BILL ANALYSIS �
SB 1245
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Date of Hearing: June 24, 2014
ASSEMBLY COMMITTEE ON BUSINESS, PROFESSIONS AND CONSUMER
PROTECTION
Susan A. Bonilla, Chair
SB 1245 (Lieu) - As Introduced: February 20, 2014
SENATE VOTE : 36-0
SUBJECT : The Dental Hygiene Committee of California.
SUMMARY : Extends the operation of the Dental Hygiene Committee
of California (DHCC) and extends the appointments of DHCC
committee members and DHCC's executive officer until January 1,
2019.
EXISTING LAW:
1) Establishes the DHCC within the jurisdiction of the Dental
Board of California (DBC) until January 1, 2015. (Business
and Professions Code (BPC) Section 1901)
2) Provides for the appointment of DHCC members and the
authority of the DHCC, with the approval of the Director of
the Department of Consumer Affairs (DCA), to appoint an
executive officer until January 1, 2015. (BPC 1903)
FISCAL EFFECT : Unknown
COMMENTS :
1)Purpose of the bill . This bill extends the operation of the
DHCC and the existence of its committee members and executive
officer until January 1, 2019. This allows DHCC to continue
to operate and continue to regulate dental hygienists to
promote and ensure quality oral health care for consumers, and
triggers the Legislature to comprehensively review DHCC again
in four years.
2)Author's statement . According to the author, this bill
"[e]xtends until January 1, 2019, the provisions establishing
the [DHCC], and extends the term of the executive officer.
Unless legislation is carried this year to extend the sunset
dates for DHCC, it will be repealed on January 1, 2015."
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3)Background of DHCC . In 2002, the Joint Legislative Sunset
Review Committee determined that "dental hygienists had
reached the point where their responsibilities warranted a
regulatory body, separate from [the DBC]." DHCC was created
as result of the passage of SB 853 (Perata), Chapter 31,
Statutes of 2008. DHCC's purpose is "[t]o permit the full
utilization of registered dental hygienists, registered dental
hygienists in alternative practice, and registered dental
hygienists in extended functions in order to meet the dental
care needs of all of the state's citizens," and its mission is
"[t]o promote and ensure the highest quality of oral health
care for all Californians."
DHCC is the only self-regulating dental hygiene agency of its
kind in the US, and has authority over all aspects of the
licensing and regulation of dental hygienists, including
enforcement and investigation authority and the approval of
educational programs that provide the prerequisite education
to become a licensed dental hygienist. DHCC also develops and
administers written and clinical licensing examinations and
conducts occupational analyses of the various professional
categories.
DHCC is responsible for overseeing 31,804 licensed dental
hygienists in the state of California. These dental
hygienists include over 31,000 registered dental hygienists,
over 500 registered dental hygienists in alternative practice,
and roughly 40 registered dental hygienists in extended
functions.
4)DHCC Sunset Review . In 2014, the Assembly Business,
Professions and Consumer Protection Committee and the Senate
Business, Professions and Economic Development Committee
(Committees) conducted joint oversight hearings to review nine
regulatory entities: Bureau of Automotive Repair; Bureau of
Home Furnishings and Thermal Insulation; Bureau for Private
Postsecondary Education (BPPE); California Massage Therapy
Certification program; California Board of Acupuncture;
California Tax Preparers Program; [DHCC]; Professional
Fiduciaries Bureau; and Structural Pest Control Board.
This bill, and other sunset extension bills, are intended to
implement legislative changes as recommended by staff of the
Committee's and which are reflected in the Background Papers
prepared by Committee staff for each agency and program
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reviewed for this year.
Committee staff recommended in DHCC's 2014 Sunset Background
Paper, that "the practice of dental hygiene [should] continue
to be regulated by the current DHCC in order to protect the
interests of the public. The DHCC should be reviewed by the
Committees again in four years." The Committee staff found
that "[t]he health, safety and welfare of consumers are
protected by a well-regulated dental hygiene profession.
Despite a quickly growing profession and the impact of a lack
of staff, it appears as if the DHCC has shown a strong
commitment to improving efficiency in its operations and
protecting the public. The DHCC should be continued with a
four-year extension of its sunset date so that the Committees
may determine if the issues and recommendations in this paper
have been addressed"
5)Key issues and updates relating to DHCC's sunset background
paper . There were a number of issues raised by the
Committees; however none of these issues required any
statutory changes at present time.
