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.