public packet
Oregon Board Of Dentistry
Board Meeting june 21, 2019
NOTICE OF REGULAR MEETING PLACE: BOARD OFFICE
DATE: June 21, 2019
TIME: 7:30 a.m. – 3:00 p.m.
Call to Order – Amy B. Fine, D.M.D., President 7:30 a.m.
OPEN SESSION
Review Agenda Sign Wall Certificates
1. Approval of Minutes • April 19, 2019 - Board Meeting • OLD BUSINESS
NEW BUSINESS
2. Association Reports • Oregon Dental Association • Oregon Dental Hygienists’ Association • Oregon Dental Assistants Association
3. Committee and Liaison Reports • WREB Liaison Report – Amy B. Fine, D.M.D. • AADB Liaison Report – Amy B. Fine, D.M.D. • ADEX Liaison Report – Hai Pham, D.M.D. • CDCA Liaison Report – Amy B. Fine, D.M.D. • Licensing, Standards and Competency Committee Meeting – May 24, Chair Amy B. Fine, D.M.D. • Memo - OBD Staff recommendations for dental implant education & informed consent forms • Upcoming Meetings: • Rules Oversight Committee Meeting August 2 at 9 am • Board Meeting August 23 at 7:30 am • Public Rulemaking Hearing September 10 at 6 pm • Public Rulemaking Hearing October 11 at 9 am
4. Executive Director’s Report • Board Member & Staff Updates • OBD Board Required Training & Policy • OBD Budget Status Report • Phone System • Customer Service Survey • Board and Staff Speaking Engagements • Information Submitted to House Committee & 2019 Legislative Session • Memo - Delegated Duties for Executive Director & Staff • Public Records Policy Update • AADA & AADB Annual Meetings • 2020 OBD Meeting Dates • Newsletter 5. Unfinished Business and Rules
6. Correspondence • Request from Center for Personalized Education for Professionals (CPEP) • Request for Board Approval - Oquirrh Mountain IV Therapy Course • Request from Dr. Stafford regarding Board determination of operating a dental clinic
7. Other • Amanda Timmons, OHA Immunization Policy Analyst will address the Board on administering vaccines • Request for approval of a Local Anesthesia Course – Phoenix College
8. Articles & Newsletters (No Action Necessary)
CAC Newsletter 2019 ADA CERP Eligibility Criteria Revised Policy Perspectives – Options to Enhance Occupational License Portability ADEA Advocate – April 2019 (No. 10) ADEA Advocate – May 2019 (No. 14) ADEA Advocate – June 2019 (No. 17) ADEA Advocate – June 2019 (No. 18) PEW Dental News & Views – Uniform Standards for Dental Therapy HPSP Newsletter – April 2019 HPSP Newsletter – May 2019
EXECUTIVE SESSION 9:30 a.m. The Board will meet in Executive Session pursuant to ORS 192.660(2)(f)(h) and (l); ORS 676.165, ORS 676.175(1) and ORS 679.320 to review records exempt from public disclosure, to review confidential materials and investigatory information, and to consult with counsel. No final action will be taken in Executive Session.
9. Review New Cases Placed on Consent Agenda 10. Review New Case Summary Reports 11. Review Completed Investigative Reports 12. Previous Cases Requiring Further Board Consideration 13. Personal Appearances and Compliance Issues 14. Licensing and Examination Issues 15. Consult with Counsel
LUNCH 12:00 p.m.
OPEN SESSION 2:00 p.m.
Enforcement Actions (vote on cases reviewed in Executive Session)
LICENSURE AND EXAMINATION 16. Ratification of Licenses Issued 17. License and Examination Issues
OPEN SESSION
OTHER BUSINESS
ADJOURN 3:00 p.m.
Notes: (1) A working lunch will be served for Board members at approximately 12:00 p.m. (2) The meeting location is accessible to persons with disabilities. A request for an interpreter for the hearing impaired or for other accommodations for persons with disabilities should be made at least 48 hours before the meeting to Teresa Haynes at (971) 673-3200. (3) The Board may from time to time throughout the meeting enter into Executive Session to discuss matters on the agenda for any of the reasons specified in ORS 192.660. Prior to entering into Executive Session, the Board President will announce the nature of and authority for holding the Executive Session. No final action will be taken in Executive Session.
Approval of Minutes
OREGON BOARD OF DENTISTRY MINUTES April 19, 2019
MEMBERS PRESENT: Gary Underhill, D.M.D., President Amy B. Fine, D.M.D., Vice President Todd Beck, D.M.D. Hai Pham, D.M.D. Yadira Martinez, R.D.H. Julie Ann Smith, D.D.S., M.D., M.C.R. Jose Javier, D.D.S. Alicia Riedman, R.D.H. Chip Dunn Jennifer Brixey
STAFF PRESENT: Stephen Prisby, Executive Director Daniel Blickenstaff, D.D.S., Dental Director/ Chief Investigator Teresa Haynes, Office Manager (portion of meeting) Shane Rubio, Investigator (portion of meeting) Haley Robinson, Investigator (portion of meeting) Samantha VandeBerg, Office Specialist (portion of meeting) Winthrop “Bernie” Carter, D.D.S., Dental Investigator
ALSO PRESENT: Lori Lindley, Sr. Assistant Attorney General
VISITORS PRESENT: Rod Rowan, the Resuscitation Group; Conor McNulty, ODA; Ticey Mason, Northwest Portland Area Indian Health Board (NPAIHB); Jen Lewis-Goff, ODA; Barry Taylor, D.M.D., ODA; Susan Kramer, R.D.H., ODHA; Cassie Leone, ODA; Shannon Bremer, Native American Rehabilitation Association NW (NARA); Michael Watkins, NARA; Lisa J. Rowley, R.D.H., ODHA; Brenda Mead, Coquille Tribe; Kippy Robins, Coquille Tribe; Alexandria Jones, Coquille Tribe; Pam Johnson, NPAIHB; Gitta Yitta, D.M.D., NPAIHB; Dane Lenaker, D.M.D., NAPIHB; Joan LaFranc, Mekinak Consulting; Mary Harrison, ODAA; Ginny Jorgensen, ODAA; Joe Finkbonner, NPAIHB; Christina Peters, NPAIHB; Kelle Little, Coquille Tribe; Doug Barrett, Confederated Tribes of Coos, Lower Umpqua and Siuslaw (CTCLUSI); Julie Johnson, OHA Tribal Affairs; Phil Marucha, OHSU; Rachel Hogan, D.D.S., NPAIHB; Heather Mobus, R.D.H., ODHA; Naomi Petrie, CTCLUSI; Kim Wright, D.M.D., NPAIHB; Laura Seurynck, Oregon Academy Of General Dentistry; Rosa Shepard; Kathy Moyd, Elders in Action
Call to Order: The meeting was called to order by the President at 7:30 a.m. at the Board office; 1500 SW 1st Ave., Suite 770, Portland, Oregon.
Dr. Julie Ann Smith joined the meeting at 7:36 am.
April 19, 2019 Board Meeting Page 1 of 19
NEW BUSINESS
Northwest Portland Area Indian Health Board (NPAIHB) – Dental Pilot Project #100 Executive Director Joe Finkbonner, Christina Peters, Gitta Yitta, D.M.D., Dane Lenaker, D.M.D. and Dr. Joan LaFranc (Mekinak Consulting) from the NPAIHB gave a 45-minute presentation to the Board. The presentation addressed concerns previously raised by the Board, such as the evaluation of DHATs and quality of care. They reported that they have seen a 57% increase in the number of patients seen in the treatment year since the implementation of the program. They also shared some public comments and feedback from patients seen at the Confederated Tribes of Coos, Lower Umpqua and Siuslaw (CTCLUSI) clinic as well as the Native American Rehabilitation Association northwest (NARA) clinic.
Oregon Academy of General Dentistry (Oregon AGD) Executive Director of the Oregon AGD, Laura Seurynck, R.D.H., and Dr. Kim Wright gave an overview and update to the Board regarding the mentorship program.
Approval of Minutes Dr. Fine moved and Ms. Martinez seconded that the Board approve the minutes from the February 15, 2019 meeting as presented. The motion passed unanimously.
ASSOCIATION REPORTS
Oregon Dental Association Dr. Barry Taylor reported another successful Oregon Dental Conference, with over 5700 attendees. He gave an update on the upcoming legislative bills that could affect the Board.
Oregon Dental Hygienists’ Association Ms. Lisa Rowley reported that the ODHA is working with the ODA on Senate Bill 824 to include dental hygienists.
Oregon Dental Assistants Association Ms. Mary Harrison thanked Teresa Haynes for her participation at the Oregon Dental Conference.
COMMITTEE AND LIAISON REPORTS
WREB Liaison Report Nothing to report.
AADB Liaison Report Dr. Beck reported that the AADB has a new president, Dr. Robert Zena.
ADEX Liaison Report Nothing to report.
CDCA Liaison Report Nothing to report.
April 19, 2019 Board Meeting Page 2 of 19
EXECUTIVE DIRECTOR’S REPORT
Board Member & Staff Updates Mr. Prisby thanked Dr. Julie Ann Smith for her 8 years of service on the OBD from 2011 to 2019. Dr. Smith’s second term of service is ending in May. She previously served as OBD President, Chair of the Anesthesia Committee, chaired other workgroups and committees and helped shape the OBD’s 2017-2020 Strategic Plan. Mr. Prisby hopes the Board continues to attract members with her professional acumen, respect for the profession, level of engagement and professional courtesy.
The Board recognized Dr. Gary Underhill for his one year of service as president of the OBD.
Board member interest forms and applications have been submitted to the governor’s office and the governor’s staff has been reviewing them. The senate will have a confirmation hearing on May 8th, and Mr. Prisby plans to be in Salem to support and welcome the new Board member. OBD staff will conduct a new board member orientation and they will join the Board at the June 21 Board Meeting.
OBD Budget Status Report Mr. Prisby presented the budget report for the 2017 - 2019 Biennium. This report, which is from July 1, 2017 through February 28, 2019, shows revenue of $3,385,255.28 and expenditures of $2,474,613.85.
Gold Star Certificate for FY 2018 The State Controller’s Office has once again issued the OBD a Gold Star Certificate signifying that the OBD has provided accurate and complete fiscal year end information for FY 2018 in a timely manner.
Customer Service Survey The new Survey Monkey Survey was launched in December 2018. The results of the survey from December 2018 – March 31, 2019 show that the OBD continues to receive positive ratings from the majority of those that submit a survey.
2019 Dental License Renewal The following are the final numbers on the March 2019 Dental Renewal: As of April 9, 2019 Renewed 1668; Expired 160; Retired 41; Revoked 1; and Deceased 6.
Board and Staff Speaking Engagements Mr. Prisby gave a “Board Updates” Presentation to the Southern Oregon Dental Society in conjunction with TDIC in Medford on Friday, February 22, 2019 and Dr. Amy B. Fine participated as well.
Teresa Haynes gave a License Application Presentation via teleconference to the graduating Dental Hygiene Students at OIT in Klamath Falls on Friday, February 22, 2019.
Mr. Prisby gave a “Board Updates and how to stay out of trouble” presentation to Pacific University dental hygiene students in Hillsboro on Wednesday, March 6, 2019.
Ingrid Nye and Teresa Haynes gave a License Application Presentation to the graduating April 19, 2019 Board Meeting Page 3 of 19
Dental Hygiene Students at OIT in Salem on Thursday, March 7, 2019.
Dr. Daniel Blickenstaff gave a “The Oregon Board of Dentistry & the Dental Hygienist” presentation to Portland Community College dental hygiene students in Portland on Monday, March 11, 2019.
Dr. Daniel Blickenstaff gave a “Board Updates” presentation to the Gum Gardener Dental Hygiene Study Club in Portland on Monday, April 1, 2019.
Dr. Daniel Blickenstaff and I gave a “Board Updates” presentation to OHSU Dental School third year students in Portland on Wednesday April 3, 2019
The Oregon Dental Conference was held at the Oregon Convention Center in Portland, April 4 - 6, 2019. The OBD had a table outside the Exhibit Hall with staff available to answer questions every day of the conference. Haley Robinson, Ingrid Nye and Stephen Prisby made presentations on Thursday, April 4th covering a detailed overview of the Board, expanded practice permits and FAQs.
Dr. Blickenstaff and Mr. Prisby also took part in the TDIC Risk Management Seminar on Thursday, April 4 regarding investigations and the enforcement process.
Dr. Blickenstaff and Haley Robinson gave a presentation on “Adequate Record Keeping and the Enforcement Process” on Friday, April 5.
Teresa Haynes participated in a dental assistants’ forum sponsored by DANB & the DALE Foundation at the ODC on Friday, April 5 updating the dental assistants on current and proposed rule changes.
Mr. Prisby gave a brief overview of the Board to the Oregon Society of Oral and Maxillofacial Surgeons in Portland on Saturday, April 6, 2019
Dr. Daniel Blickenstaff gave a presentation on TMD to the dental hygiene students at Portland Community College in Portland on Tuesday, April 9, 2019.
Ingrid Nye and Teresa Haynes gave a License Application Presentation to the graduating Dental Hygiene Students at Portland Community College on Wednesday, April 17, 2019.
Idaho Board of Dentistry Presentation Invitation In June 2018, Lori Lindley and Stephen Prisby gave a “Board Updates” Presentation to the Washington State Dental Quality Assurance Commission in Lacey, Washington. They reciprocated and presented an update on Washington State at our August 2018 Board Meeting. Now there is an opportunity to do the same with the Idaho Board of Dentistry. Mr. Prisby has been invited to present a “Board Updates” presentation on Friday, July 26, 2019 in Boise, Idaho. He plans to invite their executive director to present updates on Idaho to the Board at a future Board meeting as well. Mr. Prisby asks that the Board approve his travel to Boise, Idaho to give a presentation to their Board of Dentistry.
Dr. Fine moved and Dr. Beck seconded that the Board approve Mr. Prisby’s request to travel to Boise to give a presentation to the Idaho Board of Dentistry. The motion passed unanimously.
AADA & AADB Mid-Year Meetings April 19, 2019 Board Meeting Page 4 of 19
The American Association of Dental Administrators (AADA) and the American Association of Dental Boards (AADB) 2019 Mid-Year Meetings were on March 9-10 in Chicago. Lori Lindley participated in the Board Attorneys’ Roundtable and Ms.Yadira Martinez attended the AADB meetings. Mr. Prisby attended both meetings as well.
Dental Licensure Compact The Council of State Governments has started an effort to convene meetings regarding the prospects for a dental licensure compact. Information was gathered and shared from American Association of Dental Administrators’ President Sandra Reen.
2019 Legislative Session The legislative session started on January 22nd, and Mr. Prisby presented bills he is tracking that may have an impact on OBD Licensees or the agency
Database Migration Project Mr. Prisby gave the Board an update on the timeline, and announced that the OBD is getting closer to choosing a vendor. We will provide updates at the June board meeting.
Interagency Agreement (IAA) with Oregon Health Authority (OHA) The OHA must develop integration performance indicators for Year 2 (2021) of the Coordinated Care Organization (CCO) 2.0 contract. Since this is during the period when OHA will also be evaluating CCO applications, OHA conversations must be governed by conflict of interest agreements. OHA anticipates that they may want to consult with the Board of Dentistry about some of their integration concepts to ensure that they fall within the scope of practice of dental practitioners.
2020 Proposed Board meeting Dates Dr. Javier moved and Ms. Martinez seconded that the Board approve the proposed 2020 meeting dates as presented. The motion passed unanimously.
UNFINISHED BUSINESS & RULES Dr. Underhill moved and Dr. Beck seconded that the Board elect Dr. Amy B. Fine as Board President. The motion passed unanimously.
Dr. Fine moved and Dr. Beck seconded that the Board elect Ms. Yadira Martinez as Vice President. The motion passed unanimously.
CORRESPONDENCE
Oregon Dental Assistants Association proposed rule changes Dr. Beck moved and Dr. Pham seconded that the Board move the proposed changes to Division 42 to the Licensing, Standards and Competency Committee for review. The motion passed unanimously.
818-042-0040 Prohibited Acts
No licensee may authorize any dental assistant to perform the following acts: (1) Diagnose or plan treatment. April 19, 2019 Board Meeting Page 5 of 19
(2) Cut hard or soft tissue. (3) Any Expanded Function duty (818-042-0070 and 818-042-0090) or Expanded Orthodontic Function duty (818-042-0100) without holding the appropriate certification. (4) Correct or attempt to correct the malposition or malocclusion of teeth except as provided by OAR 818042-0100. (5) Adjust or attempt to adjust any orthodontic wire, fixed or removable appliance or other structure while it is in the patient’s mouth. (6) Administer any drug except fluoride, topical anesthetic, desensitizing agents, over the counter medications per package instructions or drugs administered pursuant to OAR 818-026-0030(6), OAR 818-026-0050(5)(a) OAR 818-026-0060(11), 818-026-0065(11), 818-026-0070(11) and as provided in 818-042-0070, 818-042-0090 and 818-042-0115. (7) Prescribe any drug. (8) Place periodontal packs. (9) Start nitrous oxide. (10) Remove stains or deposits except as provided in OAR 818-042-0070. (11) Use ultrasonic equipment intra-orally except as provided in OAR 818-042-0100. (12) Use a high-speed handpiece or any device that is operated by a high-speed handpiece intra- orally except as provided in OAR 818-042-0095, and only for the purpose of adjusting occlusion, contouring, and polishing restorations on the tooth or teeth that are being restored. (13) Use lasers, except laser-curing lights. (14) Use air abrasion or air polishing. (15) Remove teeth or parts of tooth structure. (16) Preliminarily fit crowns to check contacts, cement or bond any fixed prosthetic prosthesis or orthodontic appliance including bands, brackets, retainers, tooth moving devices, or orthopedic appliances except as provided in 818-042-0100. (17) Condense and carve permanent restorative material except as provided in OAR 818-042- 0095. (18) Place any type of retraction material subgingivally except as provided in OAR 818-042-0090. (19) Take jaw registrations or oral impressions for supplying artificial teeth as substitutes for natural teeth, except diagnostic or opposing models or for the fabrication of temporary or provisional restorations or appliances. (20) Apply denture relines except as provided in OAR 818-042-0090(2). (21) Expose radiographs without holding a current Certificate of Radiologic Proficiency issued by the Board (818-042-0050 and 818-042-0060) except while taking a course of instruction approved by the Oregon Health Authority, Oregon Public Health Division, Office of Environmental Public Health, Radiation Protection Services, or the Oregon Board of Dentistry. (22) Use the behavior management techniques known as Hand Over Mouth (HOM) or Hand Over Mouth Airway Restriction (HOMAR) on any patient. (23) Perform periodontal probing. (24) Place or remove healing caps or healing abutments, except under direct supervision. (25) Place implant impression copings, except under direct supervision. (26) Any act in violation of Board statute or rules. No licensee may authorize any dental assistant to perform the following acts:
818-042-0050 Taking of X-Rays — Exposing of Radiographs
(1) A dentist may authorize the following persons to place films, adjust equipment preparatory to exposing films, and expose the films under general supervision: (a) A dental assistant certified by the Board in radiologic proficiency; or (b) A radiologic technologist licensed by the Oregon Board of Medical Imaging and certified by the Oregon Board of Dentistry (OBD) who has completed ten (10) clock hours in a Board approved dental radiology course. (2) A dentist or dental hygienist may authorize a dental assistant who has completed a course of instruction approved by the Oregon Board of Dentistry, and who has passed the written Dental Radiation Health and Safety Examination administered by the Dental Assisting National Board, or April 19, 2019 Board Meeting Page 6 of 19
comparable exam administered by any other testing entity authorized by the Board, or other comparable requirements approved by the Oregon Board of Dentistry to place films, adjust equipment preparatory to exposing films, and expose the films under the indirect supervision of a dentist, dental hygienist, or dental assistant who holds an Oregon Radiologic Proficiency Certificate. The dental assistant must submit within six months, certification by an Oregon licensed dentist or dental hygienist that the assistant is proficient to take radiographs.
818-042-0060 Certification — Radiologic Proficiency
(1) The Board may certify a dental assistant in radiologic proficiency by credential in accordance with OAR 818-042-0120, or if the assistant: (2) Submits an application on a form approved by the Board, pays the application fee and: (a) Completes a course of instruction approved by the Oregon Board of Dentistry, in accordance with OAR 333-106-0055 or submits evidence that the Oregon Health Authority, Center for Health Protection, Radiation Protection Services recognizes that the equivalent training has been successfully completed; (b) Passes the written Dental Radiation Health and Safety Examination administered by the Dental Assisting National Board, Inc. (DANB), or comparable exam administered by any other testing entity authorized by the Board, or other comparable requirements approved by the Oregon Board of Dentistry; and (c) Certification by an Oregon licensed dentist or dental hygienist that the assistant is proficient to take radiographs.
818-042-0070 Expanded Function Dental Assistants (EFDA)
The following are direct patient care duties and are considered Expanded Functions Duties and may be performed only after the dental assistant complies with the requirements of 818-042- 0080: (1) Polish the coronal surfaces of teeth with a brush or rubber cup as part of oral prophylaxis to remove stains providing the patient is checked by a dentist or dental hygienist after the procedure is performed, prior to discharge; (2) Remove temporary crowns for final cementation and clean teeth for final cementation; (3) Preliminarily fit crowns to check contacts or to adjust occlusion outside the mouth; (4)(3) Place temporary restorative material (i.e., zinc oxide eugenol based material) in teeth providing that the patient is checked by a dentist before and after the procedure is performed; (5)(4) Place and remove matrix retainers for alloy and composite restorations any direct restoration; (6) Polish amalgam or composite surfaces with a slow speed hand piece; (7) Remove excess supragingival cement from crowns, bridges, bands or brackets with hand instruments providing that the patient is checked by a dentist after the procedure is performed; (8)(5) Fabricate temporary crowns or bridges, and temporarily cement the temporary crown or bridge. The cemented crown or bridge must be examined and approved by the dentist prior to the patient being released; and (9)(6) Under general supervision, when the dentist is not available and the patient is in discomfort, an EFDA may recement a temporary crown or recement a permanent crown with temporary cement for a patient of record providing that the patient is rescheduled for follow-up care by a licensed dentist as soon as is reasonably appropriate;. and (10) Perform all aspects of teeth whitening procedures.
818-042-0080 Certification — Expanded Function Dental Assistant (EFDA) The Board may certify a dental assistant as an expanded function assistant: (1) By credential in accordance with OAR 818-042-0120, or (2) If the assistant submits a completed application, pays the fee and provides evidence of; April 19, 2019 Board Meeting Page 7 of 19
(a) Certification of Radiologic Proficiency (OAR 818-042-0060); and satisfactory completion of a course of instruction in a program accredited by the Commission on Dental Accreditation of the American Dental Association; or (b) Certification of Radiologic Proficiency (OAR 818-042-0060); and passage of the Basic Infection Control Examination (ICE) or CDA examination, and the Expanded Function Dental Assistant examination, or equivalent successor examinations, administered by the Dental Assisting National Board, Inc. (DANB), or any other testing entity authorized by the Board; and within six months of being authorized to perform all expanded function duties, certification by an Oregon licensed dentist that the applicant has successfully polished 12 amalgam or composite surfaces, removed supra-gingival excess cement from six (6) crowns or bridges with hand instruments; placed temporary restorative material (i.e., zinc oxide eugenol based material) in six (6) teeth; preliminarily fitted six (6) crowns to check contacts or to adjust occlusion outside the mouth; removed six (6) temporary crowns for final cementation and cleaned teeth for final cementation; fabricated six (6) temporary crowns and temporarily cemented the crowns; polished the coronal surfaces of teeth with a brush or rubber cup as part of oral prophylaxis in six (6) patients; placed two matrix bands in each quadrant on teeth prepared for Class II restorations; and complete six (6) teeth whitening or bleach procedures is proficient in all expanded function duties. If no expanded function certificate is issued within the six months of being authorized to perform the duties, the assistant is no longer able to continue performing expanded function duties until EFDA certification is achieved.
818-042-0100 Expanded Functions — Orthodontic Assistant (EFODA) (1) An EFODA may perform the following duties while under the indirect supervision of a licensed dentist: (a) Remove orthodontic bands and brackets and attachments with removal of the bonding material and cement. An ultrasonic scaler, hand scaler or slow speed handpiece may be used. Use of a high speed handpiece is prohibited; (b) Select or try for the fit of orthodontic bands; (c) Recement loose orthodontic bands; (d) Place and remove orthodontic separators; (e) Prepare teeth for bonding or placement of orthodontic appliances and select, pre-position and cure orthodontic brackets, attachments and/or retainers after their position has been approved by the supervising licensed dentist; (f) Fit and adjust headgear; (g) Remove fixed orthodontic appliances; (h) Remove and replace orthodontic wires. Place and ligate archwires. Place elastic ligatures or chains as directed; (i) Cut arch wires; and (j) Take impressions for study models or temporary oral devices such as, but not limited to, space maintainers, orthodontic retainers and occlusal guards. (2) An EFODA may perform the following duties while under the general supervision of a licensed dentist: (a) An expanded function orthodontic assistant may remove any portion of an orthodontic appliance causing a patient discomfort and in the process may replace ligatures and/or separators if the dentist is not available, providing that the patient is rescheduled for follow-up care by a licensed dentist as soon as is reasonably appropriate. (b) An EFODA may recement orthodontic bands if the dentist is not available and the patient is in discomfort, providing that the patient is rescheduled for follow-up care by a licensed dentist as soon as is reasonably appropriate.
818-042-0110 Certification — Expanded Function Orthodontic Assistant The Board may certify a dental assistant as an expanded function orthodontic assistant (1) By credential in accordance with OAR 818-042-0120, or (2) Completion of an application, payment of fee and satisfactory evidence of; April 19, 2019 Board Meeting Page 8 of 19
(a) Completion of a course of instruction in a program in dental assisting accredited by the American Dental Association Commission on Dental Accreditation; or (b) Passage of the Infection Control Examination (ICE) Basic, CDA or COA examination, and Expanded Function Orthodontic Assistant examination, or equivalent successor examinations, administered by the Dental Assisting National Board, Inc. (DANB), or any other testing entity authorized by the Board; and within six months of being authorized to perform all expanded orthodontic function duties, certification by an Oregon licensed dentist that the applicant has successfully placed and ligated orthodontic wires on ten (10) patients and removed bands/brackets and remaining adhesive using an ultrasonic, hand scaler or a slow speed hand piece from teeth on four (4) patients is proficient to perform all expanded function orthodontic duties. If no expanded functions orthodontic certificate is issued within the six months of being authorized to perform the duties, the assistant is no longer able to continue performing expanded function orthodontic duties until EFODA certification is achieved.
818-042-0113 Certification — Expanded Function Preventive Dental Assistants (EFPDA) The Board may certify a dental assistant as an expanded function preventive dental assistant: (1) By credential in accordance with OAR 818-042-0120, or (2) If the assistant submits a completed application, pays the fee and provides evidence of; (a) Certification of Radiologic Proficiency (OAR 818-042-0060); and satisfactory completion of a course of instruction in a program accredited by the Commission on Dental Accreditation of the American Dental Association; or (b) Certification of Radiologic Proficiency (OAR 818-042-0060); and passage of the Oregon Basic Infection Control Examination (ICE) or and the Certified Preventive Functions Dental Assistant (CPFDA) examination, and or the Expanded Function Dental Assistant examination, or the Coronal Polish (CP) examination, or equivalent successor examinations, administered by the Dental Assisting National Board, Inc. (DANB), or any other testing entity authorized by the Board; and within six months of being authorized to perform coronal polishing, certification by an Oregon licensed dentist that the applicant is proficient to has successfully polished the coronal surfaces of teeth with a brush or rubber cup as part of oral prophylaxis to remove stains on six patients. If no expanded functions preventive certificate is issued within the six months of being authorized to perform coronal polishing, the assistant is no longer able to continue performing coronal polishing until EFPDA certification is achieved.
Request for approval of Dental Anesthesia Assistant course – The Resuscitation Group Dr. Fine moved and Ms. Martinez seconded that the Board move the Resuscitation Group’s Anesthesia course for Dental Anesthesia Assistants to the Licensing, Standards and Competency Committee for further review. The motion passed unanimously.
Request for approval of Restorative Dental Hygiene and Dental Assisting Course- Oregon Health & Sciences University (OHSU) CE Department Dr. Beck moved and Dr. Javier seconded that the Board approve OHSU CE Department’s Restorative course for dental hygiene and dental assisting as requested. The motion passed unanimously.
OTHER ISSUES
Proposed change to OAR 818-021-0017 regarding limited specialty practice requirements Dr. Beck moved and Ms. Martinez seconded that the Board move the proposed changes to OAR 818-021-0017 – Application to Practice as a Specialist – to the Licensing, Standards and Competency Committee for review. The motion passed unanimously.
April 19, 2019 Board Meeting Page 9 of 19
818-021-0017 Application to Practice as a Specialist (1) A dentist who wishes to practice as a specialist in Oregon, who does not have a current Oregon license, in addition to meeting the requirements set forth in ORS 679.060 and 679.065, shall submit to the Board satisfactory evidence of: (a) Having graduated from a school of dentistry accredited by the Commission on Dental Accreditation of the American Dental Association and active licensure as a general dentist in another state. Licensure as a general dentist must have been obtained as a result of the passage of any clinical Board examination administered by any state or regional testing agency; (b) Certification of having passed the dental examination administered by the Joint Commission on National Dental Examinations or Canadian National Dental Examining Board Examination; and (c) Proof of satisfactory completion of a post-graduate specialty program accredited by the Commission on Dental Accreditation of the American Dental Association. (2) A dentist who graduated from a dental school located outside the United States or Canada who wishes to practice as a specialist in Oregon, who does not have a current Oregon license, in addition to meeting the requirements set forth in ORS 679.060 and 679.065, shall submit to the Board satisfactory evidence of: (a) Completion of a post-graduate specialty program of not less than two years at a dental school accredited by the Commission on Dental Accreditation of the American Dental Association, proficiency in the English language, and evidence of active licensure as a general dentist in another state obtained as a result of the passage of any clinical Board examination administered by any state or regional testing agency; or (b) Completion of a post-graduate specialty program of not less than two years at a dental school accredited by the Commission on Dental Accreditation of the American Dental Association, proficiency in the English language and certification of having successfully passed the clinical examination administered by any state or regional testing agency within the five years immediately preceding application; and (c) Certification of having passed the dental examination administered by the Joint Commission on National Dental Examinations or Canadian National Dental Examining Board Examination; and (3) An applicant who meets the above requirements shall be issued a specialty license upon: (a) Passing a specialty examination approved by the Board within the five years immediately preceding application, or; (b) Passing a specialty examination approved by the Board greater than five years prior to application, and; (A) Having conducted licensed clinical practice in the applicant’s dental specialty in Oregon, other states or in the Armed Forces of the United States, the United States Public Health Service or the United States Department of Veterans Affairs for a minimum of 3,500 hours in the five years immediately preceding application. Licensed clinical practice could include hours devoted to teaching the applicant’s chosen dental specialty by dentists employed by a dental education program in a CODA-accredited dental school, with verification from the dean or appropriate administration of the institution documenting the length and terms of employment, the applicant's duties and responsibilities, the actual hours involved in teaching clinical dentistry, and any adverse actions or restrictions; and; (B) Having completed 40 hours of continuing education in accordance with the Board's continuing education requirements contained in these rules within the two years immediately preceding application, and; (b) (c) Passing the Board's jurisprudence examination. (4) Any applicant who does not pass the first examination for a specialty license may apply for a second and third regularly scheduled specialty examination. The applicable fee and application for the reexamination shall be submitted to the Board at least 45 days April 19, 2019 Board Meeting Page 10 of 19
before the scheduled examination. If the applicant fails to pass the third examination for the practice of a recognized specialty, the applicant will not be permitted to retake the particular specialty examination until he/she has attended and successfully passed a remedial program prescribed by a dental school accredited by the Commission on Dental Accreditation of the American Dental Association and approved by the Board. (5) Licenses issued under this rule shall be limited to the practice of the specialty only.
Proposed change to OAR 818-021-0088 regarding volunteer license renewal requirements.
Dr. Fine moved and Dr. Beck seconded that the Board move the proposed changes to OAR 818- 021-0088 – Volunteer License – to the Licensing, Standards and Competency Committee for review. The motion passed unanimously.
818-021-0088 - Volunteer License (1) An Oregon licensed dentist or dental hygienist who will be practicing for a supervised volunteer dental clinic, as defined in ORS 679.020(3)(f) and (g), may begranted a volunteer license provided licensee completes the following: (a) Licensee must register with the Board as a health care professional and provide a statement as required by ORS 676.345. (b) Licensee will be responsible to meet all the requirements set forth in ORS 676.345. (c) Licensee must provide the health care service without compensation. (d) Licensee shall not practice dentistry or dental hygiene for remuneration in any capacity under the volunteer license. (e) Licensee must comply with all continuing education requirements for active licensed dentist or dental hygienist. (f) Licensee must agree to volunteer for a minimum of 40 hours per calendar year 80 hours per renewal cycle. (2) Licensee may surrender the volunteer license designation at anytime and request a return to an active license. The Board will grant an active license as long as all active license requirements have been met.
ARTICLES AND NEWS (no action necessary) HPSP Newsletter, February 2019 HPSP Newsletter, March 2019 ADEA Advocate, February 2019 ADEA Advocate, March 2019 OSAP-DANB-DALE Foundation launch website for dental infection control education and certification ADEA 2017-2018 snapshot of dental education CODA winter 2019 accreditation actions ADA News – anesthesiology recognized as a dental specialty WREB 2018 dental student newsletter CITA letter announcing merger
EXECUTIVE SESSION: The Board entered into Executive Session pursuant to ORS 192.606 (1)(2)(f), (h) and (k); ORS 676.165; ORS 676.175 (1), and ORS 679.320 to review records exempt from public disclosure, to review confidential investigatory materials and investigatory information, and to consult with counsel
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PERSONAL APPEARANCES AND COMPLIANCE ISSUES
OPEN SESSION: The Board returned to Open Session.
CONSENT AGENDA
2019-0053, 2019-0176, 2019-0171 Dr. Fine moved and Dr. Javier seconded that the Board close the matters with a finding of No Violation or No Further Action. The motion passed unanimously.
COMPLETED CASES
2019-0036, 2019-0131, 2006-0172, 2009-0004, 2009-0133, 2012-0037, 2013-0028, 2014-0222, 2019-0104, 2016-0066, 2019-0040, 2019-0082, 2019-0031, 2019-0167, 2019-0086, 2019-0151 Dr. Fine moved and Dr. Javier seconded that the Board close the matters with a finding of No Violation or No Further Action. The motion passed unanimously.
THOMPSON, JARED M., D.M.D. 2018-0209 Ms. Martinez moved and Dr. Smith seconded that the Board, in regards to Respondents #1 – 4, move to close the matter with a Letter of Concern reminding Licensees to assure that they take Healthcare Provider Level BLS/CPR. Per Board Protocol, in regards to Respondent #5 move to issue a Notice of Proposed Disciplinary Action and offer Licensee a Consent Order incorporating a reprimand. The motion passed unanimously.
BAHEN, MATTHEW S., D.M.D. 2018-0264 Dr. Smith moved and Dr. Beck seconded that the Board issue a Notice of Proposed Disciplinary Action and offer Licensee a Consent Order incorporating a reprimand, pay a $5,000.00 civil penalty within 60 days of the effective date of the Order, complete 30 hours of community service within one year, and monthly submission of spore testing results for a period of one year from the effective date of the order. The motion passed unanimously.
2018-0255 Dr. Beck moved and Mr. Dunn seconded that the Board accept Licensee’s retirement form and close the matter with No Further Action. The motion passed unanimously.
2019-0150 Mr. Dunn moved and Dr. Javier seconded that the Board close the matter with a Letter of Concern reminding the Licensee to assure that his Healthcare Provider BLS/CPR is renewed on time. The motion passed unanimously.
2019-0037 Dr. Pham moved and Ms. Riedman seconded that the Board close the matter with a Letter of Concern reminding Licensee to assure that he is cognizant of Ante’s Law when treatment planning and designing fixed bridges. The motion passed with Dr. Underhill, Dr. Fine, Ms. Brixey, Dr. Javier, Ms. Martinez, Dr. Pham, Ms. Riedman, Mr. Dunn and Dr. Smith voting aye. Dr. Beck recused.
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2018-0272 Ms. Riedman moved and Ms. Brixey seconded that the Board close the matter with a Letter of Concern reminding Licensee to assure that he thoroughly document a diagnosis for any recommended treatment, and to open an investigation into the owner of the practice for failure to provide the Board with the biological monitoring results for the sterilizers in the office, and proof of the amalgam separator installation. The motion passed unanimously.
2019-0021 Ms. Brixey moved and Dr. Beck seconded that the Board close the matter with a Letter of Concern reminding licensee to assure that she maintains her Healthcare Provider BLS/CPR OBD licensing requirements without lapsing. The motion passed unanimously.
2019-0061 Ms. Martinez moved and Dr. Beck seconded that the Board close the matter with a Letter of Concern reminding Licensee to assure that when the patient declines to have additional radiographs taken, that it is thoroughly documented, and to assure that the instruments he uses have been sterilized in an autoclave that is tested with a biological monitor on a weekly basis. Also, move to instruct the Board staff to open an investigation in to the managing dentist at the dental clinic to address the missing biological monitoring tests. The motion passed with Dr. Underhill, Dr. Fine, Ms. Brixey, Dr. Beck, Ms. Martinez, Dr. Pham, Ms. Riedman and Mr. Dunn voting aye. Dr. Javier and Dr. Smith recused.
2019-0017 Dr. Javier moved and Ms. Martinez seconded that the Board close the matter with a Letter of Concern reminding Licensee to assure that she maintains a current and valid Healthcare Provider BLS/CPR certification. The motion passed unanimously.
2019-0096 Dr. Beck moved and Dr. Smith seconded that the Board close the matter with a Letter of Concern reminding Licensee to assure that a valid Healthcare Provider BLS/CPR card is maintained while licensed. The motion passed unanimously.
2019-0153 Dr. Smith moved and Ms. Riedman seconded that the Board close the matter with a Letter of Concern reminding Licensee to assure that all CE is completed in the proper areas. The motion passed unanimously.
HALE, LAUREN A., R.D.H. 2019-0034 Mr. Dunn moved and Dr. Javier seconded that the Board issue a Notice of Proposed Disciplinary Action and offer Licensee a Consent Order incorporating a reprimand, pay $1,000.00 civil penalty and complete ten hours of community service within 60 days of the effective date of this Order. The motion passed unanimously.
2019-0038 Dr. Pham moved and Ms. Martinez seconded that the Board close the matter with a Letter of Concern reminding the Licensee to assure that she is aware of her licensing requirements, attentive to tracking those requirements, and is timely and accurate with complying with those requirements. The motion passed unanimously.
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2019-0066 Dr. Beck moved and Ms. Riedman seconded that the Board close the matter with a STRONGLY WORDED Letter of Concern reminding Licensee to make sure they are familiar and compliant with the Dental Practice Act prohibited acts for auxiliary staff. The motion passed unanimously.
2019-0049 Ms. Riedman moved and Dr. Javier seconded that the Board close the matter with Letter of Concern reminding the Licensee to assure that a valid Healthcare Provider BLS/CPR certification is maintained while licensed. The motion passed unanimously.
LEE, NATHAN N., D.D.S. 2019-0091 Ms. Brixey moved and Dr. Smith seconded that the Board issue a Notice of Proposed Disciplinary Action and offer Licensee a Consent Order incorporating a reprimand, an $18,000.00 civil penalty, 120 hours of Board approved community service, monthly submission of biological monitoring testing of his autoclaves for a period of one year, and passage of the Oregon Board of Dentistry Jurisprudence Exam within 30 days. The motion passed unanimously.
2019-0058 Dr. Javier moved and Dr. Smith seconded that the Board close the matter with a STRONGLY WORDED Letter of Concern reminding the Licensee to assure that she maintains a current and valid Healthcare Provider BLS/CPR certification. The motion passed unanimously.
2019-0179 Ms. Martinez moved and Dr. Smith seconded that the Board close the matter with a Letter of Concern reminding Licensee to assure that a valid Healthcare Provider BLS/CPR certification is maintained. The motion passed unanimously.
2019-0057 Dr. Smith moved and Dr. Beck seconded that the Board accept Licensee’s resignation and close the matter with No Further Action. The motion passed unanimously.
2019-0046 Dr. Beck moved and Mr. Dunn seconded that the Board close this matter with a Letter of Concern reminding Licensee to ensure instruments are sterilized and spore testing is completed weekly. The motion passed unanimously.
MILLER, DANIEL J., D.M.D. 2019-0118 Mr. Dunn moved and Dr. Smith seconded that the Board issue a Notice of Proposed Disciplinary Action and offer Licensee a Consent Order incorporating a reprimand, a $1000.00 civil penalty and completion of the Ethics and Boundaries Essay Examination within six months of the effective date of the order. The motion passed unanimously.
2019-0019 Dr. Pham moved and Ms. Martinez seconded that the Board close the matter with a Letter of Concern reminding Licensee to maintain a current and valid Healthcare Provider BLS/CPR certification. The motion passed unanimously.
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2019-0152 Ms. Riedman moved and Ms. Martinez seconded that the Board close the matter with a Letter of Concern reminding the License to assure that all CE is completed within the licensure period. The motion passed unanimously.
NELSON, JAMES B., D.D.S. 2018-0263 Ms. Brixey moved and Ms. Riedman seconded that the Board issue a Notice of Proposed Disciplinary Action and offer Licensee a Consent Order incorporating a reprimand; a $4,000.00 civil penalty, 20 hours of Board approved community service, and monthly submission of spore testing results for a period of one year from the effective date of the Order, per Board protocols. The motion passed unanimously.
2019-0029 Dr. Javier moved and Ms. Martinez seconded that the Board close the matter with a Letter of Concern reminding Licensee to assure that the instruments that she uses have been sterilized in an autoclave that is tested with a biologic medium on a weekly basis, and to direct staff to open a complaint against the clinical director of the office. The motion passed unanimously.
2015-0135 Ms. Martinez moved and Dr. Javier seconded that the Board close the matter with a Letter of Concern reminding Licensee to assure that all prescriptions and dental justifications for all prescriptions are documented in the patient record. The motion passed unanimously.
RAWLEY, DANIEL J., D.D.S. 2019-0155 Dr. Beck moved and Mr. Dunn seconded that the Board issue a Notice of Proposed Discipline Action and offer Licensee a Consent Order incorporating a reprimand. The motion passed with Dr. Underhill, Dr. Fine, Ms. Brixey, Dr. Javier, Ms. Martinez, Dr. Pham, Ms. Riedman, Mr. Dunn and Dr. Beck voting aye. Dr. Smith recused
2018-0259 Dr. Smith moved and Dr. Javier seconded that the Board close the matter with a STRONGLY WORDED Letter of Concern advising licensee to ensure completion of infection control continuing education as required by the Dental Practice Act. The motion passed unanimously.
SALEH, MO Y., D.M.D. 2019-0109 Mr. Dunn moved and Dr. Beck seconded that the Board issue a Notice of Proposed Disciplinary Action and offer Licensee a Consent Order incorporating a reprimand, a $9,000.00 civil penalty, 60 hours of Board approved community service, complete a three hour Board approved continuing education course on Record Keeping within 30 days, pass the Oregon Board of Dentistry Jurisprudence Exam within 30 days, and monthly submission of biological monitoring test results for a period of one year from the effective date of the Order. The motion passed with Dr. Underhill, Dr. Fine, Ms. Brixey, Dr. Smith, Ms. Martinez, Dr. Pham, Ms. Riedman, Mr. Dunn and Dr. Beck voting aye. Dr. Javier recused
SHEBANI, AMNA, D.D.S. 2019-0156 Ms. Riedman moved and Dr. Smith seconded that the Board issue a Notice of Proposed Disciplinary Action and offer Licensee a Consent Order incorporating a reprimand and a $500.00 civil penalty. The motion passed with Dr. Underhill, Dr. Fine, Ms. Brixey, Dr. Smith, Ms. Martinez, Dr. Javier, Ms. Riedman, Mr. Dunn and Dr. Beck voting aye. Dr. Pham recused
April 19, 2019 Board Meeting Page 15 of 19
2019-0033 Dr. Pham moved and Ms. Riedman seconded that the Board close the matter with a Letter of Concern reminding the licensee to assure that she knows what the requirements are for License renewal. The Licensee is recommended to pay attention to detail and fully comply with licensure requirements. Licensee is also reminded that she is required to maintain CE credit documents of at least two licensure periods. The motion passed unanimously.
2018-0265 Ms. Riedman moved and Ms. Martinez seconded that the Board close the matter with a Letter of Concern reminding Licensee to assure that all CE is completed during the renewal cycle and certificates of completion are available when needed. The motion passed unanimously.
TOLMAN, NATHAN A., D.M.D. 2019-0022 Ms. Brixey moved and Dr. Smith seconded that the Board issue a Notice of Proposed Disciplinary Action and offer Licensee a Consent Order incorporating a reprimand, pay a $2,000.00 civil penalty, complete ten hours of Board approved community service within 60 days and complete the four hours of continuing education needed to complete the 40 hour requirement for the 2015-2017 licensure period within 60 days of the order, and to pass the Oregon Board of Dentistry Jurisprudence Exam within 30 days of the effective date of this Order. The motion passed unanimously.
VAN ORMAN, JEFFREY B., D.M.D. 2019-0188 Dr. Javier moved and Ms. Martinez seconded that the Board issue a Notice of Proposed Disciplinary Action and offer Licensee a Consent Order incorporating a reprimand. The motion passed unanimously.
2019-0173 Ms. Martinez moved and Dr. Smith seconded that the Board close the matter with a Letter of Concern reminding Licensee to assure that all advertisement is within the Licensee’s scope of practice. The motion passed unanimously.
WEILAND, JOSHUA, D.M.D. 2019-0044 Dr. Smith moved and Dr. Javier seconded that the Board issue a Notice of Proposed Disciplinary Action and offer Licensee a Consent Order incorporating a reprimand, a $12,000.00 civil penalty, 80 hours of Board approved community service and monthly submission of biological testing results of his autoclaves for a period of one year from the effective date of the Order. The motion passed unanimously.
2019-0041 Dr. Beck moved and Dr. Javier seconded that the Board close the matter with a Letter of Concern to remind Licensee to assure that the treatment scheduled is actually warranted and to assure that he has informed consent from the patient or patient’s parent to provide the dentistry scheduled. The motion passed unanimously.
XU, NA, D.D.S. 2018-0244 Mr. Dunn moved and Dr. Beck seconded that the Board issue a Notice of Proposed Disciplinary Action and to offer Licensee a Consent Order incorporating a reprimand, a $6,000.00 civil penalty, 40 hours of Board approved community service, monthly submission of biological testing results of her autoclaves for a period of one year from the effective date of the Order, take a Board approved course in Record Keeping and pass the Oregon Board of Dentistry April 19, 2019 Board Meeting Page 16 of 19
Jurisprudence Exam within 30 days of the effective date of the Order. The motion passed unanimously.
PREVIOUS CASES REQUIRING BOARD ACTION
ENAYATI, MEHRAN, D.D.S. 2018-0191 Dr. Pham moved and Dr. Smith seconded that the Board deny the Licensee’s request, and reaffirm the Boards decision on 8/24/18 to offer licensee a Consent Order incorporating a reprimand, a $6,000.00 civil penalty, 40 hours of Board approved community service & monthly submission of the results of the previous months weekly biological monitoring testing of sterilization devices. The motion passed unanimously.
2018-0182 Ms. Riedman moved and Ms. Martinez seconded that the Board accept Licensee’s retirement form, and issue an Order of Dismissal dismissing the Notice of Proposed Disciplinary Action, dated 2/21/19, and close the matter with No Further Action. The motion passed unanimously.
2017-0155 Ms. Brixey moved and Dr. Smith seconded that the Board, for Respondent #1, ratify the Order of Dismissal dated 2/26/19, dismissing the Amended Order Notice of Proposed Disciplinary Action, dated 12/17/18. The motion passed unanimously.
2019-0137 Dr. Javier moved and Dr. Smith seconded that the Board issue an Order of Dismissal, dismissing the Notice of Proposed Disciplinary action dated 2/21/19 and close the matter with No Further Action. The motion passed unanimously.
NEGRU, MIHAI P., D.D.S. 2018-0161 Ms. Martinez moved and Dr. Javier seconded that the Board grant Licensee’s request, issue an Order of Dismissal dismissing the Final Default Order, dated 2/15/19, and refer the matter to a hearing on the underlying merits of the case. The motion passed unanimously.
PETERSEN, JAMES G., D.M.D. 2018-0192 Dr. Smith moved and Dr. Javier seconded that the Board offer Licensee a Consent Order incorporating a reprimand, and a $7,000.00 civil penalty. The motion passed unanimously.
ANGLE, DARRELL L., D.D.S. 2016-0180 Dr. Beck moved and Dr. Javier seconded that the Board issue a Final Order Denial Request for Stay denying Licensee a stay of the Board’s Final Order, dated 2/15/19. The motion passed unanimously.
2014-0003 Mr. Dunn moved and Dr. Javier seconded that the Board reaffirm the Board’s decision on October 17, 2014 and close the matter with a finding of No Violation. The motion passed unanimously.
April 19, 2019 Board Meeting Page 17 of 19
LICENSURE AND EXAMINATION
RATIFICATION OF LICENSES
As authorized by the Board, licenses to practice dentistry and dental hygiene were issued to applicants who fulfilled all routine licensure requirements. It is recommended the Board ratify issuance of the following licenses. Complete application files will be available for review during the Board meeting.
Dr. Pham moved and Mr. Dunn seconded that the Board ratify the issuance of the following licenses. The motion passed unanimously.
DENTAL HYGIENISTS
H7795 BRENDAN ANDREW LAING, R.D.H. 2/21/2019 H7796 KRISTENE HEINTZMAN, R.D.H. 2/21/2019 H7797 LINDSEY KATE THOMPSON, R.D.H. 2/25/2019 H7798 YEKATERINA DEGTYAREVA, R.D.H. 2/25/2019 H7799 AUDREY BARRETT, R.D.H. 3/1/2019 H7800 KAYLIE ANN KOONING, R.D.H. 3/14/2019 H7801 SARAH ELIZABETH MARIE BOOTHE, R.D.H. 3/14/2019 H7802 JENNIFER ANN JESSEN-JOHNSON, R.D.H. 4/3/2019 H7803 STACEY LYNN MCDANIELS, R.D.H. 4/3/2019
DENTISTS
D11000 NIDHI TANEJA, D.D.S. 2/8/2019 D11001 ERIC L ELTZROTH, D.D.S. 2/8/2019 D11002 JAMES A BURNESON, D.D.S. 2/21/2019 D11003 JOSHUA MATTHEW SMITH, D.D.S. 2/21/2019 D11004 MINH PHAN, D.M.D. 2/21/2019 D11005 DANIEL JORDAN DECILLIS, D.D.S. 3/1/2019 D11006 SAMI BAHIJ KAWAS, D.D.S. 3/1/2019 D11007 NOELLE M GEORGE, D.M.D. 3/1/2019 D11008 KARIN HERZOG, D.D.S. 3/1/2019 D11009 JEFFERSON B GOURLEY, D.D.S. 3/1/2019 D11010 BRAD N STRONG, D.D.S. 3/1/2019 D11011 LYUDMYLA ALDER, D.M.D. 3/1/2019 D11012 SCOTT ROBERT YEAMAN, D.D.S. 3/1/2019 D11013 CRAIG DAVID KOZELUH, D.D.S. 3/14/2019 D11014 DEAN ROY GRETZINGER, D.D.S. 3/14/2019 D11015 THERESE NGOC PHAM, D.M.D. 3/14/2019 D11016 TARIM S SONG, D.D.S. 3/18/2019 D11017 MONIKA CZEKALSKA, D.D.S. 3/18/2019 D11018 CHRISTIAN ANTON BADER, D.D.S. 3/19/2019 D11019 MINDY CHEN KNOX, D.D.S. 3/22/2019 D11020 INDERRAJ DHILLON, D.D.S. 4/3/2019 April 19, 2019 Board Meeting Page 18 of 19
D11021 MONTE CURTIS JUNKER, D.D.S. 4/3/2019 D11022 ANNA MARIE L MESSENGER, D.D.S. 4/3/2019 D11023 JACOB DEAN HUTCHINGS, D.M.D. 4/3/2019
OTHER BUSINESS Nothing to report.
ADJOURNMENT
The meeting was adjourned at 3:30 p.m. Dr. Underhill stated that the next Board Meeting would take place on June 21, 2019.
Amy B. Fine, D.M.D. President
April 19, 2019 Board Meeting Page 19 of 19
ASSOCIATION REPORTS
Nothing to report under this tab
committee reports
DRAFT 1
LICENSING, STANDARDS AND COMPETENCY COMMITTEE
Minutes May 24, 2019
MEMBERS PRESENT: Amy B. Fine, D.M.D., Chair Alicia Riedman, R.D.H., E.P.P. Todd Beck, D.M.D. Hai Pham, D.M.D. Chip Dunn Daren L. Goin, D.M.D. - ODA Representative Susan Kramer, R.D.H. - ODHA Representative Ginny Jorgensen, CDA, EFDA, EFODA - ODAA Representative
STAFF PRESENT: Stephen Prisby, Executive Director Daniel Blickenstaff, D.D.S., Dental Director/Chief Investigator Teresa Haynes, Office Manager Ingrid Nye, Examination & Licensing Manager
ALSO PRESENT: Lori Lindley, Sr. Assistant Attorney General
VISITORS PRESENT: Julie Ann Smith, D.D.S., M.D., M.C.R.; Katie Simonsen; Jen Lewis-Goff, ODA; Dean Philip Marucha, OHSU Dental School; Abigail Rollins, D.M.D., Chemeketa Community College; Jill Lomax, Chemeketa Community College; Michael Christie, Resuscitation Group; Mary Harrison, ODAA; Dayna Steringer, Willamette Dental Group; Cassie Leone, ODA; Despoina Bompolaki, Prosthodontist, OHSU; Magda C. D’Angelis-Morris, Portland Community College; Lisa Rowley, R.D.H., ODHA; Heather Mobus, R.D.H., ODHA; Leslie Greer, Lane Community College
Call to Order: The meeting was called to order by Dr. Fine, at 12:00 p.m.
MINUTES
Dr. Beck moved and Dr. Pham seconded that the minutes of the December 15, 2017 Licensing, Standards and Competency Committee meeting be approved as presented. The motion passed unanimously.
Dr. Beck moved and Ms. Riedman seconded that the Committee recommend that the Board move OAR 818-001-0002(a)-(j) as presented to the Rules Oversight Committee. The motion passed unanimously.
818-001-0002 Definitions As used in OAR Chapter 818: (1) "Board" means the Oregon Board of Dentistry, the members of the Board, its
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DRAFT 1
employees, its agents, and its consultants. (2) "Dental Practice Act" means ORS Chapter 679 and 680.010 to 680.170 and the rules adopted pursuant thereto. (3) "Dentist" means a person licensed pursuant to ORS Chapter 679 to practice dentistry. (4) "Direct Supervision" means supervision requiring that a dentist diagnose the condition to be treated, that a dentist authorize the procedure to be performed, and that a dentist remain in the dental treatment room while the procedures are performed. (5) "General Supervision" means supervision requiring that a dentist authorize the procedures, but not requiring that a dentist be present when the authorized procedures are performed. The authorized procedures may also be performed at a place other than the usual place of practice of the dentist. (6) "Hygienist" means a person licensed pursuant to ORS 680.010 to 680.170 to practice dental hygiene. (7) "Indirect Supervision" means supervision requiring that a dentist authorize the procedures and that a dentist be on the premises while the procedures are performed. (8) "Informed Consent" means the consent obtained following a thorough and easily understood explanation to the patient, or patient's guardian, of the proposed procedures, any available alternative procedures and any risks associated with the procedures. Following the explanation, the licensee shall ask the patient, or the patient's guardian, if there are any questions. The licensee shall provide thorough and easily understood answers to all questions asked. (9) "Licensee" means a dentist or hygienist. (a) “Volunteer Licensee” is a dentist or dental hygienist licensed according to rule to provide dental health care without receiving or expecting to receive compensation. (10) "Limited Access Patient" means a patient who, due to age, infirmity, or handicap is unable to receive regular dental hygiene treatment in a dental office. (11) "Specialty." The specialty definitions are added to more clearly define the scope of the practice as it pertains to the specialty areas of dentistry. (a) “Dental Anesthesiology” is the specialty of dentistry that deals with the management of pain through the use of advanced local and general anesthesia techniques. (a) (b) "Dental Public Health" is the science and art of preventing and controlling dental diseases and promoting dental health through organized community efforts. It is that form of dental practice which serves the community as a patient rather than the individual. It is concerned with the dental health education of the public, with applied dental research, and with the administration of group dental care programs as well as the prevention and control of dental diseases on a community basis. (b) (c) "Endodontics" is the branch of dentistry which is concerned with the morphology, physiology and pathology of the human dental pulp and periradicular tissues. Its study and practice encompass the basic and clinical sciences including biology of the normal pulp, the etiology, diagnosis, prevention and treatment of diseases and injuries of the pulp and associated periradicular conditions. (c) (d) "Oral and Maxillofacial Pathology" is the specialty of dentistry and discipline of pathology that deals with the nature, identification, and management of diseases affecting the oral and maxillofacial regions. It is a science that investigates the causes, processes, and effects of these diseases. The practice of oral pathology includes research and diagnosis of diseases using clinical, radiographic, microscopic, May 24, 2019 Licensing, Standards and Competency Meeting Page 2 of 42
DRAFT 1
biochemical, or other examinations. (d) (e) “Oral and Maxillofacial Radiology” is the specialty of dentistry and discipline of radiology concerned with the production and interpretation of images and data produced by all modalities of radiant energy that are used for the diagnosis and management of diseases, disorders and conditions of the oral and maxillofacial region. (e) (f) "Oral and Maxillofacial Surgery" is the specialty of dentistry which includes the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region. (f) (g) "Orthodontics and Dentofacial Orthopedics" is the area of dentistry concerned with the supervision, guidance and correction of the growing or mature dentofacial structures, including those conditions that require movement of teeth or correction of malrelationships and malformations of their related structures and the adjustment of relationships between and among teeth and facial bones by the application of forces and/or the stimulation and redirection of functional forces within the craniofacial complex. Major responsibilities of orthodontic practice include the diagnosis, prevention, interception and treatment of all forms of malocclusion of the teeth and associated alterations in their surrounding structures; the design, application and control of functional and corrective appliances; and the guidance of the dentition and its supporting structures to attain and maintain optimum occlusal relations in physiologic and esthetic harmony among facial and cranial structures. (g)(h) "Pediatric Dentistry" is an age defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs. (h)(i) "Periodontics" is the specialty of dentistry which encompasses the prevention, diagnosis and treatment of diseases of the supporting and surrounding tissues of the teeth or their substitutes and the maintenance of the health, function and esthetics of these structures and tissues. (i) (j) "Prosthodontics" is the branch of dentistry pertaining to the restoration and maintenance of oral functions, comfort, appearance and health of the patient by the restoration of natural teeth and/or the replacement of missing teeth and contiguous oral and maxillofacial tissues with artificial substitutes. (12) “Full-time” as used in ORS 679.025 and 680.020 is defined by the Board as any student who is enrolled in an institution accredited by the Commission on Dental Accreditation of the American Dental Association or its successor agency in a course of study for dentistry or dental hygiene. (13) For purposes of ORS 679.020(4)(h) the term “dentist of record” means a dentist that either authorized treatment for, supervised treatment of or provided treatment for the patient in clinical settings of the institution described in 679.020(3). (14) “Dental Study Group” as used in ORS 679.050, OAR 818-021-0060 and OAR 818- 021-0070 is defined as a group of licensees who come together for clinical and non- clinical educational study for the purpose of maintaining or increasing their competence. This is not meant to be a replacement for residency requirements. (15) “Physical Harm” as used in OAR 818-001-0083(2) is defined as any physical injury that caused, partial or total physical disability, incapacity or disfigurement. In no event shall physical harm include mental pain, anguish, or suffering, or fear of injury. (16) “Teledentistry” is defined as the use of information technology and telecommunications to facilitate the providing of dental primary care, consultation, education, and public awareness in the same manner as telehealth and telemedicine. May 24, 2019 Licensing, Standards and Competency Meeting Page 3 of 42
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(17) “BLS for Healthcare Providers or its Equivalent” The CPR certification standard is the American Heart Association’s BLS Healthcare Providers Course or its equivalent, as determined by the Board. This initial CPR course must be a hands-on course; online CPR courses will not be approved by the Board for initial CPR certification: After the initial CPR certification, the Board will accept a Board-approved BLS for Healthcare Providers or its equivalent Online Renewal course for license renewal. A CPR certification card with an expiration date must be received from the CPR provider as documentation of CPR certification. The Board considers the CPR expiration date to be the last day of the month that the CPR instructor indicates that the certification expires.