Should the DHCC be approved to have an additional managerial
position? DHCC noted throughout its sunset report the need
for the creation of a managerial position so that its
Executive Officer could focus on her statutorily required
duties. However, when DHCC tried to reclassify a vacant
position to create a managerial position, DCA's Office of
Human Resources (DCA OHC) indicated that it did not conform to
current California Department of Human Resources (CalHR)
standards due to "an insufficient number of analytical staff
that the manager would supervise."
Staff recommended that DHCC confer with DCA administrative
staff to review the recently submitted request for a
managerial position, and that both parties should work to
create a solution for filling the vacant position in order to
assist the DHCC with their increasing workload. In DHCC's
response to the sunset background paper, it indicated that
after additional research and review of CalHR's standards for
a managerial position, it continues to disagree with DCA's OHR
opinion that DHCC's request does not conform to the manager
standards, and that there were no issues or concerns about the
request's justifications or workload for the DHCC's managerial
position; only that it did not conform to the "current CalHR
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standards" due to a staff to manager ratio for supervision.
DHCC notes that in larger state programs, such a standard is
more applicable, and that other boards with smaller licensing
populations have more staff and more supervisory positions
than DHCC. DHCC states that it will continue to pursue the
manager position and work with DCA, emphasizing the
recommendation and endorsement of the Committees to justify
its request.
Should supervision requirements for dental hygienists be
amended? Direct supervision requires that a dentist is
physically present, while general supervision allows the
hygienist to receive authorization from a dentist to perform
certain services without the physical presence of a dentist.
Hygienists are required to be under direct supervision when
administering soft tissue curettage (a surgical procedure
designed to remove the soft tissue lining of the periodontal
pocket with a curet), local anesthesia, and nitrous
oxide-oxygen analgesia. Supervision requirements vary across
states and there is limited research on expanding the scope of
practice, although various pilot programs have shown safe and
effective outcomes when these procedures are administered
without direct supervision. DHCC requests changing the
supervision level from direct to general for those three
designated services because there are no reported incidents of
consumer harm, and the dentist would still be able to decide
if he or she wants to be present. The dentist industry trade
group, the California Dental Association, disagreed and stated
that it has concerns based on those procedures which carry the
greatest risk for patients, and that direct supervision
ensures a depth of experienced professionals that are equipped
to prevent and deal with potential medical emergencies. DBC
has not taken a position on this issue.
Staff recommended that DHCC consult with DBC regarding the
implications of adopting a general supervision model for the
procedures, and if DHCC seeks to amend its practice act to
allow for a change in supervision model, it will need to seek
legislation to pursue this change. DHCC has responded that it
will consult with DBC on whether there are any implications
for dentists in adopting such a general supervision model, and
that if it seeks to amend its practice, it will seek future
legislation.
6)Arguments in support . The California Dental Hygienists'
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Association (CDHA) writes in support, "The DHCC was created in
2008 as a result of a Sunset Review Report of several years
prior that stated the profession of dental hygiene has evolved
into a specialized area of oral healthcare that requires
specialized skills. The JLSRC agreed several years ago that
dental hygienists had reached the point where their
responsibilities warranted a regulatory body, separate from
Dental Board of CA.
"The DHCC provides all regulatory functions for the practice of
Dental Hygiene. It autonomously administers licensing, Dental
Hygiene programs, enforcement and education standards for the
three categories of dental hygienists - Registered Dental
Hygienists, Registered Dental Hygienist in Alternative
Practice, and Registered Dental Hygienist in Extended
Functions.
"Many hygienists have their own practices outside the dental
office setting where they go to the patient to provide
preventative care. They visit patients who lack access to a
dentist in their region or to those who are not able to visit
a dental office [such as] needy students, the elderly in
skilled nursing facilities and the developmentally disabled
living in group homes. We are pleased the legislature has
provided a way for more Californians to receive the
preventative dental care so necessary in order to be healthy.
We fully support extending the life of the DHCC."
REGISTERED SUPPORT / OPPOSITION :
Support
California Dental Hygienists Association (CDHA)
California Dental Association (CDA)
Opposition
None on file.
Analysis Prepared by : Eunie Linden / B.,P. & C.P. / (916)
319-3301
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