the sentence, "All applicants for licensure shall be interviewed by at least one member of the board or the board's designated representative." Number 069 CHAIR BUNDE declared that there was an amendment before the committee. He asked for further discussion. DR. MCGUIRE said that his prior comments were still germane and indicated that it was up to the legislature to decide what the rules were going to be. CHAIR BUNDE reiterated the intent of the amendment. He asked Dr. McGuire if under those guidelines would he continue to interview applicants. Number 100 DR. MCGUIRE said a common ground must be found and the decision should be that of the legislature. He said the board would comply. CHAIR BUNDE said there was no intention within the bill as amended to require an interview to be conducted telephonically. He then asked for further discussions or any objections. Chair Bunde stated his objection for the record. He then called for a vote. Number 126 CHAIR TOOHEY clarified by saying that the intent of the amendment was to remove the words "in person." Reps. Vezey, Olberg, and Toohey voted "yea" and Reps. Bunde, Kott, Nicholia, and Brice voted "nay." Number 135 CHAIR BUNDE stated that the amendment failed. He asked for further discussion. DR. MCGUIRE asked if the provision for the designated representative had survived the process. CHAIR BUNDE said yes, the issue was not discussed at all. Number 152 CHAIR BUNDE closed public testimony and asked the pleasure of the committee for HB 507 as amended. REP. KOTT made a motion to pass HB 507 as amended out of committee with individual recommendations. CHAIR BUNDE, hearing no objections, declared HB 507 was so moved. He then brought HB 324 to the table. HB 324 - EXTEND BOARD OF DENTAL EXAMINERS TAPE 94-32, SIDE B Number 000 CHAIR BUNDE passed the gavel to Rep. Toohey to preside over the remainder of the meeting. Number 019 REP. CON BUNDE said that before the committee was HB 324, which extends the termination date for the Board of Dental Examiners and provides for an effective date. He said that the Board of Dental Examiners did sunset on June 30, 1993. He explained that the board was in the process of phasing itself out. He further explained that the board's role is to regulate and control licensing permits and revocation of licenses in the dental profession. He then cited other responsibilities of the board. Chair Bunde indicated that Mr. Sam Kito, Representing the Alaska Dental Association, was available for questions. Number 092 CHAIR TOOHEY asked if there were any questions for Mr. Kito. There were none. REP. BUNDE made a motion to pass HB 324 out of committee with individual recommendations. CHAIR TOOHEY, hearing no objections, declared HB 324 so moved. CHAIR TOOHEY indicated for the record that Rep. G. Davis arrived at 3:50 p.m. She then brought HB 320 to the table. HB 320 - PUBLIC SCHOOL HEALTH AND SAFETY EDUCATION CHAIR TOOHEY stated that there was a committee substitute (CS) that had been previously adopted for HB 320 and then asked for comment from Rep. G. Davis. Number 142 REP. G. DAVIS said his concerns about mandates and the issue of grade level/content appropriateness had been resolved. He said content of education is at the discretion of the school district and there is an opt-out inclusion within the bill. REP. BRICE asked if the opt-out clause was new. CHAIR TOOHEY said no. Number 191 REP. OLBERG asked if the fiscal note was still for $452,000. CHAIR TOOHEY said the fiscal note had been revised to show $39,400. She said the decrease was the result of removing mandates on everything except the HIV/AIDS curriculum. She said all other health educational programs would be strongly urged. REP. BUNDE made a motion to pass CSHB 320 out of committee with accompanying fiscal note. He then indicated that Rep. Vezey had pointed out that a voice vote was required in an open hearing. Reps. Brice, Nicholia, Olberg, Toohey, Bunde, and G. Davis verbally voted "yea." The CS for HB 320 was so moved. Number 282 CHAIR TOOHEY brought HB 472 to the table. HB 472 - REFERRALS INVOLVING DENTAL SERVICES CHAIR TOOHEY asked Rep. G. Davis to address the bill. Number 303 REP. GARY DAVIS stated that HB 472 will prohibit the receipt of compensation by a dentist for referring a person to another dentist or dental practice. He further stated that the receipt of compensation by a person or advertisement that refers a dental service is prohibited, unless the compensation for referral is disclosed at the time of referral. He maintained that the proposal would ensure that patients would be referred to a dentist or a dental practice as a result of the quality of service. He said the bill was before the committee as a result of the American Dental Association, Principles of Ethics and Professional Code of Conduct. He said that it is against their code to solicit patients in any form through referrals. He stated that the legislation would put some of the American Dental Association's ethics in statute. CHAIR TOOHEY asked for questions. Number 348 REP. VEZEY asked why the committee was attempting to codify the ethical standards of any professional organization. REP. G. DAVIS replied that the initial attempt was made through a resolution, but Legal Services felt there was room in statute for the provisions. He also said Mr. Sam Kito from the Alaskan Dental Association was present to answer questions. REP. BUNDE asked if the legislation was inspired by any specific cases concerning unethical "kickbacks." Number 338 REP. G. DAVIS said the request was based specifically on the 1-800 number agencies that advertise for referrals. CHAIR TOOHEY stated that Dr. Dan Pitts from Soldotna was on line to answer questions. Number 407 DR. DAN PITTS, Former President, Alaska Dental Society, testified via offnet from Soldotna in support of HB 472. He stated that the emphasis of the bill is to protect the public. He stated that the code of ethics indicates that it is unethical for any dentist to make payment to another person or entity for referral of a patient for professional services. He said commercial referral agencies violate that code. He said the advertising is false and misleading. He explained that most commercial referral services have had no contact with the Alaska Dental Society to check the credentials of