Dr. Beck moved and Ms. Kramer seconded that the Committee recommend that the Board move OAR 818-001-0002(17) as presented to the Rules Oversight Committee. The motion passed unanimously.
818-001-0002 Definitions As used in OAR chapter 818: (1) "Board" means the Oregon Board of Dentistry, the members of the Board, its employees, its agents, and its consultants. (2) "Dental Practice Act" means ORS Chapter 679 and 680.010 to 680.170 and the rules adopted pursuant thereto. (3) "Dentist" means a person licensed pursuant to ORS Chapter 679 to practice dentistry. (4) "Direct Supervision" means supervision requiring that a dentist diagnose the condition to be treated, that a dentist authorize the procedure to be performed, and that a dentist remain in the dental treatment room while the procedures are performed. (5) "General Supervision" means supervision requiring that a dentist authorize the procedures, but not requiring that a dentist be present when the authorized procedures are performed. The authorized procedures may also be performed at a place other than the usual place of practice of the dentist. (6) "Hygienist" means a person licensed pursuant to ORS 680.010 to 680.170 to practice dental hygiene. (7) "Indirect Supervision" means supervision requiring that a dentist authorize the procedures and that a dentist be on the premises while the procedures are performed. (8) "Informed Consent" means the consent obtained following a thorough and easily understood explanation to the patient, or patient's guardian, of the proposed procedures, any available alternative procedures and any risks associated with the procedures. Following the explanation, the licensee shall ask the patient, or the patient's guardian, if there are any questions. The licensee shall provide thorough and easily understood answers to all questions asked. (9) "Licensee" means a dentist or hygienist. (a) “Volunteer Licensee” is a dentist or dental hygienist licensed according to rule to provide dental health care without receiving or expecting to receive compensation. (10) "Limited Access Patient" means a patient who, due to age, infirmity, or handicap is unable to receive regular dental hygiene treatment in a dental office. (11) "Specialty." The specialty definitions are added to more clearly define the scope of May 24, 2019 Licensing, Standards and Competency Meeting Page 4 of 42
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the practice as it pertains to the specialty areas of dentistry. (a) “Dental Anesthesiology” is the specialty of dentistry that deals with the management of pain through the use of advanced local and general anesthesia techniques. (a) (b) "Dental Public Health" is the science and art of preventing and controlling dental diseases and promoting dental health through organized community efforts. It is that form of dental practice which serves the community as a patient rather than the individual. It is concerned with the dental health education of the public, with applied dental research, and with the administration of group dental care programs as well as the prevention and control of dental diseases on a community basis. (b) (c) "Endodontics" is the branch of dentistry which is concerned with the morphology, physiology and pathology of the human dental pulp and periradicular tissues. Its study and practice encompass the basic and clinical sciences including biology of the normal pulp, the etiology, diagnosis, prevention and treatment of diseases and injuries of the pulp and associated periradicular conditions. (c) (d) "Oral and Maxillofacial Pathology" is the specialty of dentistry and discipline of pathology that deals with the nature, identification, and management of diseases affecting the oral and maxillofacial regions. It is a science that investigates the causes, processes, and effects of these diseases. The practice of oral pathology includes research and diagnosis of diseases using clinical, radiographic, microscopic, biochemical, or other examinations. (d) (e) “Oral and Maxillofacial Radiology” is the specialty of dentistry and discipline of radiology concerned with the production and interpretation of images and data produced by all modalities of radiant energy that are used for the diagnosis and management of diseases, disorders and conditions of the oral and maxillofacial region. (e) (f) "Oral and Maxillofacial Surgery" is the specialty of dentistry which includes the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region. (f) (g) "Orthodontics and Dentofacial Orthopedics" is the area of dentistry concerned with the supervision, guidance and correction of the growing or mature dentofacial structures, including those conditions that require movement of teeth or correction of malrelationships and malformations of their related structures and the adjustment of relationships between and among teeth and facial bones by the application of forces and/or the stimulation and redirection of functional forces within the craniofacial complex. Major responsibilities of orthodontic practice include the diagnosis, prevention, interception and treatment of all forms of malocclusion of the teeth and associated alterations in their surrounding structures; the design, application and control of functional and corrective appliances; and the guidance of the dentition and its supporting structures to attain and maintain optimum occlusal relations in physiologic and esthetic harmony among facial and cranial structures. (g)(h) "Pediatric Dentistry" is an age defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs. (h)(i) "Periodontics" is the specialty of dentistry which encompasses the prevention, diagnosis and treatment of diseases of the supporting and surrounding tissues of the teeth or their substitutes and the maintenance of the health, function and esthetics of these structures and tissues. May 24, 2019 Licensing, Standards and Competency Meeting Page 5 of 42
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(i) (j) "Prosthodontics" is the branch of dentistry pertaining to the restoration and maintenance of oral functions, comfort, appearance and health of the patient by the restoration of natural teeth and/or the replacement of missing teeth and contiguous oral and maxillofacial tissues with artificial substitutes. (12) “Full-time” as used in ORS 679.025 and 680.020 is defined by the Board as any student who is enrolled in an institution accredited by the Commission on Dental Accreditation of the American Dental Association or its successor agency in a course of study for dentistry or dental hygiene. (13) For purposes of ORS 679.020(4)(h) the term “dentist of record” means a dentist that either authorized treatment for, supervised treatment of or provided treatment for the patient in clinical settings of the institution described in 679.020(3). (14) “Dental Study Group” as used in ORS 679.050, OAR 818-021-0060 and OAR 818- 021-0070 is defined as a group of licensees who come together for clinical and non- clinical educational study for the purpose of maintaining or increasing their competence. This is not meant to be a replacement for residency requirements. (15) “Physical Harm” as used in OAR 818-001-0083(2) is defined as any physical injury that caused, partial or total physical disability, incapacity or disfigurement. In no event shall physical harm include mental pain, anguish, or suffering, or fear of injury. (16) “Teledentistry” is defined as the use of information technology and telecommunications to facilitate the providing of dental primary care, consultation, education, and public awareness in the same manner as telehealth and telemedicine. (17) “BLS for Healthcare Providers or its Equivalent” The CPR certification standard is the American Heart Association’s BLS Healthcare Providers Course or its equivalent, as determined by the Board. This initial CPR course must be a hands-on course; online CPR courses will not be approved by the Board for initial CPR certification: After the initial CPR certification, the Board will accept a Board-approved BLS for Healthcare Providers or its equivalent Online Renewal course for license renewal. A CPR certification card with an expiration date must be received from the CPR provider as documentation of CPR certification. The Board considers the CPR expiration date to be the last day of the month that the CPR instructor indicates that the certification expires.
Dr. Beck left the meeting at 12:20 p.m. and rejoined at 12:28 p.m.
The Committee deferred to later in the meeting reviewing and discussing OAR 818-012-0005.
Dr. Goin moved and Dr. Pham seconded that the Committee recommend that the Board move OAR 818-012-0006 as amended to the Rules Oversight Committee. The motion passed unanimously.
818-012-0006 – Qualifications – Administration of Vaccines (1) A dentist may administer vaccines to a patient of record. (2) A dentist may administer vaccines under Section (1) of this rule only if: (a) The dentist has completed a course of training approved by the Board; (b) The vaccines are administered in accordance with the “Model Standing Orders” approved by the Oregon Health Authority (OHA); and (c) The dentist has a current copy of the CDC reference, “Epidemiology and Prevention of Vaccine-Preventable Diseases.” May 24, 2019 Licensing, Standards and Competency Meeting Page 6 of 42
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(d) The dentist has an emergency kit that contains at a minimum; (i) Epinephrine auto injector – Adult 0.3mg (ii) Epinephrine auto injector – Pediatric 0.15mg (i) 1 multi-dose vial of 1:1000 epinephrine with appropriate syringes, or 3 adult- dose epinephrine auto-injectors and 3 pediatric-dose auto-injectors. (iii) (ii) Diphenhydramine 50mg/mL (iv) (iii) Ammonia Inhalants (v) (iv) Appropriate syringes with needles (vi) (v) CPR shield (3) The dentist may not delegate the administration of vaccines to another person. (4) The dentist may not self-administer a vaccine to themselves.
Dr. Pham moved and Ms. Riedman seconded that the Committee recommend that the Board move OAR 818-012-0007 as proposed to the Rules Oversight Committee. The motion passed unanimously.
818-012-0007 – Procedures, Record Keeping and Reporting (1) Prior to administering a vaccine to a patient of record, the dentist must follow the “Model Standing Orders” approved by the Oregon Health Authority (OHA) for administration of vaccines and the treatment of severe adverse events following administration of a vaccine. (2) The dentist must maintain written policies and procedures for handling and disposal of used or contaminated equipment and supplies. (3) The dentist or designated staff must give the appropriate Vaccine Information Statement (VIS) to the patient or legal representative with each dose of vaccine covered by these forms. The dentist or designated must ensure that the patient or legal representative is available and has read, or has had read to them, the information provided and has had their questions answered prior to the dentist administering the vaccine. The VIS given to the patient must be the most current statement. (4) The dentist or designated staff must document in the patient record: (a) The date and site of the administration of the vaccine; (b) The brand name, or NDC number, or other acceptable standardized vaccine code set, dose, manufacturer, lot number, and expiration date of the vaccine; (c) The name or identifiable initials of the administering dentist; (d) The address of the office where the vaccine(s) was administered unless automatically embedded in the electronic report provided to the OHA ALERT Immunization System; (e) The date of publication of the VIS; and (f) The date the VIS was provided and the date when the VIS was published. (5) If providing state or federal vaccines, the vaccine eligibility code as specified by the OHA must be reported to the ALERT system. (6) A dentist who administers any vaccine must report, the elements of Section (3), and Section (4) of this rule if applicable, to the OHA ALERT Immunization System within 14 days of administration. (7) The dentist must report adverse events as required by the Vaccine Adverse Events Reporting System (VAERS), to the Oregon Board of Dentistry within 10 business days and to the primary care provider as identified by the patient. (8) A dentist who administers any vaccine will follow storage and handling May 24, 2019 Licensing, Standards and Competency Meeting Page 7 of 42
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guidance from the vaccine manufacturer and the Centers for Disease Control and Prevention (CDC). (9) Dentists who do not follow this rule can be subject to discipline for failure to adhere to these requirements.
Dr. Beck moved and Ms. Riedman seconded that the Committee recommend that the Board move OAR 818-012-0030 as amended to the Rules Oversight Committee. The motion passed unanimously
818-012-0030 Unprofessional Conduct The Board finds that in addition to the conduct set forth in ORS 679.140(2), unprofessional conduct includes, but is not limited to, the following in which a licensee does or knowingly permits any person to: (1) Attempt to obtain a fee by fraud, or misrepresentation. (2) Obtain a fee by fraud, or misrepresentation. (a) A licensee obtains a fee by fraud if the licensee knowingly makes, or permits any person to make, a material, false statement intending that a recipient, who is unaware of the truth, rely upon the statement. (b) A licensee obtains a fee by misrepresentation if the licensee obtains a fee through making or permitting any person to make a material, false statement. (c) Giving cash discounts and not disclosing them to third party payers is not fraud or misrepresentation. (3) Offer rebates, split fees, or commissions for services rendered to a patient to any person other than a partner, employee, or employer. (4) Accept rebates, split fees, or commissions for services rendered to a patient from any person other than a partner, employee, or employer. (5) Initiate, or engage in, with a patient, any behavior with sexual connotations. The behavior can include but is not limited to, inappropriate physical touching; kissing of a sexual nature; gestures or expressions, any of which are sexualized or sexually demeaning to a patient; inappropriate procedures, including, but not limited to, disrobing and draping practices that reflect a lack of respect for the patient's privacy; or initiating inappropriate communication, verbal or written, including, but not limited to, references to a patient's body or clothing that are sexualized or sexually demeaning to a patient; and inappropriate comments or queries about the professional's or patient's sexual orientation, sexual performance, sexual fantasies, sexual problems, or sexual preferences. (6) Engage in an unlawful trade practice as defined in ORS 646.605 to 646.608. (7) Fail to present a treatment plan with estimated costs to a patient upon request of the patient or to a patient's guardian upon request of the patient's guardian. (8) Misrepresent any facts to a patient concerning treatment or fees. (9)(a) Fail to provide a patient or patient's guardian within 14 days of written request: (A) Legible copies of records; and (B) Duplicates of study models, radiographs of the same quality as the originals, and photographs if they have been paid for. (b) The licensee may require the patient or guardian to pay in advance a fee reasonably calculated to cover the costs of making the copies or duplicates. The licensee may charge a fee not to exceed $30 for copying 10 or fewer pages of written material and no more than $0.50 per page for pages 11 through 50 and no more than $0.25 for each May 24, 2019 Licensing, Standards and Competency Meeting Page 8 of 42
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additional page (including records copied from microfilm), plus any postage costs to mail copies requested and actual costs of preparing an explanation or summary of information, if requested. The actual cost of duplicating radiographs may also be charged to the patient. Patient records or summaries may not be withheld from the patient because of any prior unpaid bills, except as provided in (9)(a)(B) of this rule. (10) Fail to identify to a patient, patient's guardian, or the Board the name of an employee, employer, contractor, or agent who renders services. (11) Use prescription forms pre-printed with any Drug Enforcement Administration number, name of controlled substances, or facsimile of a signature. (12) Use a rubber stamp or like device to reproduce a signature on a prescription form or sign a blank prescription form. (13) Order drugs listed on Schedule II of the Drug Abuse Prevention and Control Act, 21 U.S.C. Sec. 812, for office use on a prescription form. (14) Violate any Federal or State law regarding controlled substances. (15) Becomes addicted to, or dependent upon, or abuses alcohol, illegal or controlled drugs, or mind altering substances, or practice with an untreated substance use disorder diagnosis that renders the licensee unable to safely conduct the practice of dentistry or dental hygiene. (16) Practice dentistry or dental hygiene in a dental office or clinic not owned by an Oregon licensed dentist(s), except for an entity described under ORS 679.020(3) and dental hygienists practicing pursuant to ORS 680.205(1)(2). (17) Make an agreement with a patient or person, or any person or entity representing patients or persons, or provide any form of consideration that would prohibit, restrict, discourage or otherwise limit a person's ability to file a complaint with the Oregon Board of Dentistry; to truthfully and fully answer any questions posed by an agent or representative of the Board; or to participate as a witness in a Board proceeding. (18) Fail to maintain at a minimum a current BLS for Healthcare Providers certificate or its equivalent. (Effective January 2015). (19) Conduct unbecoming a licensee or detrimental to the best interests of the public, including conduct contrary to the recognized standards of ethics of the licensee’s profession or conduct that endangers the health, safety or welfare of a patient or the public. (20) Knowingly deceiving or attempting to deceive the Board, an employee of the Board, or an agent of the Board in any application or renewal, or in reference to any matter under investigation by the Board. This includes but is not limited to the omission, alteration or destruction of any record in order to obstruct or delay an investigation by the Board, or to omit, alter or falsify any information in patient or business records. (21) Knowingly practicing with a physical or mental impairment that renders the Licensee unable to safely conduct the practice of dentistry or dental hygiene. (22) Take any action which could reasonably be interpreted to constitute harassment or retaliation towards a person whom the licensee believes to be a complainant or witness. (23) Fail to register with the Prescription Drug Monitoring Program (PDMP) in order to have access to the Program’s electronic system if the Licensee holds an Oregon DEA registration. (24) Every dental office, facility or location providing dental or dental hygiene services in the state of Oregon must have a properly functioning automated external defibrillator (AED) or defibrillator. (a) An expanded practice dental hygienist must have access to a properly functioning automated external defibrillator(AED) or defibrillator. The AED or May 24, 2019 Licensing, Standards and Competency Meeting Page 9 of 42
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defibrillator must be available and within reach within sixty seconds. (b) A dental office or facility may share a single AED or defibrillator with adjacent businesses if it meets the requirements of this section. (Effective January 1, 2021).
Dr. Pham moved and Dr. Goin seconded that the Committee recommend that the Board move OAR 818-012-0070 as amended to the Rules Oversight Committee. The motion passed unanimously.
818-012-0070 Patient Records (1) Each licensee shall have prepared and maintained an accurate and legible record for each person receiving dental services, regardless of whether any fee is charged. The record shall contain the name of the licensee rendering the service and include: (a) Name and address and, if a minor, name of guardian; (b) Date description of examination and diagnosis; (c) An entry that informed consent has been obtained and the date the informed consent was obtained. Documentation may be in the form of an acronym such as "PARQ" (Procedure, Alternatives, Risks and Questions) or "SOAP" (Subjective Objective Assessment Plan) or their equivalent. (d) Date and description of treatment or services rendered; (e) Date, description and documentation of informing the patient of any recognized treatment complications; (f) Date and description of all radiographs, study models, and periodontal charting; (g) Health history; and (h) Date, name of, quantity of, and strength of all drugs dispensed, administered, or prescribed. (2) Each licensee shall have prepared and maintained an accurate record of all charges and payments for services including source of payments. (3) Each licensee shall maintain patient records and radiographs for at least seven years from the date of last entry unless: (a) The patient requests the records, radiographs, and models be transferred to another licensee who shall maintain the records and radiographs; (b) The licensee gives the records, radiographs, or models to the patient; or (c) The licensee transfers the licensee’s practice to another licensee who shall maintain the records and radiographs. (4) When a dental implant is placed the following information must be given to the patient in writing and maintained in the patient record: (a) Manufacture brand; (b) Design name of implant; (c) Diameter and, length; (d) Lot number; (e) Reference number; (f) Expiration date; (g) Product labeling containing the above information may be used in satisfying this requirement. (4)(5) When changing practice locations, closing a practice location or retiring, each licensee must retain patient records for the required amount of time or transfer the custody of patient records to another licensee licensed and practicing dentistry in Oregon. Transfer of patient records pursuant to this section of this rule must be reported May 24, 2019 Licensing, Standards and Competency Meeting Page 10 of 42
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to the Board in writing within 14 days of transfer, but not later than the effective date of the change in practice location, closure of the practice location or retirement. Failure to transfer the custody of patient records as required in this rule is unprofessional conduct. (5)(6) Upon the death or permanent disability of a licensee, the administrator, executor, personal representative, guardian, conservator or receiver of the former licensee must notify the Board in writing of the management arrangement for the custody and transfer of patient records. This individual must ensure the security of and access to patient records by the patient or other authorized party, and must report arrangements for permanent custody of patient records to the Board in writing within 90 days of the death of the licensee.
The Committee reviewed and discussed OAR 818-015-0007 and decided not to take any action on OAR 818-015-0007, OAR 818-021-0012, OAR 818-021-0015 and OAR 818-021-0017 pending potential legislation. It was determined that after the legislative session is complete, there is time for the Rules Oversight Committee to review any rule changes based on the legislation.
818-015-0007 Specialty Advertising (1) A dentist may only advertise as a specialist in an area of dentistry which is recognized by the Board and in which the dentist is licensed or certified by the Board. (2) The Board recognizes the following specialties: (a) Endodontics; (b) Oral and Maxillofacial Surgery; (c) Oral and Maxillofacial Radiology; (d) Oral and Maxillofacial Pathology; (e) Orthodontics and Dentofacial Orthopedics; (f) Pediatric Dentistry; (g) Periodontics; (h) Prosthodontics; (i) Dental Public Health (3) A dentist whose license is not limited to the practice of a specialty under OAR 818- 021-0017 may advertise that the dentist performs or limits practice to specialty services even if the dentist is not a specialist in the advertised area of practice so long as the dentist clearly discloses that the dentist is a general dentist or a specialist in a different specialty. For example, the following disclosures would be in compliance with this rule for dentists except those licensed pursuant to 818-021-0017: "Jane Doe, DDS, General Dentist, practice limited to pediatric dentistry." "John Doe, DMD, Endodontist, practice includes prosthodontics."
(1) A dentist shall not advertise or hold themselves out to the public as a specialist or use any variation of the term, in the area of practice, if the communication is false, deceptive or misleading under OAR 818-015-0005. (2) It shall not be false, deceptive or misleading for a dentist to hold themselves out to the public as a specialist in a practice area provided the dentist has completed a qualifying postdoctoral education program in that area. A qualifying postdoctoral education program is a postdoctoral advanced dental educational program accredited by an agency recognized by the United States Department of Education. May 24, 2019 Licensing, Standards and Competency Meeting Page 11 of 42
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(3) A dentist who has not completed a qualifying postdoctoral educational program shall not advertise or otherwise hold themselves out to the public as a specialist, certified specialist, or board-certified specialist, or use any variation of those terms, unless they hold current certification by a qualifying specialty board or organization and are licensed by the laws of Oregon to practice a dental specialty. The Board shall consider the following criteria in determining a qualifying specialty board or organization: (a) The organization requires completion of a training program with training, documentation, and clinical requirements similar in scope and complexity to a qualifying postdoctoral education program in the specialty or subspecialty field of dentistry in which the dentist seeks certification. Programs that require solely experiential training, continuing education classes, on-the-job training, or payment to the specialty board shall not constitute an equivalent specialty board; (b) The organization requires all dentists seeking certification to pass a written or oral examination, or both, that tests the applicant’s knowledge and skill in the specialty or subspecialty area of dentistry and includes a psychometric evaluation for validation; (c) The organization has written rules on maintenance of certification and requires periodic recertification; (d) The organization has written bylaws and a code of ethics to guide the practice of its members; (e) The organization has staff to respond to consumer and regulatory inquiries; and (f) The organization is recognized by another entity whose primary purpose is to evaluate and assess dental specialty boards and organizations. (4) A dentist qualifying under Subsection (3) and advertising or otherwise holding themselves out to the public as a “specialist,” “certified specialist,” or “board- certified specialist” shall disclose in the advertisement or communication the specialty board by which the dentist was certified and provide information about the certification criteria or where the certification criteria may be located. (5) A dentist shall maintain documentation of either completion of a qualifying postdoctoral educational program or of his or her current specialty certification and provide the documentation to the Board upon request. Dentists shall maintain documentation demonstrating that the certifying board qualifies under the criteria in Subsection (3)(a)-(f) of this rule and provide the documentation to the Board upon request. (6) Nothing in this section shall be construed to prohibit a dentist who does not qualify as a “specialist,” “certified specialist,” or “board-certified specialist” under paragraphs (2) and (3) of this rule from restricting their practice to one or more specific areas of dentistry or from advertising the availability of their services, provided that such advertisements do not include the terms “specialist,” “certified specialist,” or “board-certified specialist” or any variation of those terms, and must state that the services advertised are being provided by a general dentist.
818-021-0012 Specialties Recognized May 24, 2019 Licensing, Standards and Competency Meeting Page 12 of 42
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(1) A dentist may advertise that the dentist is an endodontist, oral and maxillofacial pathologist, oral and maxillofacial surgeon, oral and maxillofacial radiologist, orthodontist and dentofacial orthopedist, pediatric dentist, periodontist, prosthodontist or dental public health dentist, only if the dentist is licensed or certified by the Board in the specialty in accordance with Board rules. a specialist in a practice area provided the dentist has completed a qualifying postdoctoral education program in that area. A qualifying postdoctoral education program is a postdoctoral advanced dental educational program accredited by an agency recognized by the United States Department of Education. (2) A dentist may advertise that the dentist specializes in or is a specialist in endodontics, oral and maxillofacial pathology, oral and maxillofacial surgery, oral and maxillofacial radiology, orthodontics and dentofacial orthopedics, pediatric dentistry, periodontics, prosthodontics or dental public health only if the dentist is licensed or certified by the Board in the specialty in accordance with Board rules. The Board shall consider the following criteria in determining a qualifying specialty board or organization: a) The organization requires completion of a training program with training, documentation, and clinical requirements similar in scope and complexity to a qualifying postdoctoral education program in the specialty or subspecialty field of dentistry in which the dentist seeks certification. Programs that require solely experiential training, continuing education classes, on-the-job training, or payment to the specialty board shall not constitute an equivalent specialty board; b) The organization requires all dentists seeking certification to pass a written or oral examination, or both, that tests the applicant’s knowledge and skill in the specialty or subspecialty area of dentistry and includes a psychometric evaluation for validation; c) The organization has written rules on maintenance of certification and requires periodic recertification; d) The organization has written bylaws and a code of ethics to guide the practice of its members; e) The organization has staff to respond to consumer and regulatory inquiries; and f) The organization is recognized by another entity whose primary purpose is to evaluate and assess dental specialty boards and organizations. (3) A dentist shall maintain documentation of either completion of a qualifying postdoctoral educational program or of his or her current specialty certification and provide the documentation to the Board upon request. Dentists shall maintain documentation demonstrating that the certifying board qualifies under the criteria in Subsection (2)(a)-(f) of this rule and provide the documentation to the Board upon request.
818-021-0015 Certification as a Specialist The Board may certify a dentist as a specialist if the dentist: (1) Holds a current Oregon dental license; (2) Is a diplomate of or a fellow in a specialty board accredited or recognized by the American Dental Association; or Has completed a qualifying postdoctoral education program in the area of specialty. A qualifying postdoctoral education program is May 24, 2019 Licensing, Standards and Competency Meeting Page 13 of 42
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a postdoctoral advanced dental educational program accredited by an agency recognized by the United States Department of Education. (3) Has completed a post-graduate program approved by the Commission on Dental Accreditation of the American Dental Association; or (43) Was qualified to Aadvertisement as a specialist is required to comply with under former OAR 818-0105-006107.
818-021-0017 Application to Practice as a Specialist (1) A dentist who wishes to practice as a specialist in Oregon, who does not have a current Oregon license, in addition to meeting the requirements set forth in ORS 679.060 and 679.065, shall submit to the Board satisfactory evidence of: (a) Having graduated from a school of dentistry accredited by the Commission on Dental Accreditation of the American Dental Association and active licensure as a general dentist in another state. Licensure as a general dentist must have been obtained as a result of the passage of any clinical Board examination administered by any state or regional testing agency; (b) Certification of having passed the dental examination administered by the Joint Commission on National Dental Examinations or Canadian National Dental Examining Board Examination; and (c) Proof of satisfactory completion of a post-graduate specialty program accredited by the Commission on Dental Accreditation of the American Dental Association postdoctoral education program in the area of specialty. A qualifying postdoctoral education program is a postdoctoral advanced dental educational program accredited by an agency recognized by the United States Department of Education. (2) A dentist who graduated from a dental school located outside the United States or Canada who wishes to practice as a specialist in Oregon, who does not have a current Oregon license, in addition to meeting the requirements set forth in ORS 679.060 and 679.065, shall submit to the Board satisfactory evidence of: (a) Completion of a post-graduate specialty program of not less than two years at a dental school accredited by the Commission on Dental Accreditation of the American Dental Association postdoctoral education program in the area of specialty. A qualifying postdoctoral education program is a postdoctoral advanced dental educational program of not less than two years accredited by an agency recognized by the United States Department of Education, proficiency in the English language, and evidence of active licensure as a general dentist in another state obtained as a result of the passage of any clinical Board examination administered by any state or regional testing agency; or (b) Completion of a post-graduate specialty program of not less than two years at a dental school accredited by the Commission on Dental Accreditation of the American Dental Association postdoctoral education program in the area of specialty. A qualifying postdoctoral education program is a postdoctoral advanced dental educational program of not less than two years accredited by an agency recognized by the United States Department of Education, proficiency in the English language and certification of having successfully passed the clinical examination administered by any state or regional testing agency within the five years immediately preceding application; and (c) Certification of having passed the dental examination administered by the Joint May 24, 2019 Licensing, Standards and Competency Meeting Page 14 of 42
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Commission on National Dental Examinations or Canadian National Dental Examining Board Examination; and (3) An applicant who meets the above requirements shall be issued a specialty license upon: (a) Passing a specialty examination approved by the Board within the five years immediately preceding application, or;. (b) Passing a specialty examination approved by the Board greater than five years prior to application, and; (A) Having conducted licensed clinical practice in the applicant’s postdoctoral dental specialty in Oregon, other states or in the Armed Forces of the United States, the United States Public Health Service or the United States Department of Veterans Affairs for a minimum of 3,500 hours in the five years immediately preceding application. Licensed clinical practice could include hours devoted to teaching the applicant’s dental specialty by dentists employed by a dental education program in a CODA-accredited dental school, with verification from the dean or appropriate administration of the institution documenting the length and terms of employment, the applicant's duties and responsibilities, the actual hours involved in teaching clinical dentistry in the specialty applicant is applying for, and any adverse actions or restrictions; and; (B) Having completed 40 hours of continuing education in accordance with the Board's continuing education requirements contained in these rules within the two years immediately preceding application, and; (bc) Passing the Board's jurisprudence examination. (4) Any applicant who does not pass the first examination for a specialty license may apply for a second and third regularly scheduled specialty examination. The applicable fee and application for the reexamination shall be submitted to the Board at least 45 days before the scheduled examination. If the applicant fails to pass the third examination for the practice of a recognized specialty, the applicant will not be permitted to retake the particular specialty examination until he/she has attended and successfully passed a remedial program prescribed by a dental school accredited by the Commission on Dental Accreditation of the American Dental Association and approved by the Board. (5) Licenses issued under this rule shall be limited to the practice of the specialty only.
The Committee reviewed and discussed splitting the hours so Licensees who wish to perform Botulinum Toxin Type A or dermal fillers are only required to take a course in the area they wish to perform. The Committee took no action.
A spelling error was noted in OAR 818-012-0005 by Dr. Julie Ann Smith and should be corrected in the rule.
818-012-0005 Scope of Practice (1) No dentist may perform any of the procedures listed below: (a) Rhinoplasty; (b) Blepharoplasty; (c) Rhydidectomy Rhytidectomy; (d) Submental liposuction; (e) Laser resurfacing; (f) Browlift, either open or endoscopic technique; May 24, 2019 Licensing, Standards and Competency Meeting Page 15 of 42
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(g) Platysmal muscle plication; (h) Otoplasty; (i) Dermabrasion; (j) Hair transplantation, not as an isolated procedure for male pattern baldness; and (k) Harvesting bone extra orally for dental procedures, including oral and maxillofacial procedures. (2) Unless the dentist: (a) Has successfully completed a residency in Oral and Maxillofacial Surgery accredited by the American Dental Association, Commission on Dental Accreditation (CODA), or (b) Holds privileges either: (A) Issued by a credentialing committee of a hospital accredited by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) to perform these procedures in a hospital setting; or (B) Issued by a credentialing committee for an ambulatory surgical center licensed by the State of Oregon and accredited by either the JCAHO or the Accreditation Association for Ambulatory Health Care (AAAHC). (3) A dentist may utilize Botulinum Toxin Type A and dermal fillers to treat a condition that is within the scope of the practice of dentistry after completing a minimum of 20 hours in a hands on clinical course(s), which includes both Botulinum Toxin Type A and dermal fillers, and the provider is approved by the Academy of General Dentistry Program Approval for Continuing Education (AGD PACE) or by the American Dental Association Continuing Education Recognition Program (ADA CERP).
Dr. Beck moved and Dr. Goin seconded that the Committee recommend that the Board move OAR 818-021-0010 as amended to the Rules Oversight Committee. The motion passed unanimously.
818-021-0010 Application for License to Practice Dentistry (1) An applicant to practice general dentistry, in addition to the requirements set forth in ORS 679.060 and 679.065, shall submit to the Board satisfactory evidence of: (a) Having graduated from a school of dentistry accredited by the Commission on Dental Accreditation of the American Dental Association; or (b) Having graduated from a dental school located outside the United States or Canada, completion of a predoctoral dental education program of not less than two years at a dental school accredited by the Commission on Dental Accreditation of the American Dental Association, and proficiency in the English language; and (c) Certification of having passed the dental examination administered by the Joint Commission on National Dental Examinations or Canadian National Dental Examining Board Examination. (2) An applicant who has not met the educational requirements for licensure may apply for examination if the Dean of an accredited school certifies the applicant will graduate. (3) An applicant must pass a Board examination consisting of a clinical portion administered by the Board, or any clinical Board examination administered by any state, or regional testing agency, national testing agency or other Board-recognized testing agency and a jurisprudence portion administered by the Board. Clinical examination results will be recognized by the Board for five years. (4) An applicant who passes the clinical portion but not the jurisprudence portion of the examination may retake the jurisprudence examination without limit on the number of May 24, 2019 Licensing, Standards and Competency Meeting Page 16 of 42
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times. The applicant must pass the jurisprudence portion within five years of passing the clinical portion or must retake the clinical examination. (54) A person who fails any Board approved clinical examination three times must successfully complete the remedial training recommended by the testing agency. Such remedial training must be conducted by a dental school accredited by the Commission on Dental Accreditation of the American Dental Association.
Ms. Riedman moved and Dr. Beck seconded that the Committee recommend that the Board move OAR 818-021-0011 as amended to the Rules Oversight Committee. The motion passed unanimously.
818-021-0011 Application for License to Practice Dentistry Without Further Examination (1) The Oregon Board of Dentistry may grant a license without further examination to a dentist who holds a license to practice dentistry in another state or states if the dentist meets the requirements set forth in ORS 679.060 and 679.065 and submits to the Board satisfactory evidence of: (a) Having graduated from a school of dentistry accredited by the Commission on Dental Accreditation of the American Dental Association; or (b) Having graduated from a dental school located outside the United States or Canada, completion of a predoctoral dental education program of not less than two years at a dental school accredited by the Commission on Dental Accreditation of the American Dental Association or completion of a postdoctoral General Dentistry Residency program of not less than two years at a dental school accredited by the Commission on Dental Accreditation of the American Dental Association, and proficiency in the English language; and (c) Having passed the dental clinical examination conducted by a regional testing agency, or by a state dental licensing authority, by a national testing agency or other Board-recognized testing agency; and (d) Holding an active license to practice dentistry, without restrictions, in any state; including documentation from the state dental board(s) or equivalent authority, that the applicant was issued a license to practice dentistry, without restrictions, and whether or not the licensee is, or has been, the subject of any final or pending disciplinary action; and (e) Having conducted licensed clinical practice in Oregon, other states or in the Armed Forces of the United States, the United States Public Health Service or the United States Department of Veterans Affairs for a minimum of 3,500 hours in the five years immediately preceding application. Licensed clinical practice could include hours devoted to teaching by dentists employed by a dental education program in a CODA accredited dental school, with verification from the dean or appropriate administration of the institution documenting the length and terms of employment, the applicant's duties and responsibilities, the actual hours involved in teaching clinical dentistry, and any adverse actions or restrictions; and (f) Having completed 40 hours of continuing education in accordance with the Board's continuing education requirements contained in these rules within the two years immediately preceding application. (2) Applicants must pass the Board's Jurisprudence Examination. (3) A dental license granted under this rule will be the same as the license held in another state; i.e., if the dentist holds a general dentistry license, the Oregon Board will May 24, 2019 Licensing, Standards and Competency Meeting Page 17 of 42
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issue a general (unlimited) dentistry license. If the dentist holds a license limited to the practice of a specialty, the Oregon Board will issue a license limited to the practice of that specialty. If the dentist holds more than one license, the Oregon Board will issue a dental license which is least restrictive.
The Committee reviewed and discussed correspondence from Dr. Bryan Williams who requests that the Board accept clinical residency hours count towards the 3,500 hours of licensed clinical practice to obtain Licensure Without Further Examination. Dr. Goin moved and Dr. Pham seconded the Committee’s recommendation that the Board accept clinical residency hours towards the 3,500 hours of licensed clinical practice for Licensure Without Further Examination.
The Committee reviewed and discussed correspondence from the American Board of Prosthodontics requesting that the Board accept their Board examination in addition to The Commission on Dental Competency Assessments (CDCA) for specialists who meet all other requirements for licensure in Oregon to obtain an Oregon license. Dr. Pham moved and Dr. Beck seconded the Committee’s recommendation that the Board accept all American Board recognized specialty examinations in addition to the CDCA’s examination for specialty licensure.
Dr. Beck moved and Dr. Goin seconded that the Committee recommend that the Board move OAR 818-021-0020 as proposed to the Rules Oversight Committee. The motion passed unanimously.
818-021-0020 Application for License to Practice Dental Hygiene (1) An applicant to practice dental hygiene, in addition to the requirements set forth in ORS 680.040 and 680.050, shall submit to the Board satisfactory evidence of: (a) Having graduated from a dental hygiene program accredited by the Commission on Dental Accreditation of the American Dental Association; or (b) Having graduated from a dental hygiene program located outside the United States or Canada, completion of not less than one year in a program accredited by the Commission on Dental Accreditation of the American Dental Association, and proficiency in the English language; and (c) Certification of having passed the dental hygiene examination administered by the Joint Commission on National Dental Examinations or the Canadian National Dental Hygiene Certificate Examination. (2) An applicant who has not met the educational requirements for licensure may apply if the Director of an accredited program certifies the applicant will graduate. (3) An applicant must pass a Board examination consisting of a clinical portion administered by the Board, or any clinical Board examination administered by any state, or regional testing agency, national testing agency or other Board-recognized testing agency and a jurisprudence portion administered by the Board. Clinical examination results will be recognized by the Board for five years. (4) An applicant who passes the clinical portion but not the jurisprudence portion of the examination may retake the jurisprudence examination without limit on the number of times. The applicant must pass the jurisprudence portion within five years of passing the clinical portion or must retake the clinical examination. (54) A person who fails any Board approved clinical examination three times must successfully complete the remedial training recommended by the testing agency. Such remedial training must be conducted by a dental hygiene program accredited by the May 24, 2019 Licensing, Standards and Competency Meeting Page 18 of 42
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Commission on Dental Accreditation of the American Dental Association.
Ms. Riedman moved and Dr. Beck seconded that the Committee recommend that the Board move OAR 818-021-0025 as amended to the Rules Oversight Committee. The motion passed unanimously.
818-021-0025 Application for License to Practice Dental Hygiene Without Further Examination (1) The Oregon Board of Dentistry may grant a license without further examination to a dental hygienist who holds a license to practice dental hygiene in another state or states if the dental hygienist meets the requirements set forth in ORS 680.040 and 680.050 and submits to the Board satisfactory evidence of: (a) Having graduated from a dental hygiene program accredited by the Commission on Dental Accreditation of the American Dental Association; or (b) Having graduated from a dental hygiene program located outside the United States or Canada, completion of not less than one year in a program accredited by the Commission on Dental Accreditation of the American Dental Association, and proficiency in the English language; and (c) Having passed the clinical dental hygiene examination conducted by a regional testing agency or by a state dental or dental hygiene licensing authority, by a national testing agency or other Board-recognized testing agency; and (d) Holding an active license to practice dental hygiene, without restrictions, in any state; including documentation from the state dental board(s) or equivalent authority, that the applicant was issued a license to practice dental hygiene, without restrictions, and whether or not the licensee is, or has been, the subject of any final or pending disciplinary action; and (e) Having conducted licensed clinical practice in Oregon, in other states or in the Armed Forces of the United States, the United States Public Health Service, the United States Department of Veterans Affairs for a minimum of 3,500 hours in the five years immediately preceding application. Licensed clinical practice could include hours devoted to teaching by dental hygienists employed by a CODA accredited dental hygiene program with verification from the dean or appropriate administration of the institution documenting the length and terms of employment, the applicant's duties and responsibilities, the actual hours involved in teaching clinical dental hygiene, and any adverse actions or restrictions; and (f) Having completed 24 hours of continuing education in accordance with the Board's continuing education requirements contained in these rules within the two years immediately preceding application. (2) Applicants must pass the Board's Jurisprudence Examination.
Dr. Pham moved and Ms. Riedman seconded that the Committee recommend that the Board move OAR 818-021-0060 as amended to the Rules Oversight Committee. The motion passed unanimously.
818-021-0060 Continuing Education — Dentists
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(1) Each dentist must complete 40 hours of continuing education every two years. Continuing education (C.E.) must be directly related to clinical patient care or the practice of dental public health. (2) Dentists must maintain records of successful completion of continuing education for at least four licensure years consistent with the licensee's licensure cycle. (A licensure year for dentists is April 1 through March 31.) The licensee, upon request by the Board, shall provide proof of successful completion of continuing education courses. (3) Continuing education includes: (a) Attendance at lectures, dental study groups, college post-graduate courses, or scientific sessions at conventions. (b) Research, graduate study, teaching or preparation and presentation of scientific sessions. No more than 12 hours may be in teaching or scientific sessions. (Scientific sessions are defined as scientific presentations, table clinics, poster sessions and lectures.) (c) Correspondence courses, videotapes, distance learning courses or similar self-study course, provided that the course includes an examination and the dentist passes the examination. (d) Continuing education credit can be given for volunteer pro bono dental services provided in the state of Oregon; community oral health instruction at a public health facility located in the state of Oregon; authorship of a publication, book, chapter of a book, article or paper published in a professional journal; participation on a state dental board, peer review, or quality of care review procedures; successful completion of the National Board Dental Examinations taken after initial licensure; a recognized specialty examination taken after initial licensure; or test development for clinical dental, dental hygiene or specialty examinations. No more than 6 hours of credit may be in these areas. (4) At least three hours of continuing education must be related to medical emergencies in a dental office. No more than four hours of Practice Management and Patient Relations may be counted toward the C.E. requirement in any renewal period. (5) All dentists licensed by the Oregon Board of Dentistry will complete a one-hour pain management course specific to Oregon provided by the Pain Management Commission of the Oregon Health Authority. All applicants or licensees shall complete this requirement by January 1, 2010 or within 24 months of the first renewal of the dentist's license. (6) At least 2 one (1) hours of continuing education must be related to infection control. (Effective January 1, 2015.) (7) At least one (1) hour of continuing education must be related to cultural competency.
Ms. Riedman moved and Dr. Goin seconded that the Committee recommend that the Board move OAR 818-021-0070 as proposed to the Rules Oversight Committee. The motion passed unanimously.
818-021-0070 Continuing Education — Dental Hygienists (1) Each dental hygienist must complete 24 hours of continuing education every two years. An Expanded Practice Permit Dental Hygienist shall complete a total of 36 hours of continuing education every two years. Continuing education (C.E.) must be directly related to clinical patient care or the practice of dental public health. May 24, 2019 Licensing, Standards and Competency Meeting Page 20 of 42
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(2) Dental hygienists must maintain records of successful completion of continuing education for at least four licensure years consistent with the licensee's licensure cycle. (A licensure year for dental hygienists is October 1 through September 30.) The licensee, upon request by the Board, shall provide proof of successful completion of continuing education courses. (3) Continuing education includes: (a) Attendance at lectures, dental study groups, college post-graduate courses, or scientific sessions at conventions. (b) Research, graduate study, teaching or preparation and presentation of scientific sessions. No more than six hours may be in teaching or scientific sessions. (Scientific sessions are defined as scientific presentations, table clinics, poster sessions and lectures.) (c) Correspondence courses, videotapes, distance learning courses or similar self-study course, provided that the course includes an examination and the dental hygienist passes the examination. (d) Continuing education credit can be given for volunteer pro bono dental hygiene services provided in the state of Oregon; community oral health instruction at a public health facility located in the state of Oregon; authorship of a publication, book, chapter of a book, article or paper published in a professional journal; participation on a state dental board, peer review, or quality of care review procedures; successful completion of the National Board Dental Hygiene Examination, taken after initial licensure; or test development for clinical dental hygiene examinations. No more than 6 hours of credit may be in these areas. (4) At least three hours of continuing education must be related to medical emergencies in a dental office. No more than two hours of Practice Management and Patient Relations may be counted toward the C.E. requirement in any renewal period. (5) Dental hygienists who hold a Nitrous Oxide Permit must meet the requirements contained in OAR 818-026-0040(1011) for renewal of the Nitrous Oxide Permit. (6) At least 2 one (1) hours of continuing education must be related to infection control. (Effective January 1, 2015.) (7) At least one (1) hour of continuing education must be related to cultural competency.
Dr. Beck moved and Dr. Pham seconded that the Committee recommend that the Board move OAR 818-021-0088 as proposed to the Rules Oversight Committee. The motion passed unanimously.
818-021-0088 - Volunteer License (1) An Oregon licensed dentist or dental hygienist who will be practicing for a supervised volunteer dental clinic, as defined in ORS 679.020(3)(f) and (g), may be granted a volunteer license provided licensee completes the following: (a) Licensee must register with the Board as a health care professional and provide a statement as required by ORS 676.345. (b) Licensee will be responsible to meet all the requirements set forth in ORS 676.345. (c) Licensee must provide the health care service without compensation. (d) Licensee shall not practice dentistry or dental hygiene for remuneration in any capacity under the volunteer license. (e) Licensee must comply with all continuing education requirements for active licensed dentist or dental hygienist. May 24, 2019 Licensing, Standards and Competency Meeting Page 21 of 42
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(f) Licensee must agree to volunteer for a minimum of 40 hours per calendar year 80 hours per renewal cycle. (2) Licensee may surrender the volunteer license designation at any time and request a return to an active license. The Board will grant an active license as long as all active license requirements have been met.
Dr. Beck moved and Mr. Dunn seconded that the Committee recommend that the Board move OAR 818-026-0030 as proposed to the Rules Oversight Committee. The motion passed unanimously.
Division 26 – Anesthesia 818-026-0030 – Requirement for Anesthesia Permit, Standards and Qualifications of an Anesthesia Monitor (1) A permit holder who administers sedation shall assure that drugs, drug dosages, and/or techniques used to produce sedation shall carry a margin of safety wide enough to prevent unintended deeper levels of sedation. (2) No licensee shall induce central nervous system sedation or general anesthesia without first having obtained a permit under these rules for the level of anesthesia being induced. (3) A licensee may be granted a permit to administer sedation or general anesthesia with documentation of training/education and/or competency in the permit category for which the licensee is applying by any one the following: (a) Initial training/education in the permit category for which the applicant is applying shall be completed no more than two years immediately prior to application for sedation or general anesthesia permit; or (b) If greater than two years but less than five years since completion of initial training/education, an applicant must document completion of all continuing education that would have been required for that anesthesia/permit category during that five year period following initial training; or (c) If greater than two years but less than five years since completion of initial training/education, immediately prior to application for sedation or general anesthesia permit, current competency or experience must be documented by completion of a comprehensive review course approved by the Board in the permit category to which the applicant is applying and must consist of at least one-half (50%) of the hours required by rule for Nitrous Oxide, Minimal Sedation, Moderate Sedation and General Anesthesia Permits. Deep Sedation and General Anesthesia Permits will require at least 120 hours of general anesthesia training. (d) An applicant for sedation or general anesthesia permit whose completion of initial training/education is greater than five years immediately prior to application, may be granted a sedation or general anesthesia permit by submitting documentation of the requested permit level from another state or jurisdiction where the applicant is also licensed to practice dentistry or dental hygiene, and provides documentation of the completion of at least 25 cases in the requested level of sedation or general anesthesia in the 12 months immediately preceding application; or (e) Demonstration of current competency to the satisfaction of the Board that the applicant possesses adequate sedation or general anesthesia skill to safely deliver sedation or general anesthesia services to the public. (4) Persons serving as anesthesia monitors in a dental office shall maintain current certification in Health Care Provider Basic Life Support (BLS)/Cardio Pulmonary May 24, 2019 Licensing, Standards and Competency Meeting Page 22 of 42
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Resuscitation (CPR) training, or its equivalent, shall be trained in monitoring patient vital signs, and be competent in the use of monitoring and emergency equipment appropriate for the level of sedation utilized. (The term "competent" as used in these rules means displaying special skill or knowledge derived from training and experience.) (4)(5) A licensee holding a nitrous or minimal sedation permit, shall at all times maintain a current BLS for Healthcare Care Providers certificate or its equivalent. (5)(6) A licensee holding an anesthesia permit for moderate sedation, deep sedation or general anesthesia at all times maintains a current BLS for Healthcare Care Providers certificate or its equivalent, and a current Advanced Cardiac Life Support (ACLS) Certificate or Pediatric Advanced Life Support (PALS) Certificate, whichever is appropriate for the patient being sedated. If a licensee permit holder sedates only patients under the age of 12, only PALS is required. If a licensee permit holder sedates only patients age 12 and older, only ACLS is required. If a licensee permit holder sedates patients younger than 12 years of age as well as older than 12 years of age, both ACLS and PALS are required. For licensees with a moderate sedation permit only, successful completion of the American Dental Association’s course “Recognition and Management of Complications during Minimal and Moderate Sedation” at least every two years may be substituted for ACLS, but not for PALS. (6)(7) Advanced Cardiac Life Support (ACLS) and or Pediatric Advanced Life Support (PALS) do not serve as a substitute for Health Ccare Provider Basic Life Support (BLS). (7) (8) When a dentist utilizes a single oral agent to achieve anxiolysis only, no anesthesia permit is required. (8) (9) The applicant for an anesthesia permit must pay the appropriate permit fee, submit a completed Board-approved application and consent to an office evaluation. (9) (10) Permits shall be issued to coincide with the applicant's licensing period.
Ms. Riedman moved and Dr. Beck seconded that the Committee recommend that the Board move OAR 818-026-0040 as amended to the Rules Oversight Committee. The motion passed unanimously.
818-026-0040 - Qualifications, Standards Applicable, and Continuing Education Requirements for Anesthesia Permits: Nitrous Oxide Permit Qualifications, Standards Applicable, and Continuing Education Requirements for Anesthesia Permits: Nitrous Oxide Permit Nitrous Oxide Sedation. (1) The Board shall issue a Nitrous Oxide Permit to an applicant who: (a) Is either a licensed dentist or licensed hygienist in the State of Oregon; (b) Maintains a current BLS for Healthcare Providers certificate or its equivalent; and (c) Has completed a training course of at least 14 hours of instruction in the use of nitrous oxide from a dental school or dental hygiene program accredited by the Commission on Dental Accreditation of the American Dental Association, or as a postgraduate. (2) The following facilities, equipment and drugs shall be on site and available for immediate use during the procedure and during recovery: (a) An operating room large enough to adequately accommodate the patient on an operating table or in an operating chair and to allow delivery of appropriate care in an emergency situation; (b) An operating table or chair which permits the patient to be positioned so that the patient's airway can be maintained, quickly alter the patient's position in an emergency, and provide a firm platform for the administration of basic life support; May 24, 2019 Licensing, Standards and Competency Meeting Page 23 of 42
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(c) A lighting system which permits evaluation of the patient's skin and mucosal color and a backup lighting system of sufficient intensity to permit completion of any operation underway in the event of a general power failure; (d) Suction equipment which permits aspiration of the oral and pharyngeal cavities and a backup suction device which will function in the event of a general power failure; (e) An oxygen delivery system with adequate full face masks and appropriate connectors that is capable of delivering high flow oxygen to the patient under positive pressure, together with an adequate backup system; (f) A nitrous oxide delivery system with a fail-safe mechanism that will insure appropriate continuous oxygen delivery and a scavenger system; and (g) Sphygmomanometer and stethoscope and/or automatic blood pressure cuff. (3) Before inducing nitrous oxide sedation, a permit holder shall: (a) Evaluate the patient; (b) Give instruction to the patient or, when appropriate due to age or psychological status of the patient, the patient's guardian; (c) Certify that the patient is an appropriate candidate for nitrous oxide sedation; and (d) Obtain informed consent from the patient or patient's guardian for the anesthesia. The obtaining of the informed consent shall be documented in the patient's record. (4) If a patient chronically takes a medication which can have sedative side effects, including, but not limited to, a narcotic or benzodiazepine, the practitioner shall determine if the additive sedative effect of nitrous oxide would put the patient into a level of sedation deeper than nitrous oxide. If the practitioner determines it is possible that providing nitrous oxide to such a patient would result in minimal sedation, a minimal sedation permit would be required. (5) A patient under nitrous oxide sedation shall be visually monitored by the permit holder or by an anesthesia monitor at all times. The patient shall be monitored as to response to verbal stimulation, oral mucosal color and preoperative and postoperative vital signs. (6) The permit holder or anesthesia monitor shall record the patient's condition. The record must include documentation of all medications administered with dosages, time intervals and route of administration. (7) Persons serving as anesthesia monitors for nitrous oxide in a dental office shall maintain current certification in BLS for Healthcare Providers Basic Life Support (BLS)/Cardio Pulmonary Resuscitation (CPR) training, or its equivalent, shall be trained and competent in monitoring patient vital signs, in the use of monitoring and emergency equipment appropriate for the level of sedation utilized. ("competent" means displaying special skill or knowledge derived from training and experience.) (8)(7) The person administering the nitrous oxide sedation may leave the immediate area after initiating the administration of nitrous oxide sedation only if a qualified anesthesia monitor is continuously observing the patient. (9)(8) The permit holder shall assess the patient's responsiveness using preoperative values as normal guidelines and discharge the patient only when the following criteria are met: (a) The patient is alert and oriented to person, place and time as appropriate to age and preoperative psychological status; (b) The patient can talk and respond coherently to verbal questioning; (c) The patient can sit up unaided or without assistance; (d) The patient can ambulate with minimal assistance; and (e) The patient does not have nausea, vomiting or dizziness. May 24, 2019 Licensing, Standards and Competency Meeting Page 24 of 42
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(10)(9) The permit holder shall make a discharge entry in the patient's record indicating the patient's condition upon discharge. (11)(10) Permit renewal. In order to renew a Nitrous Oxide Permit, the permit holder must provide proof of a current BLS for Healthcare Providers certificate or its equivalent. In addition, Nitrous Oxide Permit holders must also complete four (4) hours of continuing education in one or more of the following areas every two years: sedation, nitrous oxide, physical evaluation, medical emergencies, monitoring and the use of monitoring equipment, or pharmacology of drugs and agents used in sedation. Training taken to maintain current BLS for Healthcare Providers certificate or its equivalent, may not be counted toward this requirement. Continuing education hours may be counted toward fulfilling the continuing education requirement set forth in OAR 818-021-0060 and 818- 021-0070.
Dr. Goin moved and Dr. Beck seconded that the Committee recommend that the Board move OAR 818-026-0050 as amended to the Rules Oversight Committee. The motion passed unanimously.
818-026-0050 Minimal Sedation Permit Minimal sedation and nitrous oxide sedation. (1) The Board shall issue a Minimal Sedation Permit to an applicant who: (a) Is a licensed dentist in Oregon; (b) Maintains a current BLS for Healthcare Providers certificate or its equivalent; and (c) Completion of a comprehensive training program consisting of at least 16 hours of training and satisfies the requirements of the current ADA Guidelines for Teaching Pain Control and Sedation to Dentists and Dental Students at the time training was commenced or postgraduate instruction was completed, or the equivalent of that required in graduate training programs, in sedation, recognition and management of complications and emergency care; or (d) In lieu of these requirements, the Board may accept equivalent training or experience in minimal sedation anesthesia. (2) The following facilities, equipment and drugs shall be on site and available for immediate use during the procedures and during recovery: (a) An operating room large enough to adequately accommodate the patient on an operating table or in an operating chair and to allow an operating team of at least two individuals to freely move about the patient; (b) An operating table or chair which permits the patient to be positioned so the operating team can maintain the patient’s airway, quickly alter the patient’s position in an emergency, and provide a firm platform for the administration of basic life support; (c) A lighting system which permits evaluation of the patient’s skin and mucosal color and a backup lighting system of sufficient intensity to permit completion of any operation underway in the event of a general power failure; (d) Suction equipment which permits aspiration of the oral and pharyngeal cavities and a backup suction device which will function in the event of a general power failure; (e) An oxygen delivery system with adequate full facemask and appropriate connectors that is capable of delivering high flow oxygen to the patient under positive pressure, together with an adequate backup system; (f) A nitrous oxide delivery system with a fail-safe mechanism that will insure appropriate continuous oxygen delivery and a scavenger system; May 24, 2019 Licensing, Standards and Competency Meeting Page 25 of 42
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(g) Sphygmomanometer, stethoscope, pulse oximeter, and/or automatic blood pressure cuff; and (h) Emergency drugs including, but not limited to: pharmacologic antagonists appropriate to the drugs used, vasopressors, corticosteroids, bronchodilators, antihistamines, antihypertensives and anticonvulsants. (3) Before inducing minimal sedation, a dentist permit holder who induces minimal sedation shall: (a) Evaluate the patient and document, using the American Society of Anesthesiologists (ASA) Patient Physical Status Classifications, that the patient is an appropriate candidate for minimal sedation; (b) Give written preoperative and postoperative instructions to the patient or, when appropriate due to age or psychological status of the patient, the patient’s guardian; (c) Certify that the patient is an appropriate candidate for minimal sedation; and (d) Obtain written informed consent from the patient or patient’s guardian for the anesthesia. The obtaining of the informed consent shall be documented in the patient’s record. (4) No permit holder shall have more than one person under minimal sedation at the same time. (5) While the patient is being treated under minimal sedation, an anesthesia monitor shall be present in the room in addition to the treatment provider. The anesthesia monitor may be the dental assistant. After training, a dental assistant, when directed by a dentist permit holder, may administer oral sedative agents or anxiolysis agents calculated and dispensed by a dentist permit holder under the direct supervision of a dentist permit holder. (6) A patient under minimal sedation shall be visually monitored at all times, including recovery phase. The record must include documentation of all medications administered with dosages, time intervals and route of administration. The dentist permit holder or anesthesia monitor shall monitor and record the patient’s condition. (7) Persons serving as anesthesia monitors for minimal sedation in a dental office shall maintain current certification in BLS for Healthcare Providers Basic Life Support (BLS)/Cardio Pulmonary Resuscitation (CPR) training, or its equivalent, shall be trained and competent in monitoring patient vital signs, in the use of monitoring and emergency equipment appropriate for the level of sedation utilized. ("competent" means displaying special skill or knowledge derived from training and experience.) (8)(7) The patient shall be monitored as follows: (a) Color of mucosa, skin or blood must be evaluated continually. Patients must have continuous monitoring using pulse oximetry. The patient’s response to verbal stimuli, blood pressure, heart rate, pulse oximetry and respiration shall be monitored and documented every fifteen minutes, if they can reasonably be obtained. (b) A discharge entry shall be made by the dentist permit holder in the patient’s record indicating the patient’s condition upon discharge and the name of the responsible party to whom the patient was discharged. (9)(8) The dentist permit holder shall assess the patient’s responsiveness using preoperative values as normal guidelines and discharge the patient only when the following criteria are met: (a) Vital signs including blood pressure, pulse rate and respiratory rate are stable; (b) The patient is alert and oriented to person, place and time as appropriate to age and preoperative psychological status; (c) The patient can talk and respond coherently to verbal questioning; May 24, 2019 Licensing, Standards and Competency Meeting Page 26 of 42
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(d) The patient can sit up unaided; (e) The patient can ambulate with minimal assistance; and (f) The patient does not have uncontrollable nausea or vomiting and has minimal dizziness. (g) A dentist permit holder shall not release a patient who has undergone minimal sedation except to the care of a responsible third party. (10)(9) Permit renewal. In order to renew a Minimal Sedation Permit, the permit holder must provide documentation of a current BLS for Healthcare Providers certificate or its equivalent. In addition, Minimal Sedation Permit holders must also complete four (4) hours of continuing education in one or more of the following areas every two years: sedation, physical evaluation, medical emergencies, monitoring and the use of monitoring equipment, or pharmacology of drugs and agents used in sedation. Training taken to maintain current BLS for Healthcare Providers certificate, or its equivalent, may not be counted toward this requirement. Continuing education hours may be counted toward fulfilling the continuing education requirement set forth in OAR 818-021-0060.
Dr. Pham moved and Dr. Beck seconded that the Committee recommend that the Board move OAR 818-026-0055 as proposed to the Rules Oversight Committee. The motion passed unanimously.
818-026-0055 Dental Hygiene and Dental Assistant Procedures Performed Under Nitrous Oxide or Minimal Sedation 1) Under indirect supervision, dental hygiene procedures may be performed for a patient who is under nitrous oxide or minimal sedation under the following conditions: (a) A licensee holding a Nitrous Oxide, Minimal, Moderate, Deep Sedation or General Anesthesia Permit administers the sedative agents; (b) The permit holder, or an anesthesia monitor, monitors the patient; or (c) if a dental hygienist with a nitrous oxide permit administers nitrous oxide sedation to a patient and then performs authorized procedures on the patient, an anesthesia monitor is not required to be present during the time the patient is sedated unless the permit holder leaves the patient. (d) The permit holder performs the appropriate pre- and post-operative evaluation and discharges the patient in accordance with 818-026-0050(7) and (8). (2) Under indirect supervision, a dental assistant may perform those procedures for which the dental assistant holds the appropriate certification for a patient who is under nitrous oxide or minimal sedation under the following conditions: (a) A licensee holding the Nitrous Oxide, Minimal, Moderate, Deep Sedation or General Anesthesia Permit administers the sedative agents; (b) The permit holder, or an anesthesia monitor, monitors the patient; and (c) The permit holder performs the appropriate pre- and post-operative evaluation and discharges the patient in accordance with 818-026-0050(7) and (8).
Dr. Pham moved and Dr. Beck seconded that the Committee recommend that the Board move OAR 818-026-0060 as amended to the Rules Oversight Committee. The motion passed unanimously.
