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New Mexico Dental Health Care
REGULAR BOARD MEETING
Friday, January 30, 2015
Santa Fe, NM
MEETING MINUTES - DRAFT
CALL TO ORDER
At 9:31 a.m. the Board Chair, Dr. Charles Schumacher, DDS, called the New Mexico Board of Dental Health Care January 30, 2015 meeting to order.
ROLL CALL
MEMBERS PRESENT: Charles Schumacher, DDS
Burrell Tucker, DDS
Kimberly Martin, DMD
Leo Paul Balderamos, DDS
Jolynn Galvin, DDS
Ermelinda Baca, RDH
Denise Teague-Myrick, RDH
Richard Hatch, Public Member
Robert Blewer, Public Member
MEMBERS ABSENT:
OTHERS PRESENT: Jennifer Salazar, Assistant Attorney General
STAFF PRESENT: Roberta Perea, Board Administrator
Melissa Saiz, Administrative Assistant
Brian McBain, Compliance Liaison
Roll Call was taken by Roberta Perea and a quorum was determined present.
APPROVAL OF AGENDA
Ms. Ermelinda Baca, RDH made a MOTION to approve the agenda as written. Dr. Burrell Tucker, DDS SECONDED the motion which was PASSED by UNANIMOUS APPROVAL.
1. APPROVAL OF MEETING MINUTES
October 17, 2014 Regular Meeting & October 17, 2014 Rule Hearing
Dr. Jolynn Galvin, DDS made a MOTION to approve the minutes of the October 17, 2014 Regular Meeting & October 17, 2014 Rule Hearing as written/amended. Ms. Ermelinda Baca, RDH SECONDED the motion which was PASSED by UNANIMOUS APPROVAL.
2. REPORTS
A. Introduction of new Compliance Officer
B. Chair’s Report – Dr. Charles Schumacher, DDS
Written & Verbal Report – (Attachment A)
C. Secretary’s Report – Dr. Burrell Tucker, DDS
Dr. Burrell Tucker, DDS reported to the board that from October 1, 2014 through January 16, 2015 the following licenses were issued:
12 Dental licenses issued by Examination
8 Dental licenses issued by Credentials
83 Dental Assistant Certificates
1 Expanded Function Dental Auxiliary Certificates
0 Community Dental Health Coordinator Certificates
1 Non-Dentist Owner
Dr. Paul Balderamos, DDS made a MOTION to enter the Boards Secretaries report into record. Ms. Denise Teague-Myrick, RDH SECONDED the motion which was PASSED by UNANIMOUS APPROVAL.
D. Dental Hygienist Committee Report – Ms. Ermelinda Baca, RDH
Dr. Burrell Tucker, DDS made a MOTION to ratify the recommendations of the Dental Hygienist Committee. Dr. Jolynn Galvin, DDS SECONDED the motion which was PASSED by UNANIMOUS APPROVAL.
Licenses Issued for Period 10/01/15 thru 01/16/2015
8 Dental Hygienists by Examination
2 Dental Hygienists by Credentials
E. Anesthesia Committee Report – Dr. John Mitchell, DDS – (Attachment B)
Dr. John Mitchell, DDS reported to the board that from October 1, 2014 thru January 16, 2015 the following permits were issued:
15 Nitrous Oxide Permits,
3 Conscious Sedation I permit,
1. Conscious Sedation II permits
2. Deep Sedation/General Anesthesia permits
Dr. Burrell Tucker, DDS made a MOTION to enter the anesthesia committee’s report into record. Ms. Ermelinda Baca, RDH SECONDED the motion which was PASSED by UNANIMOUS APPROVAL.
F. Administrator’s Report – Ms. Roberta Perea
Written Report – (Attachment C)
G. Compliance Liaison Report – Mr. Brian McBain
No Report
H. Health Action New Mexico Report – Ms. Pamela K. Blackwell, JD
Written Report – (Attachment D)
I. CODA Report. Charles Schumacher, DDS
No Report
J. NMDHA Report – Ms. Mary Kay Vigil, RDH
Verbal Report
K. NMDA Report
No Report
L. NM Department of Health Report – Ms. Carol Hanson, RDH
Written Report – (Attachment E)
M. NM Health Services Medicaid Report – Dr. Devi Gajapathi
No Report
N. PIMA Report – Ms. Melissa McDougal-Plese
No Report
O. AADB – Dr. Burrell Tucker, DDS
No Report
P. WREB Report – Ms. Ermelinda Baca, RDH
Verbal Report
Q. CRDTS Report –Ms. Ermelinda Baca, RDH
Verbal Report – (Attachment F)
R. NERB Report – Ms. Ermelinda Baca, RDH
Verbal Report – (Attachment G)
S. SRTA Report
No Report
T. ADEX Report
Written Report – (Attachment H)
U. CITA Report – Dr. Kimberly Martin, DMD
No Report
V. Prescription Drug Misuse and Overdose Prevention and Pain Management Advisory Council Report
Written Report – (Attachment I)
W. Rules Committee – Dr. Charles Schumacher, DDS
Verbal Report
X. Statutes Committee – Dr. Charles Schumacher, DDS
No Report
Y. Ad Hoc Committees
Verbal Report
3. OLD BUSINESS
A. Confirm Future Meeting Dates and Locations
April Board Meeting – April 24, 2015 – Albuquerque
July Board Meeting – July 17, 2015 – Ruidoso
October Board Meeting – October 16, 2015 – Santa Fe- Rule Hearing
January Board Meeting – January 30, 2015 – Santa Fe
B. WREB Exam Letter – Ms. Ermelinda Baca – No Action Taken
4. NEW BUSINESS
A. Mobile Dentistry – Dr. Schumacher – No Action Taken
B. Approval of Regional Exams for Dentists 2015 – Dr. Schumacher
Dr. Burrell Tucker, DDS made a MOTION to approve with the addendum that any optional portion of the exam must be taken for those particular exams for dentists. Dr. Balderamos, DDS SECONDED the Motion. Motion PASSED by UNANIMOUS APPROVAL.
