HB 182 DELEGATION OF DUTIES TO DENTAL ASSISTANTS  Number 002 CHAIRMAN GREEN called the Senate Health, Education and Social Services (HESS) Committee work session to order at 9:10 a.m. and introduced HB 182 as the only order of business. BENJAMIN BROWN, staff to Representative Toohey, explained that HB 182 was made necessary by a 1988 Attorney General determination. The dental hygienist statute specifies that dental hygienists can perform the application of preventive agents and pit and fissure sealants, therefore, it was determined that no one else can do this but dentists. That determination changed the long-standing dental practice in Alaska which created a critical need, especially in rural Alaska; itinerant dentists cannot carry a hygienist along with them. Itinerant dentists have the option of performing those procedures themselves, getting a hygienist to perform those procedures - which is prohibitively expensive, or those procedures are just not performed. The Dental Society is unanimously in support of HB 182 as well as many of the nonprofit regional Native health cooperations. TOM BORNSTEIN, Director of Dental Services for the Southeast Alaska Regional Health Consortium (SEARHC), supported HB 182 which allows dentists to delegate the responsibility of the application of pit and fissure sealants to dental assistants. He informed the committee that he had earned a BA, a BS, a DDS, and a two year advanced general practice residency after his DDS degree. The consortium is in favor of getting sealants on teeth in the most cost effective manner possible. He said that dental assistants can provide this service in a quality manner. Dental sealants have been in wide spread use over the past 20 years. SEARHC has used sealants extensively in the last 10 years. Dental assistants have been applying these sealants for the last 10 years. Number 078 CHAIRMAN GREEN noted that a quorum had arrived and that a formal meeting was called to order. TOM BORNSTEIN said that he was not aware of any problems with allowing dental assistants to apply these sealants. He explained that the problem occurred when the Attorney General's Office of Alaska notified SEARHC that dental assistants were not allowed under the State Dental Practice Act to apply dental sealants. However, the Attorney General's Office also informed SEARHC that federally hired dental assistants are not under the purview of the State Dental Practice Act and can therefore, continue to apply dental sealants. Both directly hired dental assistants and federally hired dental assistants work side by side with the same training. Mr. Bornstein dismissed the characterization of dental assistants as untrained people. Of the 16 dental assistants working for SEARHC, 14 have more than 10 years experience as dental assistants. Under Occupational Safety and Health Association (OSHA) guidelines dentists are required to provide certain written policies and procedures that dental assistants must follow in order to protect themselves and the patient. Mr. Bornstein said that technically sealants are an easy procedure to perform. The scope of knowledge necessary for a dental assistant to perform this procedure is well within their level of training. Number 154 With regards to the notion that allowing a dental assistant to perform sealants would decrease the importance or the role of the dental hygienist, dental sealants are a minor portion of what dental hygienist does. Delegating this procedure to dental assistants would not devalue the hygienist's role. He noted that SEARHC has difficulty in filling hygienist positions. Allowing dental hygienists to perform procedures for which they were specifically trained would ensure the value of the hygienist. Mr. Bornstein noted that there had been some information circulating regarding the possible certification of dental assistants to do sealants. At one time, there was a program in which the Indian Health Services West was preparing to certify dental assistants. The IHS determined that there was no need to certify dental assistants in this procedure. He said that the certification process was more cumbersome than the training of the dental assistants who apply sealants. Mr. Bornstein explained that the knowledge necessary is already required by OSHA. SENATOR LEMAN asked if those hygienists that had worked more than 30 years were highly stressed. TOM BORNSTEIN informed the committee of a dental hygienist in Sitka who has been working for 32 years and seems to be more enthusiastic. Number 218 SENATOR LEMAN inquired as to the material used in these sealants. TOM BORNSTEIN said that it is an unfilled resin material, a composite resin that is unfilled. The material is similar to that used in fillings. Mr. Bornstein explained that sealants attempt to cover the grooves with a thin coat. The material is soft and people eventually wear the thin coat off except in the grooves which affords a smoother service for easier cleansing. SENATOR LEMAN asked if the material was a silver, mercury amalgam. TOM BORNSTEIN specified that there is no metal at all in sealants. In response to Senator Leman, Mr. Bornstein said that the opposition he had discussed earlier was in response to a letter from a dental hygienist's concerns that he had read. CHAIRMAN GREEN commented that she had received much opposition to this from dental hygienists. She said that she did not want to offend dental hygienists; professions do have territories. She wanted to ensure that there was a mechanism in place in order to eliminate the possibility that hygienists are dismissed. TOM BORNSTEIN informed the committee that a Juneau office had been actively recruiting for a dental hygienist for a year and a half. He said that this legislation would not undervalue the services of the dental hygienist. Another concern raised in the letter from the Hygiene Organization to hygienists was that this legislation would allow dental assistants to polish teeth. That function is clearly delineated in the Dental Practice Act that policing teeth is a hygiene function. A lot of the hygienists who are opposed to this legislation have been given some misinformation. Number 268 SENATOR SALO inquired as to what would happen if there was a mistake in the application of the sealant. TOM BORNSTEIN explained that the most common problem in the application of a dental sealant is that the area where the sealant is being applied does not remain dry. If the area becomes moist with the patient's saliva or water, the sealant does not adhere. The etching solution that creates a porous surface for the sealant to adhere to would also be problematic if the area does not remain dry. Mr. Bornstein said that another reason for dental assistants to be allowed to help with this procedure is due to the need for two persons to be working on the sealant in order to keep things dry. The worst scenario with sealants would be that it did not work. He noted that the instruments used could be a danger, but those instruments are used everyday. CHAIRMAN GREEN asked if the dentist under which the assistant works would be ultimately liable for any problems. TOM BORNSTEIN said yes. The dentists and dental assistants in the federal or IHS programs are usually covered under the Federal Torts Malpractice. All dentists are required to have malpractice insurance while dental assistants are not. Mr. Bornstein pointed out that dentists are required to insure their employees, therefore the dentist would be ultimately held liable. CHAIRMAN GREEN inquired as to if the IHS training program was in place and active. TOM BORNSTEIN indicated that the IHS was interested in certifying dental assistants to perform dental sealants. IHS determined that certification was not necessary. In speaking for most of the dental programs for the Native corporations, the corporations ensure that dental assistants performing sealants go through training. However, there is not a formal training mechanism in the state. In some states, dental assistants who go through a training program would receive information regarding sealants; not all dental assistants go through this dental assisting program. All of the dental assistants at the corporations are trained before they are allowed to practice. Number 338 CATHERINE REARDON, Director of the Division of Occupational Licensing, informed the committee that she was present in order to answer questions regarding licensing or anything that affected her division. She said that the division does not have any objections to this legislation. SENATOR LEMAN inquired as to the meaning of the division not having any objections. CATHERINE REARDON explained that the Dental Board has not taken a formal position on this bill. The division's position is officially neutral. At this time, the division would not be involved in the delegation of authority. SENATOR LEMAN expressed concern with how his vote on this would be interpreted with respect to other areas such as engineering. Number 359 SENATOR LEMAN moved that CSHB 182(HES) be forwarded out of committee with individual recommendations. Hearing no objection, it was so ordered.