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818-026-0060 Moderate Sedation Permit Moderate sedation, minimal sedation, and nitrous oxide sedation. (1) The Board shall issue or renew a Moderate Sedation Permit to an applicant who: (a) Is a licensed dentist in Oregon; (b) In addition to a current BLS for Healthcare Providers certificate or its equivalent, either maintains a current Advanced Cardiac Life Support (ACLS) certificate and/or a Pediatric Advanced Life Support (PALS) certificate, whichever is appropriate for the patient being sedated; and (c) Satisfies one of the following criteria: (A) Completion of a comprehensive training program in enteral and/or parenteral sedation that satisfies the requirements described in Part V of the current ADA Guidelines for Teaching Pain Control and Sedation to Dentists and Dental Students at the time training was commenced. (i) Enteral Moderate Sedation requires a minimum of 24 hours of instruction plus management of at least 10 dental patient experiences by the enteral and/or enteral-nitrous oxide/oxygen route. (ii) Parenteral Moderate Sedation requires a minimum of 60 hours of instruction plus management of at least 20 dental patients by the intravenous route. (B) Completion of an ADA accredited postdoctoral training program (e.g., general practice residency) which affords comprehensive and appropriate training necessary to administer and manage parenteral sedation, commensurate with these Guidelines. (C) In lieu of these requirements, the Board may accept equivalent training or experience in moderate sedation anesthesia. (2) The following facilities, equipment and drugs shall be on site and available for immediate use during the procedures and during recovery: (a) An operating room large enough to adequately accommodate the patient on an operating table or in an operating chair and to allow an operating team of at least two individuals to freely move about the patient; (b) An operating table or chair which permits the patient to be positioned so the operating team can maintain the patient's airway, quickly alter the patient's position in an emergency, and provide a firm platform for the administration of basic life support; (c) A lighting system which permits evaluation of the patient's skin and mucosal color and a backup lighting system of sufficient intensity to permit completion of any operation underway in the event of a general power failure; (d) Suction equipment which permits aspiration of the oral and pharyngeal cavities and a backup suction device which will function in the event of a general power failure; (e) An oxygen delivery system with adequate full face mask and appropriate connectors that is capable of delivering high flow oxygen to the patient under positive pressure, together with an adequate backup system; (f) A nitrous oxide delivery system with a fail-safe mechanism that will insure appropriate continuous oxygen delivery and a scavenger system; (g) A recovery area that has available oxygen, adequate lighting, suction and electrical outlets. The recovery area can be the operating room; (h) Sphygmomanometer, precordial/pretracheal stethoscope, capnograph, pulse oximeter, oral and nasopharyngeal airways, larynageal mask airways, intravenous fluid administration equipment, automated external defibrillator (AED); and
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(i) Emergency drugs including, but not limited to: pharmacologic antagonists appropriate to the drugs used, vasopressors, corticosteroids, bronchodilators, antihistamines, antihypertensives and anticonvulsants. (3) No permit holder shall have more than one person under moderate sedation, minimal sedation, or nitrous oxide sedation at the same time. (4) During the administration of moderate sedation, and at all times while the patient is under moderate sedation, an anesthesia monitor, and one other person holding a current BLS for Healthcare Providers certificate or its equivalent, shall be present in the operatory, in addition to the dentist permit holder performing the dental procedures. (5) Before inducing moderate sedation, a dentist permit holder who induces moderate sedation shall: (a) Evaluate the patient and document, using the American Society of Anesthesiologists (ASA) Patient Physical Status Classifications, that the patient is an appropriate candidate for moderate sedation; (b) Give written preoperative and postoperative instructions to the patient or, when appropriate due to age or psychological status of the patient, the patient's guardian; and (c) Obtain written informed consent from the patient or patient's guardian for the anesthesia. The obtaining of the informed consent shall be documented in the patient’s record. (6) A patient under moderate sedation shall be visually monitored at all times, including the recovery phase. The dentist permit holder or anesthesia monitor shall monitor and record the patient's condition. (7) Persons serving as anesthesia monitors for moderate sedation in a dental office shall maintain current certification in BLS for Healthcare Providers Basic Life Support (BLS)/Cardio Pulmonary Resuscitation (CPR) training, or its equivalent, shall be trained and competent in monitoring patient vital signs, in the use of monitoring and emergency equipment appropriate for the level of sedation utilized. ("competent" means displaying special skill or knowledge derived from training and experience.) (8)(7) The patient shall be monitored as follows: (a) Patients must have continuous monitoring using pulse oximetry, and End-tidal CO2 monitors. Patients with cardiovascular disease shall have continuous electrocardiograph (ECG) monitoring. The patient's blood pressure, heart rate, and respiration shall be recorded at regular intervals but at least every 15 minutes, and these recordings shall be documented in the patient record. The record must also include documentation of preoperative and postoperative vital signs, all medications administered with dosages, time intervals and route of administration. If this information cannot be obtained, the reasons shall be documented in the patient's record. A patient under moderate sedation shall be continuously monitored and shall not be left alone while under sedation; (b) During the recovery phase, the patient must be monitored by an individual trained to monitor patients recovering from moderate sedation. (9)(8) A dentist permit holder shall not release a patient who has undergone moderate sedation except to the care of a responsible third party. (a) When a reversal agent is administered, the dentist permit holder shall document justification for its use and how the recovery plan was altered. (10)(9) The dentist permit holder shall assess the patient's responsiveness using preoperative values as normal guidelines and discharge the patient only when the following criteria are met: (a) Vital signs including blood pressure, pulse rate and respiratory rate are stable; May 24, 2019 Licensing, Standards and Competency Meeting Page 29 of 42
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(b) The patient is alert and oriented to person, place and time as appropriate to age and preoperative psychological status; (c) The patient can talk and respond coherently to verbal questioning; (d) The patient can sit up unaided; (e) The patient can ambulate with minimal assistance; and (f) The patient does not have uncontrollable nausea or vomiting and has minimal dizziness. (11)(10) A discharge entry shall be made by the dentist permit holder in the patient's record indicating the patient's condition upon discharge and the name of the responsible party to whom the patient was discharged. (12)(11) After adequate training, an assistant, when directed by a dentist permit holder, may dispense oral medications that have been prepared by the dentist permit holder for oral administration to a patient under direct supervision. Pursuant to OAR 818-042-0115 a Certified Anesthesia Dental Assistant, when directed by a dentist permit holder, may introduce additional anesthetic agents into an infusion line under the direct supervision of a dentist permit holder. (13)(12) Permit renewal. In order to renew a Moderate Sedation Permit, the permit holder must provide documentation of a current BLS for Healthcare Providers certificate or its equivalent; a current Advanced Cardiac Life Support (ACLS) certificate and/or a current Pediatric Advanced Life Support (PALS) certificate; Successful completion of a board approved course on minimal/moderate sedation at least every two years may be substituted for ACLS, but not for PALS; and must complete 14 hours of continuing education in one or more of the following areas every two years: sedation, physical evaluation, medical emergencies, monitoring and the use of monitoring equipment, or pharmacology of drugs and agents used in sedation. Training taken to maintain current ACLS or PALS certification or successful completion of the American Dental Association’s course “Recognition and Management of Complications during Minimal and Moderate Sedation” may be counted toward this requirement. Continuing education hours may be counted toward fulfilling the continuing education requirement set forth in OAR 818-021- 0060.
Dr. Pham moved and Dr. Beck seconded that the Committee recommend that the Board move OAR 818-026-0065 as amended to the Rules Oversight Committee. The motion passed unanimously.
818-026-0065 Deep Sedation Permit Deep sedation, moderate sedation, minimal sedation, and nitrous oxide sedation. (1) The Board shall issue a Deep Sedation Permit to a licensee who holds a Class 3 Permit on or before July 1, 2010 who: (a) Is a licensed dentist in Oregon; and (b) In addition to a current BLS for Healthcare Providers certificate or its equivalent, maintains a current Advanced Cardiac Life Support (ACLS) certificate and/or a Pediatric Advanced Life Support (PALS) certificate, whichever is appropriate for the patient being sedated. (2) The following facilities, equipment and drugs shall be on site and available for immediate use during the procedures and during recovery:
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(a) An operating room large enough to adequately accommodate the patient on an operating table or in an operating chair and to allow an operating team of at least two individuals to freely move about the patient; (b) An operating table or chair which permits the patient to be positioned so the operating team can maintain the patient's airway, quickly alter the patient's position in an emergency, and provide a firm platform for the administration of basic life support; (c) A lighting system which permits evaluation of the patient's skin and mucosal color and a backup lighting system of sufficient intensity to permit completion of any operation underway in the event of a general power failure; (d) Suction equipment which permits aspiration of the oral and pharyngeal cavities and a backup suction device which will function in the event of a general power failure; (e) An oxygen delivery system with adequate full face mask and appropriate connectors that is capable of delivering high flow oxygen to the patient under positive pressure, together with an adequate backup system; (f) A nitrous oxide delivery system with a fail-safe mechanism that will insure appropriate continuous oxygen delivery and a scavenger system; (g) A recovery area that has available oxygen, adequate lighting, suction and electrical outlets. The recovery area can be the operating room; (h) Sphygmomanometer, precordial/pretracheal stethoscope, capnograph, pulse oximeter, electrocardiograph monitor (ECG), automated external defibrillator (AED), oral and nasopharyngeal airways, laryngeal mask airways, intravenous fluid administration equipment; and (i) Emergency drugs including, but not limited to: pharmacologic antagonists appropriate to the drugs used, vasopressors, corticosteroids, bronchodilators, antihistamines, antihypertensives and anticonvulsants. (3) No permit holder shall have more than one person under deep sedation, moderate sedation, minimal sedation, or nitrous oxide sedation at the same time. (4) During the administration of deep sedation, and at all times while the patient is under deep sedation, an anesthesia monitor, and one other person holding a current BLS for Healthcare Providers certificate or its equivalent, shall be present in the operatory, in addition to the dentist permit holder performing the dental procedures. (5) Before inducing deep sedation, a dentist permit holder who induces deep sedation shall: (a) Evaluate the patient and document, using the American Society of Anesthesiologists (ASA) Patient Physical Status Classifications, that the patient is an appropriate candidate for deep sedation; (b) Give written preoperative and postoperative instructions to the patient or, when appropriate due to age or psychological status of the patient, the patient's guardian; and (c) Obtain written informed consent from the patient or patient's guardian for the anesthesia. The obtaining of the informed consent shall be documented in the patient’s record. (6) A patient under deep sedation shall be visually monitored at all times, including the recovery phase. The dentist permit holder or anesthesia monitor shall monitor and record the patient's condition. (7 Persons serving as anesthesia monitors for deep sedation in a dental office shall maintain current certification in BLS for Healthcare Providers Basic Life Support (BLS)/Cardio Pulmonary Resuscitation (CPR) training, or its equivalent, shall be trained and competent in monitoring patient vital signs, in the use of monitoring and emergency equipment appropriate for the level of sedation utilized. May 24, 2019 Licensing, Standards and Competency Meeting Page 31 of 42
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("competent" means displaying special skill or knowledge derived from training and experience.) (8)(7) The patient shall be monitored as follows: (a) Patients must have continuous monitoring using pulse oximetry, electrocardiograph monitors (ECG) and End-tidal CO2 monitors. The patient's heart rhythm shall be continuously monitored and the patient’s blood pressure, heart rate, and respiration shall be recorded at regular intervals but at least every 5 minutes, and these recordings shall be documented in the patient record. The record must also include documentation of preoperative and postoperative vital signs, all medications administered with dosages, time intervals and route of administration. If this information cannot be obtained, the reasons shall be documented in the patient's record. A patient under deep sedation shall be continuously monitored; (b) Once sedated, a patient shall remain in the operatory for the duration of treatment until criteria for transportation to recovery have been met. (c) During the recovery phase, the patient must be monitored by an individual trained to monitor patients recovering from deep sedation. (9)(8) A dentist permit holder shall not release a patient who has undergone deep sedation except to the care of a responsible third party. When a reversal agent is administered, the dentist permit holder shall document justification for its use and how the recovery plan was altered. (10)(9) The dentist permit holder shall assess the patient's responsiveness using preoperative values as normal guidelines and discharge the patient only when the following criteria are met: (a) Vital signs including blood pressure, pulse rate and respiratory rate are stable; (b) The patient is alert and oriented to person, place and time as appropriate to age and preoperative psychological status; (c) The patient can talk and respond coherently to verbal questioning; (d) The patient can sit up unaided; (e) The patient can ambulate with minimal assistance; and (f) The patient does not have uncontrollable nausea or vomiting and has minimal dizziness. (11)(10) A discharge entry shall be made by the dentist permit holder in the patient's record indicating the patient's condition upon discharge and the name of the responsible party to whom the patient was discharged. (12)(11) Pursuant to OAR 818-042-0115 a Certified Anesthesia Dental Assistant, when directed by a dentist permit holder, may administer oral sedative agents calculated by a dentist permit holder or introduce additional anesthetic agents into an infusion line under the direct visual supervision of a dentist (13)(12) Permit renewal. In order to renew a Deep Sedation Permit, the permit holder must provide documentation of a current BLS for Healthcare Providers certificate or its equivalent; a current Advanced Cardiac Life Support (ACLS) certificate and/or a current Pediatric Advanced Life Support (PALS) certificate; and must complete 14 hours of continuing education in one or more of the following areas every two years: sedation, physical evaluation, medical emergencies, monitoring and the use of monitoring equipment, or pharmacology of drugs and agents used in sedation. Training taken to maintain current ACLS and/or PALS certificates may be counted toward this requirement. Continuing education hours may be counted toward fulfilling the continuing education requirement set forth in OAR 818-021-0060.
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Dr. Pham moved and Dr. Beck seconded that the Committee recommend that the Board move OAR 818-026-0070 as amended to the Rules Oversight Committee. The motion passed unanimously.
818-026-0070 General Anesthesia Permit General anesthesia, deep sedation, moderate sedation, minimal sedation and nitrous oxide sedation. (1) The Board shall issue a General Anesthesia Permit to an applicant who: (a) Is a licensed dentist in Oregon; (b) In addition to a current BLS for Healthcare Providers certificate or its equivalent, maintains a current Advanced Cardiac Life Support (ACLS) certificate and/or a Pediatric Advanced Life Support (PALS) certificate, whichever is appropriate for the patient being sedated, and (c) Satisfies one of the following criteria: (A) Completion of an advanced training program in anesthesia and related subjects beyond the undergraduate dental curriculum that satisfies the requirements described in the current ADA Guidelines for Teaching Pain Control and Sedation to Dentists and Dental Students consisting of a minimum of 2 years of a postgraduate anesthesia residency at the time training was commenced. (B) Completion of any ADA accredited postdoctoral training program, including but not limited to Oral and Maxillofacial Surgery, which affords comprehensive and appropriate training necessary to administer and manage general anesthesia, commensurate with these Guidelines. (C) In lieu of these requirements, the Board may accept equivalent training or experience in general anesthesia. (2) The following facilities, equipment and drugs shall be on site and available for immediate use during the procedure and during recovery: (a) An operating room large enough to adequately accommodate the patient on an operating table or in an operating chair and to allow an operating team of at least three individuals to freely move about the patient; (b) An operating table or chair which permits the patient to be positioned so the operating team can maintain the patient's airway, quickly alter the patient's position in an emergency, and provide a firm platform for the administration of basic life support; (c) A lighting system which permits evaluation of the patient's skin and mucosal color and a backup lighting system of sufficient intensity to permit completion of any operation underway in the event of a general power failure; (d) Suction equipment which permits aspiration of the oral and pharyngeal cavities and a backup suction device which will function in the event of a general power failure; (e) An oxygen delivery system with adequate full face mask and appropriate connectors that is capable of delivering high flow oxygen to the patient under positive pressure, together with an adequate backup system; (f) A nitrous oxide delivery system with a fail-safe mechanism that will insure appropriate continuous oxygen delivery and a scavenger system; (g) A recovery area that has available oxygen, adequate lighting, suction and electrical outlets. The recovery area can be the operating room; (h) Sphygmomanometer, precordial/pretracheal stethoscope, capnograph, pulse oximeter, electrocardiograph monitor (ECG), automated external defibrillator (AED), oral
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and nasopharyngeal airways, laryngeal mask airways, intravenous fluid administration equipment; and (i) Emergency drugs including, but not limited to: pharmacologic antagonists appropriate to the drugs used, vasopressors, corticosteroids, bronchodilators, intravenous medications for treatment of cardiac arrest, narcotic antagonist, antihistaminic, antiarrhythmics, antihypertensives and anticonvulsants. (3) No permit holder shall have more than one person under general anesthesia, deep sedation, moderate sedation, minimal sedation or nitrous oxide sedation at the same time. (4) During the administration of deep sedation or general anesthesia, and at all times while the patient is under deep sedation or general anesthesia, an anesthesia monitor, and one other person holding a current BLS for Healthcare Providers certificate or its equivalent, shall be present in the operatory in addition to the dentist permit holder performing the dental procedures. (5) Before inducing deep sedation or general anesthesia the dentist permit holder who induces deep sedation or general anesthesia shall: (a) Evaluate the patient and document, using the American Society of Anesthesiologists (ASA) Patient Physical Status Classifications, that the patient is an appropriate candidate for general anesthesia or deep sedation; (b) Give written preoperative and postoperative instructions to the patient or, when appropriate due to age or psychological status of the patient, the patient's guardian; and (c) Obtain written informed consent from the patient or patient's guardian for the anesthesia. The obtaining of the informed consent shall be documented in the patient’s record. (6) A patient under deep sedation or general anesthesia shall be visually monitored at all times, including recovery phase. A dentist permit holder who induces deep sedation or general anesthesia or anesthesia monitor trained in monitoring patients under deep sedation or general anesthesia shall monitor and record the patient's condition on a contemporaneous record. (7) Persons serving as anesthesia monitors for general anesthesia in a dental office shall maintain current certification in BLS for Healthcare Providers Basic Life Support (BLS)/Cardio Pulmonary Resuscitation (CPR) training, or its equivalent, shall be trained and competent in monitoring patient vital signs, in the use of monitoring and emergency equipment appropriate for the level of sedation utilized. ("competent" means displaying special skill or knowledge derived from training and experience.) (8)(7) The patient shall be monitored as follows: (a) Patients must have continuous monitoring of their heart rate, heart rhythm, oxygen saturation levels and respiration using pulse oximetry, electrocardiograph monitors (ECG) and End-tidal CO2 monitors. The patient's blood pressure, heart rate and oxygen saturation shall be assessed every five minutes, and shall be contemporaneously documented in the patient record. The record must also include documentation of preoperative and postoperative vital signs, all medications administered with dosages, time intervals and route of administration. The person administering the anesthesia and the person monitoring the patient may not leave the patient while the patient is under deep sedation or general anesthesia; (b) Once sedated, a patient shall remain in the operatory for the duration of treatment until criteria for transportation to recovery have been met. (c) During the recovery phase, the patient must be monitored, including the use of pulse oximetry, by an individual trained to monitor patients recovering from general anesthesia. May 24, 2019 Licensing, Standards and Competency Meeting Page 34 of 42
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(9)(8) A dentist permit holder shall not release a patient who has undergone deep sedation or general anesthesia except to the care of a responsible third party. When a reversal agent is administered, the dentist permit holder shall document justification for its use and how the recovery plan was altered. (10)(9) The dentist permit holder shall assess the patient's responsiveness using preoperative values as normal guidelines and discharge the patient only when the following criteria are met: (a) Vital signs including blood pressure, pulse rate and respiratory rate are stable; (b) The patient is alert and oriented to person, place and time as appropriate to age and preoperative psychological status; (c) The patient can talk and respond coherently to verbal questioning; (d) The patient can sit up unaided; (e) The patient can ambulate with minimal assistance; and (f) The patient does not have nausea or vomiting and has minimal dizziness. (11)(10) A discharge entry shall be made in the patient's record by the dentist permit holder indicating the patient's condition upon discharge and the name of the responsible party to whom the patient was discharged. (12)(11) Pursuant to OAR 818-042-0115 a Certified Anesthesia Dental Assistant, when directed by a dentist permit holder, may introduce additional anesthetic agents to an infusion line under the direct visual supervision of a dentist permit holder. (13)(12) Permit renewal. In order to renew a General Anesthesia Permit, the permit holder must provide documentation of a current BLS for Healthcare Providers certificate or its equivalent; a current Advanced Cardiac Life Support (ACLS) certificate and/or a current Pediatric Advanced Life Support (PALS) certificate; and must complete 14 hours of continuing education in one or more of the following areas every two years: sedation, physical evaluation, medical emergencies, monitoring and the use of monitoring equipment, or pharmacology of drugs and agents used in sedation. Training taken to maintain current ACLS and/or PALS certificates may be counted toward this requirement. Continuing education hours may be counted toward fulfilling the continuing education requirement set forth in OAR 818-021-0060.
The Committee recommends the Board refer back to the Anesthesia Committee for further clarification on defining anesthesia monitors for OAR 818-026-0060, OAR 818-026-0065 and OAR 818-026-0070.
Dr. Pham moved and Dr. Goin seconded that the Committee recommend that the Board move OAR 818-026-0080 as proposed to the Rules Oversight Committee. The motion passed unanimously.
818-026-0080 Standards Applicable When a Dentist Performs Dental Procedures and a Qualified Provider Induces Anesthesia (1) A dentist who does not hold an anesthesia permit may perform dental procedures on a patient who receives anesthesia induced by a physician anesthesiologist licensed by the Oregon Board of Medical Examiners, another Oregon licensed dentist holding an appropriate anesthesia permit, or a Certified Registered Nurse Anesthetist (CRNA) licensed by the Oregon Board of Nursing.
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(2) A dentist who does not hold a Nitrous Oxide Permit for nitrous oxide sedation may perform dental procedures on a patient who receives nitrous oxide induced by an Oregon licensed dental hygienist holding a Nitrous Oxide Permit. (3) A dentist who performs dental procedures on a patient who receives anesthesia induced by a physician anesthesiologist, another dentist holding an anesthesia permit, a CRNA, or a dental hygienist who induces nitrous oxide sedation, shall maintain a current BLS for Healthcare Providers certificate, or its equivalent, and have the same personnel, facilities, equipment and drugs available during the procedure and during recovery as required of a dentist who has a permit for the level of anesthesia being provided. (4) A dentist, a dental hygienist or an Expanded Function Dental Assistant (EFDA) who performs procedures on a patient who is receiving anesthesia induced by a physician anesthesiologist, another dentist holding an anesthesia permit or a CRNA shall not schedule or treat patients for non emergent care during the period of time of the sedation procedure. (5) Once anesthetized, a patient shall remain in the operatory for the duration of treatment until criteria for transportation to recovery have been met. (6) The qualified anesthesia provider who induces moderate sedation, deep sedation or general anesthesia shall monitor the patient’s condition the patient is discharged until easily arousable and can independently and continuously maintain their airway with stable vital signs. Once this has occurred the patient may be monitored by a qualified anesthesia monitor until discharge criteria is met. The patient’s dental record shall document the patient's condition at discharge in the patient's dental record as required by the rules applicable to the level of anesthesia being induced. The A copy of the anesthesia record shall be maintained in the patient's dental record and is the responsibility of the dentist who is performing the dental procedures. (7) No qualified provider shall have more than one person under any form of sedation or general anesthesia at the same time exclusive of recovery. (8)(7) A dentist who intends to use the services of a qualified anesthesia provider as described in section 1 above, shall notify the Board in writing of his/her intent. Such notification need only be submitted once every licensing period.
The Committee reviewed and discussed correspondence from Ms. Gonzales regarding if it was permissible for dental hygienist to administer silver nitrate as an antimicrobial. The Committee reviewed OAR 818-035-0025 Prohibitions and OAR 818-035-0030 Additional Functions of Dental Hygienists and determined under current rules dental hygienists can prescribe, administer and dispense antimicrobials. No action was taken.
The Committee reviewed and discussed correspondence from Ms. DeMallie regarding if it was permissible for dental hygienist to take final impressions for supplying artificial teeth as substitutes for natural teeth. The Committee reviewed 818-035-0025 Prohibitions and determined under current rules dental hygienists can take final impressions. No action was taken
818-035-0025 Prohibitions A dental hygienist may not: (1) Diagnose and treatment plan other than for dental hygiene services; (2) Cut hard or soft tissue with the exception of root planing; May 24, 2019 Licensing, Standards and Competency Meeting Page 36 of 42
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(3) Extract any tooth; (4) Fit or adjust any correctional or prosthetic appliance except as provided by OAR 818- 035-0030(1)(h); (5) Prescribe, administer or dispense any drugs except as provided by OAR 818-035- 0030, 818-035- 0040, 818-026-0060(11) and 818-026-0070(11); (6) Place, condense, carve or cement permanent restorations except as provided in OAR 818-035-0072, or operatively prepare teeth; (7) Irrigate or medicate canals; try in cones, or ream, file or fill canals; (8) Use the behavior management techniques of Hand Over Mouth (HOM) or Hand Over Mouth Airway Restriction (HOMAR) on any patient. (9) Place or remove healing caps or healing abutments, except under direct supervision. (10) Place implant impression copings, except under direct supervision.
818-035-0030 Additional Functions of Dental Hygienists (1) In addition to functions set forth in ORS 679.010, a dental hygienist may perform the following functions under the general supervision of a licensed dentist: (a) Make preliminary intra-oral and extra-oral examinations and record findings; (b) Place periodontal dressings; (c) Remove periodontal dressings or direct a dental assistant to remove periodontal dressings; (d) Perform all functions delegable to dental assistants and expanded function dental assistants providing that the dental hygienist is appropriately trained; (e) Administer and dispense antimicrobial solutions or other antimicrobial agents in the performance of dental hygiene functions. (f) Prescribe, administer and dispense fluoride, fluoride varnish, antimicrobial solutions for mouth rinsing or other non-systemic antimicrobial agents. (g) Use high-speed handpieces to polish restorations and to remove cement and adhesive material. (h) Apply temporary soft relines to complete dentures for the purpose of tissue conditioning. (i) Perform all aspects of teeth whitening procedures. (2) A dental hygienist may perform the following functions at the locations and for the persons described in ORS 680.205(1) and (2) without the supervision of a dentist: (a) Determine the need for and appropriateness of sealants or fluoride; and (b) Apply sealants or fluoride.
Dr. Beck moved and Dr. Pham seconded that the Committee recommend that the Board move OAR 818-042-0040 as amended to the Rules Oversight Committee. The motion passed unanimously.
818-042-0040 Prohibited Acts No licensee may authorize any dental assistant to perform the following acts: (1) Diagnose or plan treatment. (2) Cut hard or soft tissue. (3) Any Expanded Function duty (OAR 818-042-0070 and OAR 818-042-0090) or May 24, 2019 Licensing, Standards and Competency Meeting Page 37 of 42
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Expanded Orthodontic Function duty (OAR 818-042-0100) or Restorative Functions (OAR 818-042-0095 or Expanded Preventive Duty OAR 818-042-0113 and OAR 818- 042-0114 or Expanded Function Anesthesia (OAR 818-042-0115) without holding the appropriate certification. (4) Correct or attempt to correct the malposition or malocclusion of teeth except as provided by OAR 818-042-0100. (5) Adjust or attempt to adjust any orthodontic wire, fixed or removable appliance or other structure while it is in the patient’s mouth. (6) Administer any drug except fluoride, topical anesthetic, desensitizing agents, over the counter medications per package instructions or drugs administered pursuant to OAR 818-026-0030(6), OAR 818-026-0050(5)(a), OAR 818-026-0060(11), OAR 818-026- 0065(11), OAR 818-026-0070(11) and as provided in OAR 818-042-0070, OAR 818- 042-0090 and OAR 818-042-0115. (7) Prescribe any drug. (8) Place periodontal packs. (9) Start nitrous oxide. (10) Remove stains or deposits except as provided in OAR 818-042-0070. (11) Use ultrasonic equipment intra-orally except as provided in OAR 818-042-0100. (12) Use a high-speed handpiece or any device that is operated by a high-speed handpiece intra-orally except as provided in OAR 818-042-0095, and only for the purpose of adjusting occlusion, contouring, and polishing restorations on the tooth or teeth that are being restored. (13) Use lasers, except laser-curing lights. (14) Use air abrasion or air polishing. (15) Remove teeth or parts of tooth structure. (16) Cement or bond any fixed prosthetic prosthesis or orthodontic appliance including bands, brackets, retainers, tooth moving devices, or orthopedic appliances except as provided in OAR 818-042-0100. (17) Condense and carve permanent restorative material except as provided in OAR 818-042-0095. (18) Place any type of retraction material subgingivally except as provided in OAR 818- 042-0090. (19) Take jaw registrations or oral impressions for supplying artificial teeth as substitutes for natural teeth, except diagnostic or opposing models or for the fabrication of temporary or provisional restorations or appliances. (2019)Apply denture relines except as provided in OAR 818-042-0090(2). (2120) Expose radiographs without holding a current Certificate of Radiologic Proficiency issued by the Board (OAR 818-042-0050 and OAR 818-042-0060) except while taking a course of instruction approved by the Oregon Health Authority, Oregon Public Health Division, Office of Environmental Public Health, Radiation Protection Services, or the Oregon Board of Dentistry. (2221) Use the behavior management techniques known as Hand Over Mouth (HOM) or Hand Over Mouth Airway Restriction (HOMAR) on any patient. (2322) Perform periodontal probing. (2423) Place or remove healing caps or healing abutments, except under direct supervision. (2524) Place implant impression copings, except under direct supervision. (2625) Any act in violation of Board statute or rules. No licensee may authorize any dental assistant to perform the following acts: May 24, 2019 Licensing, Standards and Competency Meeting Page 38 of 42
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Dr. Pham moved and Dr. Beck seconded that the Committee recommend that the Board move OAR 818-042-0050 as proposed to the Rules Oversight Committee. The motion passed unanimously.
818-042-0050 Taking of X-Rays — Exposing of Radiographs (1) A dentist may authorize the following persons to place films/sensors, adjust equipment preparatory to exposing films/sensors, and expose the films and create the images under general supervision: (a) A dental assistant certified by the Board in radiologic proficiency; or (b) A radiologic technologist licensed by the Oregon Board of Medical Imaging and certified by the Oregon Board of Dentistry (OBD) who has completed ten (10) clock hours in a Board approved dental radiology course. (2) A dentist or dental hygienist may authorize a dental assistant who has completed a course of instruction approved by the Oregon Board of Dentistry, and who has passed the written Dental Radiation Health and Safety Examination administered by the Dental Assisting National Board, or comparable exam administered by any other testing entity authorized by the Board, or other comparable requirements approved by the Oregon Board of Dentistry to place films/sensors, adjust equipment preparatory to exposing films/sensors, and expose the films and create the images under the indirect supervision of a dentist, dental hygienist, or dental assistant who holds an Oregon Radiologic Proficiency Certificate. The dental assistant must submit within six months, certification by an Oregon licensed dentist or dental hygienist that the assistant is proficient to take radiographics images.
Ms. Riedman moved and Dr. Beck seconded that the Committee recommend that the Board move OAR 818-042-0095 as proposed to the Rules Oversight Committee. The motion passed unanimously.
818-042-0095 Restorative Functions of Dental Assistants Restorative Functions of Dental Assistants (1) The Board shall issue a Restorative Functions Certificate (RFC) to a dental assistant who holds an Oregon EFDA Certificate, and has successfully completed: (a) A Board approved curriculum from a program accredited by the Commission on Dental Accreditation of the American Dental Association or other course of instruction approved by the Board, and successfully passed the Western Regional Examining Board’s Restorative Examination or other equivalent examinations approved by the Board within the last five years, or (b) If successful passage of the Western Regional Examining Board’s Restorative Examination or other equivalent examinations approved by the Board occurred over five years from the date of application, the applicant must submit verification from another state or jurisdiction where the applicant is legally authorized to perform restorative functions and certification from the supervising dentist of successful completion of at May 24, 2019 Licensing, Standards and Competency Meeting Page 39 of 42
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least 25 restorative procedures within the immediate five years from the date of application. (2) A dental assistant may perform the placement and finishing of direct restorations, except gold foil, under the indirect supervision of a licensed dentist, after the supervising dentist has prepared the tooth (teeth) for restoration(s): (a) These functions can only be performed after the patient has given informed consent for the procedure and informed consent for the placement of the restoration by a Restorative Functions dental assistant. (b) Before the patient is released, the final restoration(s) shall be checked by a dentist and documented in the chart.
The Committee reviewed and discussed correspondence from Ms. Harrison, Ms. Jorgensen and the Dental Assisting Consortiums regarding amending Division 42. The Committee asked that the Consortium and Ms. Harrison and Ms. Jorgensen to form a workgroup and asked that they work together to come with proposed language for possible changes to Division 42. Dr. Beck agreed to represent the Board at this workgroup.
Dr. Pham moved and Dr. Beck seconded that the Committee recommend that the Board move OAR 818-042-0113 as amended to the Rules Oversight Committee. The motion passed unanimously
818-042-0113 Certification — Expanded Function Preventive Dental Assistants (EFPDA) The Board may certify a dental assistant as an expanded function preventive dental assistant: (1) By credential in accordance with OAR 818-042-0120, or (2) If the assistant submits a completed application, pays the fee and provides evidence of; (a) Certification of Radiologic Proficiency (OAR 818-042-0060); and satisfactory completion of a course of instruction in a program accredited by the Commission on Dental Accreditation of the American Dental Association; or (b) Certification of Radiologic Proficiency (OAR 818-042-0060); and passage of the Oregon Basic or Certified Preventive Functions Dental Assistant (CPFDA) examination, and or the Expanded Function Dental Assistant examination, or the Coronal Polish (CP) examination, or equivalent successor examinations, administered by the Dental Assisting National Board, Inc. (DANB), or any other testing entity authorized by the Board; and certification by an Oregon licensed dentist that the applicant has successfully polished the coronal surfaces of teeth with a brush or rubber cup as part of oral prophylaxis to remove stains on six patients
Dr. Beck moved and Dr. Pham seconded that the Committee recommend that the Board move OAR 818-042-0116 as proposed to the Rules Oversight Committee. The motion passed unanimously
818-042-0116 Certification — Anesthesia Dental Assistant The Board may certify a person as an Anesthesia Dental Assistant if the applicant submits a completed application, pays the certification fee and shows satisfactory May 24, 2019 Licensing, Standards and Competency Meeting Page 40 of 42
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evidence of: (1) Successful completion of: (a) The "Oral and Maxillofacial Surgery Anesthesia Assistants Program" or successor program, conducted by the American Association of Oral and Maxillofacial Surgeons; or (b) The "Oral and Maxillofacial Surgery Assistants Course" or successor course, conducted by the California Association of Oral and Maxillofacial Surgeons (CALAOMS), or a successor entity; or (c) The "Certified Oral and Maxillofacial Surgery Assistant" examination, or successor examination, conducted by the Dental Assisting National Board or other Board approved examination; and or (d) The Resuscitation Group – Anesthesia Dental Assistant course; or (e) Other course approved by the Board; and (2) Holding valid and current documentation showing successful completion of a Healthcare Care Provider BLS/CPR course, or its equivalent.
The Committee reviewed and discussed the Implant Safety Workgroup recommendations:
• Require a written informed consent form for dental implant placement. The level of detail that should be included in such a form was not yet agreed upon. • Develop the educational requirements/prerequisites for dentists who wish to place implants. • Develop a plan for “grandfathering in” licensees with a great deal of experience and success placing and restoring dental implants. • Require a certain amount of CE pertaining to dental implants be required of licensees practicing implant dentistry for each renewal cycle. • Determine whether all licensed dentists will be required to complete a certain amount of CE pertaining to dental implants each renewal cycle. • Communicate with the Oregon Dental Association regarding developing a set of specific “guidelines” for Oregon licensed dentists practicing implant dentistry. • Develop a requirement for how important information related to the implant (such as type/ manufacturer) is properly documented and provided to the patient.
The Committee directed Board staff to draft language to present to the full Board at their August 23, 2019 meeting for action on the following:
• Minimal requirements for a written informed consent form for dental implant placement. • Continuing education requirements pertaining to dental implants for licensees practicing implant dentistry.
May 24, 2019 Licensing, Standards and Competency Meeting Page 41 of 42
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Dr. Fine noted that the recommendation regarding information related to implants being properly documented and provided to the patient in writing was added to the proposed rule change previously voted on to go to the Board to refer to the Rules Oversight Committee.
The Committee reviewed and discussed the Anesthesia Office Evaluation Safety Workgroup recommendations:
• Add an Attestation Form to renewal forms for those that have any level of anesthesia permit, with the form also indicating that the drugs kept for emergency management have not expired. • A reminder at the time of renewal that every office should hold quarterly emergency drills and the Board would give a brief outline of what should be covered in those drills. • A quiz be added to renewal forms for those that have a moderate, deep and general anesthesia permit. • That those that utilize a qualified provider per OAR 818-026-0080, attest that they hold emergency drills annually with that provider. • A recommendation that OAR 818-026-0080 be reviewed closer to highlight that no two patients can be sedated at any time, and that there be proper protocol and hand off to a qualified anesthesia monitor, if the qualified provider will no longer be required to monitor the patient until criteria for discharge met. • Review and update lists of drugs an office should have relevant to the anesthesia permit they hold and also of those the qualified provider has.
The Committee determined the items dealing with the renewal process could be implemented when the OBD gets a new database as the existing database would not support it.
Dr. Fine noted that the recommendation regarding OAR 818-026-0080 highlighting no two patients can be sedated at the same time, and when a patient who was sedated can be released to a qualified anesthesia monitor was added to the proposed rule change previously voted on to go to the Board to refer to the Rules Oversight Committee.
The meeting adjourned at 3:30 p.m.
May 24, 2019 Licensing, Standards and Competency Meeting Page 42 of 42
TO: OBD Board Members, Licensees and Interested Parties
FROM: Stephen Prisby, Executive Director
DATE: June 11, 2019
SUBJECT: Proposed Dental Implant Continuing Education and Informed Consent Forms
At the Licensing, Standards and Competency Committee Meeting on May 24, 2019 the Committee directed OBD Staff to:
• Develop proposed continuing education rules regarding placement of dental implants • Develop proposed informed consent form language that would be required prior to placing dental implants
The Committee directed the staff to have the information ready by the August 23, 2019 Board meeting. Staff were able to develop ideas in time for this June Meeting, so that the Board and other interested parties can digest these proposals.
I attached sample informed consent forms to review and for your discussion at the meeting. OBD staff believe a form should be similar to the one that the OHSU School of Dentistry uses, which has the patient acknowledge with initials each piece of important information relating to the procedure and possible outcomes.
Since these proposals were not reviewed by the Licensing, Standards and Competency Committee, they should not be referred to the Rules Committee for action yet. 818-021-0060 – Continuing Education-Dentists
(7) A dentist may place endosseous implants to replace natural teeth after completing a minimum of 56 hours of hands on clinical course(s), which includes treatment planning, appropriate case selection, potential complications and the surgical placement of the implants under direct supervision, and the provider is approved by the Academy of General Dentistry Program Approval for Continuing Education (AGD PACE) or by the American Dental Association Continuing Education Recognition Program (ADA CERP). (8) A dentist placing endosseous implants must complete at least seven (7) hours of continuing education related to the placement and or restoration of dental implants every licensure renewal period. SAMPLE #1
OHSU School of Dentistry Advanced Education Program in Periodontics CONSENT: TWO-STAGE, ONE-STAGE, &/or IMMEDIATE OSSEOINTEGRATED IMPLANT SURGERY
Patient Name: ______Patient Chart # ______
Today’s date: ______
Surgery date: ______
You have the right to be given pertinent information about your proposed implant placement so that you have sufficient information to make the decision as to whether or not to proceed with surgery. What you are being asked to sign is a confirmation that we have discussed the nature of the proposed treatment, the known risks associated with it and the feasible alternate treatments.
PLEASE INITIAL EACH PARAGRAPH AFTER READING. IF YOU HAVE ANY QUESTIONS, PLEASE ASK YOUR DOCTOR BEFORE INITIALING.
____1. I hereby authorize Dr(s). ______, and any other agents, assistants, or employees selected by him / her to treat the condition described as: ______
____2. The procedure necessary to treat the condition has been explained to me, and I understand the nature of the procedure to be: ______
____3. I understand incisions will be made inside my mouth for the purpose of placing one or more root form structures (implants) in my jaw to serve as anchors for a missing tooth or teeth or to stabilize a crown (cap), bridge or denture. I acknowledge that the doctor has explained the procedure, including the number and location of the incisions and the type of implant to be used. I understand that the crown, bridge or denture that will later be attached to this implant will be made and attached by Dr. ______and that a separate charge will be made for that work.
____4. I understand that the implant must remain covered by gum tissue for a minimum of three to six months before it can be used and that a second surgery is required to uncover the top of the implant if a two stage implant. If the implant is placed with the top exposed this is a one stage implant with no second surgery required to uncover the implant. If a tooth is being extracted with an implant placed at the same surgery appointment, that implant is an immediate implant.
____5. No guarantee can be or has been given that the implant(s) will last for a specific time period. It has also been explained to me that once the implant is inserted, the entire treatment plan must be followed and completed on schedule. If this schedule is not carried out, the implant(s) may fail.
____6. It has been explained to me that during the course of the procedure, unforeseen conditions may be revealed which will necessitate extension of the original procedure or a different procedure from those described in paragraph 2 above. I authorize my doctor and his/her staff to perform such different procedure(s) as necessary and desirable in the exercise of his/her professional judgment.
page 1 of 3 SAMPLE #1
OHSU School of Dentistry Advanced Education Program in Periodontics CONSENT: TWO-STAGE, ONE-STAGE, &/or IMMEDIATE OSSEOINTEGRATED IMPLANT SURGERY
____7. I have been informed of possible alternative methods of treatment (if any), including _____ no treatment _____ removable partial denture _____ fixed partial denture (bridge) _____ full conventional denture _____ other: ______I understand that other forms of treatment or no treatment at all are choices that I have and the risks of those choices have been presented to me.
____8. My doctor has explained to me that there are certain inherent and potential risks, side effects in any surgical procedure. In this specific instance such risks include, but are not limited to the following: ____a. Postoperative discomfort and swelling that may require several days of at-home recouperation. ____b. Prolonged or heavy bleeding that may require additional treatment. ____c. Injury or damage to adjacent teeth or roots of adjacent teeth. ____d. Postoperative infection that may require additional treatment. ____e. Stretching of the corners of the mouth that may cause cracking and bruising, and may heal slowly. ____f. Restricted mouth opening for several days; sometimes related to swelling and muscle soreness and sometimes related to stress on the jaw joints (TMJ). Pre-existing TMJ symptoms get worse. ____g. Injury to the nerve branches in the lower jaw resulting in numbness or tingling of the chin, lips, cheek, gums or tongue on the operated side. This may persist for several weeks, months or, in rare instances, permanently. In some cases the implant may need to be removed. ____h. Opening into the sinus (a normal chamber above the upper back teeth) requiring additional treatment. ____i. If the sinus is intentionally entered (sinus lift procedure with grafting), there will usually be several weeks of sinusitis symptoms requiring certain medications and additional recovery time. ____j. If an indirect sinus lift with use of a mallet is necessary to place the implants, dizziness & inability to be balanced when standing or walking (Benign Paroxysmal Positional Vertigo, JP 01/10 p.158) can result. ____k. The removal of grafted bone from any donor site has its own potential risks and complications, which have been explained to me. _____l. Fracture of the jaw. ____m. Other: ______
____9. I have been made aware that certain medications, drugs, anesthetics and prescriptions which I may be given can cause drowsiness, incoordination, and lack of awareness which also may be increased by the use of alcohol and other drugs. I have been advised not to operate any vehicle or hazardous machinery and not to return to work while taking such medications, or until fully recovered from the effects of same. I understand this recovery may take up to 24 hours or more after I have taken the last dose of medication. If I am to be given sedative medication during my surgery, I agree not to drive myself home and will have a responsible adult drive me home and accompany me until I am fully recovered from the effects of the sedation.
page 2 of 3 SAMPLE #1
OHSU School of Dentistry Advanced Education Program in Periodontics CONSENT: TWO-STAGE, ONE-STAGE, &/or IMMEDIATE OSSEOINTEGRATED IMPLANT SURGERY
____10. I consent to the administration of ______anesthesia in connection with the procedure referred to above. If intravenous sedation anesthesia is used, there may be soreness at the injection site or along the vein, as well as bruising around the injection site. In rare instances, the vein irritation may cause restricted mobility of the arm or hand and may require additional treatment.
____11. I understand that I am not to have anything (or have not had anything) by mouth for at least six hours before my surgery if intravenous sedation is to be used. To do otherwise may be life- threatening.
____12. It has been explained to me, and I understand, that a perfect result is not, and cannot be guaranteed or warranted. I understand that implant placement is an elective procedure.
____13. I agree to follow all pre-operative and post-operative instructions. I will use proper oral hygiene measures and will return for all post treatment follow-up appointments.
I certify that I have read all of the previous information and consent prior to my surgery, I have been fully informed of the nature of root form implant surgery, and acknowledge that any and all questions have been answered to my satisfaction regarding the proposed treatment, routine post surgical course, and possible complications. The procedure(s), alternatives, and risks have been explained to me in substantial detail, and I am satisfied with my surgeon’s explanations. I have no additional questions about the procedure(s), other alternative procedures, or risks.
I also consent to the use of an alternative implant system or method if clinical conditions are found to be unfavorable for the use of the implant system that has been described to me. If clinical conditions prevent the placement of implants, I defer to my surgeon’s judgment on the surgical management of that situation. I also give my permission to receive supplemental bone grafts or other types of grafts to build up the ridge of my jaw and thereby to assist in placement, closure and security of my implants.
I authorize photos, slides, x-rays or any other viewing of my care and treatment during or after its completion to be used for the advancement of dentistry and for reimbursement purposes. However, my identity will not be revealed to the general public without my permission.
I also certify that I speak, read, and write English, or, have used a translator to explain all of the previous information to me and I understand all of the information translated to me. I give my permission and consent to the procedure(s) proposed.
I CERTIFY THAT I HAVE READ AND FULLY UNDERSTAND THIS DOCUMENT
Patient/parent or Guardian Time Date
Witness/Staff Time Date
Surgeon Time Date
page 3 of 3 WBC/0313 SAMPLE #2
INFORMED CONSENT FORM FOR ORAL AND MAXILLOFACIAL SURGERY AND ANESTHESIA
Dear Patient:
You have a right to be informed about your diagnosis and planned surgery so that you may make a decision whether to undergo a procedure after knowing the risks and hazards. The disclosure is not meant to frighten or alarm you. It is simply an effort to make you better informed so we may give an informed consent to the procedure. Please be assured that we will do our best at all times to make healing as rapid and trouble-free as possible.
POSSIBLE COMPLICATIONS (may be variable in occurrence):
Please initial each paragraph after reading. If you have any questions, please ask your doctor before initialing.
_____ ALL SURGERIES: 1. Soreness, pain, swelling, bruising, and restricted mouth opening during healing sometimes related to swelling and muscle soreness and sometimes related to stress on the jaw joints (TMJ), especially when TMJ problems already exists. 2. Bleeding, usually controllable, but may be prolonged and required additional care. 3. Drug reactions or allergies. 4. Infection; possibly requiring additional care, including hospitalization and additional surgery. 5. Stretching or cracking at the corners of the mouth.
_____ ALL TOOTH EXTRACTIONS: 1. Dry socket (delayed healing) causing discomfort a few days after extraction requiring further care. 2. Damage to adjacent teeth or fillings. 3. Sharp ridges or bone splinters; may require additional surgery to smooth area. 4. Portions of tooth remaining - sometimes fine root tips break off and may be deliberately left in place to avoid damage to nearby vital structures such as nerves or the sinus cavity.
_____ UPPER TEETH: 1. SINUS INVOLVEMENT: Due to closeness of the roots of upper back teeth to the sinus or from a root teeth being displaced into the sinus, a possible sinus infection and/or sinus opening may result, which may require medication and/or later surgery to correct.
_____ LOWER TEETH: 2. NUMBNESS: Due to proximity of tooth roots (especially wisdom teeth) and other surgical sites to the nerves, it is possible to loose function of nerves following the removal of the tooth or surgery in the area. The lip, chin, teeth, gums, or tongue could thus feel numb (resembling local anesthetic injection). There may also be pain, loss of taste, and change in speech. This could remain for days, weeks, or possibly, permanently. 3. JAW FRACTURE: While quite rare, it is possible in difficult or deeply impacted teeth and usually requires additional treatment, including surgery and hospitalization. SAMPLE #2
_____ ANESTHESIA: 1. LOCAL ANESTHESIA: Certain possible risks exists that, although rare, could include pain, swelling, bruising, infection, nerve damage, and unexpected reactions which could result in heart attacks, stroke, brain damage, and/or death. 2. INTRAVENOUS OR GENERAL ANESTHESIA: Certain possible risk exists that, although uncommon, may include nausea, pain, swelling, inflammation, and/or bruising at the injection site.
Rare complications include nerve or blood vessel injury (phlebitis) in the arm or hand and allergic or unexpected drug reactions, pneumonia, heart attack, stroke, brain damage, and/or death.
If I am having intravenous sedation or general anesthesia, I understand that I have NOT HAD ANY FOOD OR DRINK FOR SIX HOURS before my appointment. To do otherwise MAY BE LIFE-THREATENING! I agree not to drive myself home for the next 24 hours and will have a responsible adult accompany me.
ALTERNATIVE TREATMENT OPTIONS:______
PATIENT NAME:______
I hereby authorize Dr. ______and staff to perform the following procedures:
______
______and to administer an anesthetic. I understand the doctor may discover other or different conditions that may require additional or different procedures than those planned. I authorize him/her to perform such other procedures as he/she deems necessary in his/her professional judgment in order to complete my surgery. I have discussed my past medical history with my doctor and disclosed all diseases and medications and drug use. I agree not to operate vehicles or hazardous machinery while taking prescription narcotic pain medications. I have received written postoperative instructions regarding home care, including emergency after hour phone numbers. I understand that individual reactions to treatment cannot be predicted, and that if I experience any unanticipated reactions during or following treatment, I agree to report them to the doctor or his/her designated agent as soon as possible. I have read and discussed the preceding with the doctor and believe I have been given sufficient information to give my consent to the planned surgery. No warrantee or guarantee has been made as to the results or cure. I certify that I speak, read, and write English and have read and fully understand this consent form for surgery; or if do not, I have had someone translate so that I can understand the consent form. All blanks were filled in prior to my initials and signature.
______Patient’s (or legal guardian’s) signature Date
______Witness signature Date
______Doctor’s signature Date SAMPLE #2
! Oral Surgery Consent Form ! Patient Name______Date______! I hearby authorize Dr.______to perform the following !procedures:______The doctor and or staff have explained to me the proposed treatment and the anticipated results of such treatment. I understand this is an elective procedure and that there are other forms of treatment available, including the option of no treatment. The doctor has explained to me that there are certain potential risks in the treatment plan or procedure. These include: 1. Injury to a nerve resulting in numbness or tingling of the chin, lip, cheek, gums, and or tongue to the operated side. This may persist for several weeks, months, or in remote instances, permanently.______2. Postoperative infection requiring additional treatment.______3. Opening of the sinus (a normal cavity situated above the upper teeth) requiring additional surgery.______4. Restricted mouth opening for several days or weeks, with possible dislocation of the tempromandibular (jaw) joint.______5. Injury to adjacent teeth and fillings.______6. In rare circumstances, cardiac arrest or breakage of the jaw.______7. Postoperative discomfort, swelling, and bleeding that may necessitate several days of recuperation.______8. Decision to leave a small piece of root in the jaw when its removal requires extensive surgery.______9. Stretching of the corners of the mouth with resultant cracking and bruising. ______Unforeseen conditions may arise during the procedure that requires a different procedure than as set forth above. I therefore authorize the doctor and any associates to perform such procedures when, in their professional judgment, they are necessary. I understand that the medications, drugs, anesthetic, and prescriptions taken for this procedure may cause drowsiness and lack of awareness and coordination. I also understand that I should not consume alcohol or other drugs because they can increase these effects. I have been advised not to work and no to operated any vehicle, automobile, or hazardous devices while taking such medications and until fully recovered from their! effects. I have also been advised not to smoke for two weeks after the surgery.______!It has been explained to me and I understand that a perfect result is not guaranteed or warranted. !Patient signature______Date______Doctor’s signature______Date______SAMPLE #3
Dental Implant Consent Form/Oral Surgery Consent Form
All patients receiving dental implants and other oral surgery will be asked to sign consent forms. We’ve included the text of our consent forms so you can review their contents before coming in to the office.
Dental Implant Consent Form
1. ACKNOWLEDGEMENT OF RECEIPT OF INFORMATION State law requires that you be given certain information and that we obtain your consent prior to beginning any treatment. What you are being asked to sign is a confirmation that we have discussed the nature and purpose of the treatment, the known risks associated with the treatment, and the feasible treatment alternatives; that you have been given an opportunity to ask questions; that all your questions have been answered in a satisfactory manner. Please read this form carefully before signing it and ask about anything that you do not understand. We will be pleased to explain.
2. CONSENT FOR DENTAL IMPLANT I hereby authorize and direct the oral and maxillofacial surgeon whose name appears above with associates or assistants of his or her choice to perform surgery upon me ( or upon any person identified above as the patient, for whom I am empowered to consent ) to insert dental implant(s) in my upper and/or lower jaw and/or placement of bone graft (etc. ) as needed.
3. NATURE AND PURPOSE OF THE PROCEDURE I understand incision(s) will be made inside my mouth for the purpose of placing one or more metal structures in my jaw(s) to serve a anchor(s) for a missing tooth or teeth or to stabilize a crown (cap), denture or bridge. I acknowledge that the oral and maxillofacial surgeon whose name appears above has explained the pocedure, including the number and location of the incisions to be made, in detail. I understand that the crown (cap) , denture or bridge, will later be attached to this implant by a general dentist or prosthodontist and that the cost for that work is not included in the charge for this procedure. I have been informed that the implant must remain covered under the gum tissue for at least three months before it can be used and that a second surgical procedure is required to uncover the top of the implant. Finally, I understand that this is a relatively new procedure. I have received literature, anesthesia information,pre and post surgical instructions and diet information and have read and understand the information.
4. ALTERNATIVES TO A DENTAL IMPLANT The alternatives to the use of a dental implant, including no treatment at all; construction of a new standard dental prosthesis; augmentation of the upper or lower jaw by means of a vestibuloplasty, skin and bone grafting, or with synthetic materials; and implantation of another type of device have been explained to me as have the advantages and disadvantages of each procedure and I choose to procede with insertation of the dental implant.
5. AUTHORIZATION OF ANCILLARY TREATMENT I also authorize and direct the oral and maxillofacial surgeon whose name appears
35 SAMPLE #3
above with the associate or assistants of his or her choice to provide such additional services as he or they may deem reasonable and necessary, including, but not limited to , the administration of anesthetic agents; the performance of necessary laboratory, radiological ( X-ray), and other diagnostic procedures; the administration of medications orally, by injection, by infusion, or by other medically accepted route of administration; and the removal of bone, tissue and fluids for diagnostic and therapeutic purposes and the retention or disposal of same in accordance with usual practices.
6. AUTHORIZATION FOR SUPPLEMENTAL TREATMENT If any unforeseen condition arises in the course of treatment which calls for the performance of procedures in addition to or different from that now contemplated and I am under general anesthesia or sedation, I further authorize and direct the oral and maxillofacial surgeon whose name appears above with associates or assistants of his choice to do whatever he deems necessary and advisable under the circumstances.
7. NO GUARANTEE OF TREATMENT RESULTS I understand that there is no way to accurately predict the healing capabilities of any particular patient following the placement of the implant and that complications do occur; and I confirm that I have been given no guarantee or assurance by the oral and maxillofacial surgeon whose name appears above, or by anyone else, as to the results that may be obtained from treatment. In the event of implant failure, there will be no refund of fees.
8. RISKS AND COMPLICATIONS ASSOCIATED WITH DENTAL IMPLANTS I have been informed and understand that there are risks and complications from surgery, drugs, and/or anesthetics.
9. SURGICAL COMPLICATIONS Such possibilities include but are not limited to, infection, tissue discoloration ( bruising ), alteration in taste and/or numbness, tingling, increased sensitivity of the lips, tongue, chin, cheek or teeth which may last for an indefinite period and may be permanent. Also possible are injury to teeth if present, loss of bone, bone fractures, nasal or sinus penetration ( for implants placed in the upper jaw ), chronic pain, bleeding and decreased ability to open the mouth. I have also been informed that any procedure which is outside the mouth will leave a scar on the skin, and that although a good cosmetic result is hoped for, it cannot be guaranteed. I also understand that any of these treatment complications may necessitate medical, dental, or surgical treatment; may necessitate wiring of my teeth or jaws, and may require an additional period of recuperation at home or even in the hospital. Finally, I have been told that this treatment may not be successful, that problems may arise during the procedure which may prevent placement of the implant, and that rejection of this implant is possible which would necessitate its removal at any time after placement. Should this happen, I understand that it may possible to insert another implant after a suitable healing period and that charge will be made for this procedure.
10. DRUG AND ANESTHETIC COMPLICATIONS If intravenous medications are used, there may be irritation of, or damage to the
36 SAMPLE #3
vein in which anesthetic medications are injected. I understand there are certain drugs and anesthetic risks, which could involve serious bodily injury, and are inherent of any procedure requiring their use.
11. RISKS ASSOCIATED WITH NO TREATMENT I understand that should I not have this implant procedure, one or more of the following may occur: faster dissolving of the jaw bone structure, increased difficulty wearing conventional dentures, increased loss of bony support of the face, lips and cheeks, increased difficulty chewing, pain and numbness, and fracture of a very thin jawbone.
12. IMPORTANCE OF PATIENT COMPLIANCE I agree and understand that the degree of success of any dental treatment is directly related to my cooperation and that, if I fail to cooperate as requested and instructed, I may suffer temporary or permanent injury to my dental and general health and to the dental work performed by my dentist. I understand that the success of dental implants depends to a great extent on my maintenance and meticulous hygiene throughout my mouth and especially around the implant posts where they come through the gum tissue. I understand that smoking, alcohol, improper dietary practices may affect gum and bone healing and will limit the success of the implant. I agree to follow home care and dietary instructions as prescribed. I will not wear my dentures for 2 weeks. I agree to return at regular intervals as specified by the doctor for inspection of my mouth and implant cleansings by the doctor or the hygienist and to have performed such dental services as may be needed to maintain my oral health. This will involve regular and long-term follow –up care for the life of the implant. I agree to report immediately any evidence of pain, swelling, or inflammation around my implant(s) and agree to attend the office/hospital if necessary. A reasonable fee will be charged for these visits commencing one year after placement of my implant (s).
I agree not to eat or drink anything for 6 hours prior to my surgery/anesthesia. Medications, drugs, anesthetics and prescriptions may cause drowsiness and lack of awareness and coordination, which can be increased by the use of alcohol or other drugs. Thus, I have been advised not to operate any vehicle, automobile, hazardous devices, or work while taking such medications and/or drugs; or until fully recovered from their effects. I understand and agree not to operate any vehicle or hazardous device for at least twenty-four hours after my release from surgery or until further recovered from the effects of anesthetic medication and drugs that may have been given to me in the office or the hospital for my care. I agree not to drive myself home after surgery and will have a responsible adult drive me or accompany me home after my discharge from surgery. Failure to follow these instructions may be life threatening.
13. AUTHORIZATION OF USE OF DENTAL RECORDS I authorize photographs, X-rays, or other viewing of my care and treatment during its progress may be used for educational purposes and research. I hereby state that I have read and I fully understand this consent form, that I have
37 SAMPLE #3
been given an opportunity to ask any questions I might have had, that those questions have been answered in a satisfactory manner.
Date______
Time______
Signature______
Signature of relative or Representative (where required) ______
Witness______
38 SAMPLE #4
!
INFORMED CONSENT FOR DENTAL IMPLANTS
Diagnosis. After careful oral examination and study of my dental condition, my doctor has advised me that my missing tooth or teeth may be replaced with artificial teeth supported by an implant.
Recommended Treatment. In order to treat my condition, my doctor has recommended the use of root form dental implants. I understand that the procedure for root form implants involves placing implants into the jawbone. This procedure has a surgical phase followed by a prosthetic phase.
Surgical Phase of Procedures. I understand that sedation may be utilized and that a local anesthetic will be administered to me as part of the treatment. My gum tissues will be opened to expose the bone. Implants will be placed by tapping or threading them in to holes that have been drilled into my jawbone. The implants will have to be snugly fitted and held tightly in place during the healing phase.
The gum and soft tissues will be stitched closed over or around the implants. A periodontal bandage or dressing may be placed. Healing will be allowed to proceed for a period of four to six months. I understand the dentures usually cannot be worn during the first one to two weeks of the healing phase.