the dentists they are referring. He felt that practice to be very misleading. He also noted that only a few dentists are getting referrals from the service and that the dentists are paying the commercial referral services for the referrals. He reiterated that this practice is unprofessional and unethical. He said the legislation is in line with the Alaska Dental Association's principles of ethics and professional conduct. Number 497 REP. BUNDE related a situation whereby dentists who utilize the commercial referral service could possibly pass a patient around for various dental work to be done only for the goal of padding their bills. He indicated that type of situation to be the only problem he could see. He further stated that the notion of the referral service is just a commercial entity that is selling a product for dentists. He felt if the dentists are not getting their money's worth, the dentist should stop buying the product, hence the services to go out of business. He saw the issue as two separate problems. DR. PITTS said the thrust of the bill is to have the commercial referral service disclose to the patient that they are paid by dentists for these referrals. He said patients are misled because they believe the commercial referral service is an official referral service that gives an objective referral. He stated that the issue is a nationwide problem and that other states have legislation that prohibits this particular practice. Number 552 REP. BUNDE clarified that the legislation would mandate that a commercial referral service disclose within conversation with a potential referral patient that the referral agency is paid by dentists for their services. DR. PITTS agreed. REP. G. DAVIS said that the legislation would include additional review by the dental boards and indicated the provision on page 2, line 1. Number 585 REP. BUNDE cited the zero fiscal note and asked if the professional dental board would be the official policing agency. He further questioned if a complaint could be brought to the board if disclosure is not made. REP. G. DAVIS said that the board already has the responsibility of oversight. REP. BUNDE said that it is also the board's responsibility to decide on ethics. He said it would be a breach of dental ethics to not disclose. He then said that the referral services are not dentists, so the board cannot fine someone who is not a dentist for violation of dental ethics. REP. G. DAVIS deferred to Dr. Pitts. DR. PITTS assumed that the legislation would make it clear as to how the commercial referral services would have to operate. He reiterated the thrust of the proposal to be that of disclosure to the patient. REP. BUNDE clarified that kickbacks between two dentists is a violation of dental ethics that could be brought up before the dental board. DR. PITTS said yes. REP. BUNDE asserted that the board has no way of addressing the ethics issue of commercial referral services because they are not dentists. He then asked if there were any services that were run by dentists. Number 646 DR. PITTS said no referral services are run by dentists. He felt for a commercial referral service to refer a patient would be "pretty close to practicing dentistry." REP. BUNDE said the commercial referral agencies are currently doing just that. He commented that the issue could also be raised if he was to tell his friends that he needs a route canal and his friends suggest a dentist. DR. PITTS said that a commercial entity would be practicing dentistry by referring the patient to a dentist. REP. BUNDE stated that the difference may be his friends would not get paid for the referral. CHAIR TOOHEY asked for further questions. Number 674 REP. VEZEY asked Dr. Pitts if the adherence to the professional ethics standards is a condition of licensure. DR. PITTS said yes. He said the proposal focuses on the commercial referral services, not on dentists. REP. VEZEY indicated that under Title 836.315 there is no provision made for the adherence to the professional ethics standards as being a requirement of licensure or grounds for revocation. DR. PITTS said the a definition of the board's purpose is to pass judgement on the ethical standards of the profession. Number 724 REP. VEZEY said he felt the added wording was really unnecessary, and further stated that he thinks the board does not have the authority to revoke a license for unethical behavior. He said he knew the board to have the authority to revoke licensure on the grounds of professional incompetence, but not for unethical behavior. REP. BUNDE interjected and said the sponsor statement indicates that the Board of Dental Examiners is charged with developing ethics policy. REP. VEZEY said the sponsor statement is not codified in law. REP. BUNDE agreed that Rep. Vezey brought up an interesting point. REP. VEZEY suggested that Dr. Pitts look at the board's statutory authority, because he did not believe the board has any authority in enforcing ethics. He stated that the board only had authority to enforce professional standards. Number 759 DR. PITTS questioned if professional standards are the same as ethics. REP. VEZEY stated that professional competence implies technical competence. DR. PITTS reiterated that the bill specifically addresses disclosure by the commercial referral services. REP. VEZEY said Dr. Pitts was referring to Section 2 that amends Title 45, which is a chapter on unfair trade practices. He further stated that the section dealing with the authority of the board of licensing is in Title 8. He again stated that he did not believe the board has the authority to revoke a license for unethical behavior. He suggested Dr. Pitts look into the matter. DR. PITTS said that he is not a board member and would have to talk with a board member. He said he had always assumed that the dental board has the authority to revoke a license for unethical behavior. CHAIR TOOHEY asked the pleasure of the committee. REP. VEZEY said he answered his own question. Number 829 CHAIR TOOHEY asked again the pleasure of the committee. REP. VEZEY made a motion to pass HB 472 out of committee with individual recommendations. CHAIR TOOHEY, hearing no objections, declared HB 472 so moved. Seeing no further business before the committee CHAIR TOOHEY ADJOURNED the meeting at 4:15 p.m.