C. Refer to rules committee to research adding (a definition of Clinical Dental Hygiene Standards of Practice and adopting the ADHA’s Standard of Practice Document.) – Ms. Ermelinda Baca
No Action Taken
D. Appointing a member from the committee to attend an Accreditation site visit to the Roswell Dental Hygiene Program and DACC– Ms. Ermelinda Baca, RDH
No Action Taken
E. Discussion on not for profit dental practice owned by a dental hygienist needs to register as a non-dentist owner – Ms. Ermelinda Baca, RDH
No Action Taken
F. Anti-Trust Discussion – Ms. Ermelinda Baca
No Action Taken
G. Approve Hearing Officers
Dr. Burrell Tucker, DDS made a MOTION to approve the following hearing officers: Dr. Robert Gherardi, DMD, Dr. Edward Ebell, DDS and Dr. Mark Yarbrough. Ms. Ermelinda Baca, RDH SECONDED the Motion. Motion PASSED by UNANIMOUS APPROVAL.
H. Public Comment
5. EXECUTIVE SESSION
Chair: I will hear a motion for closure of the meeting to enter into Executive Session.
Board Member Dr. Kimberly Martin, DMD: I move that the New Mexico Dental Health Care Board close this meeting in order to enter into Executive Session to discuss the items listed in the agenda. Pursuant to Sections 10-15-1.H 1, 3 &7 of the Open Meetings Act authorizing closed sessions for matters related to issuance, suspension, renewal, revocation of a license. Ms. Ermelinda Baca, RDH SECONDED the motion. Motion PASSED by UNANIMOUS APPROVAL.
Chair: Would the Board Administrator take a roll call vote to enter into Executive Session?
Roll Call Vote:
Charles Schumacher, DDS
Burrell Tucker, DDS
Kimberly Martin, DMD
Leo Paul Balderamos, DDS
Jolynn Galvin, DDS
Ermelinda Baca, RDH
Denise Teague-Myrick, RDH
Richard Hatch, Public Member
Robert Blewer, Public Member
Chair: The motion is approved by a unanimous approval. Let the record show that at 10:47a.m. the Board entered into closed session and the recorder has been turned off.
Back in Open Session
Let the record show that the recorder is back on. The New Mexico Board of Dental Health Care is back in open session. The time is 12:25p.m. Pursuant to 10-15-1 H 1, 3 & 7 of the Open Meetings Act the matters discussed in the closed meeting were limited only to the items listed in the motion.
6. BOARD ACTION ON MATTERS DISCUSSED IN EXECUTIVE SESSION
Let the record show that the Complaint Committee Members Dr. Kimberly Martin, DMD and Mr. Robert Blewer, Ms. Ermelinda Baca, RDH and Dr. Jolynn Galvin, DDS abstained from voting on complaints and pre-NCA settlement agreements.
(Items listed on Agenda)
Retirement Status
Dennis R. Miller
Ms. Ermelinda Baca, RDH made a MOTION to rescind the motion from the October 17, 2014 board meeting and place Dr. Miller’s license back into active status. Dr. Paul Balderamos, DDS SECONDED the motion. Motion PASSED by UNANIMOUS APPROVAL.
Applications for Consideration:
14-61-APP
No Action was taken by the Board on this item.
14-62-APP
No Action was taken by the Board on this item.
15-01-APP
Mr. Richard Hatch made a MOTION to issue and NCA to Deny this application and refer to the AGO for a Pre-NCA Stipulation of Licensure Agreement for violation of 61-5A.21 (A)(6), (A)(13) and 61-5A-12(C), with the following terms proposed for early resolution: (1) Respondent shall abstain completely from the use of mind-altering substances, except as legitimately prescribed. 2) Respondent shall register and report to the MTP. Dr. Burrell Tucker, DDS, SECONDED the motion. Motion PASSED by UNANIMOUS APPROVAL.
15-02-APP
Mr. Richard Hatch made a MOTION to issue an NCA to Deny the application and refer to the AGO for an NCA for violations of 61-5A.21 (A)(6), (A)(13) and 61.5A.12(C). The Board also directs the Compliance Liaison to expedite the NCA referral. Ms. Denise Teague-Myrick, RDH, SECONDED the motion. Motion PASSED by UNANIMOUS APPROVAL.
COMPLAINTS:
Dr. Burrell Tucker, DDS made a MOTION to dismiss the following case(s): 14-49-COM, 14-56-COM, 14-82-COM, and 14-83-COM: Dr. Leo Paul Balderamos, DDS SECONDED the motion. Motion PASSED by UNANIMOUS APPROVAL.
Ms. Denise Teague-Myrick, RDH, made a MOTION to dismiss with Advisory Letter, the following case(s):13-72-COM, 14-55-COM, 14-59-COM, 14-66-COM, 14-70-COM, 14-81-COM, 14-84-COM, 14-86-COM, 14-90-COM: Dr. Leo Paul Balderamos, DDS, SECONDED the motion. Motion PASSED by UNANIMOUS APPROVAL.
14-73-INC, 14-74-INC, 14-75-MAL, 14-76-MAL, 14-78-MAL, 14-79-MAL, 14-88-MAL, 14-89-MAL, 14-91-MAL, 14-92-MAL:
No Action was taken by the Board on these items; these items were placed on the agenda for informational purposes only.
14-54-COM
No Action was taken by the Board on this item.