I further understand that if clinical conditions turn out to be unfavorable for the use of this implant system or prevent the placement of implants, my doctor will make a professional judgment on the management of the situation. The procedure also may involve supplemental bone grafts or other types of grafts to build up the ridge of my jaw and thereby to assist in placement, closure, and security of my implants.
For implants requiring a second surgical procedure, the overlying tissues will be opened at the appropriate time, and the stability of the implant will be verified. If the implant appears satisfactory, an attachment will be connected to the implant. Plans and procedures to create an implant prosthetic appliance can then begin.
Prosthetic Phase of Procedure. This phase is just as important as the surgical phase for the long-term success of the oral reconstruction. During this phase, an implant prosthetic device will be attached to the implant.
Expected Benefits. The purpose of dental implants is to allow me to have more functional artificial teeth. The implants provide support, anchorage, and retention for these teeth.
Principal Risks and Complications. I understand that some patients do not respond successfully to dental implants, and in such cases, the implant may be lost. Implant surgery may not be successful in providing artificial teeth. Because each patient’s condition is unique, long-term success may not occur.
!1 SAMPLE 4
SAMPLE #4 I understand that complications may result from the implant surgery, drugs, and anesthetics. These complications include, but are not limited to:
• Post surgical infection • Bleeding • Swelling • Pain • Facial discoloration • Transient but on occasion permanent numbness of the lip, tongue, teeth, chin, or gum • Jaw joint injuries or associated muscle spasm • Transient but on occasion permanent increased tooth looseness • Tooth sensitivity to hot, cold, sweet, or acidic foods • Shrinkage of the gum upon healing resulting in elongation of some teeth and greater spaces between some teeth • Cracking or bruising of the corners of the mouth • Restricted ability to open the mouth for several days or weeks • Impact on speech • Allergic reactions • Injury to teeth • Bone fractures • Nasal sinus penetrations • Delayed healing • Accidental swallowing of foreign matter
The exact duration of any complications cannot be determined, and they may be irreversible.
I understand that the design and structure of the prosthetic appliance can be a substantial factor in the success or failure of the implant. I further understand that alterations made on the artificial appliance or the implant can lead to loss of the appliance or implant. This loss would be the sole responsibility of the person making such alterations. I am advised that the connection between the implant and the tissue may fail and that it may become necessary to remove the implant. This can happen in the preliminary phase, during the initial integration of the implant to the bone, or at any time thereafter.
Alternative to Suggested Treatment. Alternative treatments for missing teeth include no treatment, new removable appliances, and other procedures—depending on the circumstances. However, continued wearing of ill-fitting and loose removable appliances can result in further damage to the bone and soft tissue of my mouth.
Necessary Follow-up Care and Self-Care. I understand that it is important for me to continue to see my dentist. Implants, natural teeth, and appliances have to be maintained daily in a clean, hygienic manner. Implants and appliances must also be examined periodically and may need to b e adjusted. I understand that it is important for me to abide by the specific prescriptions and instructions given by my doctor.
No Warranty or Guarantee. I hereby acknowledge that no guarantee, warranty, or assurance has been given to me that the proposed treatment will be successful. Due to individual patient differences, a doctor cannot
-2- SAMPLE #4
predict certainty of success. There exists the risk of failure, relapse, additional treatment, or worsening of my present condition, including the possible loss of certain teeth, despite the best of care.
Publication of Records. I authorize photos, slides, x-rays, or any other viewings of my care and treatment during or after its completion to be used for the advancement of dentistry and for reimbursement purposes. My identity will not be revealed to the general public, however, without my permission.
PATIENT CONSENT
I have been fully informed of the nature of root form implant surgery, the procedure to be utilized, the risks and benefits of the surgery, the alternative treatments available, and the necessity for follow-up care and self care. I have had an opportunity to ask any questions I may have in connection with the treatment and to discuss my concerns with my doctor. After thorough deliberation, I hereby consent to the performance of dental implant surgery as presented to me during consultation and in the treatment plan presentation as described in this document.
I also consent to use of an alternative implant system or method if clinical conditions are found to be unfavorable for the use of the implant systems that has been described to me. If clinical conditions prevent the placement of implants, I defer to my doctor’s judgment on the surgical management of that situation. I also give my permission to receive supplemental bone grafts or other types of grafts to build up the ridge of my jaw and thereby to assist in placement, closure, and security of my implants.
I CERTIFY THAT I HAVE READ AND FULLY UNDERSTAND THIS DOCUMENT.
Date Patient, Parent or Guardian Name (Print) Signature ______
______Date Witness Name (Print) Signature -3- Executive Director's Report
EXECUTIVE DIRECTOR’S REPORT June 21, 2019
Board Member & Staff Updates The Governor appointed and the Senate confirmed Dr. Reza J. Sharifi as our newest Board Member on May 15. He replaces Dr. Julie Ann Smith. Dr. Sharifi’s term of service is May 15, 2019 through May 14, 2023. OBD Staff welcomed him with a new board member orientation on June 7 with our assigned attorney Lori Lindley participating as well.
Reza J. Sharifi, DMD, FACS, Diplomate of the American Board of Oral and Maxillofacial Surgeons was born and raised in Portland, Oregon. He received his undergraduate degree from Portland State University and his Doctor of Dental Medicine degree from the Boston University School of Dental Medicine. He then completed his Oral Surgery residency at Tripler Army Medical Center in Honolulu, Hawaii. He was stationed at Fort Gordon, Georgia as the Assistant Program Director at Dwight D. Eisenhower Army Medical Center Oral Surgery Residency program. After nine years of serving in the United States Army, he decided to return home to Portland. He was honored with numerous awards while serving the military and has extensive experiences of lecturing to his dental colleagues.
OBD Board Required Training - Policy #50-010-01 The State of Oregon has updated its Discrimination and Harassment Free Workplace Policy. All Board Members and staff are required to complete the training by October 31, 2019. Attachment #1
OBD Budget Status Report Attached is the budget report for the 2017 - 2019 Biennium. This report, which is from July 1, 2017 through April 30, 2019, shows revenue of $3,751,071.61 of and expenditures of $2,731,310.45. Attachment #2
Phone System The statewide government phone system periodically encounters issues and outages that can impact our work with licensees, stakeholders and overall customer service. Attachment #3
Customer Service Survey Attached are the legislatively mandated survey results from December 2018 through May 2019. The results of the survey show that the OBD continues to receive positive ratings from the majority of those that submit a survey. Attachment #4
Board and Staff Speaking Engagements I attended and spoke at a forum on ethics and Board rules with the Student Professionalism and Ethics Association at OHSU Dental School in Portland on Wednesday, May 1, 2019.
Ingrid Nye and Teresa Haynes gave a License Application Presentation to the graduating Dental Hygiene Students at Lane Community College in Eugene on Monday, May 6, 2019.
Ingrid Nye and Teresa Haynes gave a License Application Presentation to the graduating Dental Students at the OHSU Dental School in Portland on Wednesday, May 15, 2019.
Dr. Daniel Blickenstaff gave a Board Presentation to the graduating Dental Hygiene Students at PCC in Portland on Wednesday, May 15, 2019.
Executive Director’s Report June 21, 2019 Page 1
Ingrid Nye and Teresa Haynes gave a License Application Presentation to the graduating Dental Hygiene Students at Pacific University in Hillsboro on Tuesday, June 4, 2019.
Dr. Daniel Blickenstaff gave a Board Updates Presentation to Advantage Dental’s Summer Meeting in Bend on Friday, June 14, 2019.
2019 Legislative Session The legislative session started on January 22nd and is scheduled to end at the end of June. I attached legislation that could impact our Licensees or the OBD as a state agency. I answered questions at a House Committee on Health Care Work Session on SB 835 on May 23rd and also included information that I provided to that Committee. Attachment #5
Memo - Delegation of Duties & Job Description Every June the new President of the OBD takes the gavel for the first regular Board meeting after being voted President at the April Board Meeting for a 1-year term of office. We also welcome a new board member at this meeting. Every June I submit to the Board for reauthorization, this memo outlining delegated duties to me as executive director and OBD staff along with my job description, which encompasses my service to the Board. Attachment #6 ACTION REQUESTED
Public Records Policy Update - #834-413-010 & #107-001-020 Back in 2016 DAS established the Public Records Requests and Management Project to address the issues, mandates and deliverables identified in a Secretary of State audit on agency responses to public records requests and Executive Order 16-06 on Public Records. State agencies were once again asked to update the policies and be approved by the State’s Archivist by May 2, 2019. The attached policy was approved by the State’s Archivist and I ask that the Board affirm that decision and approve this policy for the OBD. Attachment #7 ACTION REQUESTED
AADA & AADB Annual Meetings The American Association of Dental Boards (AADB) Annual Meeting will be October 19 - 20 in Las Vegas, NV. Dr. Amy Fine and Yadira Martinez, RDH, are invited to attend the AADB Meeting. Lori Lindley will attend the Attorneys Roundtable Meeting as well. The American Association of Dental Administrators Annual Meeting (AADA) will be held in conjunction with the AADB Meeting on October 17 -18. I ask that the Board approve my attendance at both of these meetings. I am the Secretary for the AADA. Attachment #8 ACTION REQUESTED
2020 OBD Meeting Dates & Calendar Attached are the Board approved meeting dates for 2019 & 2020 and I also included a calendar of other important dates. The Board adopted the 2020 OBD meeting dates at the April 19, 2019 Board Meeting. Attachment #9
Newsletter Article ideas are being collected and staff look forward to working with our newsletter editor, Alicia Riedman, RDH on this for a fall/winter edition.
Executive Director’s Report June 21, 2019 Page 2
State HR Policy
SUBJECT: Discrimination and Harassment Free Workplace NUMBER: 50.010.01
DIVISION: Chief Human Resources Office EFFECTIVE DATE: 2/01/2019
APPROVED: Signature on file with the Chief Human Resources Office
POLICY Oregon state government as an employer is committed to a discrimination and STATEMENT: harassment free work environment. This policy outlines types of prohibited conduct and procedures for reporting and investigating prohibited conduct ORS 174.100, 240.086(1); 240.145(3); 240.250; 240.316(4); 240.321; 240.555; AUTHORITY: 240.560; 659A.029; 659A.030; Title VII; Civil Rights Act of 1964; Executive Order EO- 93-05; Rehabilitation Act of 1973; Employment Act of 1967; Americans with Disabilities Act of 1990; and 29 CFR §37.
APPLICABILITY: All employees, including limited duration and temporary employees, board and commission members, volunteers, and others working in an agency, unless this policy conflicts with an applicable collective bargaining agreement.
ATTACHMENTS: None
DEFINITIONS: Also refer to State HR Policy 10.000.01, Definitions
Collective Bargaining Agreement (CBA): A written agreement between Oregon state government (Department of Administrative Services) and a labor union. References to CBAs contained in this policy are applicable only to employees covered by a CBA.
Complainant: A person or persons allegedly subjected to, or who witnessed observed, discrimination, workplace harassment or sexual harassment and who files a complaint with their immediate supervisor, another manager, or the agency, board, or commission Human Resources section, Executive Director, chair, or DAS Chief Human Resources Office.
Contractor: An individual or business with whom Oregon state government has entered into an agreement or contract to provide goods or services. Qualified rehabilitation facilities who by contract provide temporary workers to state agencies are considered contractors. Contractors are not subject to ORS 240 but must comply with all federal and state laws.
Discrimination: Making employment decisions related to hiring, firing, transferring, promoting, demoting, benefits, compensation, and other terms and conditions of employment, based on or because of an employee’s protected class status.
Policy: 50.010.01 1 of 6 Effective:Attachment 2/01/2019 #1 State HR Policy
Discrimination and Harassment Free Workplace 50.010.01
Employee: Any person employed by the state in one of the following capacities: management service, unclassified executive service, unclassified or classified unrepresented service, unclassified or classified represented service, or represented or unrepresented temporary service. This definition includes board and commission members, and individuals who volunteer their services on behalf of state government.
Higher Standard: Applies to managers and supervisors. Managers/supervisors are held to a higher standard and are expected to be proactive in creating and maintaining a discrimination and harassment free workplace. Managers/supervisors must exercise appropriate measures to prevent and promptly correct any discrimination, workplace harassment or sexual harassment they know about or should know about.
Manager/Supervisor: Those who supervise or have authority or influence to effect employment decisions.
Protected Class Under Federal Law: Race; color; national origin; sex (includes pregnancy- related conditions); religion; age (40 and older); disability; a person who uses leave covered by the Federal Family and Medical Leave Act; a person who uses Military Leave; a person who associates with a protected class; a person who opposes unlawful employment practices, files a complaint or testifies about violations or possible violations; and any other protected class as defined by federal law.
Protected Class Under Oregon State Law: All federally protected classes, plus: age (18 and older); physical or mental disability; injured worker; a person who uses leave covered by the Oregon Family Leave Act; marital status; family relationship; sexual orientation; whistleblower; expunged juvenile record; and any other protected class as defined by state law.
Sexual Harassment: Sexual harassment is unwelcome, unwanted or offensive sexual advances, requests for sexual favors, and other verbal or physical conduct of a sexual nature when:
(1) Submission to such conduct is made either explicitly or implicitly a term or condition of the individual’s employment, or is used as a basis for any employment decision (granting leave requests, promotion, favorable performance appraisal, etc.); or
(2) Such conduct is unwelcome, unwanted or offensive and has the purpose or effect of unreasonably interfering with an individual’s work performance or creating an intimidating, hostile or offensive working environment.
Examples of sexual harassment include but are not limited to: unwelcome, unwanted or offensive touching or physical contact of a sexual nature, such as closeness, impeding or blocking movement, assaulting or pinching; gestures; innuendoes; teasing, jokes, and other sexual talk; intimate inquiries; persistent unwanted courting; sexist put-downs or insults; epithets; slurs; or derogatory comments.
Policy: 50.010.01 2 of 6 Effective:Attachment 2/01/2019 #1 State HR Policy
Discrimination and Harassment Free Workplace 50.010.01
An individual’s actual or perceived Sexual Orientation under Oregon State Law: heterosexuality, homosexuality, bisexuality or gender identity, regardless of whether the individual’s gender identity, appearance, expression or behavior differs from that traditionally associated with the individual’s sex at birth.
Workplace Harassment: Unwelcome, unwanted or offensive conduct based on or because of an employee’s protected class status.
Harassment may occur between a manager/supervisor and a subordinate, between employees, and among non-employees who have business contact with employees. A complainant does not have to be the person harassed, but could be a person affected by the offensive conduct.
Examples of harassing behavior include, but are not limited to, derogatory remarks, slurs and jokes about a person’s protected class status.
Volunteer: Any individual who is performing work on behalf of Oregon state government or a state agency and is not paid for their service. This may include interns, externs and other categories of unpaid workers.
POLICY: Oregon state government is committed to a discrimination and harassment free work environment. This policy outlines types of prohibited conduct and procedures for reporting and investigating prohibited conduct.
(1) Discrimination, Workplace Harassment and Sexual Harassment. Oregon state government provides a work environment free from unlawful discrimination or workplace harassment based on or because of an employee’s protected class status. Additionally, Oregon state government provides a work environment free from sexual harassment. Employees at every level of the organization, including state temporary employees and volunteers, must conduct themselves in a business-like and professional manner at all times and not engage in any form of discrimination, workplace harassment or sexual harassment.
(2) Higher Standard. Managers/supervisors are held to a higher standard and are expected to be proactive in creating and maintaining a discrimination and harassment free workplace. Managers/supervisors must exercise appropriate measures to prevent and promptly correct any discrimination, workplace harassment or sexual harassment they know about or should know about.
(3) Reporting. Anyone who is subject to or aware of what they believe to be discrimination, workplace harassment or sexual harassment should report that behavior to their immediate supervisor, another manager, or the agency, board, or commission Human Resources section, Executive Director, Chair, or DAS Chief Human Resources Office as applicable. A report of discrimination, workplace harassment or sexual harassment is considered a complaint. A supervisor or manager receiving a complaint should promptly notify the Human Resources section, Executive Director or Chair, as applicable.
(a) A complaint may be made orally or in writing.
(b) An oral or written complaint should contain the following:
Policy: 50.010.01 3 of 6 Effective:Attachment 2/01/2019 #1 State HR Policy
Discrimination and Harassment Free Workplace 50.010.01
(A) the name of the complainant and the name of the person that was subjected to the discrimination or harassment if they are not the same person;
(B) the names of all parties involved, including witnesses;
(C) a specific and detailed description of the conduct or action that the employee believes is discriminatory or harassing;
(D) the date or time period in which the alleged conduct occurred; and
(E) a description of the desired remedy.
(4) Other Reporting Options. Nothing in this policy prevents any person from filing a formal grievance in accordance with a CBA, a formal complaint with the Bureau of Labor and Industries (BOLI) or the Equal Employment Opportunity Commission (EEOC), or if applicable, the United States Department of Labor (USDOL) Civil Rights Center. However, some CBAs require an employee to choose between the complaint procedure outlined in the CBA and filing a BOLI or EEOC complaint.
(5) Filing a report with the U.S. Department of Labor (USDOL) Civil Rights Center. An employee whose agency receives federal financial assistance from the U.S. Department of Labor under the Workforce Innovation and Opportunity Act (WIOA), Mine Safety and Health Administration (MSHA), Occupational Safety and Health Administration (OSHA), Veterans’ Employment and Training Services (VETS), may file a complaint with the State of Oregon Equal Opportunity Officer or directly through the USDOL Civil Rights Center. The complaint must be written, signed and filed within 180 days of when the alleged discrimination or harassment occurred.
(6) Investigation. The agency, board, or commission Human Resources section, Executive Director, or Chair, or DAS Chief Human Resources Office as applicable, will coordinate and conduct, or delegate responsibility for coordinating and conducting, an investigation.
(a) All complaints will be taken seriously and an investigation will be initiated as quickly as possible.
(b) The agency, board or commission may need to take steps to ensure employees are protected from further potential discrimination or harassment.
(c) Complaints will be dealt with in a discreet and confidential manner, to the extent possible.
(d) All parties are expected to cooperate with the investigation and keep information regarding the investigation confidential.
(e) The agency, board or commission will notify the accused and all witnesses that retaliating against a person for making a report of discrimination, workplace harassment or sexual harassment will not be tolerated.
(f) The agency, board or commission will notify the complainant and the accused when the investigation is concluded.
(g) Immediate and appropriate action will be taken if a complaint is substantiated.
Policy: 50.010.01 4 of 6 Effective:Attachment 2/01/2019 #1 State HR Policy
Discrimination and Harassment Free Workplace 50.010.01
(h) The agency, board or commission will inform the complainant if any part of a complaint is substantiated and action has been taken. The complainant will not be given the specifics of the action.
(i) The complainant and the accused will be notified by the agency, board or commission if a complaint is not substantiated.
(7) Penalties. Conduct in violation of this policy will not be tolerated.
(a) Employees engaging in conduct in violation of this policy may be subject to disciplinary action up to and including dismissal.
(b) State temporary employees and volunteers who engage in conduct in violation of this policy may be subject to termination of their working or volunteer relationship with the agency, board or commission.
(c) An agency, board or commission may be liable for discrimination, workplace harassment or sexual harassment if it knows of or should know of conduct in violation of this policy and fails to take prompt, appropriate action.
(d) Managers and supervisors who know or should know of conduct in violation of this policy and who fail to report such behavior or fail to take prompt, appropriate action may be subject to disciplinary action up to and including dismissal.
(8) Retaliation. This policy prohibits retaliation against anyone who files a complaint, participates in an investigation, or reports observing discrimination, workplace harassment or sexual harassment.
(a) Anyone who believes they have been retaliated against because they filed a complaint, participated in an investigation, or reported observing discrimination, workplace harassment or sexual harassment, should report this behavior to the employee’s supervisor, another manager, the Human Resources section, the Executive Director, or the Chair, as applicable. Complaints of retaliation will be investigated promptly.
(b) Employees who violate this policy by retaliating against others may be subject to disciplinary action, up to and including dismissal.
(c) State temporary employees and volunteers who retaliate against others may be subject to termination of their working or volunteer relationship with the agency, board or commission.
(9) Policy Notification. All employees including board/commission members, state temporary employees and volunteers shall:
(a) be required to complete harassment and discrimination training upon their initial hire or appointment, and annually thereafter
(b) be given a copy or the location of Statewide Policy 50.010.01, Discrimination and Harassment Free Workplace
(c) be given directions to read the policy
(d) be provided an opportunity to ask questions and have their questions answered – Questions regarding this policy may be directed to the employee’s immediate supervisor, another manager, or the agency,
Policy: 50.010.01 5 of 6 Effective:Attachment 2/01/2019 #1 State HR Policy
Discrimination and Harassment Free Workplace 50.010.01
board, or commission Human Resources section, Executive Director, or Chair, or DAS Chief Human Resources Office as applicable.
(e) sign an acknowledgement indicating the employee read the policy and had the opportunity to ask questions. The agency, board or commission must keep signed acknowledgements on file, or use an electronic acknowledgment system to comply with this requirement.
Policy: 50.010.01 6 of 6 Effective:Attachment 2/01/2019 #1 Appn Year 2019 BOARD OF DENTISTRY Fund 3400 BOARD OF DENTISTRY For the Month of APRIL 2019
REVENUES Budget Obj Budget Obj Title Prior Month Current Month Bien to Date Financial Plan Unoblig 0605 INTEREST AND INVESTMENTS 48,003.31 3,958.52 51,961.83 7,500.00 -44,461.83 0205 OTHER BUSINESS LICENSES 3,047,985.00 67,621.00 3,115,606.00 3,350,001.00 234,395.00 0975 OTHER REVENUE 13,235.89 530.00 13,765.89 49,999.00 36,233.11 0210 OTHER NONBUSINESS LICENSES AND FEES 12,104.00 800.00 12,904.00 10,000.00 -2,904.00 0505 FINES AND FORFEITS 526,365.39 6,000.00 532,365.39 100,000.00 -432,365.39 0410 CHARGES FOR SERVICES 24,332.00 136.50 24,468.50 17,500.00 -6,968.50 3,672,025.59 79,046.02 3,751,071.61 3,535,000.00 -216,071.61 TRANSFER OUT Budget Obj Budget Obj Title Prior Month Current Month Bien to Date Financial Plan Unoblig 2443 TRANSFER OUT TO OREGON HEALTH AUTHORITY 107,397.60 74,835.00 182,232.60 226,800.00 44,567.40 107,397.60 74,835.00 182,232.60 226,800.00 44,567.40 PERSONAL SERVICES Budget Obj Budget Obj Title Prior Month Current Month Bien to Date Financial Plan Unoblig 3110 CLASS/UNCLASS SALARY & PER DIEM 980,536.43 55,627.27 1,036,163.70 1,240,538.00 204,374.30 3250 WORKERS' COMPENSATION ASSESSMENT 356.90 18.04 374.94 552.00 177.06 3270 FLEXIBLE BENEFITS 175,013.79 9,018.88 184,032.67 276,576.00 92,543.33 3260 MASS TRANSIT 6,041.06 327.57 6,368.63 7,427.00 1,058.37 3210 ERB ASSESSMENT 253.34 14.98 268.32 399.00 130.68 3230 SOCIAL SECURITY TAX 80,046.06 4,483.84 84,529.90 98,479.00 13,949.10 3220 PUBLIC EMPLOYES' RETIREMENT SYSTEM 141,494.02 4,874.40 146,368.42 192,216.00 45,847.58 3180 SHIFT DIFFERENTIAL 41.75 7.84 49.59 0.00 -49.59 3190 ALL OTHER DIFFERENTIAL 11,648.29 531.70 12,179.99 36,796.00 24,616.01 3221 PENSION BOND CONTRIBUTION 55,652.65 2,584.91 58,237.56 71,090.00 12,852.44 3170 OVERTIME PAYMENTS 4,891.09 207.60 5,098.69 5,911.00 812.31 3160 TEMPORARY APPOINTMENTS 56,619.92 2,546.56 59,166.48 4,065.00 -55,101.48 1,512,595.30 80,243.59 1,592,838.89 1,934,049.00 341,210.11 SERVICES and SUPPLIES Budget Obj Budget Obj Title Prior Month Current Month Bien to Date Financial Plan Unoblig 4150 EMPLOYEE TRAINING 26,818.49 5.00 26,823.49 59,523.00 32,699.51 4200 TELECOMM/TECH SVC AND SUPPLIES 19,492.16 968.78 20,460.94 24,013.00 3,552.06 4715 IT EXPENDABLE PROPERTY 9,334.76 0.00 9,334.76 22,622.00 13,287.24 4315 IT PROFESSIONAL SERVICES 15,300.00 0.00 15,300.00 57,611.00 42,311.00 Attachment #2 Agy834_Budget Dental Feb19.bqy 05/ 20/ 19 Page 1 of 2 Budget Obj Budget Obj Title Prior Month Current Month Bien to Date Financial Plan Unoblig 4300 PROFESSIONAL SERVICES 257,659.48 8,332.25 265,991.73 245,596.00 -20,395.73 4275 PUBLICITY & PUBLICATIONS 7,619.46 1,037.39 8,656.85 14,311.00 5,654.15 4250 DATA PROCESSING 38,149.28 2,659.54 40,808.82 29,684.00 -11,124.82 4650 OTHER SERVICES AND SUPPLIES 80,690.77 2,465.88 83,156.65 113,260.00 30,103.35 4425 FACILITIES RENT & TAXES 145,507.64 7,065.85 152,573.49 172,540.00 19,966.51 4575 AGENCY PROGRAM RELATED SVCS & SUPP 32,521.22 1,015.20 33,536.42 146,640.00 113,103.58 4700 EXPENDABLE PROPERTY $250-$5000 1,794.38 0.00 1,794.38 5,622.00 3,827.62 4225 STATE GOVERNMENT SERVICE CHARGES 119,716.76 232.25 119,949.01 122,459.00 2,509.99 4325 ATTORNEY GENERAL LEGAL FEES 235,206.90 10,797.95 246,004.85 235,911.00 -10,093.85 4100 INSTATE TRAVEL 32,613.53 2,537.67 35,151.20 48,926.00 13,774.80 4175 OFFICE EXPENSES 59,950.38 11,117.64 71,068.02 87,890.00 16,821.98 4400 DUES AND SUBSCRIPTIONS 7,291.60 20.99 7,312.59 6,865.00 -447.59 4125 OUT-OF-STATE TRAVEL 548.36 0.00 548.36 0.00 -548.36 4375 EMPLOYEE RECRUITMENT AND DEVELOPMENT 0.00 0.00 0.00 679.00 679.00 4475 FACILITIES MAINTENANCE 0.00 0.00 0.00 562.00 562.00 6,382,233.66 Script1,090,215.17 Script 48,256.39Script1,138,471.56425,948.34 1,394,714.00 256,242.44 834 3400 Monthly Activity Biennium Activity Financial Plan
REVENUES REVENUE 79,046.02 3,751,071.61 3,535,000.00 Total 79,046.02 3,751,071.61 3,535,000.00 EXPENDITURES PERSONAL SERVICES 80,243.59 1,592,838.89 1,934,049.00 SERVICES AND SUPPLIES 48,256.39 1,138,471.56 1,394,714.00 Total 128,499.98 2,731,310.45 3,328,763.00 TRANSFER OUT TRANSFER OUT 74,835 182,232.6 226,800.00 Total 74,835 182,232.6 226,800.00
Attachment #2 Agy834_Budget Dental Feb19.bqy 05/ 20/ 19 Page 2 of 2 From: Balducci, Ed
Subject: Voice Services Outage: Problem with multiple sites, getting message "RF2 no telephony possible" reporting they are unable to receive or make calls.
Description / Details including Applications / Services Impacted: OSV application, Unable to make Incoming and outgoing calls statewide (all phone systems).
Current Status: The issue is currently under investigation, please do not open any tickets for this issue.
Next Update: Updates will be sent out 30 minutes
Distributed to: [email protected]
With best regards
Ed Balducci - ITIL® Foundation Certified
Service Delivery Director
Phone: 408.492.2420; M: 925.699.9114 [email protected]
WWW.Atos.net
Attachment #3 Oregon Board of Dentistry
Q1 How would you rate the timeliness of services provided by the Oregon Board of Dentistry?
Answered: 87 Skipped: 0
Don't Know 6% (5) Poor Don't Know 5% (4)6% (5) Poor Fair Poor 5% (4) 2% (2)5% (4) Fair 2% (2)
Good 24% (21) Good 24% (21) Excellent 63% (55) Excellent 63% (55)
ANSWER CHOICES RESPONSES
Excellent 63% 55
Good 24% 21
Fair 2% 2
Poor 5% 4
Don't Know 6% 5 TOTAL 87
1 / 7 Attachment #4 Oregon Board of Dentistry
Q2 How do you rate the ability of the Oregon Board of Dentistry to provide services correctly the first time?
Answered: 86 Skipped: 1
Don't Know 6% (5) Poor Don't Know 5% (4)6% (5) Poor Fair Poor 5% (4) 3% (3)5% (4) Fair 3% (3)
Good 21% (18) Good 21% (18)
Excellent 65% (56) Excellent 65% (56)
ANSWER CHOICES RESPONSES
Excellent 65% 56
Good 21% 18
Fair 3% 3
Poor 5% 4
Don't Know 6% 5 TOTAL 86
2 / 7 Attachment #4 Oregon Board of Dentistry
Q3 How do you rate the helpfulness of the Oregon Board of Dentistry employees?
Answered: 87 Skipped: 0
Don't Know 6% (5) Poor Don't Know 1%1% (1)(1) 6% (5) Poor Fair Poor 1% (1) 3% (3)1% (1) GoodFair 18%18% (16)(16)3% (3) Good 18% (16)
Excellent 71% (62) Excellent 71% (62)
ANSWER CHOICES RESPONSES
Excellent 71% 62
Good 18% 16
Fair 3% 3
Poor 1% 1
Don't Know 6% 5 TOTAL 87
3 / 7 Attachment #4 Oregon Board of Dentistry
Q4 How do you rate the knowledge and expertise of the Oregon Board of Dentistry employees?
Answered: 87 Skipped: 0
Don't Know 9% (8) PoorDon't Know 2% (2)9% (8) Poor Fair Poor 2% (2) 5% (4)2% (2) Fair 5% (4)
Good 22% (19) Good Excellent 22% (19) 62% (54) Excellent 62% (54)
ANSWER CHOICES RESPONSES
Excellent 62% 54
Good 22% 19
Fair 5% 4
Poor 2% 2
Don't Know 9% 8 TOTAL 87
4 / 7 Attachment #4 Oregon Board of Dentistry
Q5 How do you rate the availability of information at the Oregon Board of Dentistry?
Answered: 87 Skipped: 0
Don't Know 3% (3) Poor Don't Know 3% (3) 3% (3) Poor Fair Poor 3% (3) 6% (5)3% (3) Fair 6% (5) Good 22% (19) Good 22% (19)
Excellent 66% (57) Excellent 66% (57)
ANSWER CHOICES RESPONSES
Excellent 66% 57
Good 22% 19
Fair 6% 5
Poor 3% 3
Don't Know 3% 3 TOTAL 87
5 / 7 Attachment #4 Oregon Board of Dentistry
Q6 How do you rate the overall quality of service provided by the Oregon Board of Dentistry?
Answered: 87 Skipped: 0
Don't Know 3% (3) Poor Don't Know 1%1% (1)(1) 3% (3) Poor Fair Poor 1% (1) 10%10% (9)(9)1% (1) Fair 10% (9)
Good 26% (23) Excellent Good 59% (51) 26% (23) Excellent 59% (51)
ANSWER CHOICES RESPONSES
Excellent 59% 51
Good 26% 23
Fair 10% 9
Poor 1% 1
Don't Know 3% 3 TOTAL 87
6 / 7 Attachment #4 Oregon Board of Dentistry
Q7 Final Question- How do you rate our new website?
Answered: 75 Skipped: 12
Don't Know 24% (18) Don't Know 24% (18)
Excellent Poor 49% (37) 4% (3) Excellent Poor 49% (37) 4%Fair (3) 5% (4) Fair 5% (4)
Good 17%17% (13)(13) Good 17% (13) ANSWER CHOICES RESPONSES
Excellent 49% 37
Good 17% 13
Fair 5% 4
Poor 4% 3
Don't Know 24% 18 TOTAL 75
7 / 7 Attachment #4
House Committee on Health Care – May 23, 2019
OREGON BOARD OF DENTISTRY Information provided by Stephen Prisby, Executive Director
AGENCY OVERVIEW
The Board of Dentistry was established in 1887 to regulate the practice of Dentistry. In 1946, Dental Hygiene was established as a licensed profession in Oregon and added to the purview of the Board. The Mission of the Board is to promote high quality oral health care in the State of Oregon by equitably regulating dental professionals.
There are ten members appointed by the Governor, and confirmed by the senate to this policymaking Board. The ten volunteer Board members include six dentists, one of whom must be a specialist, two dental hygienists and two public members. It is a diverse Board with representatives from private practice & public health. Geographic diversity, ethnic diversity and political diversity are the hallmarks of our well-represented board. The public members are engaged and are essential in carrying out all the important duties and responsibilities they are entrusted with.
There are also 8 full time paid staff to carry out all the day to day functions of the Board. All staff live in Oregon and drive the mission and goals of the agency in supporting all Oregonians for ensuring they receive safe oral healthcare from competent practitioners.
The Board’s highest priorities are the licensing, administration, enforcement and monitoring of Dentists and Dental Hygienists in Oregon. The Dental Practice Act are the statutes and rules pertaining to dentistry and dental hygiene, now totals over 80,000 words.
The OBD’s funding is 100% Other Funds generated primarily from fees paid by licensees and applicants for new licenses, license renewals and various permits and certifications. No additional tax revenues fund the Board.
The Board receives legal advice and assistance from our assigned Senior Assistant Attorney General, including advice on pending investigations, representation in contested case hearings, negotiations of settlements, advice on proposed rulemaking, assistance with responses to public records requests and response to other legal matters as necessary.
Total Licensed Oregon Dentists – 3756 Total Licensed Dental Hygienists - 4327 Specialists – 711
SB 835
The Board has NO Position and NO Opinion on SB 835.
The Board only had one piece of legislation for the Legislature to consider in the 2019 Session, which was HB 5013, our budget bill.
Some testimony presented to this Committee on May 21, 2019 was inaccurate or incomplete and I am here to clarify some points and be a resource to this committee.
SB 835 as proposed, does not change or limit what any licensee can currently do or practice in the state.
Attachment #5
The Board convened a Dental Implant Safety Workgroup, based on the types and volume of complaints the board was receiving in 2015, 2016 and into 2017. We did not “survey” consumers or licensees on this matter. We have a customer service survey, that we use, which is part of our key performance measures. Our Licensees and the dental community of this state were notified of the Dental Implant Safety Workgroup through email blasts, in our newsletter, in our Board meeting materials, and in presentations to dental societies. Additionally, the Oregon Dental Association did a great job sharing the news with their members as well. Any interested Oregon licensed dentist was invited to participate on this volunteer workgroup. The Dental Implant Safety Workgroup’s stated purpose was to “to research, review and discuss dental implants, complications and the resulting investigations with the goal of advising the OBD on what should be the most effective actions in protecting the public and educating dentists regarding dental implants.” The workgroup’s membership was comprised of general dentists and specialists. All Board meetings are open to the public and this workgroup had 4 meetings which made recommendations for our Board to consider.
Some testimony implied communication from the Board on SB 835 was lacking. SB 835 is not our bill. Our Board meeting packets include reference to legislation that could impact our licensees but due to the timing of legislative session, when legislation is introduced and our meetings being every other month, sometimes bills aren’t referenced. We look forward to hearing how we can better inform our Licensees on important information that they want from us.
When Licensees are due to renew their license we typically send out six (6) reminders (with emails, eblasts, postcards). We utilize regular eblasts for meeting notices, reminders to sign up on the PDMP, notices of public rulemaking hearings and other timely news.
ORS 679.120(4) requires a dentist to advise the board within 30 days of change of address. This is important because license renewal reminders go to this address of record. Investigations are also initiated through the mail and we request patient records and other information via the US mail.
We have already set public rulemaking hearing dates on September 10th and October 11th for the rules to be further amended and implemented. Our meeting dates for 2020 have already been set. We are intentional and deliberate in our transparency to keep our licensees informed and up to date on issues that could impact their license or the safe practice of dentistry and dental hygiene in Oregon.
I am happy to answer any questions that you have. Thank you for your time today.
Attachment #5 Custom Report Report Date: June 10, 2019
Bill Name Bill Name Last Three Actions Current Committee HB 2011 HB 2011 EN 05/30/19 - Governor signed. 05/23/19 - President signed. 05/23/19 - Speaker signed. Relating to cultural competency continuing education; and prescribing an effective date. Requires specified professional regulatory boards to require persons authorized to practice professions regulated by board to complete cultural competency continuing education. Relating to cultural competency continuing education; and prescribing an effective date. HB 2220 HB 2220 EN 05/10/19 - Chapter 58, (2019 Laws): Effective date May 6, 2019. 05/06/19 - Governor signed. 04/29/19 - President signed. Relating to vaccines administered by dentists; and declaring an emergency. Authorizes dentists to prescribe and administer vaccines. Relating to vaccines administered by dentists; and declaring an emergency. HB 2257 HB 2257 A 06/10/19 - Public Hearing and Work Session Ways and Means (J) scheduled. 05/29/19 - Assigned to Subcommittee On Human Services. 02/18/19 - Referred to Ways and Means by prior reference. Relating to drugs; declaring an emergency. Declares legislative intent to consider substance use disorder as chronic illness. Relating to drugs; creating new provisions; amending ORS 431A.850, 431A.855, 431A.860, 431A.865, 431A.867 and 431A.898; and declaring an emergency. HB 2353 HB 2353 EN 06/04/19 - Governor signed. 05/28/19 - President signed. 05/28/19 - Speaker signed. Relating to public records; and declaring an emergency. Authorizes Attorney General, district attorney or court to award penalty to public records requester, or order fee waiver or fee reduction, if public body responds to request with undue delay or fails to be responsive to request. Relating to public records; and declaring an emergency. HB 2431 HB 2431 A 04/03/19 - Referred to Ways and Means by Ways and Means (J) order of Speaker. 04/03/19 - Recommendation: Do pass with amendments, be printed A-Engrossed, and be referred to Ways and Means. 03/26/19 - Work Session held. Relating to state agency accountability for public records law compliance. Requires each state agency to report to Attorney General, Public Records Advocate and public records subcommittee of Legislative Counsel Committee on number of public records requests received during preceding year, and number of those requests still outstanding after specified periods of time. Relating to state agency accountability for public records law compliance.
6/10/2019 - Page: 1 Attachment #5 Custom Report Report Date: June 10, 2019
Bill Name Bill Name Last Three Actions Current Committee HB 2454 HB 2454 A 05/20/19 - Referred to Rules by order of the Rules (S) President. 05/20/19 - Recommendation: Without recommendation as to passage and be referred to Rules. 05/09/19 - Work Session held. Relating to regulated professions in the Eastern Oregon Border Economic Development Region. Allows out-of-state applicant seeking occupational license in Oregon more time to meet Oregon standards if applicant is already licensed in another state and is seeking to work in Eastern Oregon Border Economic Development Region. Relating to regulated professions in the Eastern Oregon Border Economic Development Region. HB 2609 HB 2609 EN 05/10/19 - Chapter 53, (2019 Laws): Effective date May 2, 2019. 05/03/19 - Governor signed. 04/26/19 - President signed. Relating to dental directors; and declaring an emergency. Directs Oregon Health Authority to disclose certain patient information to dental directors for specified purposes. Relating to dental directors; and declaring an emergency. HB 3030 HB 3030 EN 05/24/19 - Chapter 142, (2019 Laws): effective on the 91st day following adjournment sine die. 05/22/19 - Governor signed. 05/16/19 - President signed. Relating to professional authorizations; and prescribing an effective date. Allows professional licensing board to issue nonrenewable temporary authorization to spouse of member of Armed Forces of United States stationed in Oregon and who holds eligible out-of-state authorization to provide occupational or professional service. Relating to professional authorizations; and prescribing an effective date. HB 3353 HB 3353 03/11/19 - Referred to Health Care. Health Care (H) INTRO 03/04/19 - First reading. Referred to Speaker's desk. Relating to dental services; prescribing an effective date. Allows nonprofit corporation that provides reduced-cost dental services to underserved populations, including individuals 55 years of age or older or individuals who require accessible facilities, to own, operate, conduct or maintain dental practice. Relating to dental services; creating new provisions; amending ORS 679.020; and prescribing an effective date. HB 5013 HB 5013 EN 04/19/19 - Chapter 24, (2019 Laws): Effective date July 1, 2019. 04/10/19 - Governor signed. 04/03/19 - President signed. Relating to the financial administration of the Oregon Board of Dentistry; and declaring an emergency. Limits biennial expenditures from fees, moneys or other revenues, including Miscellaneous Receipts, but excluding lottery funds and federal funds, collected or received by Oregon Board of Dentistry. Relating to the financial administration of the Oregon Board of Dentistry; and declaring an emergency.
6/10/2019 - Page: 2 Attachment #5 Custom Report Report Date: June 10, 2019
Bill Name Bill Name Last Three Actions Current Committee SB 60 SB 60 EN 06/04/19 - Governor signed. 05/28/19 - Speaker signed. 05/28/19 - President signed. Relating to health care professional liability limitation; and declaring an emergency. Allows acupuncturists and podiatric physicians to claim liability limitation for provision of health care services without compensation. Relating to health care professional liability limitation; and declaring an emergency. SB 240 SB 240 A 04/15/19 - Referred to Ways and Means by Ways and Means (J) order of the President. 04/15/19 - Recommendation: Do pass with amendments and be referred to Ways and Means. (Printed A-Eng.) 04/09/19 - Public Hearing and Work Session held. Relating to electronic government records; prescribing an effective date. Directs governmental agencies of this state to use electronic records and electronic signatures by July 1, 2020. Relating to electronic government records; creating new provisions; amending ORS 84.052; and prescribing an effective date. SB 688 SB 688 A 06/04/19 - Third reading. Carried by Neron. Passed. Ayes, 55; Excused, 4--Boles, Clem, Hernandez, Speaker Kotek; Excused for Business of the House, 1--Power. 06/03/19 - Second reading. 05/30/19 - Subsequent referral to Business and Labor rescinded by order of the Speaker. Relating to professional authorizations. Directs professional licensing board to annually report to interim committee of Legislative Assembly related to veterans information about temporary authorizations to practice occupational or professional service for spouses or domestic partners of members of Armed Forces of United States who are stationed in this state. Relating to professional authorizations. SB 770 SB 770 A 06/07/19 - Assigned to Subcommittee On Ways and Means (J) Human Services. 04/16/19 - Referred to Ways and Means by prior reference. 04/16/19 - Recommendation: Do pass with amendments and be referred to Ways and Means by prior reference. (Printed A-Eng.) Relating to statewide health care coverage; declaring an emergency. Establishes Universal Health Care Commission charged with recommending to Legislative Assembly design of Health Care for All Oregon Plan, administered by Health Care for All Oregon Board to provide publicly funded, equitable, affordable, comprehensive and high quality health care to all Oregon residents. Relating to statewide health care coverage; and declaring an emergency. SB 773 SB 773 03/25/19 - Public Hearing held. Judiciary (S) INTRO 02/14/19 - Referred to Judiciary. 02/12/19 - Introduction and first reading. Referred to President's desk. Relating to criminal background criteria used by professional licensing boards. Requires each professional licensing board to study criminal background criteria and character standards for licensure, certification or other authorization to provide occupational or professional service regulated by board. Relating to criminal background criteria used by professional licensing boards. 6/10/2019 - Page: 3 Attachment #5 Custom Report Report Date: June 10, 2019
Bill Name Bill Name Last Three Actions Current Committee SB 778 SB 778 03/25/19 - Public Hearing held. Judiciary (S) INTRO 02/14/19 - Referred to Judiciary. 02/12/19 - Introduction and first reading. Referred to President's desk. Relating to certificates of good standing. Expands eligibility of Certificate of Good Standing to include persons convicted of person felony or person Class A misdemeanor. Relating to certificates of good standing; creating new provisions; amending ORS 59.205, 86A.115, 86A.212, 94.980, 194.315, 194.340, 319.042, 319.628, 326.603, 342.143, 443.004, 443.735, 462.075, 463.185, 464.470, 471.313, 471.380, 471.385, 475B.045, 475B.266, 671.090, 672.200, 673.170, 673.700, 674.140, 675.070, 675.540, 675.745, 678.111, 678.442, 679.115, 680.082, 680.200, 683.140, 684.100, 685.110, 686.132, 687.081, 688.525, 688.655, 689.405, 692.180, 696.301, 696.535, 697.039, 697.540, 697.752, 702.012, 703.480, 704.020, 717.235, 725.145, 725A.026, 726.075, 744.013, 744.074, 744.338, 744.718 and 750.575 and sections 1 and 2, chapter 526, Oregon Laws 2017; and repealing section 3, chapter 526, Oregon Laws 2017. SB 808 SB 808 04/15/19 - Referred to Rules by order of the Rules (S) INTRO President. 04/15/19 - Recommendation: Do Pass and subsequent referral to Ways and Means be rescinded and refer to Rules. 04/08/19 - Work Session held. Relating to continuing education for professionals; prescribing an effective date. Directs Oregon Health Authority and specified professional regulatory boards to require licensees regulated by authority or board to complete continuing education related to suicide risk assessment, treatment and management and to report completion of continuing education to authority or board. Relating to continuing education for professionals; creating new provisions; amending ORS 676.860; and prescribing an effective date. SB 824 SB 824 B 06/04/19 - Third reading. Carried by Hayden. Passed. Ayes, 55; Nays, 1--Evans; Excused, 3--Clem, Hernandez, Speaker Kotek; Excused for Business of the House, 1--Power. 06/03/19 - Second reading. 05/30/19 - Recommendation: Do pass with amendments and be printed B-Engrossed. Relating to dental licensure examinations; declaring an emergency. Allows Oregon Board of Dentistry to accept results of national standardized examinations under specified circumstances when determining fitness of applicant to practice dentistry or dental hygiene. Relating to dental licensure examinations; creating new provisions; amending ORS 679.070 and 680.060; and declaring an emergency. SB 834 SB 834 EN 05/24/19 - Governor signed. 05/20/19 - Speaker signed. 05/20/19 - President signed. Relating to licensees of the Oregon Board of Dentistry. Provides that expression of regret or apology made by or on behalf of person licensed by Oregon Board of Dentistry does not constitute admission of liability in civil action and that person who makes expression may not be examined with respect to expression. Relating to licensees of the Oregon Board of Dentistry.
6/10/2019 - Page: 4 Attachment #5 Custom Report Report Date: June 10, 2019
Bill Name Bill Name Last Three Actions Current Committee SB 835 SB 835 EN 06/07/19 - Speaker signed. 06/06/19 - President signed. 06/04/19 - Third reading. Carried by Hayden. Passed. Ayes, 55; Nays, 1--Evans; Excused, 3--Clem, Hernandez, Speaker Kotek; Excused for Business of the House, 1--Power. Relating to advertising by dentists; and declaring an emergency. Allows dentist to advertise practice in specialty area of dentistry. Relating to advertising by dentists; and declaring an emergency. SB 836 SB 836 02/26/19 - Referred to Health Care. Health Care (S) INTRO 02/26/19 - Introduction and first reading. Referred to President's desk. Relating to dental pilot projects. Authorizes Oregon Board of Dentistry to review patient charts associated with dental pilot projects approved by Oregon Health Authority. Relating to dental pilot projects; amending section 1, chapter 716, Oregon Laws 2011. SB 854 SB 854 A 06/07/19 - Recommendation: Do pass. 06/06/19 - Work Session held. 06/03/19 - Public Hearing held. Relating to acceptable identification numbers for state-issued authorizations; prescribing an effective date. Directs professional licensing boards, in certain circumstances, to accept individual taxpayer identification number or other federally-issued identification number in lieu of Social Security number on applications for issuance or renewal of authorization to practice occupation or profession. Relating to acceptable identification numbers for state-issued authorizations; and prescribing an effective date. SB 855 SB 855 A 06/07/19 - Recommendation: Do pass. 06/06/19 - Work Session held. 06/03/19 - Public Hearing held. Relating to professional practice authorizations; declaring an emergency. Directs professional licensing boards to study manner in which persons who are immigrants or refugees become authorized to practice occupation or profession. Relating to professional practice authorizations; and declaring an emergency. SB 912 SB 912 A 06/10/19 - Work Session scheduled. Ways and Means (J) 06/05/19 - Assigned to Subcommittee On Education. 04/22/19 - Referred to Ways and Means by prior reference. Relating to sexual conduct toward children; declaring an emergency. Revises definition of terms "sexual conduct" and "substantiated report" for purposes of certain laws related to abuse and sexual conduct by school employees. Relating to sexual conduct toward children; creating new provisions; and amending ORS 339.370, 339.372, 339.388 and 339.396; and declaring an emergency.
6/10/2019 - Page: 5 Attachment #5 Custom Report Report Date: June 10, 2019
Bill Name Bill Name Last Three Actions Current Committee SB 933 SB 933 EN 06/04/19 - Speaker signed. 06/03/19 - President signed. 05/30/19 - Third reading. Carried by Williamson. Passed. Ayes, 57; Excused for Business of the House, 3--Holvey, Rayfield, Speaker Kotek. Relating to inquiries issued by public bodies about race or ethnicity. Provides that form or document issued by public body asking person to identify person's race or ethnicity must allow person to select multiple races or ethnicities . Relating to inquiries issued by public bodies about race or ethnicity. SB 1049 SB 1049 EN 06/04/19 - Speaker signed. 06/03/19 - President signed. 05/30/19 - Vote explanation(s) filed by Alonso Leon, Bynum, Keny-Guyer, McLain, Meek, Mitchell, Neron, Piluso, Prusak, Salinas, Sanchez, Schouten, Smith Warner, Sollman, Wilde, Williams, Williamson. Relating to public employee retirement; and declaring an emergency. Redirects portion of employee contributions of member of Public Employees Retirement System to employee pension stability account. Relating to public employee retirement; and declaring an emergency.
6/10/2019 - Page: 6 Attachment #5 TO: OBD Board Members
FROM: Stephen Prisby, Executive Director
DATE: June 11, 2019
SUBJECT: OBD Delegated Duties to Executive Director & Staff
Annually at every June Board Meeting, I ask that the Board review and approve delegated duties to the Executive Director and staff. The Board convenes this June 2019 Board Meeting with a new President and a new Board Member. I attached the delegated duties that I would like the Board to affirm, as well as the executive director’s current job description.
• Delegated Authority to Executive Director & Board Staff • Executive Director’s Job Description
Attachment #6 Delegated Authority to OBD Executive Director and Staff
Investigations:
Manage the Board’s Confidential Diversion Program, including initiating investigations Grant extensions to respond within ten days to a Board request for information Initiate investigations on any and all matters under the Board’s jurisdiction and statutory authority including CE noncompliance, malpractice claims, PLR, etc…
Notices/Consent Orders/Orders/Interim Consent Orders:
Issue Amended Notice to address errors or correct allegations Approve ordered continuing education courses Approve ordered community service arrangements Approve ordered mentorships and mentors Grant extension to complete ordered continuing education Grant extension to complete ordered community service Grant extension to pay ordered civil penalties, refunds and restitution Offer & Accept Interim Consent Orders for subsequent ratification by the Board
General Approval:
Regarding Board and Committee/Workgroup Minutes, simplify Board approval of motions with the language “Motion approved unanimously”, instead of listing each members’ name, of course any no votes, or when members recuse themselves, the individual will be identified
New and Renewal Applications:
Executive Director determines whether an applicant/licensee with a criminal record or disciplinary action record(s) needs to go to the Board for issuing or renewing a license.
Recommendation: In the matter of delegated duties, move to authorize the listed duties for the OBD Executive Director and Staff.
______Date Amy B. Fine, D.M.D. President Oregon Board of Dentistry
Attachment #6 Attachment #6 Attachment #6 Attachment #6 Attachment #6 Attachment #6 Attachment #6 Attachment #6
BOARD OF DENTISTRY 10 Members
EXECUTIVE DIRECTOR Principal Executive/Manager E Stephen Prisby Classification Z7008 Position 521 1.0 FTE
INVESTIGATION AND COMPLIANCE LICENSING/ADMINISTRATIVE MONITORING SUPPORT
Interim Dental Director/Chief OFFICE MANAGER Investigator Teresa Haynes Dr. Daniel E. Blickenstaff Classification X0806 Classification C5911 Position 524 1.0 FTE Position 531 1.0 FTE
Investigator 2 Haley Robinson LICENSING ADMIN SUPPORT Classification C5232 Licensing & Examination Manager Office Specialist 2 Position 528 1.0 FTE Admin Specialist 2 Samantha VandeBerg Ingrid Nye Classification C0104 Classification CO 180 Position 529 1.0 FTE Investigator 2 Position 525 1.0 FTE Harvey Wayson Classification C5232 Position 530 1.0 FTE
Dental Investigator Dr. Winthrop B. Carter, Jr. Classification C5911 Position 531 1.0 FTE
Investigator 2 Shane Rubio Classification C5232 Position 530 1.0 FTE
2 Attachment #6 Attachment #7 POLICY NUMBER 107-001-020
STATEWIDE POLICY EFFECTIVE DATE June 1, 2019
EXHIBIT A – Model Public Records Management Policy
POLICY ORS 192.018 requires every state agency to have a “written policy that sets forth the agency’s use, retention and ownership of public records” so that public records are maintained and managed appropriately across the enterprise of state government, from the time of creation of a public record to the time of final disposition of the public record.
Agencies are required to seek review and approval from the State Archivist, in accordance with ORS 192.018, prior to adopting an internal public records management policy.
Agencies must review and, if necessary, update their public records management policy at least once per biennium to reflect changes in applicable laws, policies and business needs, and to ensure ongoing access to agency records. Any updates or revisions must be submitted for review and approval by the State Archivist according to ORS 192.018, prior to adoption.
SPECIAL SITUATIONS Retained records may be subject to public disclosure upon request, even if their retention was not required by law. The statutes requiring public disclosure of records apply more broadly than the statutes requiring records to be retained. Agencies are not required to create public records that would not otherwise exist. Only the official copy of a public record must be retained. Stock of publications are not public records and may be preserved for convenience or destroyed.
GENERAL INFORMATION The goal of this policy is to ensure public records are managed and maintained appropriately within the Oregon Board of Dentistry and consistently across the enterprise of state government.
This Oregon Board of Dentistry Public Records Management Policy, adopted according to the requirements of DAS Statewide Policy 107-011-020 and ORS 192.018, addresses the following components: I. Public Records Maintenance II. Roles and Responsibilities III. Education and Training IV. Access and Ownership V. Integrity VI. Retention, Generally VII. Storage and Retrieval VIII. Public Records Requests IX. Disposition and Destruction of Public Records
COMPLIANCE The Oregon Board of Dentistry will develop and implement internal processes and procedures that support compliance, deter abuse and detect violations of this policy.
DAS STATEWIDE MODEL PUBLIC RECORDS MANAGEMENT POLICY AttachmentPAGE #71 OF 6 DEFINITIONS Authorized Retention Schedule: Either a General Schedule published by the State Archivist in the OAR in which certain common public records are described or listed by title and a retention period is established for each; or a Special Schedule approved by the State Archivist for the public records of a specific agency.
Cloud-computing: Has the meaning established in the National Institute of Standards and Technology (NIST) Special Publication 800-145.
Custodian: A public body mandated, directly or indirectly, to create, maintain, care for or control a public record. "Custodian" does not include a public body that has custody of a public record as an agent of another public body that is the custodian, unless the public record is not otherwise available.
Instant Messaging: Real-time text communications between or among computers or mobile devices over the internet or functionally similar communications networks.
Metadata: Data that provides information about other data. Metadata assists in resource discovery by allowing resources to be found by relevant criteria, identifying resources, bringing similar resources together, distinguishing dissimilar resources and giving location information.
Public Record: Has the meaning established in ORS 192.005. In general it refers to information that is prepared, owned, used or retained by a state agency or political subdivision; relates to an activity, transaction or function of a state agency or political subdivision; and is necessary to satisfy the fiscal, legal, administrative or historical policies, requirements or needs of the state agency or political subdivision. Refer to the Secretary of State’s guide for determination of a public record: https://sos.oregon.gov/archives/Documents/recordsmgmt/train/brm/managingrecords.pdf.
Social Media: Web-based and mobile communication technologies that allow the creation and exchange of user-generated content such as comments or responsive postings. Examples of social media include but are not limited to Twitter, Flickr, blogging sites, Facebook, YouTube and Instagram.
Text Messaging: Messages exchanged between fixed-line phones or mobile phones and fixed or portable devices over a network. Excluded from the definition of text messages are electronic mail (email) communications, whether such messages are exchanged among or between official state government email accounts or email accounts maintained by private entities.
Unified Communications: A service of IBM; the packaged services or user profiles available to agencies (e.g., instant messaging, video conferencing, telephony, call management and call control across multiple systems, etc.). Also known as IBM Unified Communications.
POLICY GUIDELINES
I. PUBLIC RECORDS MAINTENANCE Public records must be maintained and managed in a manner that protects the integrity of the records within the Oregon Board of Dentistry without regard to the technology or medium used to create or communicate the record, from the time of creation of a public record to the time of final disposition of the public record as determined by their authorized records retention schedule.
II. ROLES AND RESPONSIBILITIES Oregon law requires agencies to designate an Agency Records Officer “to coordinate its agency’s Records Management Program” (ORS 192.105(2)(a)). The Oregon Board of Dentistry records officer will serve as primary liaison with the State Archivist and receive training from the State Archivist in performing their duties.
DAS STATEWIDE MODEL PUBLIC RECORDS MANAGEMENT POLICY AttachmentPAGE #72 OF 6
The Oregon Board of Dentistry will ensure agency public records are managed in accordance with their authorized records retention schedules, from the time of creation to final disposition.
III. EDUCATION AND TRAINING Basic public records training will be completed as a component of the Oregon Board of Dentistry new employee orientation training and incorporated as part of regular employee training, completed once a biennium.
The Oregon Board of Dentistry will utilize the following training program to provide public records training: ILearn
IV. ACCESS AND OWNERSHIP Without regard to how public records are being stored, the Oregon Board of Dentistry will have custody and control over public records. Through ongoing review of technological advances, The Oregon Board of Dentistry will ensure all public records are maintained and accessible for as long as required by authorized retention schedules or litigation holds.
The Oregon Board of Dentistry’s disaster mitigation process is addressed in the Oregon Board of Dentistry disaster preparedness and recovery plan.
V. INTEGRITY The Oregon Board of Dentistry will ensure appropriate access and version controls are applied to all electronically stored records from record creation to final disposition.
The authenticity of each record can be demonstrated either by certified copy of paper records or via accompanying metadata for all electronic records.
VI. RETENTION, GENERALLY The Oregon Board of Dentistry will preserve and classify public records according to ORS chapter 192, OAR chapter 166-300, OAR chapter 166-350 Retention Schedule and DAS Statewide Policy 107-004- 050 regarding Information Asset Classification.
The Oregon Board of Dentistry will work with the Archives Division to establish retention practices to ensure compliance with ORS chapter 192 and OAR chapter 166-300.
a. CLOUD COMPUTING The Oregon Board of Dentistry practices and procedures with respect to public records management in the Cloud will comply with the DAS Statewide Cloud Computing Policy 107-004-150 and OAR chapter 166-300.
b. EMAIL Official Email Accounts In most circumstances, emails sent to or from a state employee’s official email account will meet the definition of a public record. Therefore, this policy requires that virtually all email messages composed or sent using employees’ official equipment or official email addresses be for primarily business purposes.
When the Oregon Board of Dentistry receives a public records request, all official email accounts and systems used for official state business are subject to search and production.
Personal Email Accounts If employees must use personal email accounts to conduct state business, the Oregon Board of Dentistry requires that employees copy their official email accounts on all such outgoing communications, and forward any received messages on which their official email accounts are not copied, immediately or as soon as practicably possible.
DAS STATEWIDE MODEL PUBLIC RECORDS MANAGEMENT POLICY AttachmentPAGE #73 OF 6
c. INSTANT MESSAGING The Oregon Board of Dentistry policy regarding Instant Messages is the same as that recited below regarding TEXT MESSAGING.
d. SOCIAL MEDIA Any content the Oregon Board of Dentistry places on any social media platform must be an accurate copy of an official record that is retained elsewhere by the Oregon Board of Dentistry per the authorized records retention schedules. At this time the Oregon Board of Dentistry has no intention of developing any social media platforms beyond its website. The Oregon Board of Dentistry would develop practices and procedures to manage agency use of social media to ensure public records are accurately captured and retained per authorized records retention schedules if necessary.
e. TEXT MESSAGING Acceptable Use: The Oregon Board of Dentistry employees may use text messaging to communicate factual and logistical information related to official state business, only if that information has been documented elsewhere or will be documented and retained as a separate public record according to the agency’s authorized records retention schedule.
