Honolulu, Hawaii
                                                   , 1999

                                 RE: H.B. No. 324
                                     H.D. 2

Honorable Calvin K.Y. Say
Speaker, House of Representatives
Twentieth State Legislature
Regular Session of 1999
State of Hawaii


     Your Committee on Consumer Protection and Commerce, to which
was referred H.B. No. 324, H.D. 1, entitled: 


begs leave to report as follows:

     The purpose of this bill is to implement Act 9, Session Laws
of Hawaii (SLH) 1997, authorizing dental hygienists to administer
intra-oral block anesthesia, by establishing:

     (1)  Educational requirements for the administration of
          infiltration local anesthesia and intra-oral block
          anesthesia; and

     (2)  Documentation to the board of certification in the
          administration of these procedures.

     Testimony in support of this measure was provided by the
Hawaii Institute for Wellness in Dentistry and many dentists and
dental hygienists.  The Hawaii Dental Association (HDA) supported
amendments to delete the three riskiest categories of block

     The Queens Medical Center and a number of dentists and
dental hygienists provided testimony in opposition to this bill.

     The Department of Commerce and Consumer Affairs (DCCA)
presented a proposed H.D. 2, which addressed some of the concerns
raised by other testifiers.  The proposed H.D. 2 was reviewed and

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supported by the Hawaii Dental Hygienists' Association (HDHA),
HDA, and Chair of the Board of Dental Examiners in his individual

     HDHA testified in favor of DCCA's proposed H.D. 2.

     Based on the testimony presented, your Committee finds that
the minimum standards of education and certification for dental
hygienists administering intra-oral block anesthesia is of
serious concern to many people, whether as professionals,
patients, or parents.

     Your Committee reviewed several issues, including:

     (1)  Whether the minimum number of hours of didactic studies
          and clinical experience should exceed the 39 hours
          mandated in the bill;

     (2)  Whether the three most dangerous categories of block
          anesthesia should be administered at all by dental
          hygienists when even dentists often choose not to
          administer them due to the risks involved; and

     (3)  Whether the dental hygienist's administration of intra-
          oral block anesthesia should be limited to the scope of
          practice of clinical dental hygiene.

     Your Committee finds that there is sufficient expert support
for the mandated minimum hours of training, particularly since
the University of Hawaii's Department of Dental Hygiene, in its
course criteria for block anesthesia, has determined that these
hours are adequate to assure competency.

     Furthermore, there is adequate protection for the consumer
in the fact that these forms of anesthesia must be administered
under the direct supervision of a licensed dentist, and thus the
decision of whether to permit a dental hygienist to administer
such anesthesia is within the control of the dentist.  No dentist
need allow any hygienist to perform these procedures, and all
dentists are free to use their judgment about the type and level
of anesthesia they will permit to be administered under their

     In reviewing the current statutory provisions of section
447-3(b), Hawaii Revised Statutes, your Committee notes that
dental hygienists are allowed to perform procedures other than
the services defined to be within the scope of clinical dental
hygiene, if those procedures are delegated by the dentist in
accordance with rules of the Board of Dental Examiners.

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Therefore, your Committee believes that it would be unduly
restrictive to limit the administration of anesthesia only to
services within the scope of clinical dental hygiene.

     Upon further consideration of the testimony, your Committee
has amended this bill by incorporating DCCA's proposed amendments
with a few minor changes, as well as including the proposed
revisions from various dentists and dental hygienists.
Specifically, your Committee has amended this bill by:

     (1)  Removing any ambiguity that the course of study for
          intra-oral block anesthesia shall cover all ten
          categories of block anesthesia;

     (2)  Removing the three riskiest categories of block
          anesthesia from the original list of 13 categories
          within the educational requirements and scope of

     (3)  Requiring the passage of an examination to determine
          the proficiency of an applicant or licensed dental
          hygienist to administer intra-oral block anesthesia;

     (4)  Allowing the Board of Dental Examiners to adopt rules
          pursuant to chapter 91, Hawaii Revised Statutes,
          relating to the education and certification of dental
          hygienists to administer intra-oral block anesthesia;
          provided that the adopted rules will supersede existing
          statutes; and

     (5)  Making technical, nonsubstantive amendments for
          purposes of clarity, style, and conformity.

     Your Committee has been assured that these amendments are
supported by DCCA, the Board of Trustees and officers of the HDA,
HDHA, and individual dentists, including a current member and
chair of the Board of Dental Examiners.  These Board members
offered their support in their individual capacities and not on
behalf of the Board of Dental Examiners.

     As affirmed by the record of votes of the Committee on
Consumer Protection and Commerce that is attached to this report,
your Committee is in accord with the intent and purpose of H.B.
No. 324, H.D. 1, as amended herein, and recommends that it pass
Third Reading in the form attached hereto as H.B. No. 324, H.D.

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                                   Respectfully submitted on
                                   behalf of the members of the
                                   Committee on Consumer
                                   Protection and Commerce,

                                   RON MENOR, Chair