14-80-COM
Ms. Denise Teague-Myrick, RDH, made a MOTION to refer to the AGO for a Pre-NCA Settlement Agreement for violation of 61-5A-21 (A)(5) and Rule 16.5.16.10 (A), for a demonstration of gross incompetence, with the following terms proposed for early resolution: Respondent shall voluntarily surrender their Dental License to practice within the State of New Mexico. Should the Pre-NCA Settlement Agreement fail the AGO may proceed with the issuance of a Notice of Contemplated Action. Dr. Leo Paul Balderamos, DDS, SECONDED the motion. Motion PASSED by UNANIMOUS APPROVAL.
PRE-NCA Agreements for Board Approval
13-69-COM
Ms. Ermelinda Baca, RDH, made a MOTION to Reject the Pre-NCA Agreement offered by Respondent. The Board will only settle the case based upon the Board’s original settlement terms. Mr. Richard Hatch SECONDED the Motion. Motion PASSED by UNANIMOUS APPROVAL.
14-10-APP
No Action was taken by the Board on this item.
DISCUSSION AND BOARD ACTION
| |
|Nothing at this time |
REPORTS
New Mexico Monitored Treatment Quarterly Report
7. ADJOURNMENT
There being no other business to come before the Dental Board, Dr. Burrell Tucker, DDS made a MOTION to adjourn the meeting at 12:35p.m. Ms. Ermelinda Baca, RDH SECONDED the motion. Motion PASSED by UNANIMOUS APPROVAL.
Submitted by: ___________
Roberta Perea, Board Administrator Date
Approved by: ________________________________________ ___________
Dr. Charles Schumacher, DDS Date
Attachment A
Chair Report- January 2015
Our additions and revisions of Rules will be in place this month. Thanks to all for all the hard work in the Rules Committee and the staff for the implementation. We will be sending out a newsletter to all licensees explaining the changes and also most common oversights and errors by dentists, hygienists, and non-dentist owners.
Enclosed in your meeting information CD is the proposal by the state of Michigan to require mobile dental providers to register with the Dept of Health. I think we could do something similar in Rules, maybe not as extensive, but mainly to provide information for follow-up care after patient treatment. As I understand it now, this is being done in NM, but I am not aware any documentation requirement.
I am hearing more concern of some Board and Committee members not being reimbursed for expenses in a timely manner. I hope that this issue can be resolved quickly. If there are staffing shortages, maybe the state can address this in order to keep our Board running smoothly.
On the ongoing discussion of the concept of dental therapists, again, it is our charge is to ensure we do everything we can to protect the public. This should be the guiding factor in reviewing any changes in the practice act that increases scope or introduces alternate providers. Please be sure to read the entire revised bill proposed by Health Action New Mexico before our meeting so that you will be familiar with its contents and how it affects the board and committee.
The Dental-Hygiene Liaison Committee, made up of members of both the NMDA and NMDHA, is still working on an alternate dental therapist bill, and will probably be introducing it by the time we have our meeting on January 30. As of the time of this submitted report, I have not seen a bill.
This is not a complete Chair Report due to the quickness of the legislative actions, so I may be reporting more information at the meeting.
Thank you to all the members of the Committee, Board and staff for all their hard work!
Charles M. Schumacher, DDS
Attachment B
January 2015
The New Mexico State Board of Dental Health Care Anesthesia Committee Agenda for 13 January 2015:
1. Read the minutes of the last meeting.
2. A discussion regarding examinations performed and/or permits approved since the last meeting.
3. Make assignments for members of the Anesthesia Committee for completion of Office Anesthesia Evaluations which are pending.
4. Discuss recommendation Dr. Flores about the possibility of amending the requirements for facilities for anesthesia providers. (see addendum#1 from Dr. Flores)
5. Re-discuss amending/creating a list of sedative agents which can be used by CSII permit holders such that induction agents (e.g. Propofol) could be used only by DS/GA permit holders. ( see addendum#2 from Dr. Flores)
6. Discuss dilemma re DS/GA by “Colorado Group” location in Santa Fe-Saint Michaels Drive
7. Adjournment.
Permits recommended for approval since last committee meeting:
A. Nitrous Oxide/ Oxygen
a. Afsaneh Kadkhoda Albuquerque
b. Amanda Schneider Albuquerque
c. Barney Carter Albuquerque
d. Chanmin Park Artesia
e. Chun-Xiao Sun Albuquerque
f. Jennifer Lapsker Albuquerque
g. Justin Heaton Farmington
h. Keely Chavez Albuquerque
i. Leilani Tanaka Albuquerque
j. Melissa Potacki Clovis
k. Michael Lysonski Albuquerque
l. Nidi Taneja Clovis
m. Richard Yai-Ni Farmington
n. Youngsil Jo Artesia
B. CSI:
a. Kaitlyn Purcell Albuquerque Permanent (Initial)
b. Phillip Absere Albuquerque Permanent (Initial)
C. CSII None
D. DS/GA
a. Jeremy Hixson Farmington Temporary (Initial)
b. Jon Wagner Albuquerque Temporary (Initial)
Office Anesthesia Evaluations Completed
A. CSII
a. Joshua Ellis Las Cruces Permanent (Initial facility only)
B. DS/GA
a. Robert Urquhart Albuquerque Permanent (Renewal)
b. David Cundick Farmington Permanent (Initial)
Office Anesthesia Evaluations Pending:
A. CSII
a. Keigm Crook Albuquerque Renewal (Dec ’14)
b. Logan Behrman Alamagordo Initial (Dec ’14)
c. Venkata Nalla Hobbs Initial (April ’15)
d. Michael Tornow Rio Rancho Renewal (Oct ’14)
e. Kendra Velasquez Rio Rancho Initial (Mar ’15)
B. DS/GA
a. Sean Healy
i. Santa Fe Initial (June ’14)
ii. Taos Initial-Facility only
iii. Los Alamos Initial-Facility only
b. Nathan Gunning Portales Initial-Facility only
c. Jon Wagner Albuquerque Initial (April ’15)
d. Jeremy Hixson Farmington Initial (Jun ’15)
Addendum #1
For any anesthesia provider, dentist, physician, nurse anesthetist providing deep sedation/general anesthesia in a dental office, the operatory in which anesthesia will be administered must:
a. have a site certification issued by the NM Anesthesia Board
b. be large enough to accommodate the patient in an operating chair/table, permit easy movement of
the anesthesia and surgical team, and allow for easy access of emergency wheeled equipment
The operator administering anesthesia must:
a. demonstrate that drug supplies are kept at manufacture recommended temperatures during out-of-
office travel
b. verify appropriate training for the level of anesthesia being provided
c. verify appropriate case documentation for pediatric (age 12 and under) cases if anesthesia is to be
provided to children
d. Anesthesia for children (age 12 and under) must be provided in a facility that is large enough to
accommodate the patient in an operating chair/table, permit easy movement of the anesthesia and
surgical team, and allow for easy access of emergency wheeled equipment
A dentist who does not hold a deep sedation/general anesthesia permit may not allow any persons to administer anesthesia to his/her patients unless the treatment is rendered in a facility that meets the above size requirement.