In the absence of separate documentation, the Oregon Board of Dentistry employees are not to use text messages for official purposes other than for routine communications that do not meet the definition of a public record.
Examples of Acceptable Uses . Scheduling. . Requesting a call or email on a matter, without substantive discussion. . Requesting or offering logistical assistance (“Can you help me get these boxes to the Capitol?”). . Forwarding any person’s contact information (“I’m at 503-378-6002.”). . Explaining your current whereabouts, or inquiring about someone else’s (“We’re at the meeting discussing this morning’s announcement. Are you around?”). . Describing facts or events that do not relate to the substance of the agency’s work (“Spilled coffee all over myself right before my presentation!”), or that have been or necessarily will be separately recorded (“Mr. Jones just testified to the committee that our bill would cost taxpayers $3 million.”). . Inquiring about events like those in the previous bullet (“Has Mr. Jones testified in committee yet?”).
Unacceptable Use: The Oregon Board of Dentistry employees must avoid communicating official state business or engaging in discussions regarding the primary business of their work over text message.
As noted above, relevant facts pertaining to official state business may be reported only if they are already documented in separate public records or they necessarily will be documented in a separate public record.
If, notwithstanding this policy, an employee uses text message to communicate information (not otherwise documented) relating to official state business or the primary business of their work, such discussion is to be immediately converted and saved in a separate public record format (e.g., by forwarding the relevant text messages to their official state email).
DAS STATEWIDE MODEL PUBLIC RECORDS MANAGEMENT POLICY AttachmentPAGE #74 OF 6 Because the Oregon Board of Dentistry requires that no text message-based public records be created – or if they are created, that they be converted and saved in an alternate format, which would serve as the official copy of the record – The Oregon Board of Dentistry will not retain text messages.
The Oregon Board of Dentistry employees’ personal electronic devices should not be used to transmit text messages related to state business. Personal devices are subject to search if used to transmit text messages regarding official state business or information related to an employee’s work that rises to the level of creating a public record.
f. UNIFIED COMMUNICATIONS The Oregon Board of Dentistry will identify public records created by use of active Unified Communications features and ensure those records are appropriately managed according to authorized records retention schedules as well as other applicable state and federal policies and laws. The Oregon Board of Dentistry will implement practices and procedures to accurately capture public records created by use of active Unified Communications features:
g. VOICEMAIL Unless otherwise required, the Oregon Board of Dentistry will not retain messages on voicemail.
Email transcriptions of voicemails that are determined to be public records will be retained according to authorized records retention schedules and may be subject to public disclosure upon request.
VII. STORAGE AND RETRIEVAL Paper Records: The Oregon Board of Dentistry will maintain a filing system of the agency’s paper records based on authorized retention schedules. The filing system will include the location of records, retention periods and procedures for retrieval to ensure accessibility of agency records.
Electronic Records: The Oregon Board of Dentistry will maintain a filing system and naming conventions for all agency records stored in electronic format based on the agency’s authorized retention schedules. The filing system and naming conventions will include the location of records in agency directories, retention periods, access controls and privacy conditions to support management of the agency’s inventory of electronic records.
The Oregon Board of Dentistry will work with the State Archivist to ensure the agency meets retention periods for all records before any data is destroyed and prior to deleting any large electronic record system.
DAS STATEWIDE MODEL PUBLIC RECORDS MANAGEMENT POLICY AttachmentPAGE #75 OF 6 VIII. PUBLIC RECORDS REQUESTS The Oregon Board of Dentistry will respond to all official requests for public records as soon as practicable and without unreasonable delay, according to timelines outlined in ORS 192.324 and ORS 192.329. General Licensee Look up information requests do not constitute a formal public records request, and will not be documented as such, as these are routine and simple requests to fulfill.
IX. DISPOSITION AND DESTRUCTION OF PUBLIC RECORDS The Oregon Board of Dentistry will dispose of or destroy public records according to the requirements of authorized records retention schedules and OAR chapter 166-300.
Pursuant to ORS 357.855, the Oregon Board of Dentistry employees will consult the State Archivist for advice and assistance with determining the disposition of certain record types not accounted for in State Agency General or Special Retention Schedules, and reconciling unforeseen public records issues.
DAS STATEWIDE MODEL PUBLIC RECORDS MANAGEMENT POLICY AttachmentPAGE #76 OF 6
Attachment #8
OREGON BOARD OF DENTISTRY MEETING DATES
EVALUATORS BOARD February 1, 2019 February 15, 2019 April 5, 2019 April 19, 2019 June 7, 2019 June 21, 2019 August 9, 2019 August 23, 2019 October 11, 2019 October 25, 2019 November date TBD December 13, 2019 February 7, 2020 February 21, 2020 April 10, 2020 April 24, 2020 June 5, 2020 June 19, 2020 August 7, 2020 August 21, 2020 October 16, 2020 October 30, 2020 December 4, 2020 December 18, 2020 2020 Calendar January February March SU MO TU WE TH FR SA SU MO TU WE TH FR SA SU MO TU WE TH FR SA 1 2 3 4 1 1 2 3 4 5 6 7 5 6 7 8 9 10 11 2 3 4 5 6 7 8 8 9 10 11 12 13 14 12 13 14 15 16 17 18 9 10 11 12 13 14 15 15 16 17 18 19 20 21 19 20 21 22 23 24 25 16 17 18 19 20 21 22 22 23 24 25 26 27 28 26 27 28 29 30 31 23 24 25 26 27 28 29 29 30 31
April May June SU MO TU WE TH FR SA SU MO TU WE TH FR SA SU MO TU WE TH FR SA 1 2 3 4 1 2 1 2 3 4 5 6 5 6 7 8 9 10 11 3 4 5 6 7 8 9 7 8 9 10 11 12 13 12 13 14 15 16 17 18 10 11 12 13 14 15 16 14 15 16 17 18 19 20 19 20 21 22 23 24 25 17 18 19 20 21 22 23 21 22 23 24 25 26 27 26 27 28 29 30 24 25 26 27 28 29 30 28 29 30 31
July August September SU MO TU WE TH FR SA SU MO TU WE TH FR SA SU MO TU WE TH FR SA 1 2 3 4 1 1 2 3 4 5 5 6 7 8 9 10 11 2 3 4 5 6 7 8 6 7 8 9 10 11 12 12 13 14 15 16 17 18 9 10 11 12 13 14 15 13 14 15 16 17 18 19 19 20 21 22 23 24 25 16 17 18 19 20 21 22 20 21 22 23 24 25 26 26 27 28 29 30 31 23 24 25 26 27 28 29 27 28 29 30 30 31
October November December SU MO TU WE TH FR SA SU MO TU WE TH FR SA SU MO TU WE TH FR SA 1 2 3 1 2 3 4 5 6 7 1 2 3 4 5 4 5 6 7 8 9 10 8 9 10 11 12 13 14 6 7 8 9 10 11 12 11 12 13 14 15 16 17 15 16 17 18 19 20 21 13 14 15 16 17 18 19 18 19 20 21 22 23 24 22 23 24 25 26 27 28 20 21 22 23 24 25 26 25 26 27 28 29 30 31 29 30 27 28 29 30 31
Holidays & Observances Important OBD Dates This indicates office closure Evaluators’ Meeting Jan 01 – New Year’s Day Jan 20 – Martin Luther King Day Feb 17 – President’s Day Board Meeting Apr 12 – Easter May 25 – Memorial Day April 23 – Ramadan Begins Jul 03 – Staff Holiday Jul 04 – Independence Day Sep 07 – Labor Day Sep 18 – Rosh Hashanah Nov 11 – Veteran’s Day Nov 26 – Thanksgiving Nov 27 – Staff Holiday Dec 25 – Christmas Day
Unfinished Business & Rules
Nothing to report under this tab
Correspondence
May 23, 2019
Stephen Prisby Executive Director Oregon Board of Dentistry 1500 SW 1st Avenue Portland, OR 97201
Dear Stephen:
CPEP, the Center for Personalized Education for Professionals, is a 501 (c)(3) non-profit organization that provides intensive educational interventions and resources for healthcare professionals. Seminars include: PROBE: Professionals Ethics and Boundaries Improving Inter-Professional Communication Medical Record Keeping Advanced Skills in Clinician – Patient Prescribing Controlled Drugs Communication
To date, CPEP has worked with 342 dental professionals from 18 states and 2 Canadian provinces, almost all of whom were referred by various licensing authorities. Of those, 301 professionals participated in PROBE, 40 in the Medical Record Keeping Seminar, and one in our Improving Inter-Professional Communication seminar.
Dental professionals have been referred to PROBE for a wide array of ethical infractions, including: Boundary Violations Financial Violation Drug diversion Billing issues Privacy and respect violations Criminal Fraud Sexual misconduct Failure to maintain or provide adequate Supervisory responsibilities records Self-referral Misrepresentation Other Credentials deception Abandonment of patients Falsification Clinical Issues Unlicensed Practice Impairment Medical error, record keeping-involving communication issues OSHA violations Professional Accountability
CPEP in an independent organization that is not a subsidiary or extension of any board, university, or other organization. This independence ensures an unbiased approach that provides fairness to participants and credibility or referring organizations.
As a mission-driven non-profit, we offer free consultation services. Referring organizations seeking guidance with challenging situations frequently reach out to us for input. If we are not the best resource for a specific case we will not hesitate to say so and can usually identify other options when appropriate.
720 South Colorado Boulevard, Denver, CO 80246 – 303-577-3232 If any dental board members or staff have questions about any of this information or about anything contained in our brochures, please feel free to contact me at 919-622-9846 or by e-mail at [email protected].
Thank you for your consideration.
Best regards,
Bill O’Neill Director, Communication and Outreach The PROBE Program: Professional/Problem-Based Ethics
PROBE is a non-adversarial ethics and boundaries program for all healthcare professionals - not just physicians. Intensive small group sessions target participants' professional misconduct such as
• Misrepresentations
• Boundary crossings
• Financial improprieties, and other lapses
Discussions and case analyses facilitate participant "probing" into why they went astray and recommitting to professional ideals. This course is designed to fulfill licensing board or credentialing requirements for remedial education. To date, over 2,000 participants have come from 48 states plus seven Canadian provinces.
What You Need to Know About PROBE Where is PROBE offered? PROBE U.S. PROBE Canada • Denver, CO • Toronto, ON • Raleigh, NC • Vancouver, BC • Newark, NJ How much does it cost? The fee for the PROBE Program is $2,295 for participants with doctoral level training or an advanced or independent practice clinician. The fee for other participants is $1,850.
What do past participants have to say about PROBE? • "The faculty were excellent. They...were very educated about the material they presented. I didn't feel judged or embarrassed about why I was here." • "The faculty...allowed us to express ourselves, helped us to find words, never were condescending or judgmental, always were clear and concise and easy to understand and follow." • "The course offers an excellent framework in objectively assessing transgressions."
• "It gave me a chance to appreciate my regulatory body's/society's perspective."
Who is eligible for PROBE? PROBE is open to all healthcare professionals and trainees. This includes physicians, nurses, pharmacists, dentists and dental assistants, physical therapists, chiropractors, medical students, residents and others. Every session is multi-disciplinary and is never restricted to one specialty or degree. What Types of violations or infractions are addressed by PROBE? Participants are referred for a variety of types of ethics violations or unprofessional conduct. Examples include, but are not limited to
• Boundary violations in the practice of health care including, but not limited to, sexual misconduct, drug diversion, and inappropriate use of social media • Misrepresentation or falsification of credentials • Financial irregularities • Disruptive behavior • Failure to adequately inform patients in obtaining consent
What are the possible outcomes? There are three possible outcomes for participants in the PROBE program.
• Unconditional Pass: Participant has demonstrated the ability to think ethically about their reasons for referral.
• Conditional Pass: Participant has largely demonstrated the ability to think ethically about their reasons for referral, but the faculty believe there are still certain areas that could benefit from additional work.
• Fail: Participant has not demonstrated the ability to think ethically about their reasons for referral.
Note: Many licensing and credentialing bodies will require a grade of Unconditional Pass in order to fulfill the requirements of their orders.
Memorial Hospital University of Colorado Health designates this live activity for a maximum of 25.25 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
For more information, visit the CPEP website at http://www.cpepdoc.org/cpep-courses/. Alternatively, you may call us at (303) 577-3232. Medical Record Keeping Seminar
Improving Patient Safety Through Effective Record Keeping This practical, case-based Seminar teaches efficient methods of documenting patient care, including effective use of Electronic Medical Records (EMR). Participants gain an understanding of the medico- legal implications of documentation, learn new strategies for overcoming barriers to effective record keeping, and leave with a concrete action plan for immediate improvement.
Upon completion of the one-day Seminar, participants have the option of enrolling in a six-month follow-up program (PIP) that includes in-depth chart reviews, detailed feedback, and coaching to fully integrate documentation skills into participants' daily practice.
This course is designated to fulfill licensing board credentialing requirements for remedial education. It is also suitable for healthcare professionals who simply wish to improve their skills in this critical area.
What do others say about the Medical Record Keeping Seminar? "This seminar was great - wish I could have been here many years back." "Because of this course, I will chart my thought process better and more accurately. The information on EMR was very insightful and valuable."
Where is the course offered? The seminar is offered three times a year in Denver, CO and once a year in Louisville, KY. Please check our website for available dates.
Who is eligible to attend this seminar? The Medical Record Keeping Seminar is open to all healthcare professionals and trainees, regardless of specialty or degree.
What's the cost? The cost for the Seminar is $1,095. The fee includes an optional pre-seminar review of charts and documentation systems.
Memorial Hospital University of Colorado Health designates this live activity for a maximum of 10 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in this activity.
Continued
For more information or to enroll, please call (303) 577-3232 or visit http://www.cpepdoc.org/cpep-courses/medical-records-keeping-seminar/ and click on the Register Now button. Medical Record Keeping Personalized Implementation Program (PIP)
PIP is the optional follow-up program for the Medical Record Keeping Seminar. Participants must first complete the Seminar and then enroll within one month of Seminar completion. PIP fosters long-term improvement as participants actively apply the techniques they’ve learned to their own practice.
PIP participants receive ongoing coaching and support. Participants submit three sets of charts to CPEP at two, four and six months after completion of the Seminar. A physician reviewer provides detailed verbal written feedback. Participants receive concrete suggestions for improvement at each point in the process
Change is a Process, not an Event Participants with significant needs will likely require ongoing coaching to implement what they learned in the Seminar. PIP provides six months of follow-up, allowing participants time to incorporate written feedback and demonstrate improvement in medical charting.
At the end of the six-month program, participants and their referring organizations receive a final report and grade of either Pass or Fail. Successful participants will consistently provide charts that:
• Are clear, concise, and complete • Accurately reflect the care provided • Convey the rationale for the diagnosis or treatment plan
The Fee for the PIP Program is $1,650.
For more information or to enroll, please call (303) 577-3232 or visit http://www.cpepdoc.org/cpep-courses/medical-records-keeping-seminar/ and click on the Register Now button. Communication, Collegiality, & Care
Improving Inter-Professional Communication: Working Effectively in Medical Teams When communication problems strain colleague or staff functions, they can have a significant impact on patient care and on team effectiveness. Healthcare professionals often do not realize how their communication may compromise patient care and impact their work satisfaction. This course is designed to give healthcare professionals the skills they need to employ professional and effective communication in the workplace.
Participants will gain insight and develop strategies and skills to • Recognize individual behavior/communication styles and how those styles impact work teams • Improve medical team member dynamics and patient care outcomes • Support and maintain behavior change which positively impacts team member dynamics over time • Develop strategies for increasing resiliency, managing stress and improving frustration tolerance
The course includes a behavior style profile, interactive discussions, simulated work encounters, and development of a personal Plan of Action identifying steps each participant can take to improve their team communication. At the conclusion of the course, the participant and his or her practice site or referring organization (with the participant’s consent) receive a summary report from the course faculty and a copy of the participant’s Plan of Action.
Coaching following the course is strongly recommended to help participants implement their Plan of Action and support positive change in their workplace communication. Interested participants can enroll in the Professional Coaching Program to receive six months of coaching following completion of the seminar.
Clinicians may enroll voluntarily or at the referral of an organization. Enrollment is limited to 12 participants per session. The course includes 14 hours of onsite classroom time and two to four hours of pre- attendance work.
Course fee is $2,500. Optional Professional Coaching Program is available for a separate enrollment fee.
TARGET AUDIENCE This course is designed to fulfill licensing board or credentialing requirements for remedial education. It is also suitable for any physicians and advanced practice professionals who could benefit from an improved understanding of how they communicate with their colleagues, as well as strategies for improvement.
This course is not designed to address significant disruptive behavior or anger management issues, physically aggressive behavior in the workplace, or untreated mental health conditions such as substance abuse or psychiatric conditions.
For more information or to enroll, please call (303) 577-3232 or visit http://www.cpepdoc.org/programs-courses/improving-inter-professional-communication Advanced Skills in Clinician-Patient Communication Denver, Colorado
Advanced Skills in Clinician-Patient Communication is designed to help clinicians refine and enhance their patient communication skills. The intensive 2.5 - day program provides education and opportunities to apply and practice new skills with simulated patients. Each participant will identify and work on individual goals, and the small group format facilitates personalized learning and individual coaching opportunities. This course is designed to fulfill licensing board or credentialing requirements for remedial education. It is also appropriate for those who simply wish to improve their skills in this critical area. The course is based on content from the Institute for Healthcare Communication (IHC) and is taught by faculty with extensive experience.
Topics covered in this course include: 1. Communication to enhance health outcomes 2. “Difficult” clinician-patient relations 3. Communication and computers in the exam room 4. HCAHPS Scores and application of communication skills 5. Disclosing unanticipated medical outcomes
Schedule • Day 1: 6:30 pm – 9:00 pm • Day 2: 8:00 am – approximately 4:30 pm. Breakfast and lunch included • Day 3: 8:00 am – 5:00 pm. Breakfast and lunch included
The fee for this activity is $2,250. Enroll online at www.cpepdoc.org/programs-courses/clinician-patient-communication
This live activity has been approved for a maximum of 17.5 AMA PRA Category 1 Credits (plus 1.5 hour pre-work credit). Physicians should claim only the credit commensurate with the extent of their participation in the activity.
For more information or to enroll, please call (303) 577-3232 or visit www.cpepdoc.org/programs-courses/clinician-patient-communication 6. Request for Board Approval for a Course in Intravenous Access or Phlebotomy
OAR 818-042-0117 states “Upon successful completion of a course in intravenous access or phlebotomy approved by the Board, a Certified Anesthesia Dental Assistant may initiate an intravenous (IV) infusion line for a patient being prepared for IV medications, sedation, or general anesthesia under the Indirect Supervision of a dentist holding the appropriate anesthesia permit.”
Dr. Brett Sullivan has submitted a letter to the Board requesting that the Board approve Oquirrh Mountain Phlebotomy School’s IV Certification Course. (Attached)
At its April 19, 2019 Meeting, the Board directed staff to get additional information from Oquirrh Mountain Phlebotomy School regarding their IV Certification Course.
Based on an email received from Dallas Rasmussen the Office Manager/Director from the school, it appears the course is seven hours, with four of those hours’ hands on training. Mr. Rasmussen stated that students should have taken a phlebotomy course prior to the IV Class, however, when I asked Dr. Sullivan’s Practice Administrator Rebekah Allison if their assistant had to take a phlebotomy course prior to taking the IV class she said they did not. (Attached)
Teresa Haynes
From: Oquirrh Mountain Phlebotomy School LLC
Follow Up Flag: Follow up Flag Status: Flagged
Our course in Oregon is 3-days 3 hours each days 9 hours total but our class in Washington is 1 week 15 hours total and our student can be signed off for the licence up there.
Dallas Rasmussen Office Manager
On Tue, Apr 23, 2019 at 11:07 AM Teresa Haynes
Do they have to take your phlebotomy course or can they take another organizations as well? How long is your phlebotomy course?
Teresa
From: Oquirrh Mountain Phlebotomy School LLC
They have to
On Tue, Apr 23, 2019, 10:52 AM Teresa Haynes
They should have or they have to?
1 Teresa
From: Oquirrh Mountain Phlebotomy School LLC
They should have already taken a phlebotomy course prior to taking the IV class.
On Tue, Apr 23, 2019, 10:21 AM Teresa Haynes
Hi Dallas,
Is there any pre-requisites to take the course?
Thank you for your information.
Sincerely,
Teresa
Teresa Haynes
Office Manager
Oregon Board of Dentistry
1500 SW 1st Avenue, Suite 770
Portland, OR 97201
Telephone: 971-673-3200
FAX: 971-673-3202
www.oregon.gov/dentistry
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“The Mission of the Oregon Board of Dentistry is to promote high quality oral health care in the State of Oregon by equitably regulating dental professionals.”
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From: Oquirrh Mountain Phlebotomy School LLC
Hi Teresa
My name is Dallas I am the director over Oquirrh Mountain Phlebotomy School. Rebekah has emailed you about us becoming approved by the Oregon Board of Dentistry for her staff. Below is the information you needed please let me know what we can do to be approved.
Description: 1-day 7 hour IV certification course. This course entirely is designed to know how to place IV catheters great for nurses or anyone wanting to further there medical career. Certificate of completion provided. Updated with the latest venipuncture practices, this program will focus on the identification of complications, their causes, and appropriate interventions to take to support the patient and restore safe and effective therapy. Students will also be taking a exams and quizzes.
3
OBJECTIVES: After completing this course, the student will be able to:
3 hours will be going over the objectives below 4 hours will be hands on practice performing IV venipuncture.
• Describe the uses of IV therapy
• Identify appropriate sites for venipuncture
• Identify equipment used to provide IV therapy
• Perform venipuncture (4 hours)
• infiltration
• extravasation
• occlusions
• vein irritation/pain at the venipuncture site
• a severed catheter
• hematoma
• venous spasm
• thrombosis/thrombophlebitis
• nerve, tendon or ligament damage
• circulatory overload
• septicemia
• air embolism
• allergic reaction
Dallas Rasmussen Office Manager
971-231-8600
4 Teresa Haynes
From: Rebekah Allison
Follow Up Flag: Follow up Flag Status: Flagged
Hi Teresa,
We sent 4 of our assistants to this course prior to realizing that it was not an OBD approved course. None of them have been through phlebotomy training.
Rebekah Allison Practice Administrator Clackamas Implant & Oral Surgery Center 503‐652‐8080
From: Teresa Haynes
Hi Rebekah,
Quick question, has your assistants taken this course? Have they also taken a phlebotomy course?
Teresa Teresa Haynes Office Manager Oregon Board of Dentistry 1500 SW 1st Avenue, Suite 770 Portland, OR 97201 Telephone: 971-673-3200 FAX: 971-673-3202 www.oregon.gov/dentistry
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From: Rebekah Allison
Hi Teresa,
I forwarded your email to the administrative office for OMPS and they are cc’d to this email. Hopefully they will be able to provide you with all of the necessary information you require as I have no more information than what I sent to you already.
I appreciate your assistance with this process.
Sincerely,
Rebekah Allison Practice Administrator
Office: 503‐652‐8080 Direct: 503‐652‐7878 Fax: 503‐652‐8992
9895 SE Sunnyside Road, Suite P Clackamas, OR 97015 www.clackamasoralsurgery.com
From: Teresa Haynes
HI Rebekah,
The Oregon Board of Dentistry reviewed Dr. Sullivan’s request, unfortunately, was not able to act on the request because they are requesting additional information on this course.
2 Please have Oquirrh Mountain Phlebotomy School, LLC send us their course outline, hours taught per objective, how many hours as part of the course the participants place IV lines, total course hours both didactic and clinical etc.
Once I receive the above information, I can take it back to the Board for review and possible approval.
Please call me if you have any questions.
Sincerely,
Teresa Teresa Haynes Office Manager Oregon Board of Dentistry 1500 SW 1st Avenue, Suite 770 Portland, OR 97201 Telephone: 971-673-3200 FAX: 971-673-3202 www.oregon.gov/dentistry
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From: Rebekah Allison
Hi Teresa,
Please let me know if the attached document provides you with the necessary information. Thank you for allowing me to amend this!
Rebekah Allison Practice Administrator Clackamas Implant & Oral Surgery Center 503‐652‐8080
3 From: Teresa Haynes
Hi Rebekah,
I need more information about the course, is this the IV course, or the phlebotomy course. How many hours is the course or courses? All of that should be in the course information.
If I can get the revised by Thursday it should be fine to get into the Board Meeting.
Teresa Teresa Haynes Office Manager Oregon Board of Dentistry 1500 SW 1st Avenue, Suite 770 Portland, OR 97201 Telephone: 971-673-3200 FAX: 971-673-3202 www.oregon.gov/dentistry
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From: Rebekah Allison
Good Afternoon Teresa,
I hope it’s not too late to submit the attached letter for the Board to consider at their next meeting! I know this was supposed to get to you yesterday, and would have, had I not had to remain home with a sick kid. ☹
4 As requested, I have included the course description and location, but if there is anything else needed, please let me know.
Sincerely,
Rebekah Allison Practice Administrator
Office: 503‐652‐8080 Direct: 503‐652‐7878 Fax: 503‐652‐8992
9895 SE Sunnyside Road, Suite P Clackamas, OR 97015 www.clackamasoralsurgery.com
From: Teresa Haynes
You would need to submit a letter requesting the Board consider them to be approved. We would need course description etc.
Our next Board meeting is April 19, and if you want them to review your request, we would need it and supplemental information by April 1, 2019.
Sincerely,
Teresa Teresa Haynes Office Manager Oregon Board of Dentistry 1500 SW 1st Avenue, Suite 770 Portland, OR 97201 Telephone: 971-673-3200 FAX: 971-673-3202 www.oregon.gov/dentistry
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From: Rebekah Allison
Thanks Teresa,
As far as I can tell, the website medtexx.com is no longer active. I have been unable to find any contact information for Medtexx on the internet. I don’t think the company is still offering these courses.
Prior to us knowing that we had to send our assistants to an OBD approved course, we sent them to a course through Oquirrh Mountain Phlebotomy School (https://oregonphlebotomyschool.com/) any chance this training could be considered valid?
Rebekah Allison Practice Administrator Clackamas Implant & Oral Surgery Center 503‐652‐8080
From: Teresa Haynes
Hi Rebekah:
This is the information we had back in 2008 when the Board approved it.
Sincerely,
Teresa Teresa Haynes Office Manager Oregon Board of Dentistry 1500 SW 1st Avenue, Suite 770 Portland, OR 97201 Telephone: 971-673-3200 FAX: 971-673-3202 www.oregon.gov/dentistry
Your opinion matters. Please complete our Customer Satisfaction Survey at 6 https://www.surveymonkey.com/r/OBDSurveyLink
“The Mission of the Oregon Board of Dentistry is to promote high quality oral health care in the State of Oregon by equitably regulating dental professionals.”
Data Classification Level 1 This e-mail is intended for the named recipient only and may not be read, copied, discussed or distributed by anyone except the named recipient. The named recipient is responsible for the confidentiality of the message. Please notify the sender should this fail to transmit correctly. Please destroy incorrectly transmitted documents immediately.
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From: Rebekah Allison
Hi Teresa,
I’m struggling trying to find any local information for classes offered by MedTexx Medical Corporation. I can’t even locate a website for MedTexx. Might you have any contact information that you can provide?
Rebekah Allison Practice Administrator Clackamas Implant & Oral Surgery Center 503‐652‐8080
From: Teresa Haynes
Hi Rebekah,
Attached is the list of approved courses.
Sincerely,
Teresa Teresa Haynes Office Manager Oregon Board of Dentistry 1500 SW 1st Avenue, Suite 770 Portland, OR 97201 Telephone: 971-673-3200 FAX: 971-673-3202 www.oregon.gov/dentistry
7
Your opinion matters. Please complete our Customer Satisfaction Survey at https://www.surveymonkey.com/r/OBDSurveyLink
“The Mission of the Oregon Board of Dentistry is to promote high quality oral health care in the State of Oregon by equitably regulating dental professionals.”
Data Classification Level 1 This e-mail is intended for the named recipient only and may not be read, copied, discussed or distributed by anyone except the named recipient. The named recipient is responsible for the confidentiality of the message. Please notify the sender should this fail to transmit correctly. Please destroy incorrectly transmitted documents immediately.
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From: Rebekah Allison
Hi Teresa,
Thanks for taking my call today. We are interested in getting our Anesthesia Dental Assistants their IV Therapy certificate. The staff who would be applying all hold state certification as an Anesthesia Dental Assistant. We wish to obtain a list of the OBD approved courses for IV Access or Phlebotomy training so that they can submit this information to DANB to obtain their IV Therapy Certificates.
Thank you for your help with this request.
Sincerely,
Rebekah Allison Practice Administrator
Office: 503‐652‐8080 Direct: 503‐652‐7878 Fax: 503‐652‐8992
9895 SE Sunnyside Road, Suite P Clackamas, OR 97015 www.clackamasoralsurgery.com
8 Teresa Haynes
From: Stephen Prisby Sent: Friday, June 7, 2019 7:13 AM To: Teresa Haynes Subject: FW: Clinic approval Attachments: Tax Exempt Letter used for proving non-profit status 501c3.pdf
From: Robert Stafford [mailto:[email protected]] Sent: Thursday, June 6, 2019 9:17 PM To: Stephen Prisby
Stephen,
I am applying to the board for approval to operate a dental clinic under ORS 679.020 (3) g. The documentation of 501 (c) (3) is attached. This Clinic will be operated under the umbrella of Portland Adventist Community Center (PACS) and their board. We are located on the PACS campus at 11020NE Halsey St, Portland, 97220. Our intention is to serve the adult population who find themselves in the gap between OHP eligibility and traditional dental insurance plans without the income to pay cash for dental services. Our intention is to provide comprehensive treatment on an ongoing basis rather than episodic emergency care therefore we are setting up our clinic much like a private, fee for service dental clinic. We have three modern operatories, one for hygiene and two for dental treatment. The equipment is being installed and the facility is poised to receive final inspection. I am the dental director, we have a paid clinic director, and we are looking to employ a dental hygienist and an administrative assistant. Our operating revenue will come from the PACS budget and from a small copay (TBD) from the patients served. We will be staffed by volunteer Oregon licensed dentists. We hope to open by late July.
Respectfully submitted,
Robert E Stafford, DDS,MPH
1 679.020 Practice of dentistry or operating dental office without license prohibited; exceptions. (1) A person may not practice dentistry without a license. (2) Only a person licensed as a dentist by the Oregon Board of Dentistry may own, operate, conduct or maintain a dental practice, office or clinic in this state. (3) The restrictions of subsection (2) of this section, as they relate to owning and operating a dental office or clinic, do not apply to a dental office or clinic owned or operated by any of the following: (a) A labor organization as defined in ORS 243.650 and 663.005 (6), or to any nonprofit organization formed by or on behalf of such labor organization for the purpose of providing dental services. Such labor organization must have had an active existence for at least three years, have a constitution and bylaws, and be maintained in good faith for purposes other than providing dental services. (b) The School of Dentistry of the Oregon Health and Science University. (c) Public universities listed in ORS 352.002. (d) Local governments. (e) Institutions or programs accredited by the Commission on Dental Accreditation of the American Dental Association to provide education and training. (f) Nonprofit corporations organized under Oregon law to provide dental services to rural areas and medically underserved populations of migrant, rural community or homeless individuals under 42 U.S.C. 254b or 254c or health centers qualified under 42 U.S.C. 1396d(l)(2)(B) operating in compliance with other applicable state and federal law. (g) Nonprofit charitable corporations as described in section 501(c)(3) of the Internal Revenue Code and determined by the Oregon Board of Dentistry as providing dental services by volunteer licensed dentists to populations with limited access to dental care at no charge or a substantially reduced charge. (h) Nonprofit charitable corporations as described in section 501(c)(3) of the Internal Revenue Code and determined by the Oregon Board of Dentistry as having an existing program that provides medical and dental care to medically underserved children with special needs at an existing single fixed location or multiple mobile locations. (4) For the purpose of owning or operating a dental office or clinic, an entity described in subsection (3) of this section must: (a) Except as provided in ORS 679.022, name an actively licensed dentist as its dental director, who shall be subject to the provisions of ORS 679.140 in the capacity as dental director. The dental director, or an actively licensed dentist designated by the director, shall have responsibility for the clinical practice of dentistry, which includes, but is not limited to: (A) Diagnosis of conditions within the human oral cavity and its adjacent tissues and structures. (B) Prescribing drugs that are administered to patients in the practice of dentistry. (C) The treatment plan of any dental patient. (D) Overall quality of patient care that is rendered or performed in the practice of dentistry. (E) Supervision of dental hygienists, dental assistants or other personnel involved in direct patient care and the authorization for procedures performed by them in accordance with the standards of supervision established by statute or by the rules of the board. (F) Other specific services within the scope of clinical dental practice. (G) Retention of patient dental records as required by statute or by rule of the board. (H) Ensuring that each patient receiving services from the dental office or clinic has a dentist of record. (b) Maintain current records of the names of licensed dentists who supervise the clinical activities of dental hygienists, dental assistants or other personnel involved in direct patient care utilized by the entity. The records must be available to the board upon written request. (5) Subsections (1) and (2) of this section do not apply to an expanded practice dental hygienist who renders services authorized by a permit issued by the board pursuant to ORS 680.200. (6) Nothing in this chapter precludes a person or entity not licensed by the board from: (a) Ownership or leasehold of any tangible or intangible assets used in a dental office or clinic. These assets include real property, furnishings, equipment and inventory but do not include dental records of patients related to clinical care. (b) Employing or contracting for the services of personnel other than licensed dentists. (c) Management of the business aspects of a dental office or clinic that do not include the clinical practice of dentistry. (7) If all of the ownership interests of a dentist or dentists in a dental office or clinic are held by an administrator, executor, personal representative, guardian, conservator or receiver of the estate of a former shareholder, member or partner, the administrator, executor, personal representative, guardian, conservator or receiver may retain the ownership interest for a period of 12 months following the creation of the ownership interest. The board shall extend the ownership period for an additional 12 months upon 30 days’ notice and may grant additional extensions upon reasonable request.
OTHER ISSUES
Board of Dentistry - Vaccine Information Sheet
HB 2220 was signed by Governor Kate Brown on May 6, 2019 This historic legislation will allow Oregon licensed dentists to administer vaccines, AFTER the Board creates standards and rules. The Board is undertaking this throughout 2019. The plan is for new rules to be effective January 1, 2020, which is the earliest Oregon licensed dentists will be able to vaccinate anyone. The Board is working with the Pharmacy Board, OHA, OHSU Dental School, ODA and other interested stakeholders to create new rules.
What are “Model Standing Orders”. They are to be approved by OHA. Do you know about this? If not, who would? OIP has been writing model standing orders for well over 20 years. They are approved by our Medical Officer, Dr. Paul Cieslak, prior to posting. You can see the most current versions here: https://www.oregon.gov/oha/ph/PreventionWellness/VaccinesImmunization/Immunizatio nProviderResources/Pages/stdgordr.aspx
Is OHA intended to do the monitoring oversight of the CDC reference and the emergency kit and contents? OIP will not be doing hands-on monitoring but we do have a standing order that lists the minimum contents of the emergency kit. If those contents are not on hand when vaccinating, then the dentist is practicing outside the requirements of the law.
This would likely only come up in the event a patient experiences anaphylaxis after receiving a vaccine and does not receive the appropriate standard of care. At that point, the Board could take disciplinary action and the patient could pursue legal action.
Who is doing the oversight and monitoring? Medical providers giving vaccines are overseen by their respective board. OIP provides significant oversight and monitoring of providers enrolled in the Vaccines for Children program, including site visits at least every other year.
Vaccine Information Statement (VIS). Where do these come from. Who is responsible for their version control? VIS sheets are developed and maintained by the CDC. Federal law requires that they be given to a patient or their parent prior to receiving the vaccine. You can see the current versions here: https://www.cdc.gov/vaccines/hcp/vis/current-vis.html
VIS are available in many languages. Translations can be accessed here: http://www.immunize.org/vis/
ALERT system What will it take to get dentists enrolled with existing system? Dentists will be able to enroll with ALERT IIS online here: https://www.oregon.gov/oha/PH/PREVENTIONWELLNESS/VACCINESIMMUNIZATIO N/ALERT/Pages/EnrollNewClinic.aspx
What will it take to get dentists access? Dentists will have to enroll and will need to take standard user training which can be found here: https://www.oregon.gov/oha/PH/PREVENTIONWELLNESS/VACCINESIMMUNIZATIO N/ALERT/Pages/TrainStandard.aspx
Is there training? Does that time need to be accounted for in any deadlines? Standard user training is available on-demand and takes about 45 minutes. At the end is a certificate of completion that will need to be emailed (or faxed) to the ALERT IIS Help Desk. Additional time will be required for processing new clinics and users as we have limited staff. If there is a huge influx of providers, it may cause delay in receiving their login credentials.
Additional trainings are available for dentists who would like to use ALERT IIS’s vaccine inventory module or its reporting and recall functions.
Is there an expense? There is no cost to end users of ALERT IIS.
VAERS-need to get information. What will it take to get dentists enrolled with existing system? What will it take to get dentists access? VAERS does not require enrollment or credentials for access. It is open to the public and any person may make a report. You can see the reporting website here: https://vaers.hhs.gov/reportevent.html
Is there training? Does that time need to be accounted for in any deadlines? Is there an expense? VAERS reporting does not require training and there is no cost associated with it.
Resource: Amanda Timmons Immunization Policy Analyst OREGON HEALTH AUTHORITY Public Health Division Immunization Program [email protected] Desk: 971‐673‐0312 Main: 971‐673‐0300 http://www.oregon.gov/OHA/PH/
818-012-0006 – Qualifications – Administration of Vaccines (1) A dentist may administer vaccines to a patient of record. (2) A dentist may administer vaccines under Section (1) of this rule only if: (a) The dentist has completed a course of training approved by the Board; (b) The vaccines are administered in accordance with the “Model Standing Orders” approved by the Oregon Health Authority (OHA); and (c) The dentist has a current copy of the CDC reference, “Epidemiology and Prevention of Vaccine-Preventable Diseases.” (d) The dentist has an emergency kit that contains at a minimum; (i) Epinephrine auto injector – Adult 0.3mg (ii) Epinephrine auto injector – Pediatric 0.15mg (i) 1 multi-dose vial of 1:1000 epinephrine with appropriate syringes, or 3 adult- dose epinephrine auto-injectors and 3 pediatric-dose auto-injectors. (iii) (ii) Diphenhydramine 50mg/mL (iv) (iii) Ammonia Inhalants (v) (iv) Appropriate syringes with needles (vi) (v) CPR shield (3) The dentist may not delegate the administration of vaccines to another person. (4) The dentist may not self-administer a vaccine to themselves.
818-012-0007 – Procedures, Record Keeping and Reporting (1) Prior to administering a vaccine to a patient of record, the dentist must follow the “Model Standing Orders” approved by the Oregon Health Authority (OHA) for administration of vaccines and the treatment of severe adverse events following administration of a vaccine. (2) The dentist must maintain written policies and procedures for handling and disposal of used or contaminated equipment and supplies. (3) The dentist or designated staff must give the appropriate Vaccine Information Statement (VIS) to the patient or legal representative with each dose of vaccine covered by these forms. The dentist or designated must ensure that the patient or legal representative is available and has read, or has had read to them, the information provided and has had their questions answered prior to the dentist administering the vaccine. The VIS given to the patient must be the most current statement. (4) The dentist or designated staff must document in the patient record: (a) The date and site of the administration of the vaccine; (b) The brand name, or NDC number, or other acceptable standardized vaccine code set, dose, manufacturer, lot number, and expiration date of the vaccine; (c) The name or identifiable initials of the administering dentist; (d) The address of the office where the vaccine(s) was administered unless automatically embedded in the electronic report provided to the OHA ALERT Immunization System; (e) The date of publication of the VIS; and (f) ThePROPOSED date the VIS was provided and the date when the VIS was published. (5) If providing state or federal vaccines, the vaccine eligibility code as specified by the OHA must be reported to the ALERT system. (6) A dentist who administers any vaccine must report, the elements of Section (3), and Section (4) of this rule if applicable, to the OHA ALERT Immunization System within 14 days of administration. (7) The dentist must report adverse events as required by the Vaccine Adverse Events Reporting System (VAERS), to the Oregon Board of Dentistry within 10 business days and to the primary care provider as identified by the patient. (8) A dentist who administers any vaccine will follow storage and handling guidance from the vaccine manufacturer and the Centers for Disease Control and Prevention (CDC). (9) Dentists who do not follow this rule can be subject to discipline for failure to adhere to these requirements.
PROPOSED 7. Request for Approval of a Local Anesthesia Course – Phoenix College.
Ms. Brandi Mazzarella, R.D.H., B.S.D.H., the Coordinator of the Center for Continuing Dental Education at Phoenix College (of Maricopa Community Colleges), is requesting that the Board approve Phoenix College’s continuing education program for local anesthesia.
Relevant Rules:
OAR 818-035-0040 – Expanded Functions of Dental Hygienists (1) Upon completion of a course of instruction in a program accredited by the Commission on Dental Accreditation of the American Dental Association or other course of instruction approved by the Board, a dental hygienist who completes a Board approved application shall be issued an endorsement to administer local anesthetic agents under the general supervision of a licensed dentist.
COURSE: DHE 227 Dental Anesthesia Online Course Section #14439 CEU 3 Day Lab Course Section #15543, 15535, 15536, 15537, 15544 and 15545 Administered through the Center for Continuing Dental Education, Phoenix College
CREDITS: 3 Credits (2 credit lecture, 1 credit lab; 40 CEUs)
INSTRUCTOR: Marlene Navedo D.D.S. (Lead Instructor) [email protected] 602-285-7330 (fax)
SEMESTER: Spring 2019
CLASS MEETS: Online Self-Study begins January 14, 2019 and ends on April 12, 2019 Clinical portion meets daily, May 3rd, 4th and 5th (Fri, Sat, Sun) 2019; 8:00 AM - 5:00 PM
TEXTS: Handbook of Local Anesthesia, 6th Edition, Malamed (with DVD) www.us.elsevierhealth.com/ ISBN 978-0-323-07412-4 Handbook of Nitrous Oxide-Oxygen Sedation, 4th Edition, Clark & Brunick, www.us.elsevierhealth.com/ ISBN 978-1-4557-4547-0 Canvas online course materials Recommended (but optional): Local Anesthesia for Dental Professionals, Bassett, DiMarco, Naughton http://www.pearsonhighered.com
COURSE DESCRIPTION: A comprehensive lecture and laboratory course providing concepts and techniques for the administration of local anesthetic agents and nitrous oxide. Students will gain experience in medical history review, record keeping, patient management and hands on experience administering local anesthetics and nitrous oxide in a clinical setting. Prerequisites: (1) Current CPR certificate and (2) a valid dental hygiene license or proof of graduation from an accredited dental hygiene school.
COURSE COMPETENCIES: Upon completion of this course, the student will be able to: 1. Explain pain/impulse conduction related to nerve anatomy and physiology.
2. Describe the pharmacological properties, actions, considerations and contraindications to local anesthetic agents, vasoconstrictors, and nitrous oxide.
3. Assess the patient’s medico-dental history as it relates to choice of technique and agents used in the administration of local anesthetics and nitrous oxide - oxygen analgesia.
4. Determine the appropriate pain control armamentarium, agents and techniques needed to ensure patient safety and comfort during the administration of local anesthesia and nitrous oxide - oxygen analgesia.
5. Determine ways to prevent and manage potential emergency situations associated with dental anesthetics and nitrous oxide.
6. Demonstrate competence in administering selected local anesthetic injections and nitrous oxide - oxygen analgesia.
7. Practice pain control techniques according to legal and ethical standards.
1
GENERAL EDUCATION ABILITIES
The faculty and staff at Phoenix College believe your college education should not only include learning content, but also the development of important lifelong skills. We call these general education outcomes. The five (5) general education outcomes we have identified that should be developed throughout your college career are: 1. Writing - develop effective writing skills to communicate. 2. Numeracy - learn to use numerical concepts and data effectively. 3. Critical Thinking - learn to apply critical thinking skills to solve problems, make informed decisions, and interpret events. 4. Oral Presentation - plan and deliver an oral presentation to a target audience.
LEARNING COLLEGE PRINCIPLES
The Learning College concept engages students as full partners in the learning process. Students are responsible for their learning and are guided by faculty and staff though four learning college principles: - Evaluation - Communication - Collaboration - Responsibility
COURSE REQUIREMENTS:
1. Participation & Absence Policy During the online portion of the course, students must login to the website, read announcements, participate on posted discussion topics, and complete assignments on a weekly basis. The instructor will check your weekly login activity, and failure to participate may result in your Withdrawal from the course. During the 3-Day Lab session, attendance at all class and clinical sessions is mandatory. Please notify the instructor ASAP in the event of an absence so that clinic schedules can be adjusted accordingly and to determine your ability to complete the course.
Faculty are required to identify the last day the student “academically attends” an online class and that date will constitute the Last Date of Attendance for purposes of the returning Title IV funds. Faculty must report a student’s last date of attendance and withdraw the student within fourteen (14) days of identifying the last date of academic attendance. The following is a list of activities that constitute online class” academic attendance” for purposes of determining the Last Date of Attendance: 1. Submitting academic assignment (assignment required in the course, regardless of whether it is graded or not), paper, or project, 2. Taking an exam, quiz, computer-assisted instruction, or an interactive tutorial required by the course, 3. Attending an online or in-person study group (where there is assigned attendance/participation as part of the course), or 4. Initiating contact with a faculty member to ask a question about the academic subject studied in the course.
Simply logging into an online class will NOT count as attendance.
2. Student Conduct (MCCCD Administrative Regulation 2.5.2 ?) The purpose of the Student Conduct Code is to help ensure a healthy, comfortable and educationally productive environment for students, employees and visitors. The College has both the authority and responsibility to maintain a campus community where the educational
2 programs can flourish for all students and where individual rights, personal and collective safety, and College operations are appropriately protected. It is a choice to attend Phoenix College and by doing so, students assume the obligations (including standards for behavior) imposed by the College. A disruptive student is any student that interrupts the learning atmosphere. Disruptive behavior on the Phoenix College campus or in Canvas will not be tolerated and will be dealt with in accordance with college policy and administrative regulations (AR 2.5.2). Disruptive behavior includes harassment of other students or instructor an inappropriate or unsafe activities with respect to other students, instructors, equipment or supplies. Prohibited conduct also includes inappropriate usage of electronic and mobile devices. Students in violation of the Conduct Code may be asked to leave the classroom. If the student refuses to leave, the instructor may notify campus security. Students in violation of the Conduct Code may be required to meet with the appropriate Dean, before being allowed to return to the class
Academic misconduct ( MCCCD Administrative Regulation 2.3.11) Academic misconduct includes, but is not limited to, cheating and plagiarism. See the Phoenix College Student Handbook for additional details. It is expected that every student will produce his/her original, independent work. Any student cheating on or plagiarizing any assignment will receive an “F” on that assignment and may be reported for disciplinary action. Any assignment assigned a failing grade as a result of academic integrity violation MAY NOT be made up at any time. A second offense will result in failure of the course. All incidents may be reported to the appropriate administrator. For your protection, please avoid even the appearance of academic dishonesty. Other penalties for academic dishonesty might include: - Lowering of assignment or course grade - Failure or no credit for plagiarized assignment with no possibility for make up - Course failure (i.e. an F in the course and written notification or an in-person meeting with the Dean of Arts and Sciences) - Written notice to student that s/he has violated the academic code - Additional academic assignments as determined by the instructor - Academic probation - College suspension - Permanent college expulsion from any MCCCD college
Etiquette ( MCCCD Administrative Regulation 2.5.2 ?) Etiquette refers to the generally accepted rules of behavior for communicating in both the face-to- face and the online environment (known as netiquette). a. Be professional and careful with what you say or post in class. Express your thoughts clearly and concisely. b. Be careful when using sarcasm and humor. Communications, especially online, are very impersonal and others may take your words as criticism. c. Be courteous and respectful of other people. If you use abusive or offensive language, you may potentially removed from your course according to AR 2.5.2 of the Student Handbook. d. Use common sense - is this message something that you want to be said or sent to you?
Disagreement within the classroom does not equal disrespect, you are encouraged to have different points of view, different opinions and values, however, it is required that students
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monitor their language within discussions. Racist, sexist, or homophobic language will not be tolerated. Consult the student handbook for college policies regarding these types of behavior.
Instructional grievances ( MCCCD Administrative Regulation 2.3.5. and Appendix S-6 ?) Your instructor attempts to provide excellent instruction in a manner that is fair to all students. If, however, you feel that you have not been dealt with fairly and/or instruction has been inadequate, procedures exist for handling such complaints. The complete process and timeline is described in Administrative Regulation 2.3.5. and Appendix S-6 and is summarized below. It is your responsibility to understand and comply with established timelines. a. Speak with your instructor first. Perhaps he/she is unaware that a problem exists. He/she may be able to resolve the problem. b. If the problem is not or cannot be resolved, speak with the Department Chair. c. If the problem is still not resolved, a written complaint should be sent to the Department Chair and the Dean of Arts and Sciences and a meeting with the Dean will be arranged.
3. Reading Assignments Reading assignments from the Malamed and Clark texts are listed on the Course Calendar. Adequate time devoted to the self-study portion of the course is imperative to your successful completion of the course. Student testimonials indicate the need for 80 hours of preparation.
4. Written & Quiz Assignments Learning Activities (about 11) and Quizzes (about 9) must be completed and sent to the instructor via the course website. See the attached course calendar with deadlines for completing and submitting these assignments. Each is worth 5 possible points (approximately 100 total points). Points will be deducted for late or incomplete submissions. One total grade will be calculated for all of these assignments and will be averaged in to the test/exam grades. All must be completed to receive a final course grade.
5. Grading Criteria Final grade for the course will be based on the results of the Learning Activities/Quizzes grade, 5 online examinations, and one local anesthesia technique exam, all of equal weight. The same grade will be given for the Lecture and Lab Sections of DHE 227. All of the following must be completed to receive a grade in DHE 227.
Learning Activities/Quiz Grade: Approximately 100 total possible points
Online exams: Test 1 Test 2 Test 3: Local Anesthesia Review/Exam Test 4 (comprehensive) Test 5 (Nitrous Oxide/Oxygen Sedation; Anesthesia Technique)
Local Anesthesia Technique Final: * Based on WREB criteria * Student must demonstrate clinical skill on PSA and IAN injection techniques only * Instructions and criteria for technique final are described in the course website * Designed to simulate the clinical portion of the WREB Local Anesthesia Exam
Demonstration of Clinical Competency Local anesthesia: The student must complete a minimum of 3 injections (evaluated as “satisfactory” or “improvable”) of 8 techniques (24 total): posterior superior alveolar (PSA), middle superior alveolar (MSA block and infiltration techniques), anterior superior alveolar (ASA),
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nasopalatine (NP or incisive palatine), greater palatine (GP or anterior palatine), inferior alveolar – lingual (IA – L), mental/incisive, and long buccal. In addition, for each injection given, the student must be able to verbally describe the landmarks, site of deposition, amount of anesthetic given, possible complications, and how to treat any complications.
Nitrous oxide - oxygen analgesia: The student must complete 3 administrations of nitrous oxide - oxygen analgesia (evaluated as “satisfactory” or “improvable”) during the lab sessions.
Grading Scale
A = 90 - 100% D = 60 - 69% B = 80 - 89% F = Below 60% C = 70 - 79%
6. Taking the course to meet Remediation requirements of WREB Students taking this course in order to meet Remediation requirements of the Western Regional Examining Board (WREB) because you have failed the WREB exam 3 times or more must inform the instructor immediately. You must complete a Remediation Contract (provided by the instructor) by the 3rd week of class in order to meet the WREB requirements.
7. Teaching/Learning Methods Methods used in this course include online self-study, lecture, small group activities, role play, group discussion, demonstration and clinical practice.
DHE 227 is success-oriented. The instructors would like all students in the class to meet their individual goals. In the course material you will find learning objectives for each assigned chapter. Learning activities are designed for you to master those objectives. It is your responsibility to read all course material, and come to class prepared to participate.
College courses require that students spend a significant amount of time outside of class in individual study time. Past students have indicated that a minimum of 80 hours, or 8 to 10 hours per week, are needed to prepare for this course. Please plan accordingly.
8. Additional References Videos: Mandibular Anesthesia, Maxillary Anesthesia; Dentsply Pharmaceutical Online Handouts: As needed to supplement textbooks Texts: Medical Emergencies in the Dental Office, Malamed Illustrated Anatomy of Head and Neck, Fehrenbach & Herring Sedation: A Guide to Patient Management, Malamed Local Anesthesia for Dental Professionals, Bassett, DiMarco, Naughton Skulls: Skulls are used for study & demonstration during the 3-Day Lab
9. Student Responsibilities The student is responsible for: Students are responsible for understanding and adhering to the material presented in this syllabus. The student is expected to ask for further clarification if needed. Students are responsible for understanding and adhering to all college policies included in the college catalog and student handbook. All information presented online and in class Student Catalog and Handbook ( http://www.phoenixcollege.edu/academics/course-catalog ).
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10. Subject To Change This syllabus is subject to change at the discretion of the instructor and according to the needs of the students. Students will be notified by the instructor of any changes in course requirements or policies.
11. Special Accommodations It is college policy to provide reasonable accommodations to students with disabilities. Students with disabilities who believe they may need accommodations in this class are encouraged to contact the Disability Resources & Services (DRS) office, Hannelly Center (HC) Building, 602-285- 7477. Disability Resources & Services ( http://www.phoenixcollege.edu/student- resources/disability )
12. Communication Policy Internet resources and email communication will be used extensively throughout this course. Emails are the preferred method of communication between the instructor and students. The instructor’s email address is provided on the first page of this syllabus, and every effort will be made to answer a student’s email correspondence within 24 hours except on weekends and holidays.
13. Course Withdrawal There are two kinds of withdrawal, student initiated withdrawal and instructor initiated withdrawal. You can find the specific withdrawal dates in my.maricopa.edu > Student Center > My Class Schedule > (Course Prefix/Number) > Calendar button under Deadlines. After the last day for student initiated withdrawal, students may ask instructors to withdraw them. Other relevant dates are listed in the college calendar. Students seeking to withdraw from this course should first meet with a Financial Aid advisor in the Hannelly Center to discuss the impact on current and future financial aid awards. Students who do not complete 67% of their attempted courses, or fall below a 2.0 cgpa, may be ineligible for future financial aid. Additionally, students who choose to withdraw from this course may have to return financial aid funds to the college. Please, meet with a Financial Aid advisor and provide documentation of your meeting before requesting to be withdrawn. As per MCCCD regulations (2.3.2) “Students who do not meet the attendance requirement as determined by the course instructor may be withdrawn.” See the attendance policy for details. Additionally, students may be dropped from a course for non-payment of fees. If you are dropped for nonpayment, paying your fees will NOT automatically reinstate you in your classes. Reinstatement requires permission from your instructor and the Department Chair and is not guaranteed.
MCCCD Administrative Regulation 2.3.6 and Appendix S-7 ?)
14. Course Calendar See separate Course Calendar
Other Information: Supplies For online class: Textbooks, access to online course.
For lab/clinic: Two aspirating syringes, one hemostat (any type) or locking cotton pliers; (note, suggested brands are 01-N2100 Septodont Petite aspirating syringe for clinicians with small hands; HMC Halsted curvy mosquito hemostat; can be ordered from Smartpractice.com), protective eyewear for yourself, and blood pressure cuff with stethoscope (or good quality digital BP monitoring device; may be purchased at
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Walgreens, CVS, etc). If you provide a patient for any clinical sessions, you must provide protective eyewear for that patient.
A hand mirror to observe your partner’s technique is helpful.
The Center will provide nitrile or vinyl gloves, masks, anesthetic, needles, topical anesthetic, autoclave bags, barrier wraps, and miscellaneous supplies for clinic. Also, each student will be supplied with one multi-use, disposable, personal nitrous oxide nose mask. We will sterilize your syringe/hemostat every day.
If you have hard-to-fit hands or special preferences for gloves or masks, please provide your own as the Center will not be able to satisfy special requests.
Dress Code Professional clinical attire is required. Please wear a name tag (one will be supplied if you don’t have one) in clinic, scrubs, and a lab jacket over the scrub uniform. Please, no sandals, shorts, or skirts in clinic.
Clinic Schedule & Partners Students are assigned different partners (fellow students) each day by the instructor. Each student will have a designated time to receive 1:1 instruction from a clinical instructor. It is the student's responsibility to be prepared at the designated time. Students scheduled in the first time period must set up their units and prepare their armamentarium before the clinical session begins. The clinic schedule will be posted daily.
Specific clinic set-up and closing responsibilities will be assigned to two students each day. All students must check the clinic schedule to determine who has been assigned to these responsibilities. The student assigned to clinic set-up must meet those responsibilities before the clinical session begins.
Students are expected to remain on the premises throughout the entire clinical session. The student will spend the clinic time engaged in the following:
1. Being an operator or a "patient" 2. Observing other students (with permission from the student) 3. Practicing "mock" injections with your partner or on a skull. No needle penetration without an instructor observing. Find landmarks, fine tune positioning, practice with armamentarium, etc. 4. Studying course materials. 5. Reviewing DVDs on injection techniques. 6. Assisting instructors or other students as needed. 7. Practicing techniques in nitrous oxide - oxygen analgesia.
Providing Patients for Clinical Sessions You will be assigned a student partner each day, and must be a patient for your partner at least the first day, but you may provide your own patients for some of the clinic time. You will inject the patients you provide and therefore not be required to receive an injection from a classmate during that session. N2O - O2 is not available to anyone other than students enrolled in the class due to a limited supply of disposable nitrous masks.
On the last day of lab, you may "screen" your local anesthesia WREB patient. You may choose only to identify landmarks and confirm the points of penetration with an instructor, assuring yourself that this patient meets WREB criteria, and does not have any unusual anatomy. Or you may choose to actually inject the patient, assuring and that you have no problems during the injection. Candidates for these experiences must have no contraindications for local anesthesia, must complete a medical history form, must be at least 18 years of age, and must be available for at least one hour during the designated clinic sessions. Friends and relatives are your best choices as they are more likely to be willing to help you.
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There will be a sign-up sheet for these “outside” patients during designated clinic sessions, so the clinic schedule can be arranged to accommodate you, your patient, and classmate partner assignments. Refer to course calendar for designated clinic sessions. The instructor will need to know the patient's name, which clinic session the patient is available and the preferred time during that session.
Clinical Evaluation Each injection performed during the clinical sessions will be evaluated by an instructor using the Local Anesthesia Evaluation form. Injections will be performed on both sides of the mouth. The student must have the Local Anesthesia Evaluation form available during every clinical session. The student will use this form to 1) keep track of clinical experiences and 2) to identify strengths and weaknesses. The form should be turned in to the instructor upon completion of the course to document required experiences. See example of the Local Anesthesia Evaluation form on course website.
A separate evaluation form will be used for the administration of nitrous oxide - oxygen analgesia. A sample is included on the website. Each N2O-O2 experience will be evaluated. The first experience will be evaluated by an instructor. The remaining two required experiences will be evaluated by designated peer evaluators.
Chart Entry A complete chart entry for local anesthesia contains all of the following elements: 1. Dates 2. BP (in progress notes, NOT Mhx form) 3. Type and % of topical anesthetic used (e.g. 20% benzocaine) 4. Type and amount of the anesthetic drug expressed in milligrams (e.g. 36 mg lidocaine w/ 0.018 mg epinephrine) 5. Areas anesthetized and injection technique (e.g., Right IA, L, LB) 6. Any complications, treatment, and/or recommendations: EXAMPLES: Hematoma while performing left IAN. Placed chemical cold pack on left cheek. Instructed patient to apply cold pack or ice to the area, 20 minutes on, 20 minutes off for next two hours. Recommend patient call if any discomfort when opening or closing mouth. Sloughing of tissue when Topical gel was applied for 1 min. Wiped area and informed patient. Unsatisfactory duration and depth of anesthesia. Try Septocaine 4% next appt. 7. Initials of clinician, patient, and instructor
Chart Management To ensure that chart entries are completed accurately and properly evaluated by your instructor, please follow these procedures:
1. Immediately following the procedure the operator will complete the chart entry. Operator and "patient" will initial. 2. Operator will place the chart and his/her Local Anesthesia Evaluation form in the vertical file of the lab instructor that evaluated the procedures. 3. At the end of the clinical session, your instructor for that session will review and initial the chart, and complete your Local Anesthesia Evaluation form. The LA Evaluation forms will be placed in a designated place for you to pick up later.
Team Work As 5 o'clock approaches, students should remember we are all on the same team. We've all had a long day and we all want to go home! Don't wait to be asked; just look around with a "how can I help” attitude. Thank you!
First Day of Lab In order to be prepared for the first day of lab/clinic:
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1. Complete the reading of all assigned chapters and course materials prior to day one of the lab course. 2. Review the basics from your CPR course. 3. Review the clinic medical emergency procedures, medical emergency kit contents, clinic exposure policy, and clinic infection control guidelines included with the online course materials. 4. Bring hard copies of course materials that you would like to have as a reference with you to class. Have them organized in a 3-ring binder.
Study Tips Tackle each learning unit in sequence. Read through the relevant learning objectives before reading the assignment. Highlight as you read, identifying the "answers" to the objectives. However, do not highlight entire paragraphs or large amounts of material. Instead, try to find the "big" ideas or key phrases in each chapter. Memorize: innervation of teeth and soft tissue, names of the anesthetics (including most common brand names), everything about the injection techniques (landmarks, what's anesthetized, site of deposition in relation to other anatomical structures, amount of anesthetic needed, etc.).
Visualization The study of local anesthesia techniques involves forming mental images of nerves and their positions relative to surrounding structures. The student must visualize in three dimensions as well as employ "X- ray vision" to picture structures which are normally hidden under tissue. Proper visualization can change a burdensome memory chore into an intriguing exploration.
Illustrations in the textbooks and in the online materials will facilitate your visualization not only of the anatomical structures but of the actual injection techniques. Imagine yourself doing the injections. Project in your mind the path of the needle as it approaches the target nerve. Physically position yourself in the proper operator positions described in the text and pretend you are administering local anesthesia. Handle your syringe - get the "feel" of it. Allow the syringe to feel as comfortable in your hand as any other instrument does.
Mastery of the subject requires careful and close study of the illustrations and pictures in the texts, videos and online materials. Soon you will be able to close your eyes and remember the techniques and the surrounding anatomical structures just as readily as you can close your eyes and picture a pocket you are instrumenting, or the contents and arrangement of items on your instrument tray.
Western Regional Examining Board (WREB) The WREB exam required for certification in local anesthesia in many states is a completely separate entity from the DHE 227 course and Phoenix College (PC), although PC is one location where the WREB exam is offered. When applying for the WREB exam, students should indicate that they are currently enrolled in DHE 227 at Phoenix College, and the course will be completed on May 5, 2019. The student is responsible for researching & understanding all requirements of WREB. Be sure to obtain a Candidate’s Guide immediately if you plan to take the WREB. An electronic copy of the WREB Candidate guide is available on Canvas as well.
The didactic/online portion of DHE 227 that pertains to the WREB written exam will be completed on April 06, 2019 (comprehensive exam date). Note that WREB requires that the WREB Written Exam must be taken at a Prometric testing center between 60 days, but no later than 15 days before a WREB clinical exam is given. WREB candidates must pass the WREB written portion before being eligible to take the WREB clinical portion. Note: students who do not pass the WREB written exam should still plan to complete the 3-day clinical/lab portion of this course in order to complete DHE227 and be in a position to take the WREB written & clinical anesthesia exams in the future.
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Upon successful completion of DHE 227, and if they have passed the WREB written exam at a Prometric center, students will be eligible to take the WREB clinical exam in Local Anesthesia. Phoenix College will provide the certificate of course completion that you will need to hand-carry to the exam.
WREB Anesthesia Exam Locations in the Phoenix area in 2019 Note: the exams listed below occur on dates that fall after the completion of DHE 227 on May 5th. Other exams are offered throughout other Western states. Go to www.wreb.org for registration deadlines and complete, current information; exams fill up fast, sometimes within hours after they are open for registration! We recommend you apply immediately when open for registration!! Phoenix College, May 31, 2019 through June 03, 2019
Arizona Certification in Local Anesthesia If your goal is to become certified in local anesthesia administration in the State of Arizona, you must complete a separate application to the Arizona State Board of Dental Examiners (BODEX) https://dentalboard.az.gov/ Completion of DHE 227 (or comparable course) and the WREB exam are required, but their completion does not automatically give you certification. You must apply and submit documentation that you’ve met the requirements.
Summary Checklist for Obtaining Arizona Local Anesthesia Certification ____ complete DHE 227 Dental Anesthesia course
____ Register for and complete WREB written & clinical exams in Local anesthesia
____ Apply for AZ certification in local anesthesia from Az State Board of Dental Examiners
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Course Calendar: Online Self-Study Portion DHE227 The following schedule must be followed in order to allow the recommended amount of self-study time before the WREB written exam deadline & before class meets for the 3-Day lab session. Reading assignments include all material on the course website, as well as the reading from the Handbook of Local Anesthesia. & the Handbook of Nitrous Oxide & Oxygen Sedation. DVD assignments refer to the corresponding Malamed DVD #1. Contact the instructor immediately if you are unable to submit your Learning Activity by the due date, or to plan an alternate self-study calendar. ([email protected]) Topic Reading in Handbook Learning Activity (these are due to the Due date for self- study reading and of Local Anesthesia; instructor by the due date listed in the next submitting Learning Activity;
Week/
Module DVD assignment column) Quizzes & Exams
1 Neurophysiology – How Local Ch 1 Neurophysiology – How Local Anesthetics Work January 19th Anesthetics Work DVD Drugs Learning Activity Ch 1 Syllabus Quiz Ch 1 Quiz 2 Pharmacology of Local Ch 2, 3 Pharmacology of Local Anesthetics & January 26th Anesthetics & DVD Drugs Vasoconstrictors Learning Activity Ch 2 & 3 Vasoconstrictors Experience Survey Ch 2 & 3 Quiz 3 Clinical Action of Specific Ch 4 Problems in Dosage Calculation February 2nd Agents DVD Drugs Learning Activity Ch 4 Remediation Contract due (if applicable) Ch 4 Quiz
February 3rd Test 1 4 Armamentarium Ch 5 – 9 The Needle & the Cartridge February 9th DVD Armamentarium Learning Activity Ch 5-9 Ch 5 – 9 Quiz 5 Physical & Psychological Ch 10 & Ch 21 Health History Evaluation & Drug Interactions February 16th Evaluation DVD Techniques Learning Activity Ch 10 Ch 10 Quiz 6 Basic Injection Technique Ch 11 & DVD Techniques February 23rd Ch 12 Quiz Anatomy Review & Ch 12 & DVD Techniques Anatomical Considerations February 24th Test 2 7 Techniques of Maxillary Ch 13 Anesthesia Review I & II March 2nd Anesthesia DVD Techniques 8 Techniques of Mandibular Ch 14 Treatment Planning for Local Anesthesia March 9th Anesthesia DVD Techniques Learning Activity Ch 13 & 14 Ch 13/14 Quiz
March 10th Test 3 Review Course I & II 11
9 Local Complications Ch 17 Final & WREB Study Guide March 16th DVD Complications WREB Study Guide Nitrous powerpoint
10 Systemic Complications Ch 18 Local & Systemic Complications March 23rd DVD Complications Learning Activity Ch 17 & 18 Ch 17 & 18 Quiz
11 Legal Considerations Ch 19 Ethical & Legal Considerations April 6th Nitrous Oxide – Oxygen Handbook of Nitrous Test 4 (Comprehensive) Analgesia Oxide-Oxygen Sedation Nitrous Oxide & Oxygen Analgesia April 7th Learning Activity Ch 19 Learning Activity Nitrous Nitrous Quiz
April 12th Test 5 (Nitrous & Anesth Tech)
12 3-Day Lab session All Injections & Nitrous experiences May 3rd, 4th and 5th
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COURSE CALENDAR 3-Day Lab Sessions:
DATE/TIME LOCATION TOPICS/ACTIVITY Friday 8:00 – 9:20 Classroom Introduction to Course Orientation to Clinic Procedures Armamentarium & Basic Injection Technique 9:30 - 10:50 Maxillary Injection Technique Maxillary Skull Anatomy Activity Mandibular Injection Techniques Mandibular Skull Anatomy Activity 11:00 – 12:00 Armamentarium Exercises Begin to set up in clinic 12:00 - 1:00 Lunch - on your own Set up units & sterile armamentarium 1:00 - 5:00 Clinic Maxillary & Mandibular Injections (1 of 3 sets – R side) Saturday
8:00 - 9:00 Classroom Review Injections N2 O - O2 Administration (DVD) 9:00 - 12:00 Clinic Nitrous Oxide - Oxygen Analgesia (1/2 of class) Maxillary & Mandibular Injections (2 of 3 sets - L side; other ½ of class)
12:00 - 1:00 Lunch - on your own
1:00 - 5:00 Clinic Nitrous Oxide - Oxygen Analgesia (1/2 of class) Maxillary & Mandibular Injections (2 of 3 sets - L side; other ½ of class) Sunday
8:00 - 9:00 Classroom Review Injections Orientation for Injection Technique Final 9:00 – 12:00 Clinic Maxillary & Mandibular Injections (3 of 3 sets – R or L side)
12:00 - 1:00 Lunch - on your own 1:00 – 5:00 Clinic Injection Technique Final (Mock Board) You may provide patient(s) for 1) the injection final, 2) to practice, or 3) to screen as a Board patient. This is your last clinic, use it fully!
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Newsletters & Articles of Interest
News & Views Citizen Advocacy Center
First Quarter 2019 – Health Care Public Policy Forum – Volume 31 Number 1
CONTINUING COMPETENCE ~ TABLE OF CONTENTS ~
ABMS Vision Commission Issues CONTINUING COMPETENCE Recommendations on Continuing ABMS Vision Commission issues Certification recommendations on continuing 1 On February 13, 2019, the American Board of certification Department of Justice Weighs in on 2 Medical Specialties released the final report of Maintenance of Certification its Vision for the Future Commission: Stakeholders Opine about Aging 4 The Continuing Board Certification: Physicians Vision for the Future Commission AMA Declines to Adopt Standards (Commission) submitted its final for Testing Older Doctors 5 Ontario Nurses Grapple with report to the American Board of Medical Definitions of Competence and 5 Specialties (ABMS) Board of Directors. Competency The Commission’s final set of recommendations marks the end of the QUALITY OF CARE Commission’s work. Health Affairs Recommends Patient Engagement to Reduce Diagnostic 6 Over the past 12 months, it has been our Errors pleasure to work with the talented and Study Finds Academicians Under- dedicated members of the Commission. Report Students’ Lapses in 6 Their insights and perspectives helped Professionalism create a report that supports and reinforces the important role that DISCIPLINE Year-long investigation concludes continuing certification plays in today’s 7 health care system and offers medical licensing system “broken”
recommendations to improve its value to TELEHEALTH all stakeholders. Telehealth Enlisted in Opioid Crisis 7 Rural Areas Use Telehealth Less 8 On behalf of the Commission, we want to Than Urban Areas recognize the Vision Initiative Planning CMS Issues Mandated Report on 9 Committee for their leadership in Telehealth Use Telehealth Use Increasing, but Still establishing and informing the 9 Commission’s framework and gathering Rare invaluable background information. We ~~ Continued on Page 2 ~~ also want to thank the representatives of 1
stakeholders from within the medical ~ Continued from Page 1 ~ profession, including practicing physicians, medical associations, and professional ETHICS societies, as well as the representatives who Medscape Asks Doctors about Their 9 Ethical Dilemmas use the credential, including hospitals and health systems, members of the credentialing CONSUMER INFORMATION community and the public, for their California Medical Board Specialist testimony and shared best practices. And, we 10 Praises Public Information especially want to acknowledge those who Federation of State Medical Boards participated in the stakeholder survey, Publishes 2018 Regulatory Trends 11 offered ideas and commentary, and were Report engaged throughout the Vision Initiative process. Your combined contributions were REGULATORY REFORM of great value and had an enormous impact in White House Advocates Choice and 11 forming the Commission’s final report. Competition in Healthcare System FTC Issues Publication on License See the report at 13 Portability https://visioninitiative.org/commission/final- U.S. Congress Legislates Licensure 14 report/ Protection for Sports Medicine Heartland Institute Joins Chorus Department of Justice Weighs in on 14 against Licensure Overreach Maintenance of Certification Some Professions Question Opposition 14 Legislation under consideration in Maryland to Licensure would affect how hospitals factor in specialty certification status when they make IN DEPTH FEATURE privileging decisions (HB857). The Address by Denise Roosendaal, CAE, legislation was proposed by a physician who Accepting the 2018 Ben Schimberg 15 serves on the board of directors of an Public Service Award organization that certifies physicians, the SCOPE OF PRACTICE National Board of Physicians and Surgeons, South Carolina Extends Telehealth which has been critical of the Maintenance of Privileges to Advanced Practice 19 Certification (MOC) requirements of the Providers member boards of the American Board of American Enterprise Institute Hosts 19 Medical Specialties (ABMS) which have Discussion of Physicians and NPs been in place for the past decade or so, but Study Finds Nurse Practitioners Well 19 which are now being significantly modified. Prepared for Primary Care Role (See previous article). This same legislator North Carolina Court Affirms Physical 20 Therapy’s Claim to Dry Needling solicited an advisory opinion from the New Nurse Practitioner Census Antitrust Division of the U.S. Department of 20 Released Justice (DOJ) about whether ABMS “may harm competition by imposing overly PATIENT SAFETY burdensome conditions on physicians who Assesses Progress toward Patient wish to maintain their certification.” He also 20 Safety Goals asked the DOJ to comment on policy options available to the legislature to correct for any
anti-competitive consequences from ABMS ~ Continued on Page 3 ~ requirements. In essence, the three policy
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options under consideration were, 1) do nothing; 2) prohibit hospitals from requiring physicians to ~ Continued from Page 2 ~ maintain board certification; or 3) promote competition between “legitimate” certifying OPEN NOTES Patient Engagement Found to bodies. On the policy options, the DOJ wrote: 21 Improve Care The Division encourages the Maryland Patients Should Check the Accuracy 21 legislature to consider ways to facilitate of Their Medical Records OpenNotes Announces Campaign for competition by legitimate certifying 21 bodies, consistent with patient health and More Effective Implementation safety. Physicians, hospitals, healthcare ROLE OF PUBLIC MEMBERS consumers, insurers, and others can Healthcare Thought Leaders Write 22 benefit from competition to provide cost- About Value of Public Members effective, high-quality certification services. Toward that end, the Division PAIN MANAGEMENT AND END
encourages drafters of the Bill to OF LIFE CARE ANA Enumerates Nursing’s Ethics consider ways to allow for entry by 22 additional, legitimate certifying bodies. Related to Pain Management
At the same time, the Division 2019 MEMBERSHIP 24 encourages the Maryland legislature to INFORMATION continue allowing hospitals and insurers 2019 MEMBERSHIP independently to decide whether to 25 consider a physician’s MOC status when ENROLLMENT FORM making business decisions, such as granting hospital privileges. The Division is concerned that the second approach outlined above could unnecessarily interfere with hospitals’ and others’ unilateral business decisions and thereby harm, not improve, the competitive landscape of healthcare in Maryland. If hospitals and insurers are free to decide whether Maintenance of Certification or another recertification program is a useful tool to identify skilled and qualified physicians, then use of such programs can promote competition and provide benefits for patients. To avoid unnecessary, unintended, or overbroad restrictions on competition, the Division recommends that the legislature not restrict such competitive benefits unless a restriction is determined to be necessary and narrowly tailored to redress well- founded consumer harms or risks. The ABMS issued a statement in reaction to the DOJ advisory opinion. It reads in part: ABMS is pleased that the DOJ letter encourages the Maryland legislature “to continue allowing hospitals and insurers independently to decide whether to consider a physician’s MOC status when making business decisions, such as granting hospital privileges” and ABMS strongly agrees with the conclusion of the DOJ that enactment of the Maryland bill could “harm, not improve, the competitive landscape of healthcare in Maryland.” ABMS applauds the recognition by the DOJ of the value to consumers and health systems of “certifying that a provider has demonstrated a certain level of training, testing, or experience over and above other providers.”
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Like the DOJ, ABMS supports and encourages a competitive marketplace for specialty Board of Directors certification. At the same time, however, we are concerned about deception of patients if Honorary Chair Emeritus (deceased) physicians are permitted to market themselves Benjamin Shimberg as “Board Certified” based on certification by a Board whose standards do not rigorously assess Chair medical knowledge and maintenance of skills. Rebecca LeBuhn After all, most consumers do not have the experience to differentiate between a claim of Board Certification based on the exacting President and CEO standards of ABMS Boards and a claim of David Swankin Board Certification not based on such standards. Secretary/Treasurer For that reason, we believe that claims of Board Ruth Horowitz certification should be based on transparent standards that will genuinely advance the Vice President interests of patients and avoid deception. We Mark Speicher are confident that, when compared to any other specialty certification programs, ABMS Boards Directors can clearly demonstrate the superiority of their Carol Cronin Julie Fellmeth certification programs in giving useful Gary Filerman Arthur Levin information to hospitals, payers, and patients. It Cheryl Matheis Barbara Safriet is for this reason that hospitals, health plans, Mark Yessian consumers, and even providers themselves, overwhelmingly select ABMS certification as the gold standard of specialty care. While we continue to work with physicians and specialty and medical societies to ensure our programs do not become overly burdensome, we are proud that our certificate represents the highest standard of knowledge and assessment currently available. Accordingly, ABMS continues to welcome an accurate comparison of our programs to other certification programs currently in the marketplace, and we continue to support the right of patients and health systems to determine which program best meets their expectations for high quality specialty care. See more at http://tinyurl.com/y3ckx6vp. Stakeholders Opine about Aging Physicians An article in the BMJ entitled “Patient safety and the ageing physician: a qualitative study of key stakeholder attitudes and experiences” addresses the safety and political dimensions of late- career physician (LCP) practice. (White AA, Sage WM, Osinska PH, et al, Patient safety and the ageing physician: a qualitative study of key stakeholder attitudes and experiences, BMJ Qual Saf Published Online First: 20 September 2018. doi:10.1136/bmjqs-2018-008276).
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The abstract reports these results and conclusions: CAC News & Views Results Stakeholders describe lax professional self-regulation of LCPs and is published quarterly by believe this represents an important unsolved challenge. Patient safety and Citizen Advocacy Center attention to physician well-being 1601 Eighteenth Street NW emerged as key organizing principles for Suite #4 policy development. Stakeholders Washington, DC 20009 believe that healthcare institutions rather Phone: (202) 462-1174 than state or certifying boards should Fax: (202) 354-5372 lead implementation of policies related Email: [email protected] to LCPs, yet expressed concerns about resistance by physicians and the ability Editor-in-Chief: Rebecca LeBuhn of institutions to address politically Contributing Editor: David Swankin complex medical staff challenges. Newsletter Layout / Subscription Respondents recommended a coaching Manager: Steven Papier and professional development framework, with environmental changes, © 2019 Citizen Advocacy Center to maximize safety and career longevity of physicians as they age. Conclusions Key stakeholders express a desire for wider adoption of LCP standards, but foresee significant culture change and practical challenges ahead. Participants recommended that institutions lead this work, with support from regulatory stakeholders that endorse standards and create frameworks for policy adoption. See more at http://dx.doi.org/10.1136/bmjqs-2018-008276 AMA Declines to Adopt Standards for Testing Older Doctors On November 14, 2018, MedPage Today reported that: A set of guiding principles from an American Medical Association council on assessing the competency of senior/late career physicians failed to gain adoption at the AMA’s interim meeting. In a floor vote of 281-222 on Tuesday, delegates sent the report back to the Council on Medical Education, which issued the guiding principles. Some hospitals and health systems already require competency testing by older physicians, but there are currently no standards for these tests. Read more at http://tinyurl.com/yyo3zeba. Ontario Nurses Grapple with Definitions of Competence and Competency The National Council of State Boards of Nursing’s Good Morning Members reported on October 19, 2018 about an article in the Journal of Nursing Regulation: According to an article in the Journal of Nursing Regulation, the College of Nurses of Ontario identified inconsistencies in the use of the terms competency and competence within the college. To support the organization’s assessment frameworks and operational
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activities, consistent definitions of the two terms were needed. The article “describes the process used to develop the definitions for competency and competence used by the College of Nurses of Ontario, as well as implications for regulators.” The College of Nurses of Ontario developed the following definitions: Competency: a component of knowledge, skill and/or judgement demonstrated by an individual for safe, ethical and effective nursing practice. Competence: an individual’s capability for consistently integrating the required knowledge, skill and judgement for safe, ethical and effective nursing practice.
The article notes that the “integration of clear definitions of competency and competence support the work of regulatory functions in protecting the public interest.” Read the article at http://tinyurl.com/y33llgdk.
QUALITY OF CARE Health Affairs Recommends Patient Engagement to Reduce Diagnostic Errors Researchers from Health Affairs magazine examined causes of diagnostic errors and found that failure to pay attention to patients is a significant contributor. Christopher Cheney writes in “Tapping Patient Engagement to Reduce Diagnostic Errors” that: In outpatient care, diagnostic errors impact about 12 million adults annually. In a new database, patients report a range of substandard clinician behavior tied to diagnostic errors such as manipulation and disrespect. Proposals to reduce diagnostic errors through patient engagement include lifelong communication training for clinicians.
The researchers recommend several methods to improve patient engagement. See more at http://tinyurl.com/yxvqzmyf. Study Finds Academicians Under-Report Students’ Lapses in Professionalism A study reported in November 2018 in Academic Medicine sought to explain the reasons academicians fail to report lapses in professionalism by medical students. Failure to report these lapses is significant because physicians who had lapses in professionalism while students are more likely to accumulate a disciplinary record during their careers. The study’s authors concluded: The findings from this study suggest several next steps. First, the failure to report professionalism lapses is both an individual and a systems problem and should be addressed as such. At the individual level, it will be important to ensure that policies and procedures are clearly stated and that there are sufficient faculty development programs to help implement and sustain these efforts. At the systems level, crafting effective reporting programs, developing and pilot testing systems approaches (similar to error reporting), and engaging faculty will be important. Finally, dialogue among faculty, students, and administrators about definitions, expectations, and the evaluation of professionalism, including the criteria for reporting lapses and the consequences that follow, would help clarify the process for all concerned. Placing the challenges of
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reporting on more empirical footing represents a first step in designing interventions that clarify and strengthen faculty and institutional commitment to professionalism as a cornerstone of medical education and practice. See more at http://tinyurl.com/yyswap4d.
DISCIPLINE Year-long Investigation Concludes Medical Licensing System “Broken” On November 30, 2018, USA TODAY published a summary of the results of its yearlong investigation of medical licensing in the US conducted in collaboration with the Milwaukee Journal Sentinel and MedPage Today. The article identifies seven takeaways from the investigation, most of which are related to the disciplinary function. This article contains links to investigative reports published throughout the year. Read the article at http://tinyurl.com/yyf7ff7l.
TELEHEALTH Telehealth Enlisted in Opioid Crisis On October 2, 2018, the Center for Connected Health Policy reported that: Congress continues with legislation designed to combat the national opioid epidemic with the introduction of H.R. 6781, the Mental Health Telemedicine Expansion Act, sponsored by Rep. Suzan DelBane (D-WA). The bill was introduced mid-September, almost a week prior to the Senate passing of the comprehensive opioid package, H.R. 6. H.R. 6781 would amend the Social Security Act by removing Medicare originating site location requirements for mental health telehealth services. These requirements restrict telehealth originating sites to areas designated as rural health professional shortage areas, counties that are not included in a Metropolitan Statistical Area, and entities that participate in a Federal telemedicine demonstration project. The bill adds mental health telehealth services as CPT codes 90834 and 90837, which are both for individual psychotherapy services. It also includes the home as an eligible originating site for mental health telehealth services. Additionally, the new originating sites added by this bill would be ineligible to receive a facility fee. Payment for the services would require a physician or practitioner to provide an in-person assessment of the patient’s needs prior to the delivery of telehealth services and to reassess those needs at a frequency specified by the Secretary. See the legislation at http://tinyurl.com/y2ze7879. Compilation of State Telehealth Laws Updated In October 2018, the Center for Connected Health Policy announced the availability of an “Updated & Redesigned Fall 2018 Edition of the 50 State Telehealth Laws and Reimbursement Policies Report.” The announcement highlighted the following significant findings from the update:
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Forty-nine states and Washington, DC provide reimbursement for some form of live video in Medicaid fee-for-service. This number has not changed since Spring 2018. Eleven states provide reimbursement for store-and-forward. Four states that were previously on the list were removed, due to clarification that their store-and-forward reimbursement only includes teleradiology (which CCHP does not count) and/or lack of information indicating a Medicaid reimbursement law providing for store-and-forward reimbursement has been implemented by the state’s Medicaid program. Twenty state Medicaid programs provide reimbursement for remote patient monitoring (RPM). This number has remained unchanged since Spring 2018. Twenty-three states limit the type of facility that can serve as an originating site. While some states removed their list of eligible facilities, others added specific facility lists, resulting in this number remaining steady since Spring 2018. Thirty-four state Medicaid programs offer a transmission or facility fee when telehealth is used. This number is up two since CCHP’s Spring 2018 update. Thirty-nine states and DC currently have a law that governs private payer telehealth reimbursement policy. This is an increase of one (Kansas) since Spring 2018, although three state laws don’t go into effect until 2019. Read the report at http://tinyurl.com/yysmsd8t. See a Legislative Roundup at http://tinyurl.com/y2b6oznt. Rural Areas Use Telehealth Less Than Urban Areas A study by the U.S. Department of Agriculture found that urban dwellers use telehealth services more than people in rural areas, regardless of other factors like level of educational attainment, household income, and employment status. Although, according to the Center for Connected Health Policy: In some instances, these other factors appeared to more strongly predict the use of telehealth than rural-urban residency. As an example, rural residency appeared to only marginally influence the use of online health research which was more strongly determined by level of educational attainment. When factoring by level of education, rural populations appeared to conduct online health research only slightly less than their urban counterparts. Researchers looked at three types of services: 1. Online health research – Personal research related to health such as the use of websites including WebMD 2. Online health maintenance – Using internet-connected technology to make appointments, examine and maintain medical records and accounts, pay medical bills, and communicate with health providers and staff 3. Online health monitoring – The use of internet-connected devices such as alert devices and monitoring implants. See more at http://tinyurl.com/yxk7sto5.
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CMS Issues Mandated Report on Telehealth Use On November 28, 2018, the Center for Connected Health Policy reported that: In response to a requirement in the 21st Century Cures Act to issue a report on telehealth use, barriers and opportunities in Medicare, CMS released an informational report on November 15th addressing the four required elements, including the following: 1. Identification of Medicare beneficiaries whose care may be improved most by telehealth services; 2. Activities by the Center for Medicare and Medicaid Innovation that examines the use of telehealth; 3. The types of high-volume services that might be suitable to be furnished using telehealth; and 4. The barriers that are preventing telehealth’s expansion. The document employs data from Medicare Fee for Service (FFS) between 2014 and 2016, reporting that although overall use of telehealth has increased, the rate of adoption is still limited. See the report at http://tinyurl.com/yxa6rsjn. Telehealth Use Increasing, but Still Rare Reuters’ new service reported on a JAMA study of the frequency of telehealth use, which found: Overall, annual telemedicine visits increased from 206 visits in 2005, or less than one per 1,000 people in the study, to more than 202,000 visits in 2017, or more than seven per 1,000. Most of this increase happened over the last few years of the study, with an average annual compound growth rate of 52 percent from 2005 to 2014 and an annual average compound growth rate of 261 percent from 2015 to 2017. See more at http://tinyurl.com/y5kr86kr. See this for data on which specialties use Telehealth most: http://tinyurl.com/y269wk93. See this 2018 trends analysis: http://tinyurl.com/y6bkf95f. See these forecasts for 2019: http://tinyurl.com/yyqmauk4 and http://tinyurl.com/y322zm9p. See a proposal to expand access to telementalhealth in New York: http://tinyurl.com/yxowkbga and Medicaid expansions in California: http://tinyurl.com/y2mu25os.
ETHICS Medscape Asks Doctors about Their Ethical Dilemmas December 10, 2018, Beckers Hospital Review posted the following: Medscape surveyed more than 5,200 physicians in more than 29 specialties to discover how they feel about the ethical issues they face in the medical field. The annual "Medscape Ethics Report 2018" surveyed physicians on key ethical issues concerning money, romance in the workplace and patients' well-being.
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Here are six findings from the report: 1. Almost 3 in 4 of those surveyed (69 percent) said physicians should be required to get an annual flu shot if they are in direct contact with patient. 2. The majority of respondents (86 percent) said they would refer patients to physicians outside of their health system despite increasing pressure to keep referrals in-house. 3. Approximately 63 percent of those surveyed said they would not cherry-pick patients to avoid those with comorbid disease. However, 44 percent of plastic surgeons, 38 percent of orthopedic surgeons, and 31 percent of orthopedists said "yes" to cherry-picking patients. 4. Among those surveyed, 72 percent of female physicians and 59 percent of male physicians said it is not acceptable to engage in a romantic or sexual relationship with a patient. 5. Roughly 39 percent of respondents said physicians should be subjected to random testing for drug and alcohol misuse, while 42 percent of those surveyed said they should not. 6. Medscape asked physicians to describe their toughest ethical dilemmas in open- ended responses. Among the responses were issues with vaccinations and moderating disputes between terminal patients and their families. One physician said their toughest ethical dilemma involved "trying to convince a parent their child needed treatment for meningitis, when the parent wanted to try homeopathic treatments. Hospital lawyer was involved; the parents went home; the child died." See the report at http://tinyurl.com/y5rw2wzt. CONSUMER INFORMATION California Medical Board Specialist Praises Public Information Medical Board of California Public Member and Board Chair wrote the following message in the Fall 2018 board newsletter: It is an honor to be elected as the president of the Medical Board of California (Board). Concurrently, I recognize what tremendous responsibility this role entails. The Board members and the Board’s staff are often called upon to do things that are uncomfortable, and I think that is a good thing. When we are uncomfortable, we must think outside the box and open ourselves to new perspectives, and ultimately, I believe, find our way to new solutions. As the Board begins this new term, I will take a “Consumers First” approach and will challenge the Board’s staff with the question: “If you are living the mission, what would you do better?” I will challenge them to identify areas in which the Board can improve and, perhaps more important, come up with creative solutions. We will shift our “Check Up on Your Doctor’s License” from a campaign to an initiative. We will strive to include a broader range of partners in our outreach efforts and we will commit to transparency in all our interactions with legislators, licensees and consumers.
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Five years ago, our team’s targeted outreach efforts began with teleconferencing. We will continue to expand those efforts, utilizing technological enhancements in everything from our web platforms to the license alert app. We will work with stakeholders to identify areas in which we can improve the Board’s vital licensing and enforcement functions, including reducing enforcement timelines. Earlier this year we celebrated the passing of the Patient Notification Bill and the mandatory consultation of CURES. We have achieved much, and we have more to do. I look forward to working alongside my fellow Board members to implement a physician’s health program and explore more ways in which we can combat the opioid epidemic gripping the nation. You have a very strong team working for you. Our commitment is demonstrated by the fact that 90 percent of our current Board members will remain on the Board for the next two years, and I look forward to working with my fellow Board members and the Board’s staff to strengthen and enhance consumer protection in California. See the newsletter at http://tinyurl.com/y4yr4h8k. Federation of State Medical Boards Publishes 2018 Regulatory Trends Report The Federation of State Medical Boards (FSMB) has published a report entitled, “U.S. Medical Regulatory Trends and Actions 2018.” The first section covers topics such as, board structure, the licensure and regulation processes, unprofessional conduct, due process, discipline information sharing, the consumer role, how to contact a medical board, and how to file a complaint, and the difference between board discipline and malpractice. The second section contains 2017 aggregate discipline statistics for the entire country rather than state-by-state. The statistics include the number of physicians with a board action, actions by board action categories, number of first-time offenders, and number of reciprocal actions. See the full report at http://tinyurl.com/yydyqeag/
REGULATORY REFORM White House Advocates Choice and Competition in Healthcare System In November 2018, the U. S. Departments of Health and Human Services, Treasury, and Labor issued a report to the President entitled “Reforming America’s Healthcare System through Choice and Competition.” The report offers recommendations in four areas, including healthcare workforce and labor markets: Reduced competition among clinicians leads to higher prices for health care services, reduces choice, and negatively impacts overall health care quality and the efficient allocation of resources. Government policies have suppressed competition by reducing the available supply of providers and restricting the range of services that they can offer. This report recommends policies that will broaden providers’ scope of practice while improving workforce mobility, including telehealth, to encourage innovation and to allow providers more easily to meet patients’ needs. The report also recommends that the Federal Government streamline funding for graduate medical education to allocate taxpayer dollars efficiently and to address physician supply shortages.
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Among the recommendation made in the report are these: Broaden Scope of Practice States should consider changes to their scope-of-practice statutes to allow all healthcare providers to practice to the top of their license, utilizing their full skill set. The federal government and states should consider accompanying legislative and administrative proposals to allow non-physician and non-dentist providers to be paid directly for their services where evidence supports that the provider can safely and effectively provide that care. States should consider eliminating requirements for rigid collaborative practice and supervision agreements between physicians and dentists and their care extenders (e.g., physician assistants, hygienists) that are not justified by legitimate health and safety concerns. States should evaluate emerging healthcare occupations, such as dental therapy, and consider ways in which their licensure and scope of practice can increase access and drive down consumer costs while still ensuring safe, effective care.
Improve Workforce Mobility States should consider adopting interstate compacts and model laws that improve license portability, either by granting practitioners licensed in one state a privilege to practice elsewhere, or by expediting the process for obtaining licensure in multiple states. The federal government should consider legislative and administrative proposals to encourage the formation of interstate compacts or model laws that would allow practitioners to more easily move across state lines, thereby encouraging greater mobility of healthcare service providers.
Facilitate Telehealth to Improve Patient Access States should consider adopting licensure compacts or model laws that improve license portability by allowing healthcare providers to more easily practice in multiple states, thereby creating additional opportunities for telehealth practice. Interstate licensure compacts and model laws should foster the harmonization of state licensure standards and approaches to telehealth. States and the federal government should explore legislative and administrative proposals modifying reimbursement policies that prohibit or impede alternatives to in-person services, including covering telehealth services when they are an appropriate form of care delivery. In particular, Congress should consider proposals modifying geographic location and originating site requirements in Medicare fee-for-service that restrict the availability of telehealth services to Medicare beneficiaries in their homes and in most geographic areas. States generally should consider allowing individual healthcare providers and payers to mutually determine whether and when it is safe and appropriate to provide telehealth services, including when there has not been a prior in-person visit.
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Congress and other policymakers should increase opportunities for license portability through policies that maintain accountability and disciplinary mechanisms, including permitting licensed professionals to provide telehealth service to out-of-state patients.
Ease Restrictions on Foreign-Trained Doctors The Department of Health and Human Services, in coordination with the Accreditation Council for Graduate Medical Education (GME), should identify foreign medical residency programs comparable in quality and rigor to American programs. Graduates of such equivalent programs should be granted “residency waivers,” allowing them to forgo completing an American residency and instead apply directly for state licensure. States should create an expedited pathway for highly qualified, foreign-trained doctors seeking licensure who have completed a residency program equivalent to an American GME program.
See the entire report at http://tinyurl.com/yayzvc4f. See more at http://tinyurl.com/y2xmdrtk and at http://tinyurl.com/y59344l3. FTC Issues Publication on License Portability On September 24, 2018, the Federal Trade Commission (FTC) posted the following press release: about a new document from the Economic Liberty Task Force: The Federal Trade Commission today released a staff report examining ways to reduce the burden on licensed workers moving to new states or wishing to market services across state lines. The Report, entitled, “Options to Enhance Occupational License Portability” is part of the FTC’s Economic Liberty Task Force initiative. This initiative, begun last year, aims to reduce hurdles to job growth and labor mobility by encouraging states to reduce unnecessary and overbroad occupational licensing regulation. Occupational licensing, when not necessary to further legitimate public health and safety concerns, can impose real and lasting costs on both American workers and American consumers. These burdens often fall disproportionately on lower income Americans trying to break into the workforce and on military families who must move frequently. In recent decades, the number of occupations subject to state licensing requirements has increased dramatically, increasing the burdens on workers. The Report released today builds on a roundtable held by the Task Force last year that examined ways to mitigate the negative effects of state-based occupational licensing requirements. The Report looks at interstate compacts and model laws that states can use to improve the portability of occupational licenses. It examines procedures that might be adopted to facilitate multistate practice by those who already hold a valid license in one state. It also considers specific initiatives to reduce the burden of state relicensing on military spouses. Commissioner Maureen K. Ohlhausen has long championed reform in this area. She stated, “Most occupations are licensed state-by-state, meaning that a valid license in one
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state often will not easily transfer to a new state. This can create real hardships for those who cannot easily bear the costs of being relicensed, and can also reduce public access to trained professionals in rural areas who might otherwise be served by telehealth services or multistate practitioners. Today’s FTC staff report provides important, useful guidance to help state policymakers find ways of reducing these burdens.” See the report at http://tinyurl.com/y68fxv4y. U.S. Congress Legislates Licensure Protection for Sports Medicine The bipartisan Sports Medicine Licensure Clarity Act passed in October 2018 by Congress protects sports medicine provides who travel across state lines with sports teams. See more at http://tinyurl.com/y3lxw38u, http://tinyurl.com/y3csobd6, and http://tinyurl.com/y5otrokw. Heartland Institute Joins Chorus against Licensure Overreach In a December 2018 Research and Commentary entitled, “Occupational Licensing Laws Hurt State Economies,” Matthew Glans concludes:
Burdensome occupational licensing laws often produce negative economic effects such as less competition and higher costs. Even worse, these onerous rules rarely yield better or safer services. In many instances, licensing laws are unnecessary, which is why many states are passing reforms to reduce state licensing boards’ authority. See the report at http://tinyurl.com/yy559brn. See also activity in Ohio, Idaho, and Florida at http://tinyurl.com/y3xxuhwv and http://tinyurl.com/y75pngun. Some Professions Question Opposition to Licensure The anti-regulatory atmosphere in states that are questioning the increase in licensure requirements in recent decades is getting pushback from some professions that want to be licensed. For example, Melissa Jackowski, president of the American Society of Radiologic Technologists (ASRT) told Matt O’Connor of HealthImaging that: We’re now seeing an occupational license reform movement that’s essentially a movement to deregulate licensure in general. That’s the battle we’re fighting. And it’s not just us. Many other groups are involved such as respiratory therapists, dental hygienists, occupational therapists and others. We’re watching several bills that mandate state-by-state investigation of licensure laws to determine which do not need regulation. We’re just not sure how they are going to determine which professions get de-licensed. See more at http://tinyurl.com/y2y4yjtp. See also this debate in Connecticut over licensure for manicurists at http://tinyurl.com/yxsoaasd.
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IN DEPTH FEATURE Address by Denise Roosendaal, CAE, Accepting the 2018 Ben Schimberg Public Service Award Thank you, Becky. I am grateful and humbled to accept the Ben Schimberg award. The list of past recipients contains some of my professional heroes and I hardly feel worthy of such distinguished recognition. I did not know Mr. Schimberg but I have crossed paths with many who did. I’ve heard numerous accounts of his passion, his intellect, and his approach to life, and these remembrances make this award even more meaningful. In 2011, just a few months after assuming the Executive Director role at Institute for Credentialing Excellence (ICE), Becky LeBuhn appeared in my office with a copy of Mr. Schimberg’s book, Occupational Licensing: A Public Perspective. With her hands on her hips-- in that simultaneously sweet and commanding way that is completely Becky-- she said, “If you know what’s good for you, you’ll read this.” Over the years, I may have overdramatized that memory but I am certain I accurately recall her respect and admiration for this man and his work. I did read that book and I continue to keep it within easy reach in my office. Shortly thereafter, David Swankin and I began our tradition of having breakfast in DuPont Circle. He taught me so much about public members and licensure … and fighting for what’s right. I knew I was learning from a great mind and from a man with incredible experience. So I listened. Plus we’ve had a lot of fun. I’ve had the privilege of working alongside so many wise and passionate leaders in my career. But what I have learned about the importance of public member service I have learned from these two powerhouse individuals, the “dynamic duo,” as I refer to them. And I would like to publicly thank them for their contributions to this cause. They have guided me and believed in me over the past seven years. You are both role models to this community and to me. Thank you for your service. It’s nice to be in a room with individuals who understand what I do and why I do it. For as long as I’ve been married (eleven years now), I’ve tried to explain my job to my mother-in-law. I throw around words like “credentialing” and “competencies.” I talk about the importance of regulation, enforcement of standards and public protection. I opine about scope of practice and psychometrics. She finally confessed that it would be easier to tell people that I work for the CIA! I am proud to lead an organization like ICE that recognizes the value of the role of the public member. ICE has a public member on each of our governing bodies – the board of directors, the NCCA Commission and the newly established Accreditation Services Council. ICE also supports public members by offering them complimentary registration to our annual conference when the Executive Director of their organization also attends. We have established the Public Member Working Group, led by Becky LeBuhn, that reaches out to public members and develops valuable services to support their efforts. Becky is also highlighting the role and importance of public members through a series of interviews in the ICE Credentialing Insights online journal. We are collecting data on the current public members in our community and plan to collect information on prospective public members, as well. It is my vision that ICE will
15 become a conduit for connecting those willing to serve with those organizations that need public members. I wish I could stand here today and say our work in protecting the public is done. But we are far from done. With legislative threats at the state level, we must stand guard and challenge efforts that could damage consumer protection and patient safety. Our work is not done. As I ponder the North Carolina Dental Board Supreme Court case, I see that our work is not done. When misunderstanding of maintenance of certification is written into licensure law or hospital credentialing practices, it is clear that our work is not done. I’m not a pessimist … and I’m not an alarmist … and I’m not opposed to common sense reform. I’m always seeking ways to move forward and create a better tomorrow. But I am concerned. I’m also curious. I’d like to know who is now in possession of the crystal ball. Apparently, some in this room have had access to a crystal ball over the years , because they have predicted a future that, in some ways, is now coming true. Allow me to share two specific examples of what I mean. In 2012, David brought me a copy of an article from the New York Times about hair-braiding licensure. He said, “This is going to be a problem.” The hair-braiding example has been raised in more credentialing meetings I’ve attended in the past year than any other. It seems to be the fuel for those seeking drastic restrictions on occupational licensure. The second example is from, Paul Grace, a two-time past president of ICE. In his lecture for the Ben Schimberg award in 2012, he said, “If the public and private entities that make up this industry are to be successful in their public service mission, the number one need is focused, informed, and courageous leadership.” I couldn’t agree more. With these two wise predictions in mind, I’d like to engage in a few predictions myself. The first has to do with recent legislative activities. Legislative conversations and inquiries about occupational reform will continue and will require more outcome measures. Since that hair-braiding article, we’ve seen a dozen states consider or enact some kind of occupational licensure reform with varying degrees of success. I’m not necessarily critical of reform. It’s always a good idea in the name of public protection and even economic progress to examine the impact of regulation. These conversations should attempt to find that balance between the public’s and the occupation’s best interest; the balance between economic health and public protection; the balance between barriers to entry (perceived or real) and the need for qualified workers. I say should, because sometimes finding that balance is nowhere in the conversation. Well, until we remind them, of course! The occupational reform legislation we saw this past year had continual problems with ill- defined terminology, which led to confusion for the lawmakers. The Louisiana legislation originally included language that would have prohibited the use of the term “certified” unless the individual was also licensed. This would have wiped out the ability of individuals with voluntary certifications from being recognized in that state. After the bill was appropriately amended, one of the sponsoring legislators confessed to not understanding the impact of the language.
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ICE is now part of a coalition, the Professional Certification Coalition (PCC), which is a joint partnership between ICE and the American Society of Association Executives. This coalition is comprised of 100 professional societies and credentialing organizations with a mutual goal of monitoring and amending, when necessary, various state legislative attempts to reform occupational licensing. We are not debating the reform initiatives on the merit of the intent. Rather, we are monitoring the proposed legislation to determine whether they contain damaging misunderstandings or misinterpretations of how certification works, or onerous evidentiary requirements for sunrise or sunset review of licensure, or if those reviews appropriately balance economic concerns with public safety or consumer protection. ICE is part of another coalition: The Right to Safe Care Coalition (RTSCC). This group of associations and credentialing bodies is addressing the proliferation of limitations or outright prohibitions on mandatory demonstration of continued competence. This coalition is focusing on educating the public about the importance of continuing competence requirements. These initiatives have resulted in conversations about the role and importance of credentialing, public safety and consumer protection, and the recognition of competence. However, while there is good research available, the highest goal of preventing harm to the public can be difficult to quantify. How do you prove that injury did not happen as a result of an individual being regulated or certified? ICE now has a research agenda for the next several years, and we will be reaching out to universities, third-party research entities and other professional organizations to assist. Many fine organizations have engaged in dynamic research endeavors, too. But we must become more focused in sharing this information more widely with external audiences. Now, let’s move on to governance. My prediction is that governance models will need to continue to evolve in the future. I teach a governance workshop for our non-profit staff and I have to admit that governance is not a sexy topic. It’s a bit difficult to get entry-level associates excited about the topic even when I tell them that governance is where the magic happens. But I do see a glimmer in their eyes when I tell them how amazing it is when a group of volunteers from all walks of life come together with a serious focus on protecting the public or shaping a profession or creating change or enabling a vision of the future. In the shadow of the North Carolina Dental Board decision, we are starting to see some legislative attempts to address concerns about governance. Some are tackling it from the anti- trust aspect; others are addressing representation-related issues. At a recent CLEAR conference, the Council on Licensure, Enforcement and Regulation, I learned of three independent Canadian studies about the state of licensure (McMaster Health Forum report; CNO Vision 20/20; PSA Review). Several common themes are clear. More public representation on professional licensing bodies is needed; some studies recommend as much as 50% public representation. There is a call for more training for public members. Also advisable are fewer popularly elected or politically connected board members and more member selections based on merit and experience. While figuring out new governance models can feel a bit mundane, when it’s structured well and focuses on what’s important, governance need not be an obstacle but source of empowerment and innovation.
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Finally, let’s look at changing demographics. My prediction is that understanding the needs of consumers, patients and the future workforce will become even more relevant and challenging. The Millennials are not coming – they’re here. This next gen professional is speaking loudly as a consumer and as a member of the workforce. You’ve heard this before, I’m certain. With an expectation to change careers – not just jobs, but careers – six times in their lifetime, the next gen professional is thinking carefully about ROI. If they graduated college with enormous debt, they are rightfully wondering whether the time and expense needed to be invested in a credential will pay off in the estimated 7.5 years they’ll be engaged in that profession before moving on to the next. In the workplace, the question has focused on whether or not this generation is adequately prepared for work. This next generation has already changed how universities and professional associations approach education and continued professional development. These future professionals are not expecting recognition or advancement without the learning as some have cynically suggested. But they are demanding to understand how their learning connects with how they will advance in their field. This generation has always had wide and deep access to technology and they will not settle for cookie-cutter approaches to the delivery of education. The eligibility requirements for certification bodies will also need to reflect those various demands and new perspectives. The good news? As consumers and citizens, this generation is demanding transparency from government, their employers, and those in positions of authority. I think they would make great public members. I just learned last week of a certification body that intentionally sought out a millennial as their public member for all the reasons I just stated. Perhaps the most disconcerting of the millennial trends is the threat on established knowledge as expressed in the book “Death of Expertise” by Tom Nichols. This book outlines how society now values the opinion of reviewers over traditionally demonstrated expertise. This is the Yelp generation. In addition, with the amount of information at our fingertips and the trend to self- inform or self-diagnose, the means to evaluating the value of a product or program or a professional is now turned upside down. Despite all of these changes and challenges, I am encouraged by what is ahead of us. I am encouraged by the conversations we’re having with various stakeholders. I am encouraged by the continued dedication of the professionals and volunteers in the credentialing community. I am encouraged by you and your dedication to this field. In the introduction of Mr. Schimberg’s book, he states, “The air is filled with charges and countercharge about who benefits the most from licensing…” (Benjamin Schimberg. Occupational Licensing: A Public Perspective (Princeton: Educational Testing Service, 1982). That was 1982. I believe it is equally true today. Finding the right balance for the highest public benefit is critical. The next time I talk with my mother-in-law about my field of work I’m simply going to tell her that I help protect the public by making sure that professionals have demonstrated they know what they’re doing. You all know the important role of public members for public protection. But you are the choir. So, I say to you today, Choir, sing. Sing loudly and sing powerfully and sing outside these walls to the many stakeholders who have not yet heard your song about protecting the public. Stay
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vigilant, stay focused, stay centered on the importance of public members and in this crazy political and regulatory environment we find ourselves in, I say “sing on and lead on.” I thank you again, for this distinguished honor. Mr. Schimberg continues to cast a long and powerful shadow in the credentialing community and I pledge to work hard to honor his legacy. Thank you
SCOPE OF PRACTICE South Carolina Extends Telehealth Privileges to Advanced Practice Providers As of July 1, 2018, Advanced Practice Providers, including Physician Assistants and Advanced Practice Registered Nurses have been permitted to establish a relationship with patients for delivering telehealth services so long as they follow the same standards that apply to medical doctors. See more at http://tinyurl.com/y6d3sv6a. American Enterprise Institute Hosts Discussion of Physicians and NPs Peter Buerhaus, PhD, director of the Center for Interdisciplinary Health Workforce Studies at Montana State University, in Bozeman told a gathering assembled by the American Enterprise Institute that, in his opinion, physicians needn’t worry about competition from nurse practitioners because the vast majority of them work with physicians. Furthermore, more providers are needed to meet the demand for primary care. Buerhaus recommended eliminating scope of practice restriction on nurse practitioners to help relieve the shortage of primary care providers. The American Enterprise Institute subsequently adopted a policy position in favor of removing scope of practice restrictions. Read more about Dr. Buerhaus’ presentation at http://tinyurl.com/y6cd8o5t, http://tinyurl.com/y65rjdbx, and http://tinyurl.com/yyajcd5l. See more about the recommendation adopted by the American Enterprise Institute at https://www.medscape.com/viewarticle/904384 and http://tinyurl.com/y6tzga5t. Read more here about the decrease in primary care physician visits and increase in visits to nurse practitioners and physician assistants at http://tinyurl.com/y5mur57h. Study Finds Nurse Practitioners Well Prepared for Primary Care Role On November 21, 2018, the National Council of State Boards of Nursing’s Good Morning Members reported that: A new study found that although NPs are well prepared to help fill health care gaps arising from a shortage of primary care physicians in California, many face employment and practice barriers. Researchers examined data from California’s 2017 Survey of Nurse Practitioners and Certified Nurse Midwives and found that “counties with high density of primary care physicians tended to also have high density of nurse practitioners.” According to the study’s lead author Joanne Spetz, the two major barriers to NPs filling the primary care gap in California are the scarcity of NP education training programs in underserved areas and that “California is the only Western state that requires written
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standardized procedures for nurse practitioners to practice and prescribe.” To maximize the impact that NPs can have in meeting care needs, the study calls for expanding education programs in underserved areas, increasing the diversity of the NP workforce and ensuring that NPs feel empowered to fully use their skills. See more at http://tinyurl.com/y2229vgj. North Carolina Court Affirms Physical Therapy’s Claim to Dry Needling In another decision in the long-standing battle between physical therapy and acupuncture over which profession is authorized to practice dry needling, the Supreme Court of North Carolina affirmed a lower court decision that dry needling is within the scope of physical therapy. Read the decision at http://tinyurl.com/yxv26eee. New Nurse Practitioner Census Released The American Association of Nurse Practitioners (AANP) released new statistics in January 2019 showing an increase in NPs providing primary care. According to AANP: NPs work in a variety of settings, including private practice (24.2 percent), hospital outpatient clinics (14.5 percent), inpatient hospital units (12.1 percent), emergency rooms (3.1 percent), urgent care (4.3 percent) and community health centers and Federally Qualified Health Centers (8.1 percent). An estimated 72.6 percent of NPs reported they deliver primary care in their main NP work site/setting. The latest data shows 89.0 percent of the NP workforce worked as full-/part-time staff or faculty. In addition to clinical practice, 14.3 percent of NPs had administrative roles at their main NP practice sites, described as “professional-level” (director, manager or supervisor) and one in five held “executive-level” positions (CEO, CNO or owner). See more at http://tinyurl.com/y4vfaehm.
PATIENT SAFETY Assesses Progress toward Patient Safety Goals On October 8, 2018, the National Council of State Boards of Nursing’s Good Morning Members reported that: In 2009, the NPSF’s Lucian Leape Institute (LLI) identified five areas of health care that require system-level attention and action to improve patient safety: Medical education must be redesigned to prepare new physicians and other health professionals to function in new cultures; Care must be delivered by multidisciplinary teams working in integrated care platforms; Health care workers need to work in safe environments and find joy and meaning in their work; Patients must become full partners in all aspects of designing and delivering health care; and Transparency must be a practiced value in everything health care workers do.
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In a new article, members of the LLI assess the implementation progress of these five concepts in the U.S. and identify ongoing challenges. The authors note that it is critical that national professional organizations, foundations and the government support these strategies as they are “as critical now as when first described and are key to advancing the LLI’s mission to have a world where patients and those who care for them are free from harm.” See the article at http://tinyurl.com/yxvnvvlo.
OPEN NOTES Patient Engagement Found to Improve Care In an article entitled, “Open Notes, Patient Narratives, and Their Transformative Effects on Patient-Centered Care,” posted on the NEJM Catalyst on October 4, 2018, researchers report that Patient education and self-tracking can help patients contribute significantly to health care improvements, particularly through their assessment of non-clinical aspects of care, their assessment of the care environment, and their observations and experience with the care process. See the article at http://tinyurl.com/y9jsvmvf. Patients Should Check the Accuracy of Their Medical Records On November 21, 2018, J Graham of Kaiser Health News wrote an article advising patients to check their medical records for errors: Patients can identify errors in their medical records that health care providers may not recognize. This news article highlights the importance of patients correcting seemingly simple mistakes such as name misspellings and phone numbers as these errors can contribute to situations that result in patient harm. Read the article at http://tinyurl.com/yasa7oue. OpenNotes Announces Campaign for More Effective Implementation In February 2019, OpenNotes’ Executive Director announced that: As we begin 2019, we are glad to report that more than 36 million Americans can access their visit notes through patient portals. But that’s only 10% of the U.S. population. It does look as if “rules” that are emerging from the bipartisan 21st Century Cures Act passed two years ago will help stimulate further spread aggressively, but the fact is that simply “turning on” note sharing does not mean that patients can find, read, and benefit from their notes easily. So we are focusing increasingly on finding ways to implement OpenNotes more effectively. Only then can a large number of patients in a given practice access and benefit from note-sharing. For more see http://tinyurl.com/y29laxgn.
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ROLE OF PUBLIC MEMBERS Healthcare Thought Leaders Write About Value of Public Members In the October 25, 2018 ACCME Announcement, the Accreditation Council for Continuing Medical Education referred readers to an article in Academic Medicine entitled, “The Role of Public Members in Health Care Regulatory Governance.” The authors are authors David Johnson, MA; Katie Arnhart, PhD; Humayun Chaudhry, DO, MS; David Johnson, MD; and Graham McMahon, MD, MMSc. The article’s Abstract reads: American medicine has progressively embraced transparency and accountability in professional self-regulation. While public members serving on health care regulatory boards involved with the accreditation, assessment, certification, education, and licensing of physicians provide formal opportunities for voicing public interests, their presence has not been deeply explored. Using 2016 survey and interview data from health care organizations and public members, the authors explore the value and challenges of public members. Public members were often defined as individuals who did not have a background in health care and provided a patient perspective, but in some instances prior health care experience did not automatically exclude these individuals from serving as public members. Public members served on the majority of national health care regulatory boards and constituted an average 9% to 15% of board composition, depending on how rigidly the organizations defined “public member.” Public members were valued for their commitment to the priorities and interests of the public, ability to help boards maintain that public focus, and various professional skills they offer to boards. A main challenge that public members faced was their lack of familiarity with and knowledge of the health care field. The authors suggest several considerations for improved public member integration into health care regulatory organizations: clearly defined roles of public members, including evaluating whether or not previous health care experience either contributes or hinders their role within the organization; greater visibility of opportunities for the public to serve on these boards; and potentially a more intensive orientation for public members. See more at http://tinyurl.com/y2m228fu.
PAIN MANAGEMENT AND END OF LIFE CARE ANA Enumerates Nursing’s Ethics Related to Pain Management The National Council of State Boards of Nursing’s Good Morning Members reported December 7, 2018 that: The ANA published a new position statement in The Online Journal of Issues in Nursing. The purpose of the position statement is to “provide ethical guidance and support to nurses as they fulfill their responsibility to provide optimal care to persons experiencing pain.” The statement includes the following position of the ANA regarding pain management: Nurses have an ethical responsibility to relieve pain and the suffering it causes; Nurses should provide individualized nursing interventions;
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The nursing process should guide the nurse’s actions to improve pain management; Multimodal and interprofessional approaches are necessary to achieve pain relief; Pain management modalities should be informed by evidence; Nurses must advocate for policies to assure access to all effective modalities; and Nurse leadership is necessary for society to appropriately address the opioid epidemic.
See the position statement at http://tinyurl.com/y3xl9vxh.
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2019 MEMBERSHIP INFORMATION
CAC offers memberships to state health professional licensing boards and other organizations and individuals interested in our work. We invite your agency to become a CAC member, and request that you put this invitation on your board agenda at the earliest possible date. CAC is a not-for-profit, 501(c)(3) tax-exempt service organization dedicated to supporting public members serving on healthcare regulatory and oversight boards. Over the years, it has become apparent that our programs, publications, meetings, and services are of as much value to the boards themselves as they are to the public members. Therefore, the CAC board decided to offer memberships to health regulatory and oversight boards in order to allow the boards to take full advantage of our offerings. We provide the following services to our members: 1) Free copies of all CAC publications that are available to download from our website for all of your board members and all of your staff; 2) A 10% discount for CAC meetings, including our fall annual meeting, for all of your board members and all of your staff; 3) A $20.00 discount for CAC webinars; 4) If requested, a free review of your board’s website in terms of its consumer-friendliness, with suggestions for improvements; 5) Discounted rates for CAC’s onsite training of your board on how to most effectively utilize your public members, and on how to connect with citizen and community groups to obtain their input into your board rule-making and other activities; and Assistance in identifying qualified individuals for service as public members.
The annual membership fees are as follows:
Individual Regulatory Board $325.00 “Umbrella” Governmental Agency plus regulatory $325.00 for the umbrella agency, plus boards $275.00 for each participating board. Non-Governmental organization $425.00 Association of regulatory agencies or organizations $500.00 Consumer Advocates and Other Individuals (NOT associated with any state licensing board, $100.00 credentialing organization, government organization, or professional organization)
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2019 MEMBERSHIP E NROLLMENT FORM
To become a CAC Member Organization for 2019, please complete this form and email, mail, or fax it us. CAC 1601 18th Street NW ● Suite 4 Washington, D.C. 20009 Voice (202) 462-1174 ● FAX: (202) 354-5372 [email protected]
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American Dental Association CCEPR
ADA CERP Eligibility Criteria Revised
At its meeting April 25-26, 2019, the Commission for Continuing Education Provider Recognition approved revisions to the CERP Eligibility Criteria. Effective July 1, 2023, the eligibility requirements include a new criterion stating:
"Commercial interests are not eligible for recognition. The CERP Glossary defines “commercial interest” as follows:
Commercial Interest: (1) An individual or entity that produces, markets, re-sells or distributes health care goods or services consumed by, or used on, patients, or (2) an individual or entity that is owned or controlled by an individual or entity that produces, markets, resells, or distributes health care goods or services consumed by, or used on, patients. Providing clinical services directly to or for patients (e.g., a dental practice, dental lab, or diagnostic lab) does not, by itself, make an individual or entity a commercial interest."
The Commission’s action was the result of a deliberative process conducted over several years, with input from the communities of interest. The changes are intended to reduce the opportunity for commercial bias to impact continuing dental education, align continuing dental education standards with those of other healthcare professions, align with U.S. Food and Drug Administration guidance regarding separation of marketing and education activities, and support the public’s trust in the profession.
In the coming months, the Commission plans to publish an eligibility questionnaire and other materials to assist in determining eligibility for CERP recognition.
Policy Perspectives Options to Enhance Occupational License Portability
Federal Trade Commission September 2018 Joseph J. Simons Chairman
Maureen K. Ohlhausen Commissioner
Noah Joshua Phillips Commissioner
Rohit Chopra Commissioner
Rebecca Kelly Slaughter Commissioner
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This policy paper represents the views of the FTC staff, and does not necessarily represent the views of the Commission or any individual Commissioner. The Commission has voted to authorize the staff to issue this policy paper. ______
ii Bilal Sayyed, Director, Office of Policy Planning
Tara Isa Koslov, Former Acting Director, Office of Policy Planning Chief of Staff, Office of the Chairman
Karen A. Goldman, Office of Policy Planning
This Policy Perspective was developed under the auspices of the FTC’s Economic Liberty Task Force, convened by former Acting Chairman Maureen K. Ohlhausen.1
Inquiries concerning this Policy Perspective should be directed to Karen A. Goldman, Office of Policy Planning, at (202) 326-2574 or [email protected].
This Policy Perspective is available online at www.ftc.gov/policy/reports/policy-reports/commission-and-staff-reports The online version of this report contains live hyperlinks.