Addendum #2
(1) A dentist without a deep sedation/general anesthesia permit shall not administer or employ any agent(s) which has a narrow margin for maintaining consciousness, including, but not limited to,
(a) Ultra short acting barbiturates including, but not limited to, sodium methohexital, thiopental, thiamylal;
(b) Alkylphenols — propofol (Diprivan) including precursors or derivatives;
(c) Neuroleptic agents;
(d) Dissociative agents — ketamine;
(e) Etomidate; and similarly acting drugs
(f) Rapidly acting steroid preparations; and
(g) Volatile inhalational agents.
(h) Or quantity of agent(s), or technique(s), or any combination, thereof, that would possibly render a patient deeply sedated or generally anesthetized
These drugs/techniques are conclusively presumed to produce general anesthesia and may only be used by a licensee holding a valid deep sedation/general anesthesia permit issued by the board.
(2) A licensee that does not hold a deep sedation/general anesthesia permit may not administer, for purpose of anxiolysis or sedation, benzodiazepines or narcotics in children under 12
Discussion: Addendum #2: Regarding Diprivan (propofol), ketamine, inhalation anesthetics, & etomidate their drug class is "general anesthetics," intended for use by practitioners who are well trained in GA (per FDA packaging). Barbituates are also considered rapid acting general anesthetics. The before mentioned drugs have a very narrow margin of safety and can result in both centralized and/or obstructive apnea very quickly. It is up to the provider to quickly figure out which one they have induced.
Versed (midazolam) has a wide margin of safety (large Theraputic Index.)
Other drugs like Precedex (Dexmedetomidine), IV clonidine, very rapid-acting narcotics i.e. remifentanyl can result in centralized apnea, profound hypotension, or rigid chest also very quickly (narrow margin of safety).
With discussions about safety and "protecting the public," its not the drug or the state it induces that is the "bad guy," it’s the "margin of safety," (how quickly can an unsafe/unintended situation be created by the operator) that needs to be considered. The next consideration is "does the operator have the CLINCAL training, skill, or experience to RAPIDLY get themselves out of the situation they created?" (Not just apnea, but arrythmias, profound hypotension, bradycardia, ventilation/perfusion mismatch, CNS depression…)
Most states like Oregon, Florida, California, and others have wording that specifically excludes any drug classified as a "General Anesthetic" or "Rapidly acting barbituate/narcotic" from the CS II permit holder. Or the state dental boards name specific drugs, i.e. Propofol, ketamine, etc. Texas is working on their new wording to exclude these drugs from CSII permits now.
In 2010, the FDA upheld the American Society of Anesthesiology's statement on propofol. “For general anesthesia or monitored anesthesia care (MAC) sedation, DIPRIVAN Injectible Emulsion should be administered only by persons trained in the administration of general anesthesia"
Just food for thought,
John C. Mitchell DDS
Chairman of Anesthesia Committee
Attachment C
Administrator’s Report
Board of Dental Health Care 1/30/2015
Board membership
|Member |Name |Start Date |Expiration Date |Term # |
|Professional Member, Board Chair |Charles Schumacher, DDS |04/19/2011 |07/01/2018 |2nd |
|Professional Member, Vice Chair |Kimberly Martin, DMD |04/15/2011 |07/01/2013 |1st |
|Professional Member, Secretary |Burrell Tucker, DDS | |07/01/2016 |2nd |
|Professional Member |Leo Paul Balderamos, DDS |12/10/2013 |07/01/2017 |1st |
|Professional Member |Jolynn Galvin, DDS |11/05/2013 |07/01/2014 |1st |
|Dental Hygiene Committee Representative |Ermelinda Baca, RDH | |07/01/2016 |1st |
|Chair of the Hygiene Committee | | | | |
|Sits on Hygiene Committee & Board | | | | |
|Dental Hygiene Committee Representative |Denise Teague-Myrick, RDH | |07/01/2015 |1st |
|Vice Chair of Hygiene Committee | | | | |
|Sits on Hygiene Committee & Board | | | | |
|Professional Member of Dental Hygiene Committee |Melissa Barbara, RDH | |07/01/2014 |1st |
|Professional Member of Dental Hygiene Committee |Sarah Kay Thiel, RDH |04/05/2014 |07/01/2017 |1st |
|Professional Member of Dental Hygiene Committee |Paula Jenkins |09/03/2014 |07/01/2018 |1st |
|Public Member |Robert Blewer |06/03/2011 |07/01/2018 |2nd |
|Public Member |Richard Hatch |10/23/2012 |07/01/2018 |1st |
the numbers
NUMBER OF CURRENT LICENSES
DD’S = 1,540
DA’S = 2,558
DH’S = 1,339
CDHC = 1
EFDA’s ==2
NON-DENTIST OWNER = 19
Accomplishments/updates
• Brian McBain was hired as the new Compliance Officer.