1 See infra p. iv. iii About the Economic Liberty Task Force
The Economic Liberty Task Force2 addresses regulatory hurdles to job growth, entrepreneurship, innovation, and competition, with a particular focus on the proliferation of occupational licensing. The Task Force was convened in March 2017 by former Acting Chairman Maureen K. Ohlhausen as her first major policy initiative for the agency. The Task Force builds on the FTC’s long history of urging policymakers to reduce or eliminate unnecessary occupational licensing requirements.
Nearly 30 percent of American jobs require a license today, up from less than five percent in the 1950s. For some professions, occupational licensing is necessary to protect the public against legitimate health and safety concerns. But in many situations, the expansion of occupational licensing threatens economic liberty. Unnecessary or overbroad restrictions erect significant barriers and impose costs that harm American workers, employers, consumers, and our economy as a whole, with no measurable benefits to consumers or society. Based on recent studies, the burdens of excessive occupational licensing—especially for entry- and mid-level jobs—may fall disproportionately on our nation’s most economically disadvantaged citizens.
To aid in the FTC’s analysis of these issues and develop policies for addressing them, the Task Force has hosted a series of public events on issues related to occupational licensing. It has also collaborated with state elected leaders and other officials who share the goal of occupational licensing reform. The FTC’s Economic Liberty Task Force looks forward to continuing this work and bringing greater attention to these important issues. Occupational licensing reform is good for competition, workers, consumers, and the American economy.
Economic Liberty Task Force Members
Maureen K. Ohlhausen, Former Acting Chairman; Commissioner
William F. Adkinson, Jr. Daniel J. Gilman Patricia Schultheiss* Katherine Ambrogi Karen A. Goldman Haidee Schwartz Gustav P. Chiarello Tara Isa Koslov Kelly Signs Neil Chilson* James F. Mongoven Michael Vita Timothy A. Deyak* Derek Moore Melissa Westman-Cherry James Frost Christine Noonan Sturm John P. Wiegand Svetlana Gans* David R. Schmidt
*No longer with the FTC.
2 See Fed. Trade Comm’n, Economic Liberty: Opening Doors to Opportunity, https://www.ftc.gov/policy/advocacy/economic-liberty. iv ______
EXECUTIVE SUMMARY
I. Introduction
II. Interest and Experience of the Federal Trade Commission
III. Importance of License Portability to an Occupation and Consumers
IV. Legal Structures: Interstate Compacts and Model Laws
A. Interstate Compacts
B. Model Laws and Model Rules
C. Modifying Interstate Compacts and Model Laws
D. Achieving Nationwide Licensure Portability: Comparison of Interstate Compacts and Model Laws
V. Portability Procedures: Mutual Recognition and Expedited Licensure
A. Mutual Recognition
B. Expedited Licensure
C. Easing Barriers and Maintaining Accountability under Mutual Recognition and Expedited Licensure Initiatives
VI. Harmonization of Licensure Requirements
VII. Authority for Disciplinary Action Across State Lines
VIII. Streamlining Licensure in Multiple Occupations: Portability Initiatives for Military Families Required to Move to Another State
IX. Conclusion
X. Appendix – Roundtable Panelists
v ______
Occupational licensing, which is almost always state-based, inherently restricts entry into a profession and limits the number of workers available to provide certain services. It may also foreclose employment opportunities for otherwise qualified workers. This reduction in the labor supply can restrain competition, potentially resulting in higher prices, reduced quality, and less convenience for consumers.
For some professions, licensing can nevertheless serve a beneficial role in protecting the health and safety of the public. However, even when state licensure serves a useful role, some aspects of licensure may create significant and unintended negative effects. In our increasingly mobile and interconnected society, state-by-state occupational licensing can pose significant hurdles for individuals who are licensed in one state, but want to market their services across state lines or move to another state. The need to obtain a license in more than one state can reduce interstate mobility and practice, and may even lead licensees to abandon an occupation when moving to another state. These effects fall disproportionately on licensees who are required to move frequently, such as military spouses. The challenges of multistate licensure are also particularly acute for professionals who are more likely to provide services across state lines, such as telehealth or accounting services. The deleterious effects of state-by-state licensing are not borne only by those who wish to provide services in a new state. This thicket of individual state licensing regulations can reduce access to critical services or increase their prices to ordinary consumers.
Recognizing the costs to both consumers and licensees of overly burdensome multistate licensing requirements, the FTC’s Economic Liberty Task Force held a Roundtable, Streamlining Licensing Across State Lines: Initiatives to Enhance Occupational License Portability, to examine ways to mitigate the negative effects of state-based occupational licensing requirements.3 This Policy Perspective builds on the key points that emerged from the Roundtable regarding the development of effective license portability initiatives.
The earliest initiatives to improve license portability were model laws, some of which have been adopted by almost all U.S. jurisdictions. More recently, a number of occupations, primarily in the health professions, have developed interstate compacts authorized by the compact clause of the U.S. Constitution. Unlike model laws, which need not be identical, interstate compacts, as contracts between the states, must be adopted verbatim; thus, they offer great uniformity and
3 See Fed. Trade Comm’n, Streamlining Licensing Across State Lines, Initiatives to Enhance Occupational License Portability (July 27, 2017), https://www.ftc.gov/news-events/events-calendar/2017/07/streamlining-licensing-across- state-lines-initiatives-enhance. All of the materials from the Roundtable, including a video of the proceedings, are available on this webpage. A transcript is also available. Fed. Trade Comm’n, Roundtable Transcript, Streamlining Licensing Across State Lines, Initiatives to Enhance Occupational License Portability (July 27, 2017), https://www.ftc.gov/system/files/documents/public_events/1224893/ftc_economic_liberty_roundtable_- _license_portability_transcript.pdf [hereinafter Roundtable Tr.].
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stability, but limited flexibility. In addition to model laws or interstate compacts for individual occupations, the U.S. Department of Defense’s State Liaison Office has proposed a number of initiatives to encourage state adoption of measures to improve portability for military spouses in multiple licensed occupations. Regardless of the legal structure of a portability initiative, strong support from within the profession is likely to be critical to nationwide adoption.
Adoption and effectiveness of a licensure portability initiative also depend on how it achieves portability. Model laws and interstate compacts generally rely on either a “mutual recognition” model, in which a multistate license issued by one state affords a privilege to practice in other member states, or a procedure for expedited licensure in each member state. Mutual recognition of a single state license poses a lower barrier to cross-state practice than expedited licensure, and thus could be more effective in enhancing cross-state competition and improving access to services. On the other hand, expedited licensure could ease relocation to another state. A successful portability initiative could be crafted to achieve both goals.
Whether a portability initiative is based on mutual recognition or expedited licensure, supporters can build confidence in an initiative by incorporating coordinated information systems and procedures to ensure that licensees are held accountable for complying with state law wherever they provide services. Harmonizing state licensing standards also builds confidence in the qualifications of those who provide services in a state pursuant to the initiative. By selecting the least restrictive licensing standards that can gain the support of states nationwide, developers of portability initiatives can limit unnecessary restrictions on labor supply and reduce barriers to competition that arise from state licensing.
For occupations that generally require state licensing as a public protection measure, FTC staff encourages stakeholders – such as licensees, professional organizations, organizations of state licensing boards, and state legislatures – to take steps to improve license portability. Each type of portability initiative has advantages and disadvantages, and all take time and effort to develop and implement. However, a thoughtful consideration of the needs of a profession and the consumers it serves is likely to lead to a solution that can gain the support of licensees, licensing boards, the public, and state legislatures. Moreover, by enhancing the ability of licensees to provide services in multiple states, and to become licensed quickly upon relocation, license portability initiatives can benefit consumers by increasing competition, choice, and access to services, especially with respect to licensed professions where qualified providers are in short supply.
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Because states require licensing for more occupations, the percentage of U.S. jobs that require licensure has increased from less than five percent in the 1950s to between 25 and 30 percent today.4 This marked shift has made occupational licensing a major component of labor regulation, and has profound implications for competition in the provision of services to consumers.5 Thus, the Federal Trade Commission has had a long-standing interest in the competitive effects of occupational licensing.6
Although for some professions licensing can serve a beneficial role in protecting the health and safety of the public,7 it generally limits the number of workers who can provide certain services. This reduction in the labor supply erects entry barriers in labor markets, which can restrain competition, potentially resulting in higher prices and reduced access to services.8 Moreover, while licensing may increase the wages of licensees at the expense of higher prices paid by consumers, studies show that it does not improve quality.9
4 See, e.g., Morris M. Kleiner & Evgeny Vorotnikov, Analyzing occupational licensing among the states, 52 J. REG. ECON. 132 (2017); MORRIS M. KLEINER, THE HAMILTON PROJECT, REFORMING OCCUPATIONAL LICENSING POLICIES 5 (2015), http://www.hamiltonproject.org/assets/legacy/files/downloads_and_links/reforming_occupational_licensing_morris _kleiner_final.pdf.
5 See, e.g., Maury Gittleman et al., Analyzing the Labor Market Outcomes of Occupational Licensing, 57 INDUS. RELATIONS 57 (2018) (“occupational licensing has become an increasingly important factor in the regulation of services in the United States”). 6 See infra notes 20-22 and accompanying text. 7 Such considerations may be especially important in the health professions, where the risk of harm from an unqualified provider may be considerable and consumers may have difficulty determining whether a provider is qualified. See, e.g., FTC STAFF, POLICY PERSPECTIVES: COMPETITION AND THE REGULATION OF ADVANCED PRACTICE NURSES (“APRNS”) 12-13 (2014), https://www.ftc.gov/system/files/documents/reports/policy- perspectives-competition-regulation-advanced-practice-nurses/140307aprnpolicypaper.pdf (describing information asymmetries between professionals and consumers and other reasons supporting the importance of licensure in health care). 8 See, e.g., Kleiner & Vorotnikov, supra note 4, at 134, 155 (2017) (the restriction in the supply of labor created by occupational licensing has long been known to increase the price of services paid by consumers, which are transferred to licensed workers in the form of higher wages); Morris M. Kleiner et al., Relaxing Occupational Licensing Requirements: Analyzing Wages and Prices for a Medical Service, 59 J.L. ECON 261 (2016) (explaining that “occupational licensing may function as a barrier to entry that drives up wages in the licensed profession and increases the price of products and services that are produced by licensed workers”); Gittleman et al, supra note 5, at 57 (those with a license earn higher pay and are more likely to be employed).
9 See, e.g. KLEINER, supra note 4, at 12-13, 15 (a review of studies finds that occupational licensing has little effect on the quality of products or services, but it may function “as if the government were granting a monopoly in the market for the service, with the long-term impacts being lower-quality services, too few providers, and higher prices”); Sean Nicholson & Carol Propper, Medical Workforce, in HANDBOOK OF HEALTH ECONOMICS, Vol. 2, ch. 14, 885 (2012) (empirical studies of the effects of licensing in medical labor markets “conclude that licensing is associated with restricted labor supply, an increased wage of the licensed occupation, rents, increased output prices, and no measurable effect on output quality.”).
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It is particularly hard to justify licensing-related barriers to entry when a practitioner qualified and licensed by one state wishes to provide identical services in another state. Because licensing rules are almost always state-based,10 it can be difficult for a qualified person licensed by one state to become licensed in another state. For some occupations, state licensing standards vary considerably, so applicants licensed in one state may need additional education or training to qualify to practice in another state.11 Even when a profession’s underlying standards are national and state licensing requirements are similar throughout the United States, the process of obtaining a license in another state is often slow, burdensome, and costly.12 Indeed, a recent study shows that occupational licensure requirements may substantially limit the interstate mobility of licensed workers, especially for occupations with state-specific licensing requirements.13
State-based licensing requirements are particularly burdensome for licensees who provide services in more than one state, and thus need multistate licensing. They are also especially hard on military families, because trailing spouses often follow service members who are required to move across state lines, and therefore must bear the financial and administrative burdens of applying for a license in each new state of residence. The need to obtain a license in another state can sometimes even lead licensees to exit their occupations when they must move to another state.14
10 See, e.g., Dent v. West Virginia, 129 U.S. 114 (1889) (upholding the right of the state of West Virginia to license physicians); Health Resources & Services Admin., U.S. Dep’t of Health & Human Services (“DHHS”), SPECIAL REPORT TO THE SENATE APPROP. COMM., TELEHEALTH LICENSURE REPORT, Requested by Senate Rep’t 111-66 (2010) (“For over 100 years, health care in the United States has primarily been regulated by the states. Such regulation includes the establishment of licensure requirements and enforcement standards of practice for health providers, including physicians, nurses, pharmacists, mental health practitioners, etc.”); NAT’L CONFERENCE OF STATE LEGISLATURES, THE STATE OF OCCUPATIONAL LICENSING: RESEARCH, STATE POLICIES AND TRENDS 2 (2017), http://www.ncsl.org/research/labor-and-employment/report-the-state-of-occupational-licensing.aspx (“An occupational license is a credential that government—most often states—requires a worker to hold in certain occupations.”). 11 See, e.g., Roundtable Tr. at 14-15 (Rogers) (although experienced teachers can get a certificate in a new state with little difficulty, inexperienced teachers “have to start literally all over with assessments and course requirements, and it’s a very, very frustrating experience”); id. at 26 (Rogers) (for teacher certification, “there are so many variations with the states”).
12 See, e.g., DHHS, supra note 10, at 9 (“The basic standards for medical and nursing licensure have become largely uniform in all states. Physicians and nurses must graduate from nationally approved educational programs and pass a national medical and nursing licensure examination.”); American Medical Association, Medical Licensure (“The process of obtaining a medical license can be challenging and time consuming. . . . . Physicians seeking initial licensure or applying for a medical license in another state should anticipate delays due to the investigation of credentials and past practice as well as the need to comply with licensing standards.”), http://www.ama- assn.org/ama/pub/education-careers/becoming-physician/medical-licensure.page. 13 See Janna E. Johnson & Morris M. Kleiner, Is Occupational Licensing a Barrier to Interstate Migration, Working Paper 24107, NAT’L BUREAU ECONOMIC RES. (Dec. 2017). 14 See U.S. Dep’t of the Treasury & U.S. Dep’t of Defense, Supporting our Military Families: Best Practices for Streamlining Occupational Licensing Across State Lines 6-11 (2012), http://archive.defense.gov/home/pdf/Occupational_Licensing_and_Military_Spouses_Report_vFINAL.PDF.
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Multistate licensing requirements can also limit consumers’ access to services. For example, licensure requirements can prevent qualified service providers from addressing time-sensitive emergency situations across a nearby state line or block qualified health care providers from providing telehealth services to consumers in rural and underserved locations.15
Recognizing the costs to both consumers and licensees of multistate licensing requirements, the FTC’s Economic Liberty Task Force held a Roundtable, Streamlining Licensing Across State Lines: Initiatives to Enhance Occupational License Portability, to examine ways to mitigate the effects of state-based occupational licensing requirements that make it difficult for those licensed by one state to obtain a license in another state and compete across state lines.16
To assist state licensure boards, professional organizations, state legislatures, and others seeking to improve licensure portability, this Policy Perspective builds on the key points that emerged from the Roundtable regarding the development of effective license portability initiatives that can help reduce barriers to entry, enhance competition, and promote economic opportunity. After explaining the interest and experience of the FTC in occupational license portability, the Policy Perspective considers: (1) how the importance of license portability to an occupation and consumers affects development and adoption of a portability initiative; (2) the use of interstate compacts and model laws to improve licensure portability; (3) portability procedures—a comparison of mutual recognition of a single state license with expedited licensure in multiple states; (4) the need for harmonization of licensing requirements; (5) disciplinary action across state lines; and (6) license portability for military families.
The Policy Perspective also analyzes options in light of their potential competitive effects. FTC staff encourages the use of options that will enhance portability while imposing the fewest restrictions on competition and labor supply, because such restrictions can lead to higher prices, lower quality, and reduced access for consumers, as well as fewer job options for service providers.
15 See, e.g., Occupational Licensing: Regulation and Competition: Hearing Before the Subcomm. on Regulatory Reform, Commercial and Antitrust Law of the H. Comm. on the Judiciary, 115th Cong. 1, 8-9 (2017) (statement of Maureen K. Ohlhausen, Acting Chairman, Federal Trade Commission), https://www.ftc.gov/system/files/documents/public_statements/1253073/house_testimony_licensing_and_rbi_act_se pt_2017_vote.pdf; KLEINER, supra note 4, at 15 (“To the extent that licensing slows both the influx of new workers and greater competition, consumers are not able to take advantage of services at the lowest cost.”); Dep’t of the Treasury Office of Economic Policy, Council of Economic Advisers, Dep’t of Labor, Occupational Licensing: A Framework for Policymakers 12-16 (2015), https://obamawhitehouse.archives.gov/sites/default/files/docs/licensing_report_final_nonembargo.pdf. 16 See supra note 3.
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Competition is at the core of America’s economy,17 and vigorous competition among sellers in an open marketplace gives consumers the benefits of lower prices, higher quality products and services, and increased innovation. To this end, the FTC is charged under the FTC Act with preventing unfair methods of competition and unfair or deceptive acts or practices in or affecting commerce.18 In addition, Section 6 of the FTC Act generally authorizes the FTC to investigate and report on market developments “in the public interest” and make recommendations based on those investigations.19 This authority supports the FTC’s research, education, and competition advocacy efforts.
The Commission and its staff have focused on occupational regulations that may unreasonably impede competition for more than thirty years. FTC staff have conducted economic and policy studies on occupational licensing20 and focused inquiries into laws and regulations relating to licensing for various occupations.21 Building on this work, in 2017 the FTC formed the Economic Liberty Task Force (“ELTF”), which has examined a broad range of licensing issues, including occupational license portability.22 This Policy Perspective arises from the ELTF efforts, especially the 2017 Roundtable, Streamlining Licensing Across State Lines: Initiatives to Enhance Occupational License Portability.23
17 Standard Oil Co. v. FTC, 340 U.S. 231, 248 (1951) (“The heart of our national economic policy long has been faith in the value of competition.”). 18 Federal Trade Commission Act, 15 U.S.C. § 45. 19 15 U.S.C. § 46.
20 See, e.g., CAROLYN COX & SUSAN FOSTER, BUREAU OF ECON., FED. TRADE COMM’N, THE COSTS AND BENEFITS OF OCCUPATIONAL REGULATION (1990), http://www.ramblemuse.com/articles/cox_foster.pdf. 21 See FTC Staff Comment to the Hon. Laura Ebke, Nebraska State Senator 2 (Jan. 17, 2018), https://www.ftc.gov/system/files/documents/advocacy_documents/federal-trade-commission-staff-comment- nebraska-state-senate-regarding-nebraska-lb299- occupational/v180004_ftc_staff_comment_to_nebraska_state_senate_re_lb_299_jan-18.pdf (referring to FTC advocacy comments on nurses, eye doctors and vendors of optical goods, lawyers and other providers of legal services, dental hygienists, and real estate brokers). 22 See, e.g., Occupational Licensing: Regulation and Competition: Hearing Before the Subcomm. on Regulatory Reform, Commercial and Antitrust Law of the H. Comm. on the Judiciary, 115th Cong. 1, 3, 6-7 (2017) (statement of Maureen K. Ohlhausen, Acting Chairman, Federal Trade Commission), https://www.ftc.gov/system/files/documents/public_statements/1253073/house_testimony_licensing_and_rbi_act_se pt_2017_vote.pdf. 23 See supra note 16 and accompanying text.
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Professional organizations and associations of state licensing boards often spearhead license portability initiatives. If those stakeholders believe interstate mobility is important to the profession, the development and implementation of a successful license portability initiative is more likely to succeed.24 Without such agreement, a portability initiative may stall.25
Agreement on the need for interstate mobility is often driven by changes in technology that allow licensees to provide services to remote customers, and the growth of licensees and firms with a nationwide presence.26 For occupations that depend on interstate mobility, license portability not only benefits licensees who wish to practice across state lines, but also consumers who seek better access to services or expect licensees to provide services nationwide. In such occupations, the need for interstate mobility likely outweighs local concerns, such as minor variations in the qualifications of licensees from different states.
Developing a license portability initiative and obtaining nationwide adoption takes time. Initiatives with broad support often arise from a profession’s long-term efforts to streamline licensing.27 For example, the founding policy and governance documents of several organizations of licensing boards have recognized the need for interstate mobility for decades or even a century.28 Perhaps because the need for interstate mobility is integral to these professions,
24 See, e.g., National Council of Architectural Registration Boards (“NCARB”), Comment to the FTC (2017), at 2, https://www.ftc.gov/system/files/documents/public_comments/2017/07/00024-141093.pdf [hereinafter NCARB Comment] (NCARB facilitates license transfer because “[e]ase of mobility is an essential business requirement for an architect and is of paramount importance to the profession.”). State programs that ease licensing of many occupations when a military spouse is required to move to a new state have enjoyed widespread support, and have been adopted by states. See Roundtable Tr. at 23 (Beauregard) (DoD found “that states were very accommodating” in finding ways to ease licensure of military spouses). 25 See, e.g., Roundtable Tr. at 16 (K. Thomas) (explaining that states were not adopting the original Nurse Licensure Compact because of a lack of agreement on licensing standards and other matters). 26 See, e.g., Roundtable Tr. at 9 (Masters) (the drivers for licensure portability include advances in technology such as cell phones and computers that facilitate practicing across state lines); Roundtable Tr. at 18 (Webb) (agreement on the need for licensure mobility in the Uniform Accountancy Act arose from “technology [that] was allowing the profession to provide services across state lines from one spot to clients in many states. And the idea that the licensure model that kind of depended heavily on presence in a state might not work so well in the future.”). 27 See, e.g., Roundtable Tr. at 17 (Webb) (the mobility effort for certified public accountants (“CPAs”), which began in 1997, was a joint effort of the American Institute of Certified Public Accounts and the National Association of State Boards of Accountancy); id. at 19 (Webb) (“we’ve worked hard for the last 20 years to get this done”).
28 See, e.g., Doug McGuirt, The Professional Engineering Century, PE MAG. 24, 27 (June 2007) (The National Council of Examiners for Engineering and Surveying (“NCEES”) “worked throughout the 1920s to coordinate reciprocal relations among the state licensing boards” and began issuing reciprocal licenses in 1925. NCEES developed a model law establishing uniform licensing guidelines and recordkeeping procedures to improve license portability, and 29 jurisdictions had adopted the model law by 1932). See also infra notes 67-69, 77-79 and accompanying text.
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their license portability provisions already have been implemented nationwide.29 Moreover, their policies appear to be able to evolve to address changes in practice and technology, to reduce state-based differences in licensing and disciplinary standards, and to reach a consensus on how to streamline procedures. The effectiveness of portability in these professions suggests both that a number of viable models for increased portability exist, and that additional professions can likely benefit from the approaches taken by the professions with greater portability experience.
Most license portability initiatives for individual occupations have been based on one of two types of legal structures: interstate compacts and model laws. While the legal structure does not dictate whether an initiative improves portability by mutual recognition of a single state license by all member states, or expedited licensure in multiple states,30 it has important effects on the extent to which states can modify the proposed portability initiative both at adoption and in the future.
Interstate compacts, which are authorized by the U.S. Constitution, art. I, § 10, cl. 3,31 are formal, binding contracts between two or more states that are neither purely state nor purely federal in nature. States acting in their sovereign capacity enter into these contracts by enacting proposed compact legislation.32 States must adopt such proposed legislation verbatim, and all compact states must agree to any modifications. Because compacts cannot be unilaterally amended, they “can provide member states with a predictable, stable, and enforceable mechanism for policy control and implementation.”33 Because of these characteristics, compacts historically have been used to address matters requiring a long-term, stable solution such as boundary disputes, water rights, and regional transportation systems spanning multiple states.34 There are more than two
29 See infra notes 66, 69, 72 and accompanying text. 30 See infra note 97 and accompanying text. 31 “No state shall, without the Consent of Congress . . . enter into any Agreement or Compact with another State, or with a foreign Power[.]” U.S. Constitution, art. I, § 10, cl. 3. See Roundtable Tr. at 9 (Masters) (“And while that clause seems to say that all compacts require the consent of Congress, the Supreme Court has made it clear that that’s only the case where the compact infringes on some enumerated power that is reserved to the federal government under the US Constitution.”). None of the existing occupational licensure compacts have required the consent of Congress.
32 See MICHAEL L. BUENGER ET AL., THE EVOLVING LAW AND USE OF INTERSTATE COMPACTS xxi, 1, § 2.1.2 (2d ed. 2016). 33 Id. at 26. 34 See id. at §§ 1.2.3, 1.3.1.
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hundred interstate compacts, but only a few, relatively recent ones address occupational licensing.35
Occupational licensure compacts typically provide procedures that improve license portability among compact jurisdictions, such as mutual recognition or expedited licensure; address licensing standards and procedures; and enhance sharing of applicants’ and licensees’ records and disciplinary histories among compact states. However, compacts generally do not alter the scope of practice provisions of state practice acts.36
Federal grants to state professional licensing boards specifically encouraged the development and implementation of licensure compacts in the health professions, many of which have relied on the expertise of the National Center for Interstate Compacts of the Council of State Governments to develop a compact.37
Presently, there are licensure compacts for seven occupations, six of which are health professions. Three of the compacts are in operation, carrying out the licensure portability functions specified in the compact legislation. Two compacts are in effect, but are not operational because the administrative structure necessary for implementation is under development. The other two compacts have not been adopted by enough states to go into effect.38
Nurse Licensure Compact (“NLC”).39 The NLC, which was the first interstate licensure compact, was initially implemented in 1999 and was substantially revised in 2015.40 It was “designed to reduce barriers, to make it easier for nursing to meet the
35 See id. at § 9.10; Roundtable Tr. at 9 (Masters); National Center for Interstate Compacts (“NCIC”), Fact Sheet on Interstate Compacts, http://www.csg.org/knowledgecenter/docs/ncic/FactSheet.pdf; NCIC Compacts Database, http://apps.csg.org/ncic/Default.aspx. 36 See Roundtable Tr. at 10 (Masters) (“The interstate compacts regulating health professions do not impact state practice acts, and are only geared toward the procedure by which professionals can gain occupational licensure across state lines.”). 37 See 42 U.S.C. § 254c-18; Office for the Advancement of Telehealth, U.S. Dep’t Health & Human Services, Funding Opportunity Announcement HRSA-16-014 (2016); Recognition of EMS Personnel Licensure Interstate CompAct (“REPLICA”), https://www.nremt.org/rwd/public/document/replica (describing funding for REPLICA from the Dep’t of Homeland Security, Office of Health Affairs, and subject matter expertise from the NCIC, Council of State Governments).
38 See, e.g., BUENGER ET AL., supra note 32, at §§ 4.6, 7.3.3.7.1 (most interstate compacts specify the number of states that must adopt the compact legislation for the compact to go into effect, while some provide a date certain or are silent on the matter). Once effective, implementation of an occupational licensure compact may require formation of a compact commission, adoption of rules, and development of administrative structures as specified by the legislation. Implementation allows the compact to become operational with respect to the functions set forth in the legislation. See, e.g., infra notes 42, 46, 48, 50 and accompanying text.
39 See NURSE LICENSURE COMPACT (May 4, 2015), https://www.ncsbn.org/NLC_Final_050415.pdf. 40 See Health Resources & Services Admin., supra note 10, at Attachment 1 (NLC first implemented by Maryland on July 1, 1999); BUENGER ET AL., supra note 32, at 261, § 9.10.1 (describing revision of the original Nurse Licensure Compact in 2015 after it had been adopted by 25 states); Sandra Evans, The Nurse Licensure Compact: A Historical Perspective, 6 J. NURS. REG. 11 (2015).
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needs of the health care delivery system and the needs of patients.”41 The revised NLC, sometimes referred to as the Enhanced Nurse Licensure Compact (“eNLC”), has been adopted by 30 states. It superseded the original NLC and became operational on January 19, 2018.42 Interstate Compact on Licensure of Participants in Live Racing with Pari- Mutuel Wagering (the “National Racing Compact”).43 Fifteen states are members of the National Racing Compact, which is operational and went into effect in 2000.44 Interstate Medical Licensure Compact (“IMLC”).45 Twenty-four states and one territory have entered into the IMLC, which began expediting licensing of physicians in 2017.46 The Physical Therapy Licensure Compact (“PTLC”).47 The PTLC, which has been enacted by 21 states, went into effect in April 2017 after adoption by the tenth state, and is expected to go into operation shortly.48 Recognition of Emergency Medical Services Licensure Interstate Compact (“REPLICA”).49 REPLICA, which has been adopted by 14 states, became effective in May 2017 after adoption by the tenth state.50
41 Roundtable Tr. at 33 (K. Thomas). 42 See National Council of State Boards of Nursing, Licensure Compacts, https://www.ncsbn.org/compacts.htm (accessed Aug. 3, 2018); The Interstate Commission of Nurse Licensure Compact Administrators (“ICNLCA”), Final Rules § 301 (Dec. 12, 2017), https://www.ncsbn.org/eNLCFinalRulesadopted121217.pdf (“The Compact shall be implemented on January 19, 2018.”). Because of the substantial revision of the original NLC, the eNLC set forth in detail the how states would make the transition to the new compact and when the new compact became effective. States that were members of the prior compact were deemed to have withdrawn from it six months after the effective date of the eNLC. See NLC, art. X. sec. a; BUENGER ET AL., supra note 32, at 261.
43 INTERSTATE COMPACT ON LICENSURE OF PARTICIPANTS IN LIVE RACING WITH PARI-MUTUEL WAGERING, http://www.racinglicense.com/modellegislation.html. 44 See National Racing Compact, Participating Jurisdictions (in addition to the 15 members, nine other jurisdictions participate but have not passed legislation to become members of the compact), http://www.racinglicense.com/accepted.html; National Racing Compact, About the National Racing Compact: History, http://www.racinglicense.com/history.html.
45 INTERSTATE MEDICAL LICENSURE COMPACT (Oct. 27, 2015), https://imlcc.org/wp- content/uploads/2018/04/IMLC-Compact-Law.pdf. 46 See IMLC, http://www.imlcc.org/ (accessed Aug. 3, 2018); IMLC, FAQs, https://imlcc.org/faqs/ (accessed Aug. 3, 2018).
47 PHYSICAL THERAPY LICENSURE COMPACT (Oct. 2015), http://www.fsbpt.org/Portals/0/documents/free- resources/LicensureCompactLanguage_20170105.pdf. 48 See Physical Therapy Licensure Compact, http://www.fsbpt.org/FreeResources/PhysicalTherapyLicensurecompact.aspx (accessed June 23, 2018); http://www.fsbpt.org/Portals/0/documents/free-resources/PTLC_Milestones_Updated20160706.pdf (PTLC will become operational after bylaws and rules are finalized).
49 RECOGNITION OF EMERGENCY MEDICAL SERVICES LICENSURE INTERSTATE COMPACT (Sept. 2014), https://content.nremt.org/static/documents/replica/EMS-Personnel-Licensure-Interstate-Compact-model.pdf.
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Psychology Interjurisdictional Compact (“PSYPACT”).51 PSYPACT has not yet been adopted by enough states to go into effect.52 Advanced Practice Registered Nurse Compact (“APRN Compact”).53 The APRN Compact is not yet in effect.54
Model laws were among the earliest initiatives to improve license portability. Some have been adopted by almost all states and other U.S. jurisdictions.55 They serve many of the same purposes as interstate compacts. As explained by the Uniform Law Commission (“ULC”), one of the purposes of a model law is to promote uniformity, and “[a]n act may be designated as ‘model’ if the act’s principal purposes can be substantially achieved even if the act is not adopted in its entirety by every state.”56 The model laws that address occupational license portability have been developed by professional associations and associations of licensing boards, not the ULC.57 Although the ULC has not undertaken any projects on occupational licensure portability, a uniform act could be a good vehicle for such an initiative, because uniform acts have the backing of the ULC and are generally more widely adopted than ULC model laws that do not receive such support.58
Unlike standalone interstate licensure compacts, occupational license portability provisions in model laws are often only a small part of a model state practice act that covers all aspects of practice, including scope of practice and disciplinary standards.59 Addition of portability
50 See Recognition of EMS Personnel Licensure Interstate CompAct, https://www.nremt.org/rwd/public/document/replica (accessed Aug. 3, 2018) (“The compact administration is now working to implement the law.”).
51 PSYCHOLOGY INTERJURISDICTIONAL COMPACT (Jan. 2016), https://cdn.ymaws.com/www.asppb.net/resource/resmgr/psypact_docs/Psychology_Interjurisdiction.pdf. 52 See Psychology Interjurisdictional Compact, http://www.asppb.net/page/PSYPACT.
53 ADVANCED PRACTICE REGISTERED NURSE COMPACT (May 4, 2015), https://www.ncsbn.org/APRN_Compact_Final_050415.pdf. 54 See APRN Compact, https://www.ncsbn.org/aprn-compact.htm; Roundtable Tr. at 17 (K. Thomas). 55 See infra notes 64, 69, 72 and accompanying text. 56 See Uniform Law Commission, Statement of Policy Establishing Criteria and Procedures for Designation and Consideration of Uniform and Model Acts § 2(e), http://www.uniformlaws.org/Narrative.aspx?title=Criteria%20for%20New%20Projects. 57 Model laws providing for occupational licensure are not in the database of the ULC, which is limited to uniform and model laws drafted by the ULC. See http://www.uniformlaws.org/Acts.aspx. There appears to be no centralized database or list of model laws affecting occupational licensing.
58 See Bruce H. Kobayashi & Larry E. Ribstein, The Non-Uniformity of Uniform Laws, 35 J. CORP. L. 327, 330 (2009) (“fewer states adopt [ULC] proposals that [ULC] does not push for uniform adoption (which [ULC] designates as “model” acts) than proposals that [ULC] urges for uniform adoption”). In addition to developing its own projects, the ULC also considers proposals from outside organizations. See ULC, New Project Proposals, http://www.uniformlaws.org/Narrative.aspx?title=New Project Proposals. 59 See infra notes 63, 70, 76, 81 and accompanying text.
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provisions to a practice act may encourage adoption by state legislatures, and also promote adoption of uniform licensing requirements.60 In some cases, license portability provisions are included in model rules, rather than model laws, encouraging adoption by state licensing boards without legislative action.61
The number of model laws that incorporate license portability provisions cannot be readily determined because there is no centralized database of model laws with portability provisions.62 In connection with the Roundtable, FTC considered a diverse set of these initiatives. These efforts vary in both the rationale behind their adoption and the procedures they use to achieve greater portability.
In 1998, to eliminate “artificial barriers to the interstate practice and mobility of certified public accountants” arising from differing state requirements for licensing, the American Institute of Certified Public Accountants (“AICPA”) and the National Association of State Boards of Accountancy (“NASBA”) added provisions to enhance interstate mobility to the Uniform Accountancy Act (“UAA”).63 These provisions, which are based on the substantial equivalency of state licensing standards for individuals, have been adopted by 55 jurisdictions, including 50 states, the District of Columbia, and four U.S. territories.64 The high level of adoption reflects technological advances that have allowed accountants to provide services across state lines electronically, as well as sustained support from the AICPA and NASBA.65 In 2014, building on the popularity of the individual mobility initiative, the two organizations added provisions for firm license mobility to the UAA; these have been adopted by 21 states.66
For older license portability initiatives, a model law or rule may be secondary to streamlining procedures arising from a professional organization’s governance documents, policies, or programs. For example, the National Association of Boards of Pharmacy (“NABP”) was founded
60 See AICPA – NASBA, UNIFORM ACCOUNTANCY ACT I-1-2 (2018) [hereinafter UAA] (describing how a 1916 model bill to regulate the practice of public accountancy became the 1984 predecessor to the UAA, to which mobility provisions were added in 1997). See also Roundtable Tr. at 17-18 (Webb) (“the UAA was the vehicle for moving this mobility effort”); id. at 28 (Webb) (“[W]e already had a model or a uniform act that was being promoted. And the idea, one of the goals is to promote uniformity. The availability of the practice privilege if your state adopts the uniform standards for licensure is a way to move the whole process.”). See also infra notes 70-81 and accompanying text. 61 See infra notes 74-76 and accompanying text. Alternatively, model rules may provide details on portability that were not set forth in the model law’s portability provision. See NASBA, UNIFORM ACCOUNTANCY ACT MODEL RULES, art. 6, Rule 9; art. 23 (2018) (Interstate practice, Substantial Equivalency). 62 See supra note 57. 63 UAA, supra note 60, at I-2. While “Uniform” is in its title, the UAA is not a uniform act drafted by the ULC. 64 See id.; id. at I-8, ¶ 3; id. at sec. 23; Roundtable Tr. at 19 (Webb) (see also presentation materials). 65 See supra notes 26 and 27. 66 See Roundtable Tr. at 19 (Webb) (firm mobility provisions have been adopted by 21 jurisdictions; see also presentation materials); AICPA, CPA Firm Mobility (June 19, 2018) https://www.aicpa.org/advocacy/state/cpafirmmobility.html (addition of firm mobility provisions in 2014).
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in 1904 “around building a license transfer process for pharmacist licensure.”67 Indeed, Article II of the NABP Constitution states that the “purpose of the Association is to provide for the interstate transfer in pharmacist licensure[.]”68 Since the NABP Constitution and Bylaws require members to participate in the NABP Electronic Licensure Transfer Program, all jurisdictions have implemented NABP’s portability program.69 The license transfer provisions are also set forth in the Model State Pharmacy Act and Model Rules of the National Association of Boards of Pharmacy.70
Similarly, in the 1920s, the National Council of Examiners for Engineering and Surveying (“NCEES”) began programs to facilitate reciprocal recognition of the licenses of engineers and surveyors in member states.71 These efforts, and a centralized recordkeeping service established in 1932,72 led to NCEES’ current “Model Law” programs for expedited licensure by comity of professionals who meet certain requirements.73 The expedited comity provisions for “Model Law Engineers,” “Model Law Surveyors,” and “Model Law Structural Engineers” are set forth in
67 National Association of Boards of Pharmacy (“NABP”), Comment to the FTC (2017), at 1-2, https://www.ftc.gov/system/files/documents/public_comments/2017/07/00016-141084.pdf [hereinafter NABP Comment]. 68 NABP, Constitution and Bylaws (2017), https://nabp.pharmacy/wp-content/uploads/2016/06/Constitution- Bylaws-2017.pdf (Constitution, art. II). 69 See NABP Comment, supra note 67, at 2 (“As required by the NABP Constitution and Bylaws, all NABP members participate in e-LTP and the NABP Clearinghouse.”); NABP Bylaws, art. II (“Active member boards shall utilize the NABP Clearinghouse to process requests for the transfer of examination scores and licenses . . . .”). While all states participate in the Electronic Licensure Transfer Program, some have additional requirements such as a jurisprudence examination or maintenance of the license of original examination as a basis for transfer). See NABP, Licensure Transfer, https://nabp.pharmacy/programs/licensure-transfer/. 70 See NABP, Model State Pharmacy Act and Model Rules of the National Association of Boards of Pharmacy (2017), https://nabp.pharmacy/wp-content/uploads/2017/11/NABP-Model-Act-2017.docx (Model Act sec. 303, Qualifications for Licensure Transfer); NABP Comment, supra note 67, at 2. 71 See McGuirt, supra note 28, at 24, 27 (during the 1920s NCEES worked to coordinate reciprocal relations among state licensing boards, leading to the use of “reciprocal cards” accepted by all member states in 1925). 72 See id. at 29; Craig N. Musselman et al., Licensure Issues of Strategic Importance to the Civil Engineering Profession – and ASCE, PROC. AM. SOC. ENGINEERING EDUC. ANN. CONF. 8 (2016), https://www.asee.org/public/conferences/64/papers/14392/download (“The Council Record Program provides a very significant benefit to engineers who practice in multiple jurisdictions in that, if the individual is deemed a “Model Law Engineer,” expedited comity is provided in most, not all, jurisdictions.”). 73 See NCEES, Model Law designation, http://ncees.org/records/model-law-designation/.
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NCEES’ Model Rules74 and Manual of Policy and Position Statements;75 it is anticipated that these provisions will be added to NCEES’ Model Law in 2020.76
In the field of architecture, reciprocal licensing goes back to the 1919 charter of the National Council of Architectural Registration Boards (“NCARB”).77 Under the charter, a core part of NCARB’s mission is “to foster consistent rules and regulations that facilitate interstate practice.”78 The NCARB Certificate, a credential for architects who meet certain education, examination, and experience requirements, was first offered in 1937 and is now the primary vehicle for multistate practice.79 The certificate alone is sufficient to allow reciprocal licensing in about half the states, while most other Boards consider it as a factor for expedited licensing.80 Requirements for certification are set forth in NCARB’s model law and model regulations for the practice of architecture, which also encourage adoption of consistent licensing requirements and provide for acceptance of the NCARB Certificate by member states.81
An important difference between model laws and interstate licensure compacts is that the former need not be identical, while the latter, as contracts between the states, must be adopted verbatim.82 While the core features of model laws are typically the same, they can accommodate
74 NCEES, Model Rules §§ 210.20(B), 230.60(F) (2015), https://ncees.org/wp-content/uploads/ModelRules- 2017.pdf. 75 NCEES, Manual of Policy and Position Statements, Professional Policies 5 & 6, and Position Statement 17 (2016), https://ncees.org/wp-content/uploads/Policy-manual-2017.pdf. 76 See NCEES Model Law, https://ncees.org/wp-content/uploads/Model_Law_2017.pdf; Craig N. Musselman et al., A Primer on Engineering Licensure in the United States, Sec. 4, PROC. AM. SOC. ENGINEERING EDUC. ANN. CONF. (2011). 77 See NCARB Comment, supra note 24, at 1 (“NCARB was formed in 1919 with the specific goal of facilitating reciprocal licensing clearly articulated in its charter.”). 78 Id. at 1, 4. 79 See NCARB Comment, supra note 24, at 2, 4; NCARB Certificate, https://www.ncarb.org/advance-your- career/ncarb-certificate. 80 See NCARB Comment, supra note 24, at 4. 81 See id; see also NCARB, Legislative Guidelines and Model Law, Model Regulations (2016-2017), https://www.ncarb.org/sites/default/files/Legislative_Guidelines.pdf (Legislative Guideline IV, Qualification for Registration under Reciprocity Procedure; Model Law sec. 3, Registration Qualifications; Model Regulations, § 100.501, Registration of NCARB Certificate Holders).
82 See BUENGER ET AL., supra note 32, at 37 (“While compacts have many of the characteristics of uniform and model laws, in contrast to compacts, states are not required to enact uniform laws or model acts verbatim. . . . . [therefore] uniform and model acts do not constitute a contract between the states even if adopted by all states in the same form.”). Cf. Roundtable Tr. at 36 (Masters) (“The unique thing about compacts is that the language, because it’s contractual, has to be substantially similar. And so unlike other types of legislation, legislators aren’t free to just amend the statute . . . .”). See also UAA, supra note 60, at I-3 (“Whether the UAA is considered for adoption wholly or only in part, adjustments may also be appropriate in light of other laws in effect in the particular state in question.”).
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not only variations between states, but also incremental changes to meet changing needs.83 Some organizations of state licensing boards and professional organizations propose such changes periodically, leading to nationwide evolution of a model law over time.84 In other cases, such changes have been achieved through the use of model rules adopted by state licensing boards.85
Since changes in interstate compacts must be adopted by all member jurisdictions to be effective, changing an interstate licensure compact can be difficult; it may require the adoption of an entirely new compact, as was the case with the NLC.86 Accordingly, once enacted, compacts “may be static for long periods of time.”87 Indeed, a recognized cost of uniformity via compact is impeding evolution of state law.88
This problem can sometimes be avoided. If an interstate licensure compact provides for a compact commission with the power to promulgate rules with the force and effect of state law, changes can be made much more rapidly, without the involvement of state legislatures.89 But while compact commissions may have the power to make binding changes equivalent to state law expeditiously, this can be controversial because commission rules may override contrary
83 Craig N. Musselman et al., A Primer on Engineering Licensure in the United States, sec. 2, PROC. AM. SOC. ENGINEERING EDUC. ANN. CONF. (2011) (no state statute or rule is identical to the NCEES model law or rule, but states “have made significant efforts to assure that their statute and rules are reasonably consistent with the Model Law and Model Rules such that duly qualified professional engineers who are residents in that state will be able to be licensed in other states.”). 84 See, e.g., UAA, supra note 60, at I-3 (“Beginning with the 1992 edition, the Uniform Accountancy Act has been designed as an ‘evergreen’ document.”); UAA, letter to interested parties, at 1 (“To keep the UAA ‘evergreen,’ a continuous process of refreshing the document is necessary.”). 85 See NABP Comment, supra note 67, at 3 (explaining that changes at the state level often occur via the regulatory process because state boards can move expeditiously, without waiting for a state legislature to convene); Federation of Associations of Regulatory Boards (“FARB”), Comment to the FTC (2017), at 2, https://www.ftc.gov/system/files/documents/public_comments/2017/07/00015-141083.pdf (regulatory boards can efficiently promulgate relevant rules and regulations). While the ability to modify a model law may improve consistency or accommodate differing needs of states, it can also reduce uniformity, contrary to the purpose of the model law. See BUENGER ET AL., supra note 32, at § 2.1.1. 86 See Roundtable Tr. at 29 (K. Thomas) (describing the difficulty of getting all member jurisdictions to adopt a change to the NLC, leading to a decision to develop a new compact with a commission with rulemaking authority); BUENGER ET AL., supra note 32, at 261 (describing provisions in the 2015 revision of the NLC for the transition from the original version); FARB, supra note 85, at 3 (“The effectiveness of such arrangements is limited by the fact that every state must enact verbatim legislation . . . .”).
87 BUENGER ET AL., supra note 32, at 27. 88 See, e.g., Larry E. Ribstein & Bruce H. Kobayashi, Uniform Laws, Model Laws and Limited Liability Companies, 66 U. COLO. L. REV. 947, 949 (1995) (“[U]niformity may impose costs, such as impeding evolution of state law. These costs are likely to outweigh the benefits of uniformity for laws for which interstate variation does not impose excessive information or compliance costs.”). 89 See NLC, art. VII, sec. g(1) (giving the compact commission the power to promulgate uniform rules with the force and effect of law, binding on all party states); BUENGER ET AL., supra note 32, at § 9.10.1 (the NLC’s compact commission has “the authority to make uniform rules, but makes it more efficient by allowing the rules to become effective without a duplicative requirement that each state adopt the uniform rules in addition to adoption by the compact governing body.”).
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state laws adopted by elected legislatures.90 Nonetheless, to provide some flexibility, recent interstate compacts addressing occupational licensing have provided for a compact commission with the power to promulgate rules with the force and effect of state law.91
License portability can be achieved either with a model law or with an interstate compact. Model laws have a longer track record, and some have been adopted or implemented by nearly all states.92 Interstate licensure compacts also hold considerable promise for improving interstate license portability and streamlining multistate practice, but whether states will adopt them nationwide remains to be seen.
Experts on compacts acknowledge that “it is difficult to get state legislatures to adopt compacts because of the strict requirement of substantive sameness between all member states and the tendency of parochial interests to trump consideration for interstate cooperation.”93 Achieving nationwide adoption, however, is difficult even when the requirement of uniformity is less strict.94
Whether a portability initiative is based on a compact or a model law, strong support from its developers and licensees likely is critical to achieving nationwide adoption.95 Without widespread agreement, supporters of interstate licensing initiatives need a deep understanding of the objections of those who are opposed, so that they can attempt to address their concerns and increase support for the portability initiative.96 In addition, the extent to which an initiative is
90 See BUENGER ET AL., supra note 32, at 50-51 (explaining that a compact may provide that rules promulgated by its commission have the force and effect of statutory law and are binding on member states unless a majority of the states’ legislatures reject the rule); Roundtable Tr. at 28 (Masters) (compact commission rulemaking is controversial when states see it as a surrender of sovereignty; thus, it is necessary to make clear to legislators that the rulemaking covers portability initiative procedures, not the substance of a state practice act); id. at 31 (J. Thomas). (“There’s concern that this commission is going to draft laws and do something to take over the practice of medicine. It really just governs the process.”).
91 See APRN COMPACT, art. VII, sec. g(1); IMLC sec. 2(m); PTLC, sec. 7(C)(5); PSYPACT, art. II, sec. W; REPLICA, sec. 2(O). A compact commission is also considered essential to effective administration of a compact. See, e.g., Roundtable Tr. at 34 (J. Thomas), id. at 34 (K. Thomas). 92 See supra Sec. IV.B.
93 BUENGER ET AL., supra note 32, at 27. 94 For example, one study found that, on average, uniform laws developed by the ULC have been adopted by only 20 jurisdictions out of 53. See Larry E. Ribstein & Bruce H. Kobayashi, An Economic Analysis of Uniform State Laws, 25 J. LEGAL STUD. 131, 135 (1996). 95 See supra Sec. III. See also Kobayashi & Ribstein, supra note 58, at 330; Ribstein & Kobayashi, supra note 94, at 131, 182, 187. 96 See Roundtable Tr. at 35 (K. Thomas) (it is important “to know who your supporters are and know who may be working against you, and try to resolve issues”).
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adopted and effective may turn as much on an initiative’s procedures for achieving portability and the consistency of state licensing requirements, as the overall legal structure of the initiative.
Multistate portability initiatives have used two procedures to improve portability: “mutual recognition” and expedited licensure. Under a mutual recognition model, licensees only need one state license (a multistate license), which gives them a privilege to practice in other states that have entered into the initiative. By contrast, initiatives based on expedited licensure require application for a license in each intended state of practice, but make the process more efficient than it otherwise would be. Both model laws and interstate licensure compacts have employed these two approaches.97
Mutual recognition by all member states of multistate licenses issued by any member of the initiative is a simple, efficient approach for multistate practice. Applicants who meet certain criteria98 need apply for only a single state license; in general, no additional fees, paperwork, or review are required.99 Mutual recognition initiatives may also allow licensees to exercise a
97 Interstate licensure compacts that rely on a mutual recognition model include: the NLC (see Roundtable Tr. at 15 (K. Thomas)); the APRN COMPACT (see id. at 17 (K. Thomas)); PTLC (see PTLC secs. 2(4)), 4; REPLICA (sec. 4); and PSYPACT (art. IV (telepsychology), art. V (temporary practice)). The UAA is an example of a model law portability initiative that uses a mutual recognition model (privilege to practice). See Roundtable Tr. at 18-19 (Webb). The IMLC is an example of a compact that uses an expedited licensure process. See Roundtable Tr. at 11 (J. Thomas). Examples of model law portability initiatives that use expedited licensure include the NABP, supra note 70 (Model Act sec. 303 (license transfer is a process whereby a licensed pharmacist obtains a license in another state)), NABP, supra note 67 (“the license transfer process is expedited”); NCEES, supra note 74 and accompanying text; and NCARB, supra notes 79-80 and accompanying text. The National Racing Compact (“NRC”) is unlike other initiatives in that its compact committee, rather than a state, issues licenses (“national licenses”) that are recognized by other compact states and may be recognized by noncompact states. See NRC, Model Legislation, sec. 7(3), sec. 11(A)(1) (2014), http://www.racinglicense.com/modellegislation.html; NRC, History, http://www.racinglicense.com/history.html. 98 For example, nurses must qualify for a multistate license to practice across state lines under the NLC. See Roundtable Tr. at 16 (K. Thomas) (Under the NLC, “to have a multistate license, you have to meet these uniform requirements. And we’re talking about pretty basic things like passing a national licensure exam, the NCLEX, and having a social security number, having an FBI criminal background check.”). Alternatively, states may not have separate licenses for single and multistate practice, allowing licensees to exercise a privilege to practice in other states on the basis of substantial equivalency of the state’s licensure requirements or the individual’s qualifications based on criteria established by the portability initiative. See UAA, supra note 60, at sec. 23(a)(1), (2). A variation on this approach is requiring applicants seeking authorization for multistate practice to meet criteria for a certificate issued by an association of licensing boards or other relevant organization; the certificate provides a privilege to practice in other compact jurisdictions. See PSYPACT, arts. II, secs. L, Q, IV sec. B(6), V sec. B(6). 99 None of the mutual recognition initiatives discussed in note 97 require additional paperwork for multistate practice except for the PTLC. Although the PTLC does not require licensure in every state of practice, it requires licensees to notify the compact commission of their intent to practice in another state; the commission then grants a compact privilege to the licensee upon payment of applicable fees. See PTLC secs. 3(C), (D), 4(A)(5), (6).
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privilege to practice without notice to other member states, because the legislation ensures that licensees are automatically considered to be within each state’s jurisdiction for purposes of disciplinary authority.100 The ease of multistate practice under a mutual recognition model may explain why it is favored by a number of professions that frequently use telework and electronic communications, or require emergency movements across state lines.101
While a mutual recognition model provides an efficient mechanism for practicing in multiple states without obtaining multiple licenses, licensees typically must apply for a new license when they move to another state or establish a principal place of business in another state.102 Initiatives address this issue in different ways, and the extent of streamlining varies. The UAA provides for reciprocity and routine issuance of a new license for CPAs who apply for a license in a new state of principal place of business if they personally possess qualifications that are substantially equivalent to the Act’s licensure provisions.103 On the other hand, under the NLC, licensees moving from one member state to another must rely on each state’s endorsement or other procedures for licensing of out-of-state applicants.104 The NLC, however, eliminates the period
100 See, e.g., Roundtable Tr. at 25 (Webb) (notice is not necessary under the UAA because it is a complaint-based system); UAA, supra note 60, at I-9, ¶ 9 (UAA provides “a no notice, no fee, and no escape approach for granting practice privileges across state lines for CPAs and CPA firms from states meeting UAA standards as well as for CPAs who individually meet UAA standards”), id. at sec. 23(a)(3) (licensees exercising the privilege to practice in another state are under the disciplinary authority of that state’s Board); Roundtable Tr. at 25 (K. Thomas) (tracking practitioners was unrealistic, and unnecessary because the compact is notified about complaints immediately); but see id. at 25 (Masters) (the PTLC has provisions to notify each state when a licensee is practicing in it); supra note 99 (discussion of PTLC). See also infra notes 112, 123 and accompanying text (discussion of coordination of enforcement and disciplinary actions). 101 See Roundtable Tr. at 18 (Webb) (discussing the UAA); id. at 15 (K. Thomas) (NLC arose from “changes in health care delivery including telehealth technologies . . . and nurses having a need to practice in multiple states from one central location”); id. at 16 (K. Thomas) (APRNs who provide mental health services often use telecommunications to provide services in rural areas across state lines); PSYPACT, art. I (the purpose of PSYPACT is to regulate the practice of telepsychology and temporary in-person services across state lines), art. IV (setting for the “Compact Privilege to Practice Telepsychology”); REPLICA sec. 1 (“This Compact is intended to facilitate the day to day movement of EMS personnel across state boundaries in the performance of their EMS duties . . . . .”). 102 See, e.g., NLC art. IV, sec. c (“If a nurse changes primary state of residence by moving between two party states, the nurse must apply for licensure in the new home state, and the multistate license issued by the prior state will be deactivated . . . .”). 103 See Roundtable Tr. at 19 (Webb) (“the UAA was changed to allow for expedited reciprocity if you personally had qualifications that matched those of the [UAA]”); UAA, supra note 60, at sec. 6(c)(2) (comment: . . . “With substantial equivalency established, however, this application process for an individual would essentially be routine and just a matter of filing an application and paying an appropriate fee.”). 104 See U.S. Dep’t of the Treasury & U.S. Dep’t of Defense, supra note 14, at 12-13 (nurses moving across state lines must apply for licensure by endorsement and pay any applicable fees; “[a]lthough the NLC and NURSYS provide some standardization to the licensure by endorsement process, they do not ensure straightforward license portability for nurses moving across state lines and do not eliminate many of the non-uniform aspects of the application process[.]”). State endorsement processes can reduce the burden of obtaining a license and enhance competition. See, e.g., Comment from FTC staff to the New York State Education Department (April 6, 2018), https://www.ftc.gov/policy/advocacy/advocacy-filings/2018/04/ftc-staff-comment-new-yorks-proposal-allow- licensure (supporting a proposed amendment that would permit experienced, licensed Canadian dentists to use the 18
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when a nurse might be unlicensed and unable to work by allowing licensees to practice under the existing multistate license during processing of the application by the new state of residence.105
Under an expedited licensure model, multistate practice is a multistep process in which applicants must obtain a license in each intended state of practice. Typically, the process begins when applicants provide their credentials to a central repository for storage and transfer. Repository officials or officials from the principal state of licensing then determine whether an applicant qualifies for expedited treatment.106 If deemed qualified, applicants receive expedited treatment in other member jurisdictions. Although the process involves multiple steps, the use of centralized databases and processes for confirming an applicant’s qualifications may reduce paperwork and review time, especially after the initial determination of qualification.107 Fees, however, may be higher, because payments to each state board and a central administrative body may be required.108 Although multistate practice under an expedited licensure model generally involves more paperwork than a mutual recognition model, expedited licensure procedures may facilitate a move to another state.109
same endorsement procedures that practicing dentists in other U.S. states follow to become licensed in New York State). 105 See, e.g., NLC art. IV, sec. c(1) (“The nurse may apply for licensure in advance of a change in primary state of residence”); Roundtable Tr. at 23 (K. Thomas) (under the NLC, applicants may receive a temporary license while their application for licensure in a new home state is being processed); See ICNLCA, Final Rules sec. 403(1) (Dec. 12, 2017) (“A nurse who changes his or her primary state of residence from one party state to another party state may continue to practice under the existing multistate license while the nurse’s application is processed and a multistate license is issued in the new primary state of residence.”). 106 For some professions, the determination of qualification for expedited licensure is made by a central organization. See, e.g., NCARB, supra note 79 and accompanying text; NCEES, supra note 73 and accompanying text. IMLC’s expedited process is based on a letter of qualification issued by the state of principal licensure. See Roundtable Tr. at 11 (J. Thomas). Initiatives that use mutual recognition models also use central databases to facilitate handling of credentials, but access is unnecessary for multistate practice. See, e.g., Roundtable Tr. at 26 (K. Thomas) (describing the database administered by the National Council of State Boards of Nursing); NLC, art. VI (requiring party states to participate in a coordinated licensure information system that includes information on licensure and disciplinary history). 107 See, e.g., Roundtable Tr. at 12 (J. Thomas) (upon receiving a letter of qualification and a fee, “a state shall issue a license”), 32-33 (some of the first applicants for expedited licensure under the IMLC received their licenses in a very short time); NABP Comment, supra note 67, at 3 (“Currently, the average processing time for a transfer application is less than 3 days. In some cases, license transfer applications are processed on the same day of receipt of the application.”). Note that for some initiatives, a licensee may need to apply for a determination of eligibility for expedited treatment more than once. See Interstate Medical Licensure Comm’n (“IMLCC”), Rule on Expedited Licensure, sec. 5.6(1)(b) (2017) (“A letter of qualification is valid for 365 days from its date of issuance to request expedited licensure in a member state.”). 108 See, e.g., Roundtable Tr. at 12 (J. Thomas) (the fee for expedited licensure through the IMLC is $700, $400 of which goes to the IMLCC; in addition, the applicant must pay the licensing fee for each state of licensure). 109 See, e.g., supra note 97 (discussion of expedited licensure pursuant to the processes of NABP, NCEES, and NCARB). Cf. IMLC sec. 4(c) (“The Interstate Commission is authorized to develop rules to facilitate redesignation of another member state as the state of principal license.”).
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Mutual recognition of a single state license poses a lower barrier to cross-state practice than expediting licensure in multiple states. Those who favor expedited licensure tend to emphasize each state’s ability to take adverse disciplinary action under its own license. Expedited licensure initiatives assert that their approach strikes the right balance between reducing the burden of multistate licensure and maintaining accountability at the state level.110
By contrast, initiatives that provide a privilege to practice under a single license tend to emphasize the ease of multistate practice,111 and maintain that their systems protect the public by giving each state enforcement authority and providing for coordination of investigations and disciplinary actions.112 For such initiatives, ease of multistate practice is further enhanced when licensees are not required to notify member states in which they are not licensed that they are practicing there. Such an arrangement likely will be the most effective in enhancing cross-state competition, improving access to services, and reducing the tendency of licensing to increase prices.
The nature of a profession, particularly the relative importance of multistate practice compared to relocation to another state, may be an important consideration in choosing a procedure for achieving license portability. On the other hand, a portability initiative could be crafted to achieve both goals—easing multistate practice through use of a mutual recognition model, while also expediting licensure upon relocation in another state. As discussed in the next section, the latter may depend on whether states’ licensing standards are substantially equivalent, or can be harmonized pursuant to the portability initiative.