• New rules went into effect on January 15, 2015.
• The board receives and average of 120 complaints a year.
Attachment D
January 1, 2015
RE: Dental Therapist Report
I. NM Dental Therapist Legislation Update
II. Dental Therapists in the News, Media Coverage nationally and in NM
III. Federal Trade Commission (FTC) Comments supportive of CODA finalizing standards for
Dental Therapist Education Programs
Dear NM Dental Board and Hygienist Committee Members,
Thank you for the opportunity to provide an update on our New Mexico dental therapist legislation and
dental therapist practice here in the U.S. for your January meeting.
I. NM Dental Therapist Legislation Update
A. Senate Bill 6 (SB 6) – Dental Therapist Licensure Bill
We are pleased to report that on September 30, the legislative Indian Affairs Committee endorsed our
Dental Therapist legislation. As you might recall, the legislative Health and Human Services Committee
(HHS) has endorsed our legislation three years in a row.
We also had the opportunity to present our legislation to the Legislative Finance Committee (LFC)
Sunset Subcommittee on Nov. 18, and to the legislative Economic and Rural Development Committee on
Nov. 25.
We will be working along with our statewide coalition of supporters, bill sponsors and cosponsors to pass
and have our legislation signed into law during the 2015 legislative session.
Our newest statewide coalition member includes Alta Mira Family Services, Inc. a regional, non-profit
organization that supports families who have family members who have special needs or developmental
disabilities. Alta Mira serves Bernalillo, Torrance and southern Santa Fe counties.
B. Recent revisions made to legislation based on input of Dental Board, Hygienist Committee &
others
Items we changed since I presented to the board and committee in October based on input from the
board, hygienists committee and others include the following.
2
1. Dental therapists would now be limited to practicing in "state or federally designated dental provider
shortage areas." Before it was limited to just federally designated DHPSAs however the federal
government and states are moving away from DHPSA to other shortage area measurements including
allowing states to also designate shortage areas in their states. So that the limitation of practicing in a
shortage areas still stands as current beyond passage of the legislation we felt it necessary to make this
change. (SB 6 - p.4,L15)
2. Instead of a dental therapist "proponent" we changed that to "dental therapist representative" since we
thought that “representative” more accurately described the person who would vote on only the joint
committee for dental therapist related regulations. The joint committee makes recommendations to the
board which the board would then ratify. The board would be the licensing authority for dental
therapists. (SB 6 - p6, L1)
3. At the request of the hygienist committee and with the input of the NMDHA we included clarifying
and stronger language for establishing the role of the hygienists committee. As you recall per legislative
drafting rules we had to delete some of the "through the committee" language. We agreed to add in
clarifying language at the hygienist committee’s request. This is the same language used to define the
role of the joint committee as a recommending body to the dental board. (SB 6-p12, L5)
4. At the request of the Hygienist Committee, Dental Board and others we deleted from the legislation
the letter of recommendation requirement from an entity from an underserved community. This
community based model aspect is crucial to the success of dental therapist practice, but will be and is
more appropriately addressed by the educational institutions with DT education programs.
We feel it is important that the joint committee remain in this legislation. Given that this is a hygienist
based model it is important that hygienists through the hygienist committee have a voice and role to play
in developing regulations for the licensure and practice of dental therapists, and likewise that dentists on
the dental board would also have a voice and role to play since dentists would be supervising dental
therapists. Ultimately the dental board is still the licensing authority for dental therapists just as it is for
all dental providers. That the dental board dentists and hygienist committee hygienists come together as
a joint committee to draft the regulations is a very efficient way to do this. This is how collaborative
practice dental hygiene regulations are developed. The dental board’s argument that a dental therapist
should have to go to the hygienist committee separately for their hygienist scope and the dental board
separately for the remainder of their scope is splitting that one dental therapist into two and is not an
efficient way to regulate and license health professionals.
C. In answer to the Dental Board’s letter opposing our dental therapist licensure bill before the
above listed revisions were made:
On Nov. 20, at our request the dental board staff sent us a copy of the dental board’s letter listing the
board’s objections to our bill. Though we had presented to the board and committee on Oct. 17, the first
time we had notice of this letter and the board’s more fully detailed objections was on Nov. 18, at the
Legislative Finance Committee (LFC), Sunset subcommittee hearing.
3
1. The joint committee is not a radical idea. It is already being done for collaborative practice
dental hygiene. It makes sense from an efficiency view as well. See above.
2. The scope of practice of a dental therapist is limited, has been tested time and time again over
decades as safe, quality efficient care, equal in quality to the care a dentist provides within a
dental therapists scope of practice. The malpractice premium insurance for a dental therapist is
only $93/year. A dentists is $1500-$2000/yr. The fact that insurance companies who do not care
who the practitioner is have determined that the premiums for DTs are only $93/year further
shows that dental therapist practice is not "risky" it is in fact safe, quality care.
3. All dental practitioners practice "dentistry" they just practice it at different levels and scopes.
Consistent with the current Dental Health Care Act, the term "dentistry" is not limited to only
dentists.
4. Dental therapist care is not substandard care. That is the equivalent of saying dental hygienist,
physician assistant or nurse practitioner care is substandard. It is not. It is quality care within a
limited scope of practice.
5. In the U.S. and the world, dental therapists practice by providing quality care under general (offsite)
supervision. To regress and require in-person dentist supervision of licensed dental
therapists would result in the status quo we already have for NM of none or not enough providers
in underserved areas of our state.
6. The Community Dental Health Coordinator, can really only coordinate care, transport patients to
a dentist if there is one to go to and provide prevention and education which is good, but they
cannot provide meaningful treatment. Dental therapists can provide a full range of prevention
and treatment services and generate revenue even when largely serving underserved
populations. Also, CDHCs are not financially viable solution to address our dental access and
oral health needs of our state.
7. Three states have enacted DT legislation - Alaska, Minnesota and Maine, plus 50 other countries
around the world have had dental therapists for almost 100 years. Fourteen thousand dental
therapists practice worldwide. Alaska's successful program has been in existence for 10 years.
DTs have an excellent, long-term track record of success.
8. Dental therapists in our legislation are held just as accountably as all dental providers are.
9. We were advised by leaders of the NM Trial Lawyers Association to delete the following
because the "good faith and without actual malice" standard is too high and an unreasonable
standard for a licensee or certificate holder who receives a complaint from a patient to have to
meet. We were also advised that other acts in NM state law already and more appropriately
address this issue still adequately protecting the public and holding providers accountable. ("C.
Licensees and certificate holders shall bear the costs of disciplinary proceedings unless
4
exonerated. D. Any person filing a sworn complaint shall be immune from liability arising out of
the civil action if the complaint is filed in good faith and without actual malice.")
10. Currently under the Dental Health Care Act (DHCA) hygienists who practice as a hygienist or
who attempt to practice as a hygienist and violate the DHCA could be found guilty of a
misdemeanor. Likewise in our legislation, dental therapists who are also dental hygienists would
also be guilty of a misdemeanor. The scope of a dental therapist practice covers preventive and
routine care and though beyond that of a hygienist is limited requiring that a dental therapist be
competent in only 90 competencies. Again, dental therapist malpractice premiums are only $93
per year demonstrating that dental therapists provide safe, quality care. A dentist or person who
attempts to practice as a dentist and violates the DHCA could be found guilty of a felony.
Dentists have a much broader and more complex scope of practice and must be competent in 500
competencies. Dentist malpractice premiums are approximately $1500-$2000 per year
demonstrating the complexity and risk of a dentist’s practice calling for a higher level of legal
responsibility than that of a dental hygienist or dental therapist.
11. There are no costs with this bill. It is an authorization bill. Any costs to the dental board and
committee would be covered through dental therapist licensure fees. Initially there would likely
be only five dental therapists in the first NM cohort. Initially in drafting regulations there could
be more work for the board and committee, but beyond that this should not be a long-term strain
on the board, hygienist committee and staff. That there could be additional work up front is not a
viable reason to prevent dental therapists from being licensed to practice in NM serving
communities that continue to go without access to dental providers.
12. Please feel free to contact the Minnesota Dental Board Executive Director, Marshall Shragg to
learn how they have developed and established regulations for the licensure and practice of
dental therapists in Minnesota.
Marshall Shragg MPH – He has offered to speak with you on what Minnesota Dental Board has done.
Executive Director, Minnesota Board of Dentistry
Work Marshall.Shragg@state.mn.us
Work 612-548-2127
Mobile 612-280-9964
Profile
15. Our bill is lengthier because it is a comprehensive bill and per legislative drafting rules must
include portions of other acts. The Dental Health Care Act as currently written is already long
and detailed in itself and is longer than many practice acts in NM and other states.
5
II. Dental Therapists in the News, Media Coverage nationally and in NM
1. The Albuquerque Journal shows support for Dental Therapists.
(Dec.
24, 2014)
2. Dental Therapists named as one of the “Big Ideas in Social Change of 2014”, NY Times Fixes
Blog This year, the New York Times Fixes column has examined 60 or so ways that people are trying to
change the world. In October 2014, Fixes featured an in-depth article on dental therapists and how they
are improving access to care.
Read the full article here:
2014/?_r=0
III. Federal Trade Commission (FTC) comments supportive of finalizing Commission Dental
Accreditation (CODA) standards for Dental Therapist Education Programs
The Federal Trade Commission (FTC) has asked CODA “to finalize and adopt proposed [dental therapy
education program] standards without unnecessary delay, so that the development of this emerging
service model can proceed, and consumers can reap the likely benefits of increased competition.” The
FTC comments to CODA also stated, "[A]ny further delay in the adoption of accreditation standards
could discourage and delay the development of education programs, reduce the availability of these new
professionals, and hinder their ability to practice in different states.”
dental (Dec. 1, 2014)
CODA continues to move forward with proposed standards for dental therapist education programs. This
second round of proposed standards is very similar to the dental therapist model we have proposed here
in NM. Health Action New Mexico and our coalition members sent public comments to CODA in
support of CODA finalizing the proposed standards. The CODA proposed standards:
? Allow for DTs to be trained at community colleges receiving associates level degrees. (The
proposed standards do not require that DT education programs be bachelors or master’s level
degree or length of programs.)
? Allow for dental hygienists to have an abbreviated pathway to be trained and educated to practice
as DTs.
? Do not require that “diagnosis” can only be included in a dentists’ scope of practice.