To instill confidence in the qualifications of practitioners licensed by other states and to encourage adoption of portability measures, both mutual recognition and expedited licensure initiatives have moved toward harmonization of state licensing standards in core areas. Generally, these include education, examination, and disciplinary and criminal history; some
110 See, e.g., Roundtable Tr. at 11 (J. Thomas) (“For states to be able to take action on a physician whose standard of care falls below the minimum standard, they need to act on a license. And so a reciprocal process would not work. We felt that each state would have to issue a license, but we would expedite the process, and we’d make the process much more efficient.”). 111 See, e.g., Roundtable Tr. at 16 (K. Thomas) (under mutual recognition model, nurses do not have to apply for licensing in multiple states, pay fees in those states, and wait for approval before employment); id. at 24 (K. Thomas) (mutual recognition model makes “it easier for the licensees and easier for the bureaucrats who have to process all of this work”). 112 See infra notes 123-125 and accompanying text.
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professions also have experience requirements.113 While similar standards foster the acceptance of each state’s licensees by other states, the standards need not be identical; rather, substantial equivalence of licensing requirements may be sufficient to generate confidence in out-of-state licensees, even under a mutual recognition model.114 Initiatives that expedite licensure also seek harmonization, to assure states considering adoption of an initiative that applicants licensed under expedited procedures will have met comparable standards.115
The licensing standards set by portability initiatives are often as demanding as those of the most restrictive states, or even higher.116 For example, the IMLC requires physicians to be board certified to qualify for expedited licensure; no individual jurisdiction has such a requirement.117 Representatives of such initiatives assert that higher standards are necessary to encourage widespread adoption by many states.118 They also point out that licensees who do not meet these standards may still qualify for an individual state license without a privilege to practice in other states, or may be able to obtain a license without the use of expedited procedures.119
113 The revised NLC (eNLC) includes certain uniform licensing requirements that were not in the original NLC, such as graduation from an approved nursing program, passing a standardized licensure examination, having an unencumbered state license, and having an FBI criminal background check. See Roundtable Tr. at 16 (K. Thomas) (explaining that these requirements were included in the revised version of the NLC because adoption of the original NCL had stalled and states said that the lack of uniform license requirements was a barrier to adoption); NLC art. III, secs. b, c (May 4, 2015). The UAA focused on standardizing the “three Es,” education, examination, and experience. See Roundtable Tr. at 18 (Webb); UAA, supra note 60, at I-9, ¶ 8 (uniformity among jurisdictions, especially with regard to examinations, education, and experience requirements, is a fundamental principle of the legislative policies of the AICPA and NASBA). 114 See supra notes 64, 98 and accompanying text (discussing the UAA’s substantial equivalency standard and its adoption by 53 jurisdictions). The UAA relies on an the NASBA National Qualification Appraisal Service to determine whether state requirements for CPA licensure are substantially equivalent to those of other states, as well as whether individuals’ qualifications are substantially equivalent. See UAA, supra note 60, at sec. 23(a); UAA, supra note 60, at App. B. 115 See Roundtable Tr. at 11 (J. Thomas) (states considering adoption of the IMLC needed standards for licensure of applicants for expedited licensing that all states could agree on); Craig N. Musselman et al., A Primer on Engineering Licensure in the United States, Sec. 3, 4, PROC. AM. SOC. ENGINEERING EDUC. ANN. CONF. (2011) (describing education, examination, and experience requirements for receiving “expedited comity” as a Model Law Engineer). 116 See, e.g., Roundtable Tr. at 30 (K. Thomas) (the NLC “set[s] the highest standard . . . to make states comfortable with that mobility”). 117 See Roundtable Tr. at 29 (J. Thomas) (the IMLC “sets the bar higher than the usual licensure standard” and requires physicians to be board certified); IMLC § 2(k)(4). 118 See Roundtable Tr. at 29 (J. Thomas) (to encourage states to join the compact, IMLC requires board certification “because the states felt that if they were going to enter into this compact, it needed to be a higher bar.”); infra note 121. 119 See Roundtable Tr. at 16 (K. Thomas) (under the NLC, “[s]tates can still evaluate individuals for single-state license” that would not provide a privilege to practice in other states); id. at 29 (J. Thomas) (although the vast majority of physicians can meet the IMLC’s standard for expedited licensure, those who cannot can still “apply through the traditional route to get a license in the traditional way.”).
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Nonetheless, some oppose the imposition of higher standards and the extent to which these higher standards may exclude or deter some otherwise qualified applicants.120 While many support certain requirements imposed by most states, such as criminal background checks,121 a substantive standard not imposed by most states could inhibit adoption of an initiative and reduce practitioners’ use of portability procedures in participating states. Moreover, higher licensing standards exacerbate the tendency of licensing to restrict the labor supply and reduce competition, which may further increase prices, without any countervailing quality, health, or safety benefits.122 Thus, in designing a license portability initiative, developers of the initiative should aim for the least restrictive licensing standard that can gain the support of states nationwide.
For portability initiatives in which a single state license provides a privilege to practice in all member jurisdictions, mechanisms to ensure that disciplinary action may be taken against a practitioner, regardless of where a violation occurs, are essential to acceptance and adoption of the initiative. Because a state can only revoke a license that it issued, portability initiatives that operate under a mutual recognition model generally have procedures for member states to bring adverse actions that can affect not only the privilege to practice in the state where the violation occurred, but also an out-of-state practitioner’s license. The initiative may require the state of licensing to evaluate out-of-state conduct under its own laws, or the laws of the other state.123 To help coordinate investigations and adverse actions in member jurisdictions, license portability
120 See id. at 29 (J. Thomas) (“there’s been criticisms that [the IMLC] is meant to keep certain individuals out. That’s actually not the case. It’s meant to just set a higher standard of safety.”). 121 See id. at 30 (K. Thomas) (“So one of the big issues for us was criminal backgrounds. And states would not feel comfortable with any state that did not do an FBI criminal background check. In particular, felonies were a big concern to the states that wouldn’t join before.”). Cf. id. at 12-13 (J. Thomas) (explaining that instituting FBI criminal background checks has been challenging because not all states that joined the IMLC meet the statutory requirements to obtain FBI criminal background checks of applicants; such states cannot serve as a state of principal license). 122 See, e.g., Nicholson & Propper, supra note 9, at 885; Morris M. Kleiner & Robert T. Kudrle, Does Regulation Affect Economic Outcomes: The Case of Dentistry, 43 J.L. ECON. 547, 576-77 (2000) (stricter state licensing standards did not improve dental health outcomes, but did raise the prices of dental services). 123 For example, under the UAA, CPAs providing services in a state under a privilege to practice must comply with that state’s practice act and are automatically subject to the disciplinary authority of the Board of that state. Moreover, the Board of the state of licensure is required to investigate complaints made by Boards of other states, and also has the authority to discipline licensees who violate the laws of other states when providing services in them. See Roundtable Tr. at 19 (Webb) (describing the authority of states to take action against a licensee’s privilege to practice, and the requirement that home states investigate and discipline licensees for violations of other states’ laws); UAA, supra note 60, at sec. 23(a), (b). Similarly, under the NLC, party states are rapidly notified about complaints and have the authority to take action against a nurse’s privilege to practice in their states. In addition, the Board of the state of licensure must take action under its own laws regarding conduct in other states as if the conduct occurred in-state. See Roundtable Tr. at 25 (K. Thomas); NLC art. III, secs. d, e; art. V, sec. a(1).
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initiatives typically require states to report complaints and adverse actions to a central database of licensee information, as well as to the state of licensing.124 Such provisions may provide for “stronger and more efficient state board enforcement in the context of modern cross-border and electronic commerce in which state lines are often blurred.”125
Portability initiatives that expedite licensure, rather than allow multistate practice under a single license, may also enable member states to coordinate information about licensees’ conduct and adverse actions, even though every state where a practitioner practices has the authority to take action based on its own license. For example, the IMLC requires certain information about licensees’ conduct and disciplinary actions to be submitted to a central database.126 It also allows a state to investigate, by itself or jointly with other states, violations of state medical practice acts that occurred in other member states.127 Moreover, when the state of principal license revokes or suspends a physician’s license, the physician’s licenses in other member states are automatically placed on the same status; a disciplinary action by any IMLC member board can lead to disciplinary action by other member jurisdictions.128
While license portability initiatives can streamline licensing upon a move to a new state, some initiatives primarily address multistate practice rather than the mechanics of relicensing in a new state. Moreover, many occupations have not taken steps to improve license portability. The burden of obtaining a license in a new state, which may be costly and delay employment, falls disproportionately on populations that move frequently. Because military families typically move every two to four years, the burden of applying for a new license with each move across
124 See, e.g., Roundtable Tr. at 27 (K. Thomas) (people who are under investigation in one state cannot escape by moving to another state, because of the information in the database); NLC art. III, sec. d (notice of adverse action to coordinated licensure information system and home state); art. VI secs. a, c (requiring member states to participate in a coordinated licensure information system covering licensure and disciplinary history, and to report significant investigative information and any adverse action); UAA, supra note 60, at sec. 12(k) (requiring Boards to report disciplinary actions against CPAs with a privilege to practice in other states to state boards or a multistate enforcement network). 125 UAA, supra note 60, at I-2. 126 See, e.g., IMLC sec. 8; Roundtable Tr. at 12 (J. Thomas) (“any complaint in any of the compact states is shared automatically with other states . . . [the compact] provides better information sharing” when physicians have licenses in multiple jurisdictions). 127 See, e.g., IMLC sec. 9. 128 See IMLC sec. 10.
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state lines is high for the 35 percent of military spouses in the labor force who work in occupations that require state licensing.129
The U.S. Department of Defense State Liaison Office (“DoD-SLO”) has worked with states to reduce barriers to licensing for relocated military spouses working in many or most occupations requiring licensing.130 The DoD-SLO has encouraged states to use one or more of three options to enhance license portability for military spouses: (1) facilitating endorsement of existing licenses from jurisdictions with substantially equivalent requirements (avoiding the need for re- examination); (2) providing temporary licenses for spouses who do not qualify for endorsement; and (3) expediting the process of getting a license.131 Fifty-six percent of the states have adopted statutory provisions requiring all three approaches, and all states now require at least one mechanism to aid military spouses.132
However, certain professions, such as teaching, are not covered by most states’ provisions for streamlining licensing of military spouses. Teachers seeking licensure in a new state often must take additional courses and tests, and the process takes time and is costly—especially for young teachers with little experience.133 Thus, the DoD-SLO is working with states to remove specific impediments to licensing of transitioning military spouses for teaching and other occupations that are not otherwise covered by their streamlining initiative.134 For some occupations, the DoD-
129 See Roundtable Tr. at 20 (Beauregard); U.S. Dep’t of the Treasury & U.S. Dep’t of Defense, supra note 14, at 3, 7, 9. 130 See Roundtable Tr. at 20-21 (Beauregard). A statutory provision facilitating licensure of military spouses may apply to many or all licensing boards within a regulatory agency that oversees the licensing boards. See, e.g., U.S. Dep’t of the Treasury & U.S. Dep’t of Defense, supra note 14, at 16 (discussing legislation to facilitate the licensure by endorsement process for military spouses that is applicable to 77 occupations regulated by the Colorado Department of Regulatory Agencies). 131 See Roundtable Tr. at 21 (Beauregard). The processes for expedited licensure for these initiatives is not the same as those discussed above. Rather, an application may be expedited by other means, including allowing military spouses to use time-saving options, such as submitting photocopies of state certificates and test scores; setting deadlines for adjudication of applications from military spouses; or giving individual boards authority to approve a license based on an affidavit from the applicant that the information provided is true and that verification has been requested. See, e.g., U.S. Dep’t of Defense, Removing Certification Impediments for Transitioning Military Spouse Teachers, Best Practices, 1, http://download.militaryonesource.mil/12038/USA4/2016/best-practices/Sp-Teacher- Certification-BPI5.pdf; Roundtable Tr. at 23 (Beauregard). 132 See Roundtable Tr. at 21 (Beauregard); Beauregard, FTC Presentation, at 4, https://www.ftc.gov/system/files/documents/public_events/1224893/slides_-_marcus_beauregard_dod_-_slo.pdf. 133 See U.S. Dep’t of Defense, Removing Certification Impediments for Transitioning Military Spouses, 1, http://download.militaryonesource.mil/12038/USA4/2017/one-pagers/Sp-Teacher-Certification-OPI9.pdf; Roundtable Tr. at 14 (Rogers) (although almost all jurisdictions have signed the Interstate Agreement of the National Association of State Directors of Teacher Education and Certification, which provides a database of state requirements, licensure of teachers is very complex and state certification requirements vary, so it is very difficult for inexperienced teachers such as young military spouses to become licensed in a new state). 134 See Roundtable Tr. at 22 (Beauregard). See USA4 MilitaryFamilies, DoD-SLO, Removing Certification Impediments for Transitioning Military Spouses, http://www.usa4militaryfamilies.dod.mil/MOS/f?p=USA4:ISSUE:0::::P2_ISSUE:9. The DoD-SLO has also commissioned a study to find out more about how the states have implemented their statutory measures to facilitate 24
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SLO also is addressing the issue by supporting interstate licensure compact provisions that facilitate licensing of military members and their spouses.135
A potential bonus from the DoD-SLO’s initiatives is that some of the procedures that have proven useful for expediting licensing of military spouses could be adopted for general use, to speed licensing for anyone. For example, temporary licensing, allowing submission of photocopies of state certificates and test scores until official copies can be obtained, and conditionally approving applications without waiting for a board meeting, could be made more broadly available to all applicants.136
Occupational licensing can protect consumers from health and safety risks, generally in situations where consumers lack sufficient information to assess the qualifications of professionals. That said, licensing occupations also restricts competition. By establishing the entry requirements for an occupation, licensing regulations tend to reduce the number of market participants. In turn, this reduction in supply leads to a loss of competition, potentially resulting in higher prices and lower quality and convenience of services.
A key barrier imposed by licensing is the inability of qualified professionals licensed by one state to work in another state. There is little justification for the burdensome, costly, and redundant licensing processes that many states impose on qualified, licensed, out-of-state applicants. Such requirements likely inhibit multistate practice and delay or even prevent licensees from working in their occupations upon relocation to a new state. Indeed, for occupations that have not implemented any form of license portability, the harm to competition from suppressed mobility may far outweigh any plausible consumer protection benefit from the failure to provide for license portability.
Moreover, a slow and burdensome process for cross-state practice is unnecessary. There are many options to enhance license portability. Individual states have adopted initiatives to streamline licensing of military spouses in many occupations. Some professions have developed model laws or interstate compacts that improve licensure portability nationwide. These examples of successful portability suggest further liberalization and reform is both possible and beneficial.
licensure for military members and spouses, and how effective these requirements have been. See Roundtable Tr. at 21 (Beauregard). 135 See, e.g., Roundtable Tr. at 22 (Beauregard); Licensing Compacts Recognizing Military Requirements, http://www.usa4militaryfamilies.dod.mil/MOS/f?p=USA4:ISSUE:0::::P2_ISSUE:7; REPLICA sec. 7(b) (Sept. 2014) (“Member states shall expedite the processing of licensure applications submitted by veterans, active military service members, and members of the National Guard and Reserves separating from an active duty tour, and their spouses.”); PTLC sec. 5 (military members and spouses may designate the home of record, permanent change of station, or state of current residence as the home state). 136 See Roundtable Tr. at 24 (J. Thomas) (discussion of expediting licensure of physicians in Minnesota).
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Accordingly, for occupations that generally require state licensing as a public protection measure, FTC staff encourages stakeholders such as licensees, professional organizations, organizations of licensing boards, and state legislators to consider the likely competitive effects of options to improve license portability. As stakeholders evaluate those options, we suggest that they consider the following points:
Both model laws and interstate compacts have been used to improve licensure portability for individual occupations
For reducing barriers to multistate practice, consider the use of a mutual recognition model, in which licensees need only one state license to practice in other member states and are not required to give notice of their intent to practice in another state
Alternatively, consider easing multistate practice by expediting licensure in each intended state of practice
Take steps to ease licensure upon relocation to a new state, whether by expediting the process or by allowing licensees to practice in the new state of residence under an existing multistate license during processing of the application
Harmonize state licensure standards, using the least restrictive standard that can gain the support of states nationwide
State-based efforts to reduce barriers to licensing of relocated military spouses often address multiple occupations that require licensing
At the state level, consider expanding the use of temporary licensing and other procedures that have helped reduce the burden of licensing for relocated military spouses to all applicants licensed by another state
Each type of portability initiative has advantages and disadvantages, and all take time and effort to develop and implement. However, a thoughtful consideration of the needs of a profession and the consumers it serves is likely to lead to a solution that can gain the support of licensees, licensing boards, the public, and state legislatures. Moreover, by enhancing the ability of licensees to provide services in multiple states, and to become licensed quickly upon relocation, license portability initiatives can benefit consumers by increasing competition, choice, and access to services, especially where providers are in short supply.
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FTC Roundtable, Streamlining Licensing Across State Lines, Initiatives to Enhance Occupational License Portability (July 27, 2017)
Katie Ambrogi, Attorney Advisor, Office of Policy Planning (moderator)
Marcus J. Beauregard, Director, Defense State Liaison Office, Office of the Deputy Assistant Secretary of Defense for Military Community and Family Policy U.S. Department of Defense
Karen A. Goldman, PhD, Attorney Advisor, Office of Policy Planning (moderator)
Rick Masters, Special Counsel to the National Center for Interstate Compacts, Counsel of State Governments
Philip S. Rogers, EdD, Executive Director, National Association of State Directors of Teacher Education and Certification
Jon Thomas, MD, MBA, Chair, Interstate Medical Licensure Compact Commission
Katherine Thomas, MN, RN, FAAN, President, National Council of State Boards of Nursing
Virgil Webb, Assistant General Counsel, Association of International Certified Professional Accountants
27
Volume 1, No. 10, April 16, 2019
Arizona Governor Signs Landmark Licensure Reciprocity Law
Last week, Arizona Gov. Doug Ducey signed the most wide- sweeping licensure reciprocity law in the country. The bill requires regulating entities to grant a license or certificate to any resident who holds a license or certificate from another jurisdiction that is in good standing and has been held for at least one year, including residents who practice in the dental professions. The legislation allows licensing entities to test licensees about laws specific to the state. The law also creates exceptions to the requirement to grant reciprocity for anyone who has been disciplined by a regulating entity (unless the licensing board determines the cause for discipline was corrected and the matter resolved), had a license revoked or voluntarily surrendered, has a complaint or investigation pending before a regulating entity, or has a disqualifying criminal history.
Some states have granted similar reciprocity to members of the military and their spouses, or to people who practice specific professions covered by an interstate compact. It is believed this is the first law in the country to grant reciprocity to nearly any licensee without also requiring other states to reciprocate.
Will Medicaid Work Requirements Be Upheld by the Appellate Courts?
On April 11, the U.S. Department of Justice, representing the Department of Health and Human Services (HHS), filed for an expedited appeal with the U.S. Court of Appeals for the District of Columbia Circuit, saying the prior decision by U.S. District Judge James Boasberg to block work requirements in two states was highly detrimental and created uncertainty.
On March 27, Judge Boasberg found that by approving work requirements in Arkansas and Kentucky, the Centers for Medicare & Medicaid Services (CMS) had violated the law governing Medicaid. The statute states that the primary goal of the Medicaid program is to provide health coverage to low-income individuals—not to provide employment.
The work requirement is the first of its kind in the more than 50-year history of the Medicaid program. Arkansas was the first and only state to enact Medicaid work rules. In 2018, over 18,000 people either failed to work or report their work for three months and lost their Medicaid benefits for the rest of the year. Kentucky’s program, which was set to start on April 1, has not yet been implemented since the decision by Judge Boasberg in March.
The Trump Administration has been a vocal supporter of the work requirements. President Trump included several proposals that would cut Medicaid spending by $1.54 trillion over 10 years and require all “able-bodied, working-age adults” to meet work requirements as a condition of Medicaid eligibility in his FY 2020 Budget.
The U.S. Court of Appeals final decision will impact more than Arkansas and Kentucky—six states have already received permission from CMS to begin implementing work requirements on Medicaid enrollees. ADEA continues to monitor proposed changes to Medicaid and their potential impact on dental education. For more information, see the ADEA U.S. Interactive Legislative and
Regulatory Tracking Map.
Ontario Budget Includes Free Dental Care for Low-Income Seniors
Ontario’s government presented its budget on April 11, which included funds to provide free dental care to low-income seniors. Individuals age 65 and over with annual incomes below $19,300, and couples with a combined annual income below $32,300, will qualify. Under the plan, seniors who qualify would be able to access dental care through public health units, community health centers, and aboriginal health access centers.
Medicaid Update
On April 11, the Tennessee House passed legislation that would ask the federal government to fund its share of the state’s Medicaid program through a block grant. The bill will now be sent to the state Senate for review. Idaho Gov. Bill Little signed legislation to expand the state’s Medicaid program under the Affordable Care Act (ACA). The legislation will implement an expansion proposal passed by voters through a referendum last November, but also modifies the plan by adding work requirements for some of the state’s Medicaid recipients. Work requirements in Arkansas and Kentucky were recently struck down by a federal judge, but the Centers for Medicare & Medicaid Services continues to approve work requirement waiver requests from other states. Legislators in Florida are also considering adding work requirements for the state’s Medicaid recipients. A bill that would create work requirements passed a committee vote in the House of Representatives late last week. Florida still has not expanded Medicaid under the ACA, and work requirements in the state in the state may create a “Catch 22” scenario under which individuals would earn too much to qualify for Medicaid, but too little to qualify for subsidies under the ACA, forcing individuals into a coverage gap.
A Uniform and a Periodontal Probe
During the 2019 ADEA Capitol Hill Day on April 11, participants heard from Renée W. Joskow, D.D.S., M.P.H., FAGD, a dentist and a medical epidemiologist. Dr. Joskow serves as the Senior Dental Advisor for the Health Resources and Services Administration. She is also a Captain in the U.S. Public Health Service (USPHS) Commissioned Corps. The Commissioned Corps’ mission is to protect, promote, and advance the health and safety of our nation. Dr. Joskow is one of more than 6,500 Commissioned Corps officers who work on the front lines of public health—fighting disease, conducting research, and caring for patients in underserved communities. Although the Commissioned Corps
is a non-military uniformed service, officers enjoy many of the same benefits as their counterparts in the other uniformed services. Corps officers serve in 15 careers in a wide range of specialties within federal agencies such as the National Institutes of Health and the Centers for Disease Control and Prevention.
The USPHS is part of the largest public health program in the world. Rear Adm. (Upper) Timothy Ricks serves as the USPHS Chief Dental Officer and as Assistant Surgeon General. In this role, he oversees dentists serving in various federal agencies. He also serves as the Surgeon General’s spokesperson on oral health and interacts with chief dental officers from other countries, military dental officers, dental organizations, and state oral health programs. He is leading the development of the second Surgeon General’s Report on Oral Health. ADEA is
participating in the development of this report and regularly supports funding for the USPHS.
Testimonials from the 2019 ADEA Hill Day on April 11
Ambika Srivastava, D3, University of Mississippi Medical Center School of Dentistry
As I stood in front of the Capitol in my white coat on a chilly morning, I pondered how effective lobbying would be today. We started off the ADEA Capitol Day with a morning full of information about the issues that we were going to be addressing. Feeling empowered from the knowledge, my colleague and I walked into Senator Roger Wicker’s office. Surprisingly, the Senator remembered me from last year’s Hill Day. The rest of the morning seemed to have a similar tone; each office we went to recognized us as “that dental group.” Many lessons can be learned from this event. One such example was how persistence and putting forth a logical front proved to be memorable to the Senators and Congressmen. As the Sunstar Inc./Jack Bresch ADEA Legislative Intern and ADEA Council of Students, Residents and Fellows National Advocacy Chair, I believe it is imperative to put forth the interest of the group. This was effectively done on a national level and I hope to be able to bring the same ambition to the state level.
Another important aspect to note is there needs to be a team effort to create change, but even one voice can start the ripple effect. Collaborating with colleagues from other states with the same vision reinforced ADEA’s message. During ADEA Capitol Hill Day, we were a unified front taking over the Capitol, hoping to ignite change.
William Boteler Key, D2, University of Mississippi Medical Center School of Dentistry
ADEA Capitol Day 2019 was my first real lobbying experience for the field of dentistry, but as they say, the best way to learn to swim is being thrown in the deep end. That day, before our scheduled meetings with our state’s Senators and Representatives, we had several knowledgeable speakers talk about many of the main issues we would be addressing in our meetings. During these meetings, I heard first-hand stories about how the financial workings of our federal government impact the field of dentistry and dental education on a nation-wide as well as a local state scale. These bills, which seem so unimportant while studying for dental school, actually impact our day-to-day lives as students in every way—from our loan payment options to even our educational opportunities during school.
A takeaway that I got from our day on the Hill would be that every student needs to get involved in advocacy, whether it be on a national level or even just the state level, to help preserve and improve the field of dentistry for our future careers as well as for the students that follow us. Another lesson I learned during my experience is that being seen making an effort by the Senators and Representatives is just as important, if not more, than the information you are presenting. If they see students are concerned about these issues and are willing to take time out of their schedules to express these concerns, they are more willing to work with you, much like professors seeing you put forth the extra effort after class to perfect that taper on your crown preps. The more people we have involved in our advocacy efforts, the better the field of dentistry
will be for all.
Volume 1, No. 14, May 14, 2019
Washington State Legislation Requiring Dental Labs to Register With the State
Recently signed legislation in Washington state requires dental labs to register with the state Department of Health and also places additional employee certification requirements on labs in the state. The bill requires dental labs to employ at least one full-time staff person who is
either certified by the National Board for Certification in Dental Laboratory Technology, or has completed at least 12 hours of continuing education in dental laboratory technology. Beginning Jan. 31, 2025, the requirements become even stricter, as the bill removes the allowance for a lab to employ someone who has met the continuing education requirements, and requires labs to employ or be owned by a certified technician. The bill allows exemptions from these requirements: dental laboratories operating under the supervision of a practicing dentist in a dental office and laboratories in educational institutions, provided that neither perform work pursuant to prescriptions or work orders originating from outside of the dental practice or educational institution.
Tennessee Sends Medicaid Block Grant Legislation to Governor
Shortly before adjourning for the year, lawmakers in Tennessee voted to pass legislation that would require Gov. Bill Lee to submit a waiver to the Centers for Medicare & Medicaid Services (CMS) requesting that the state receive its Medicaid funds through a block grant. If approved, the state would be the first to receive Medicaid funding through a block grant, and the waiver would mark a fundamental shift in the way the state-federal partnership funds the program. Medicaid is
currently an entitlement program, meaning anyone who qualifies can receive coverage under the program and the cost of that coverage is split between the state and the federal government. Funding for the program is not fixed under this arrangement, and in Tennessee, the state currently covers about 35% of the costs, while the federal government covers just over 65%. By shifting to a block grant, the state would essentially be asking the federal government to place a cap on the amount of funds it receives. In exchange, the federal government would have fewer strings attached, and the state would receive increased flexibility in the way it administers the program. Lawmakers in favor of the block grant argue that the state can innovate and reduce costs without federal strings attached. Opponents, however, are concerned that if enrollment or other costs rise, the fixed federal funding structure could compel the state to reduce benefits, reduce enrollment or cut reimbursement rates.
The Trump administration may be amenable to such a request. The President’s budget proposes Medicaid as a block grant or per-capita cap program, and CMS appears to be drafting guidance on designing a fixed cost spending model. Several other states have expressed an interest in block grants, or a per-capita program similar to the one requested by Utah.
Maine Votes to Increase Maximum Amount Under Dental Loan Repayment Program
Last week, the Maine state legislature voted to increase the maximum annual amount that can be paid under the Maine Dental Education Loan Program from $20,000 to $25,000. The increase is effective for all recipients who receive a first loan or sign a first agreement after Jan. 1, 2020. Individuals accepted under the program must agree to work in a dental health professional shortage area, and are eligible to receive loan repayments for up to four years. Additional information about this program and others can be found on ADEA’s Summary of State and Federal Loan Forgiveness Programs.
Some Good News for Student Borrowers
On May 8, the U.S. Treasury conducted its last 10-year Treasury Note auction prior to June 1. Each year, the Department of Education uses this auction to set interest rates for student loans issued after July 1 of that year. As a result, the interest rate for graduate/professional Direct
Unsubsidized Loans issued after July 1, 2019 will drop from 6.595% to 6.079%, and from 7.595% to 7.079% for Parent and Grad PLUS loans.
Trump Administration Proposes Changes to Poverty Level Calculation
Last week, the Office of Management and Budget submitted a request for comments on a proposal to change the way inflation is calculated when determining the federal poverty level (FPL). FPL is used to determine income eligibility for a number of government programs, including Medicaid. The level currently is determined by calculating three times the cost of a minimum food diet, and is adjusted with the annual rate of inflation. The new proposal would likely calculate inflation at a slower rate by tying the rate of inflation to chained consumer price index (CPI), a formula that assumes consumers will substitute less expensive items when there is a large increase in prices for specific consumer goods. FPL varies by family size and location, and in 2018, FPL was $25,100 for a family of four living in
the continental United States.
Appropriations Committee Updates
On May 8, the full House Committee on Appropriations held a markup of the Labor, Health and Human Services (HHS), Education, and Related Agencies appropriations bill. There are no funding reductions and some increases for programs that are important to ADEA and its members. Some of the numbers may represent a starting position for Democrats in the House as they prepare for negotiations with the Republican Senate and White House, and are not likely to be the final overall levels that the House, Senate and administration ultimately agree upon. The funding levels ADEA is tracking are as follows:
The bill will now go to the House floor for consideration, which may not take place until after the Appropriations Committee holds a markup on the defense appropriations bill. The timing of the defense bill is unclear at this time, as the defense appropriations subcommittee markup may have to wait until after the House Armed Services Committee completes action on the FY20 Defense Authorization legislation, which is tentatively scheduled for this week.
On the Senate side, the Appropriations Committee plans to start marking up bills in June, and the timing of the Labor-HHS bill in the Senate remains uncertain. ADEA will keep you informed as the process continues.
Correction
In last week’s ADEA Advocate, it was reported that the Vermont legislature sent a bill to the state’s Governor that would allow public health dental hygienists to practice in out of office settings without general supervision of a licensed dentist. That was incorrect. The bill allows public health dental hygienists to practice in specified out of office settings, but not without the general supervision of a licensed dentist. The legislation allows the state Board of Dental Examiners to adopt rules setting guidelines for general supervision of public health dental hygienists, and allows public health dental hygienists to practice in those out of office settings in a manner consistent with those guidelines. We apologize for any confusion. ADEA AGR will continue to monitor this bill and update members regarding future regulations.
Volume 1, No. 17, June 4, 2019
Arizona Allows Dental Hygienists to Practice Under Physician Supervision
On May 25, Arizona Gov. Doug Ducey (R) signed legislation that allows dental hygienists to practice in an inpatient-hospital setting under the general supervision of a licensed physician. The bill requires
a supervising physician to be available for consultation, regardless of whether the physician is physically present at the hospital.
The bill also allows dental hygienists to supervise dental assistants, under the terms of an affiliated-practice agreement between a dental hygienist and a dentist. The legislation also allows dental assistants to expose radiographs for diagnostic purposes, under the direct supervision of an affiliated-practice dental hygienist.
Canadians Overwhelmingly Support Publicly Funded Dental Care for Those Without Insurance
A recent poll conducted by Ipsos, a research and consulting firm, found that almost 86% of Canadians support publicly funding dental care for individuals without insurance. While nearly 70% of Canadians have dental coverage, at least one public health expert noted that this rate lags behind many European countries.
That health expert also pointed to data that preventable dental issues have resulted in 60,000 emergency room visits in Ontario in 2014, resulting in a cost of nearly $40 million that year. Not surprisingly, the Ipsos poll also found that almost half of individuals lacking dental coverage chose not to visit a dentist at all.
At least one province, Ontario, is taking steps to address gaps in dental coverage. The province’s 2019 budget included funding for a a new program that provides free dental coverage for low- income seniors.
California Senate Votes to Reimburse Medi-Cal Providers for Use of Silver Diamine Fluoride
On May 24, the California State Senate passed legislation to allow reimbursement to Medi-Cal providers for the application of silver diamine fluoride when used as a caries-arresting agent. The legislation limits this benefit to children under the age of 6, persons with disabilities or other underlying conditions and adults who live in a licensed nursing facility or a licensed intermediate-care facility. Additionally, the bill allows for the reimbursement of this service when provided by a registered dental hygienist in alternative practice who meets the requirements described in the bill.
Similar legislation was vetoed by former California Gov. Jerry Brown (D) in 2018, due to concerns related to the cost of providing the reimbursement. This year’s legislation attempts to limit costs by restricting the benefit to the populations mentioned above. The bill will now move to the State Assembly for consideration.
Trump Administration Appeals Ruling Blocking Medicaid Work Requirements
On May 14, the Trump Administration asked a federal appeals court to overturn a ruling that blocked Medicaid work requirements in Kentucky and Arkansas. In a brief filed with the court, officials from the U.S. Department of Health and Human Services argued that U.S. District Judge James Boasberg was incorrect in his assessment that work requirements do not further the objectives of Medicaid. The brief compared the work requirements to those already in place for programs such as the Supplemental Nutrition Assistance Program and the Temporary Assistance for Needy Families, and asserted that work requirements do further the objectives of Medicaid by
freeing state resources. Additionally, both Kentucky and Arkansas filed briefs appealing the ruling.
Federal Task Force Shares Findings on Pain Management Alternatives
On May 30, the Pain Management Best Practices Inter-Agency Task
Force issued a 108-page report laying out new approaches to pain management that emphasize alternative treatments to opioids. The report delves into a multidisciplinary approach that, in addition to opioids, includes behavioral and physical therapy along with other minimally invasive procedures.
The findings of the 29-member task force reflect the growing trend of providers seeking alternatives to using opioids for pain management. The report emphasizes that because certain populations, such as children and seniors, have unique issues when it comes to pain management, there can be no one-size-fits-all solution. The task force was mandated under the Comprehensive Addiction and Recovery Act of 2016 and is overseen by the U.S. Department of Health and Human Services.
Volume 1, No. 18, June 11, 2019
Nevada and Connecticut May License Dental Therapists
The Nevada Legislature on June 3, and the Connecticut General Assembly on June 4, both passed legislation to license dental therapists. Much like dental therapy laws in other states, the bills restrict locations dental therapists can practice. In Connecticut, dental therapists would be limited to practicing in public health facilities, while Nevada would allow dental therapists to practice in hospitals and specified sites that traditionally assist underserved populations. Both bills also establish requirements individuals must meet before being eligible for licensure, define the scope of practice, and require dental therapists to enter into a collaborative agreement with a licensed dentist. The bills will now go to the desks of Nevada Gov. Steve Sisolak (D) and Connecticut Gov. Ned Lamont (D). If they become law, Connecticut and Nevada will join 10 other states in licensing dental therapists in some capacity.
Maine Expands Dental Benefits for Adults Covered by Medicaid
On June 5, members of the Maine State Legislature voted to expand dental benefits for adults under the state’s Medicaid program. If signed into law, the bill would add benefits for medically necessary and comprehensive preventive, diagnostic and restorative dental services in accordance with rules adopted by the Maine Department of Health and Human Service. The state currently offers limited benefits for adults that include treatment for traumatic injuries, severe pain, the elimination or prevention of infection and several other services defined in current law. As
introduced, the bill also required the Department of Health and Human Services to create an incentive program to reward dentists who significantly increased their number of Mainecare patients or provided services to a disproportionate number of Mainecare patients, but those provisions were struck from the final bill.
On May 30, Maine state legislators also passed a bill to provide coverage for dental services under Medicaid for adults who have an intellectual disability, autism spectrum disorder or who receive home-based or community-based services under the brain injury and other related conditions waivers under Medicaid. The bill requires individuals who receive benefits under the legislation to have the same benefits as those provided to individuals under the age of 21 who receive dental coverage under Medicaid. Both bills will now go to the appropriations table for review before being sent to the governor.
Appropriations Take the Next Step
The U.S. House of Representatives will begin an aggressive schedule to complete action on all 12 appropriations bills by the end of June. The plan involves packaging several bills together and considering them as a group rather than as individual bills. The first such package,
H.R. 2740, will be on the floor the week of June 10. This package includes five appropriations bills, including the Labor, Health and Human Services, Education, and Related Agencies bill and the U.S. Department of Defense bill. This huge bill is expected to pass. The U.S. Senate has not yet begun the process of marking up bills and still must settle on overall numbers for FY20 spending before its Committee on Appropriations can begin work. We are hearing rumors that the Committee will begin reporting bills during the week of June 24. Watch future issues of ADEA Advocate for updates.
American Dream and Promise Act
On June 6, the U.S. House of Representatives approved the American Dream and Promise Act (H.R.6) by a vote of 237 to 187, with seven Republicans joining 230 Democrats in voting for the bill. The American Dental Education Association joined the American Council on Education and 40 higher education groups in sending a letter to all members of the House, including Speaker Nancy Pelosi (D-CA) and Minority Leader Kevin McCarthy (R-CA) before the vote, expressing their strong support for the bill’s passage.
The legislation would grant Dreamers 10 years of conditional Permanent Resident Status. At the end of that period, if they remain in school, employed or in the military and do not commit a crime, they may apply for actual Permanent Resident Status/a green card.
It is substantially similar to a bipartisan bill in the U.S. Senate introduced by Sens. Lindsey Graham (R-SC) and Dick Durbin (D-IL) along with two other Republicans and two other Democrats. Senate action is uncertain at this point. President Donald Trump has threatened to veto the bill.
Connecticut May Eliminate Live Patients Exams and Make Additional Changes to Licensure Laws
On June 4, the Connecticut General Assembly passed a bill that made changes to the state’s requirements for initial licensure, continuing education and the scope of practice for dental hygienists under supervision. HB 7303 will head to the desk of Gov. Ned Lamont (D), and if signed into law will make significant changes that include:
Eliminating examinations with human patients by July 1, 2021, or upon the Connecticut State Dental Commission’s approval of exams that do not require the participation of patients. Establishing a one-year clinical residency as a standard requirement for licensure as a dentist. The State Dental Commission may, with the consent of the Commissioner of the Connecticut Department of Public Health, accept the results of clinical or practical examinations, in lieu of the clinically based postdoctoral general residency. Reducing the amount of a time a practicing dentist is required to practice from five years to one year before being eligible for licensure by credentials. (Current law allows, but does not require, the Department of Public Health to issue a license by credentials to individuals who hold a license from another jurisdiction). Allowing dentists and dental hygienists to substitute eight hours of volunteer practice at temporary dental clinics for one hour of continuing education, up to 10 hours in a 24-month period. Allowing dental hygienists to take alginate impressions of teeth, under the indirect supervision of a dentist, for use in study models, orthodontic appliances, whitening trays, mouth guards and fabrication of temporary crowns. Clarifying that state law does not prohibit a dental hygiene student from performing dental hygiene work as a component of coursework, provided such work is performed under the direct supervision of a dentist and other conditions are met. Allowing dentists to administer the finger-stick procedure to measure a patient’s HbA1c percentage. Convening a working group to make recommendations regarding the scope of practice, educational and training requirements for dental therapists. The working group is required to report it recommendations to the legislature by Jan. 1, 2020.
Dental News and Views
Uniform Standards for Dental
Therapy?
State requirements for dental therapists—such as rules for training and supervision—can vary, as do the costs. These differences can make licensing and practice more difficult for these midlevel providers. But new model legislation could help standardize the profession.
New model legislation for authorizing the work of dental therapists could lead to more uniformity among state and tribal laws governing how much education these providers should receive and how they should be allowed to practice.
An expert panel of dental educators and leaders, funded in part by Pew, began working in the summer of 2018 on model legislation to serve as a guide for policymakers.
“This model act provides the evidence-based guidance states need to develop licensing laws that protect the safety of patients without unnecessarily driving up the cost of care and inhibiting access for the underserved,” said Jean Moore, director of the Center for Health Workforce Studies in Rensselaer, New York, and a consortium member.
Dental therapists have been authorized to practice in eight states, and at least a dozen more are considering legislation. Expanding their ability to practice would help boost access to quality dental care, especially in areas with shortages of dentists. The therapists typically provide preventive and routine restorative care, such as filling cavities, placing temporary crowns, and extracting severely diseased or loose teeth— always under the supervision of a dentist.
State and tribal rules differ on the length of dental therapy education, the level of dentist supervision, and the array of procedures that dental therapists can provide. In some instances, these rules run counter to what research and practice experience suggest.
Members of the panel crafting the model proposal had concerns about the length of time required for training and education costs. Overly restrictive supervision requirements increase the cost of care and impede efforts to extend access to community locations if they mandate that dental therapists work alongside a dentist. And varying credentialing standards make it difficult for dental therapists to practice in different states.
Policymakers in statehouses that are considering dental therapy legislation must consider such inconsistencies, especially when setting education and supervision requirements. How much is enough to ensure quality and safety while achieving the goal of increased access to dental care?
To answer these questions, the panel turned to a growing base of research on the experience of dental therapists practicing in the United States and abroad. It also reviewed the dental therapy educational standards adopted in 2015 by the American Dental Association’s Commission on Dental Accreditation (CODA), the nation’s sole accreditor of dental education programs.
Among its provisions, the model law says that:
Educational programs must be accredited by CODA or approved by the state dental board. Dental therapy education programs must offer a minimum of three academic years to allow students to master about one-fourth of the scope of practice of a dentist, an approach that follows the CODA guidelines. As with the accreditation standards, the language is silent on degree level, which each educational program could determine. Dentists must supervise dental therapists under the terms of a written management agreement.Therapists would be allowed to work under “general” supervision, treating patients without the presence of a dentist to the extent authorized by the supervising dentist. Dental therapists are not required to be credentialed as dental hygienists.
“Institutions of higher education should have the freedom to develop a variety of programs, students should have the freedom to choose the credential that best meets their goals, and employers should be able to determine the type of education and training that best meets their practices’ needs,” said Colleen Brickle, a panel member who runs a Minnesota dental therapy training program. The program, jointly operated by Normandale Community College and Metropolitan State University, offers a master’s degree in dental therapy to credentialed hygienists.
“The CODA educational standards for dental therapy education should now be seen as the gold standard in the U.S.,” added Mary Williard, a panel member and head of the Alaska Dental Therapy Educational Program. Ilisagvik College, which hosts the program, is the first dental therapy training program to apply for CODA accreditation.
The expert panel included dental school leaders, a state dental board director, dental employers, researchers, dental therapy and hygiene educators, and state government and tribal leaders.
Jane Koppelman directs the research portfolio for The Pew Charitable Trusts’ dental campaign.
HealthProCHOICES A newsletter for participants in the Health Professionals’ Services Program (HPSP) April 2019
"Anyone who stops learning is old, whether at twenty or eighty. Anyone who keeps learning stays young. The greatest thing in life is to keep your mind young." Henry Ford
2019 Oregon Professional Recovery Network Conference The Oregon Professional Recovery Network delivered an excellent conference for 2019. HPSP was well represented with Operations and Toxicology Lead, Tina and Agreement Monitors Jenn, Kate, and Scott in attendance. It is always nice to meet current and past HPSP participants. Monitoring Programs Director, Christopher and Scott presented on HPSP and all things toxicology. We look forward to seeing you at the 2020 Conference. We will share the date as soon as it becomes available. For more information on the PRN, please visit: http://prnoforegon.org.
Spring and Summer Travel Plans?
Please remember that travel requests need to be made two weeks in advance in order to guarantee appropriate site allocation and chain of custody form distribution. The Guideline for Toxicology Testing Exemptions and all other HPSP Guidelines are available at www.RBHMonitoring.com.
Additional Over-the-Counter Allergy Relief Reminder
Allergies will soon be in full force. As a reminder, several over-the-counter medications may have sedating or stimulating effects. These include centrally acting antihistamines, such as diphenhydramine (Benadryl), and hydroxyzine (Vistaril or Atarax). Like prescriptions with addictive potential and/or psychotropic medications, be sure to have your primary care provider complete a Medication Management Form (MMF) prior to use of these OTC medications. The MMF and other useful forms are available at www.RBHMonitoring.com.
HPSP Outreach
The HPSP Team is scheduling informational sessions on HPSP. If the administrators of your health care workplace are interested in learning more about HPSP, please ask them to contact Christopher Hamilton, Ph.D. (503-802-9813; [email protected]) for more information, or to schedule a meeting. An
Company Reliant Behavioral Health (RBH) Behavioral Reliant Allergies: Nothing to Sneeze At
Like other allergy symptoms, hay fever's leaky eyes, runny nose, sneezing, and burning palate mean your immune system is overreacting to an otherwise harmless substance you've inhaled, swallowed, or touched.
"The immune system is our defense mechanism," explains allergy specialist S. Michael Phillips, M.D., a University of Pennsylvania professor of medicine and neurology. "It has been ordered to destroy substances foreign to our bodies."
But the chemical weapons your immune system unleashes on these "allergens" have powerful inflammatory properties. The result? Those runny noses and eyes, or a variety of other symptoms from hives to itchy skin.
Roughly one person in four has some kind of allergy. The most common is "allergic rhinitis," which includes seasonal hay fever and year-round allergies to dust, pollen, animal dander, mold, and some foods.
Here are some common questions about allergies:
Q: How can I pinpoint the cause of my allergies?
A: You may already know what exposures trigger your allergies - like the spring pollen season, dust, or certain pets. But if you are unsure, skin or blood tests can help identify the allergens that plague you. Once you know what you are allergic to, you can take steps to avoid your allergen(s) and tailor your medical treatment to prevent and control symptoms.
Q: How can I minimize my exposure to allergens?
A: Components of dust such as animal dander, molds, and dust mites can cause allergic reactions, says the American Academy of Allergy, Asthma and Immunology (AAAAI). Keep your home clean and uncluttered, remove carpeting, avoid smoke and other irritants, and use air conditioners to keep pollen outside and dehumidifiers to curb moisture (if you live in a humid climate), limiting dust mites and mold. If a pet triggers your allergy, you may have to find your pet a new home. At the very least, keep your pet out of the bedroom and outside the house if possible.
Q: What medication should I take for hay fever?
A: Antihistamines dominate the market. As the name implies, block histamines - the substances your body releases that cause hay fever and animal allergies. Older antihistamines tend to cause drowsiness more than the new generation of prescription medications. One of the less sedating medications, loratidine, is available without a prescription. "Because the active ingredient works without entering the brain, they alleviate your symptoms without making you sleepy," says Texas allergist Susan Rudd Wynn, M.D. New time-released antihistamines can last up to 24 hours. However, the advantage of the older antihistamines is that they work faster and are cheaper than the newer ones. Remember before taking any antihistamines to check with your prescriber and have them fill out a Medication Management Form. The HPSP Medication Management Form and associated cover letter are available at www.RBHMonitoring.com.
Q: What about nasal sprays?
A: Newer prescription-only sprays are safer than many over-the-counter decongestant sprays that can be habit-forming if used improperly. "New synthetic cortisone sprays have been designed to relieve swelling in the nose," explains Dr. Wynn. "New antihistamine sprays work like their oral counterparts - to reduce symptoms without causing drowsiness."
Q: Do allergy shots help?
A: Doctors can inject increasing concentrations of allergic material into your body to build immunity and ease allergy symptoms. "These days, the majority of sufferers don't need allergy shots," says Robert Miles, M.D., vice president of the American College of Allergy, Asthma, and Immunology. But the AAAAI says allergy shots can help when your symptoms are moderate to severe, occur more than two to three months a year, don't respond well to medications and involve an allergen that is not easily avoided. Allergies: Nothing to Sneeze At (Continued)
Q: Why do I have allergies if my spouse doesn't?
A: Blame genetics. "If one of your parents is allergic, there is a 25 to 30 percent chance you will be," explains Dr. Phillips. "If both are allergic, the likelihood increases to 75 percent."
Q: If I move to another part of the country, will I leave my allergies behind?
A: "You may escape the allergens your body is already familiar with," says Dr. Miles, "but, after a little while, you'll develop new allergies," probably within three years.
Q: So I'm stuck with allergies for my whole life?
A: Age works in your favor. Allergies peak from ages 35 to 45, then level off. As the immune system starts wearing out in our 60s, we have fewer reactions to allergens. After age 75, it's unusual to suffer allergies.
Q: Can I keep my kids from inheriting allergies?
A: No, but you can affect their development and severity. "Breast-feeding for up to nine months is highly recommended," says Dr. Miles. To prevent food allergies, delay exposure to potentially allergenic foods. Solid foods should be delayed until 6 months of age, the AAAAI says. Then introduce very bland foods, one food type at a time. Keeping your home free of pets during the child's early years will help diminish animal allergies later in their lives.
The StayWell Company, LLC ©2019
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Company HealthProCHOICES A newsletter for participants in the Health Professionals’ Services Program (HPSP) May 2019
“Change must start from the individual. And the individual must want and feel ready to make such change.”– Efrat Cybulkiewicz
Memorial Day Testing Holiday Monday, May 27th is Memorial Day which is a testing holiday for HPSP licensees participating in toxicology. On Monday, licensees do not need to check to see if they need to test. Have a safe, extended holiday weekend. For a full list of State of Oregon observed holidays, please visit: www.rbhmonitoring.com.
New HPSP Team Members
Please join us in welcoming our new team members: Tonia Cottrell, LCSW is HPSP’s new Agreement Monitor. Tonia has a master’s degree in social work from Hunter College School of Social Work, City University of New York. In New York, she worked Harlem and the South Bronx with children, adults and families struggling with addiction. In Oregon, Tonia’s career to-date has focused on inpatient and intensive outpatient treatment of dually diagnosed clients. She also had a private practice for 16 years. In her spare time, Tonia enjoys gardening and working in her community to find solutions to houselessness. (This is the newest language that the advocacy groups are using. The concept that they are trying to promote is that people take “home”/sense of home within themselves, but they do not always have a house.)
Kristine Herrington is HPSP’s new Assistant Case Coordinator. Kristine’s experience includes outpatient treatment and medical intake. Kristine has a medical secretary associates degree from Lewis-Clark State College in Lewiston, ID. She completed her Connecticut Community for Addiction Recovery (CCAR) Recovery Coach Certificate in 2016. In her spare time, Kristine is grandmother to 12 grandchildren!
HPSP Outreach
The HPSP Team is scheduling informational sessions on HPSP. If the administrators of your health care workplace are interested in learning more about HPSP, please ask them to contact Christopher Hamilton, Ph.D. (503-802-9813; [email protected]) for more information, or to schedule a meeting.
Wellness Resources
The Indiana State Medical Association has a great new Physician Wellness Resource page with information that can benefit HPSP licensees. For more information visit: http://www.ismanet.org/doctoryourspirit/
Upcoming Events An International Doctors in Alcoholics Anonymous (IDAA) 2019 Meeting. The next IDAA
meeting is July 31 – August 4, 2019 in Knoxville, Tennessee. This is the IDAA’s 70th Company Birthday. The annual meeting will be held at the Knoxville Convention Center. Please visit www.idaa.org for more information. Reliant Behavioral Health (RBH) Behavioral Reliant Ways to Improve Your Workout
A proven way to improve your health is finding— or making—the time to exercise. But just going through the motions won't give you the health benefits you want.
"Doing the same workout over and over can get boring, and you're unlikely to improve because you're always using the same muscles," says Cedric Bryant, chief exercise physiologist of the American Council on Exercise (ACE). "However, changing elements in your routine over time can bring amazing results, which in turn are likely to inspire you to make regular exercise part of your life."
Make Changes
Change the mode or intensity of your training. Altering your routine will help you avoid conditioning plateaus and force your body to adapt to new movements and intensity levels.
The American College of Sports Medicine suggests aerobic, or endurance, exercise three to five days each week and strength training on the other days. If you do aerobic exercise daily, alternate weight-bearing exercise (for instance, walking) with non-weight-bearing exercise (for instance, swimming). Cross training between different weight bearing exercises (walking, biking, elliptical) is also an effective way to vary aerobic exercise and can also reduce the likelihood of overuse injuries.
To avoid injury, it's important not to increase the length or intensity of an aerobic or weight training routine by more than 10 percent a week. If you walk or run, you can spend 10 percent more time doing the activity or increase your effort or speed by 10 percent. To change a resistance or weight routine, increase the number of reps or times you lift a weight, the number of sets you do or the weight you lift by 10 percent. You also can do a different set of exercises that work the same muscle groups.
Hire a Personal Trainer
When you work out with a certified personal trainer, you can focus on the exercise at hand and let the trainer worry about the routine. A trainer also will help you keep your workouts fresh and always progressing. If cost is an issue, hire a trainer for a one-on-one session every few months, or for group sessions with family members or friends. It's very important to notify the trainer of any pain while working out or of any pre-existing or current injuries.
Eat Properly and Stay Hydrated
Without proper nutrition and fluid intake, you can't have a great workout. Your body needs these fuels to build muscle and repair damaged tissue.
Incorporate Mind-body Training
Mind-body fitness routines can improve muscle strength, flexibility, balance and coordination, as well as increase mental development and self-esteem. Try yoga, pilates, tai chi and other martial arts training regimens.
Exercise at the Right Time for Your Body
That is, work with your body's natural energy level, not against it. "There's no 'best' time to work out," says Mr. Bryant. "For instance, if you're not a morning person, you probably won't stick with a 5 a.m. running schedule. Clearly, the best workout time for you is the one you can actually stick with."
Get a Workout Partner An Exercising with a partner makes you accountable to someone else for each workout and can improve your adherence to a program. A partner also can inspire you to push Company yourself when your energy level is low. Ways to Improve Your Workout, cont.
Emphasize Breathing
When strength training, take full breaths during each exercise, exhaling on the exertion and inhaling as you release. During cardiovascular exercise, full breaths will deliver as much oxygen as possible to the working muscles, making them more efficient.
Use a Heart-rate Monitor
A heart-rate monitor is a great tool to gauge how hard your body is working and can help you stay within your target heart- rate training zone.
Listen to Music
Music can make a workout more fun and give you that extra burst of energy you need to work your hardest. "Most people find listening to up-tempo music they like is a positive distraction from the boredom or difficulty of working out," says Mr. Bryant. "As such, it's a valuable tool to help you stick with and gain the benefits of being fit, which include maintaining a healthy weight, managing stress and reducing your health risks."
Reward Yourself
Although the physical and mental improvements from regular physical activity are their own reward, you may find that giving yourself a periodic reward for consistently following a routine beneficial. It may be as simple as putting a small amount of money aside after each workout to buy yourself a new CD.
The StayWell Company, LLC ©2019
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License Ratification
16 . RATIFICATION OF LICENSES
As authorized by the Board, licenses to practice dentistry and dental hygiene were issued to applicants who fulfilled all routine licensure requirements. It is recommended the Board ratify issuance of the following licenses. Complete application files will be available for review during the Board meeting.
DENTAL HYGIENISTS
H7804 NATALIE J HAAS, R.D.H. 4/11/2019 H7805 XIAOHAN PATTERSON, R.D.H. 4/11/2019 H7806 SHAILEE PATEL SHAH, R.D.H. 4/18/2019 H7807 ERIN NICOLE VARNER, R.D.H. 4/26/2019 H7808 AMBER GELDERMANN, R.D.H. 4/26/2019 H7809 SAMANTHA JO CURRY, R.D.H. 4/26/2019 H7810 NHU HOANG, R.D.H. 4/26/2019 H7811 KACY JOY LEUTHOLD, R.D.H. 5/1/2019 H7812 CHLOEE SAZAMA, R.D.H. 5/1/2019 H7813 LINDSEY L TAYLOR, R.D.H. 5/1/2019 H7814 COURTNEY RAMEY CHEAVTHARN, R.D.H. 5/10/2019 H7815 CARA MARIE SCHURMAN, R.D.H. 5/10/2019 H7816 SARAH MARIE GRANBERG, R.D.H. 5/10/2019 H7817 COURTNEY PARIS, R.D.H. 5/10/2019 H7818 BRITTNI LEE ROGERS, R.D.H. 5/17/2019 H7819 ITATI GUILLEN, R.D.H. 5/17/2019 H7820 KAYLA DALE MORGAN, R.D.H. 5/17/2019 H7821 KIRSTEN-NIKKI CHRISTINE ROCHEFORT, 5/17/2019 R.D.H. H7822 MEGHAN KATHLEEN KELLY, R.D.H. 5/17/2019 H7823 KIRSTEN MICHELLE GARNERO, R.D.H. 5/17/2019 H7824 STACY LYN BICKNELL, R.D.H. 5/17/2019 H7825 XOCHITL B URBIETA, R.D.H. 5/23/2019 H7826 DESIREE RENE JESS, R.D.H. 5/23/2019 H7827 ALLYSON ELYSE ANDERSON, R.D.H. 5/23/2019 H7828 ALAINA MADSEN, R.D.H. 5/23/2019 H7829 JESSICA CHRISTINE HOTALING, R.D.H. 5/23/2019 H7830 JORDAN MCKENZIE YECHOUT, R.D.H. 5/23/2019 H7831 JANEEN S PEIL, R.D.H. 5/23/2019 H7832 MICHAEL TROFIMCHIK, R.D.H. 5/23/2019 H7833 SIERRA CHRISTINE SHUEY, R.D.H. 5/23/2019 H7834 KRISTEN LEE JOHNSON, R.D.H. 5/23/2019 H7835 DEVAN FROMWILLER, R.D.H. 5/23/2019 H7836 CRYSTAL LUCILLE ANDERSON, R.D.H. 5/23/2019 H7837 RACHEL HAUSER, R.D.H. 5/23/2019 H7838 KIMBERLY L PARKER, R.D.H. 5/23/2019 H7839 MOLLY MARIE MANGUAL, R.D.H. 5/23/2019 H7840 BRITTNEY KAYE ROBERTSON, R.D.H. 5/23/2019 H7841 MARIA ELENA SANCHEZ-GUTIERREZ, 6/4/2019 R.D.H. H7842 SHANE MARCUS PAAP, R.D.H. 6/4/2019 H7843 RACHEL DANIELLE STONE, R.D.H. 6/4/2019 H7844 LILLIAN Q DO, R.D.H. 6/4/2019 H7845 MEGAN CHRISTINE HANKS, R.D.H. 6/4/2019
DENTISTS
D11024 PANAGIOTA STATHOPOULOU, D.M.D. 4/11/2019 D11025 CHET L JENKINS, D.D.S. 4/11/2019 D11026 KEVIN M WOODY, D.M.D. 4/11/2019 D11027 EDWARD SUNGWON NAM, D.D.S. 4/18/2019 D11028 ANTHONY C OKOLI, D.M.D. 4/22/2019 D11029 ANNA TU-ANH NONAKA, D.D.S. 4/22/2019 D11030 ANTHONY T ADAMS, D.M.D. 4/26/2019 D11031 MARC A RASMUSSEN, D.D.S. 4/30/2019 D11032 JAMES GARRy LIVINGSTON, D.D.S. 5/1/2019 D11033 BRIAN HALE NELSON, D.M.D. 5/1/2019 D11034 TYLER DALE HANKS, D.M.D. 5/1/2019 D11035 BRYAN CLEVENGER, D.D.S. 5/1/2019 D11036 RAMYA S KAMATH, D.D.S. 5/1/2019 D11037 BROCK JESSE NELSON, D.M.D. 5/10/2019 D11038 JUSTIN LANE HARRIS, D.D.S. 5/10/2019 D11039 GEOFFREY RICHARD CLIVE, D.D.S. 5/10/2019 D11040 SUSANA LEE, D.M.D. 5/10/2019 D11041 JILLIAN ROSE, D.M.D. 5/17/2019 D11042 JOE WAYNE HOWARD, D.D.S. 5/17/2019 D11043 MICHAEL A HOLM, D.D.S. 5/17/2019 D11044 KELSEY L LOONTJER, D.D.S. 5/17/2019 D11045 SUSAN STROMMER, D.M.D. 5/24/2019 D11046 ANNE STEINBERG, D.M.D. 5/24/2019 D11047 LEAH DIANE LEONARD, D.D.S. 5/24/2019 D11048 DANIEL HALSEY REYNOLDS, D.M.D. 5/24/2019 D11049 WILLIAM ANTON WANNINGER, D.M.D. 5/24/2019 D11050 HILLARY EATON LATHROP, D.M.D. 5/24/2019 D11051 ROMAN LEO ZAKHARIYA, D.M.D. 5/24/2019 D11052 JULIE M STRAUSS, D.M.D. 5/24/2019 D11053 SEI JIN KIM, D.M.D. 6/4/2019 D11054 MARIYA S MELNIK, D.M.D. 6/4/2019 D11055 KRISTA JEAN LILL, D.D.S. 6/4/2019 D11056 LAVONNE HAMMELMAN, D.M.D. 6/4/2019 D11057 KYLE EDWARD HERNDON, D.D.S. 6/4/2019 D11058 COLBY DIMOND, D.D.S. 6/4/2019 D11059 JAD MOURAD, D.M.D. 6/4/2019 D11060 EVAN CHRISTIAN WHISENANT, D.M.D. 6/4/2019 D11061 ANDREW CHARLES LANE, D.M.D. 6/4/2019 D11062 RODHERICK HU, D.M.D. 6/4/2019 D11063 ADAM C SHERON, D.M.D. 6/4/2019
License, Permit & Certification
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