Attachment E
To: New Mexico Board of Dental Health Care and the Dental Hygiene Committee
From: Carol Hanson, RDH, BSDH, MPH
NM Dental Support Center (NMDSC) Coordinator
New Mexico DOH/PHD/HSB/OPCRH
300 San Mateo NE, Suite 900
Albuquerque, NM 87108
505-222-8685
carol.hanson@state.nm.us
Date: January 8, 2015
• In partnership with the New Mexico Primary Care Association (NMPCA): Developed and disseminated October, November, and December 2014 Oral Health e-News to network dental providers, dental educators, and other interested parties; planned and participated in the October 17, 2014 NMPCA/NMDSC Provider Meeting—a total of 16 attended
• Maintained and updated the NMDSC Provider and Dental Educator databases and distribution lists
• Provided technical assistance for network dental providers and educators
• Disseminated information on continuing education opportunities and other pertinent information to network dental providers and educators
• Operated exhibit booth at the Route 66 Native American Behavioral Summit on September 26, 2014
• Facilitated NM Dental Educator Consortium meeting on October 10, 2014—a total of 8 attended
• Assisted with the NM Health Service Corps program
• Toured Albuquerque Health Care for the Homeless on October 21, 2014
• Participated in the Head Start Region VI Institute Planning Meetings on October 30 and November 6, 2014. Chaired Community Connections Booths at Institute
• Disseminated monthly Brush Up on Oral Health Newsletters to NM Head Start/Early Head Start Directors and Health Coordinators
• Provided dental screenings and sealants for students at: Bluewater Elementary on November 3, Chaparral Elementary on November 17, and Seboyeta Elementary on December 9, 2014
• Provided dental screenings and conducted 3rd grade survey at Park View Elementary on December 8, 2014
• Attended and assisted with the DOH NM Healthy Aging Collaborative Fall Symposium on November 14, 2014
• Participated in the NM Healthy Aging Collaborative meetings on October 28 and December 15, 2014
• Attended NM Public Health Association Health Policy Legislative Forum on December 10, 2014
• Worked on the Office of Primary Care and Rural Health Special Needs Project
• Attended NM Chronic Disease Prevention Council meeting on December 16, 2014; Working to include oral health in the Shared Strategic Plan
• Attended an Oral Health campaign meeting on December 19, 2014
• Participated in the Association of State and Territorial Dental Directors Healthy Aging Committee meetings on October 16 and November 20 (Chaired) 2014; assisted with tasks
• Made suggestions for DOH Office of Oral Health website
Respectfully Submitted,
Carol Hanson
Attachment F
CRDTS STEERING COMMITTEE REPORT
SUBMITTED BY ERMELINDA BACA
JANUARY 30, 2015
I attended the CRDTS Steering Committee in Kansas City, MO on November 1m 2014. I would like to report the following items:
• A new 2015 DH Exam site was approved. This site is Carrington College, Sacramento, CA in the Summer of 2015.
• The November 2015 Executive/Steering Committee Meeting dates will be moved to January 22-23, 2016. This will be a trial change as weather may affect attendance. Cost of Conference Call for members not able to attend due to inclement weather will be researched.
Attachment G
January 13, 2015
TheNERBisnowTheCommissiononDentalCompetencyAssessments
DearColleagues,
OnJanuary9thatourorganization’s45thannualmeeting,weannouncedandintroducedournewnameandidentity,TheCommissiononDentalCompetencyAssessments(CDCA).
Asyouknow,theNorthEastRegionalBoard(NERB)wasfoundedasthefirstagencytofacilitatethelicensureexaminationprocessforcandidatesandeliminatetheneedforrepetitionofstateboardclinicalexaminations. Ourorganizationnowincludes24memberstates/jurisdictions. In2014,memberstatesstretchedfromMainetoHawaii,OregontoFloridaandWisconsintoMississippi.
Asanonprofit,independentcorporation,comprisedofaconsortiumofmemberdentalboards,ourorganizationsoughttorenameitselfwithanewnamethatmoreaptlyreflectedallofitsmembersanditsongoingmissiontofurtherestablishcommonexaminationstandards.
TheCDCA’snamerecognizesthegeographicaldiversityofourcurrentmemberdentalboards,whichnowresidein5differenttimezones.Ournewnamealsoreflectsthefactthatweadministermanydifferentassessmentsinthedentalprofessionforstatedentalboards.ForexampletheCDCAadministersallofthestaterequireddentalspecialtyexaminationsintheUnitedStates.TheCDCAalsoadministersNitrousOxideandInjectableLocalAnesthesiaexaminations,aswellasstatespecificassessmentsinotherdentalalliedfieldsandethicsandJurisexaminations.TheCDCAisfirmlycommittedtoourcontinuingmissiontobeapreeminentresourceinthedevelopment,innovationandadministrationofcompetencyassessmentsfortheoralhealthprofessions.
Today,CDCAadministeredclinicalexaminationsareacceptedin46differentUSstates/jurisdictionsandJamaica. TheCDCAremainspledgedtoexcellence,integrityandfairnessandcommittedtoservingboardsofdentistrybydesigningandadministeringassessmentsthatarebasedonsoundprinciplesoftestingandmeasurement.
Whileourname,logo,webaddressandemailaddresseshavechanged,pleasenotethatthesamecommitmenttotestingexcellenceandqualityremains. Additionally,past,presentandfuturestatutoryandlegalreferencestotheNERBremainviableandsynonymouswiththeCDCA.
Also,whileourpublicwebsiteandotherpublicfacingreferenceshavealreadybeenconvertedtoournewname,therewillbeaperiodoftransitionbeforeallexamandcandidateoperationsarefullyconverted. Inthemeantime,ifyouhavequestions,concernsorideas,weinviteyoutosharethematdirector@.
ThankyouforyourcontributionsandeffortsthathaveledtocreationofTheCommissiononDentalCompetencyAssessments!
Guy S. ShampaineDavid W. PerkinsAlex Vandiver
Guy S. Shampaine, DDSDavid W. Perkins, DMDAlexander Vandiver, MBA
ChairChair –ElectExecutive Director
Attachment H
REPORT ON ADEX ANNUAL MEETING
ADEX- The American Board of Dental Examiners- held its annual meeting November 7-9, 2014 in Chicago, IL. I attended as a representative from New Mexico. I was on the subcommittee on endodontics, the examination review committee and the House of Delegates. ADEX is a dental board developer and does not give the test itself, they design the clinical board exam and then testing agencies use the ADEX test at their sites. ADEX does monitor those agencies to be sure the test is given within the parameters that are needed to make the test psychometrically valid. ADEX is now accepted by 43 states and is administered by NERB, SERTA and CITA.
One of the weak points in the past was the poor calibration of examiners for ADEX examiners at the various agencies. To that end ADEX has revamped their calibration to a computer notebook type exam using real photos of cases, where the answers cannot be changed and there is real time feedback on which examiners have passed the exam or not. Examiners must score an 80% on the exam or take the test again. This is similar to WREB however the exam is only 25 questions over the combined exam. WREB examines with 25 questions for each area. It is however an improvement from the old system where examiners basically just discussed the slides and then wrote down the right answer.
Also to help with calibration there is a move to make the criteria for grading measurable. For example in endo the access opening must be 3mm from the incisal edge and not less than 2 mm from the marginal ridges. The danger of this movement is that if candidates are told to simply measure where the opening goes and you will pass, the exam becomes a technical skill test and not a test of clinical judgment. Dr. Bill Pappas of Nevada and I successfully argued this point to the exam committee so that the measurable criteria will be used for examiner evaluations but candidates will still have to use clinical judgment. One of the problems is that ADEX uses identical typodont teeth for the endo, and crown and bridge exams. If candidates know the ideal for that tooth there is no clinical judgment. ADEX acknowledges that using identical typodont teeth is a weak point but is trying to appease those schools who object to using extracted human teeth.
ADEX used to have three grading levels- Acceptable, marginally unacceptable and critically deficient. Theoretically several “marginally unacceptable” results could add up and have a candidate fail the exam. In reality this never happened so the psychometricians dropped the marginally unacceptable category. The clinical exam will now be pass/fail on each criteria that is graded.
ADEX has a perio treatment portion of their exam that is optional for candidates. They have dropped the requirement that 5 of the 12 subgingival calculus areas needed for patient acceptance should be in pockets of 5mm or more. So now the exam simply grades for removal of 12 areas of subgingival calculus. Candidates are graded on identifying those areas of calculus correctly.
Lastly ADEX (through NERB) will be the first testing agency to give a Curriculum Integrated Format exam as recommended by the ADA. This will occur this coming spring testing period at a school to be announced soon. They will train and calibrate dental school staff to evaluate lesions for acceptance for the restorative portion of the exam. The candidates will then restore these lesions in the regular course of treatment of the patient at their school. These preparations will be graded by a small group of outside, regular examiners who will be present at the school on specific dates. These will be graded to the regular ADEX criteria. There will be logistics to work out but it will be interesting to see.
Lastly ADEX will probably be going international as Jamaica and other foreign countries ask to use the ADEX format for their dental boards. This should not affect New Mexico as long as we continue to require that candidates take a board accepted by NM (NERB,SERTA,CRDTS, WREB) . However this does raise questions as to the validity of the ADEX exam in differently trained students.
Recommendations- ADEX is a reasonable clinical dental exam and should continue to be accepted by New Mexico through NERB and SERTA. However the NM board should closely monitor the actions of ADEX as at times they seem more anxious to gain universal acceptance at the cost of keeping the exam appropriately difficult to weed out those candidates who should not be allowed to practice.
NM should require that all candidates for licensure in NM take the ADEX (NERB or SERTA) exam that includes the periodontal treatment portion.
NM should be sure to continue to require graduation and a diploma from a CODA accredited school, as soon exams that NM accepts may be given in foreign countries. The problem with this is that the exam that is given and accepted here is based on the fact that the dental program is CODA accredited and so an instant “picture” of that candidate can be a valid determination of the acceptability of the candidate for licensure. If you take exams developed for CODA accepted schools and give them to non-CODA educated students the validity of that clinical exam no longer applies.
Respectfully submitted,
Robert J. Gherardi DMD
Attachment I
Prescription Drug Misuse and Overdose Prevention and Pain Management Advisory Council
Meetings of December 5 2014 and January 9 2015
Related to Dentistry:
1. ALL LICENSEES MUST UTILIZE THE PMP PER NMBDHC RULES
Our board rules work. Dentistry tends to manage acute pain with short duration prescriptions. The intent of the council has been met by The NMBDHC.
2. To be able to vote on the Council a voting member MUST BE APPOINTED BY THE GOVERNOR AS A VOTING MEMBER. Therefore the NMBDHC has a member delegate with no voting privileges. If the NMBDHC wishes to have a voting representative that person’s name needs to be submitted to the Governor’s Office. The Council meets 6 times a year, typically on a Friday.
Non Dental Related:
Discussions on the Storage of Naloxone in Community Health Clinics.
Discussions on the protocol for use of Medical Marijuana in Chronic Pain Medical Patients.
Discussions on Department of Health and The University of New Mexico Health Science Center Education and Training programs regarding opiates and controlled substances.
Respectfully Submitted: L. Paul Balderamos DDS, MS, FACP
-----------------------
New Mexico Regulation and Licensing Department
BOARDS AND COMMISSIONS DIVISION
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hûrCJaJ&h7sh7s5?CJOJQJ\?^JaJ hûr5?CJOJQJ\?^JaJ h?yt5?CJOJQJ\?^JaJ h7sh7sCJOJQJ^JNew Mexico Board of Dental Health Care and
New Mexico Dental Hygienist Committee
Toney Anaya Building ▪ P.O. Box 25101 ▪ Santa Fe, New Mexico 87505
(505) 476-4680▪ Fax (505) 476-4545 ▪ rld.state.nm.us
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