Honolulu, Hawaii
                                                   , 1999

                                 RE: S.B. No. 779
                                     S.D. 2
                                     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 S.B. No. 779, S.D. 2, H.D. 1, entitled: 


begs leave to report as follows:

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

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

     (2)  Requirements for documentation to the Board of Dental
          Examiners regarding certification in the administration
          of infiltration local anesthesia and intra-oral block

     The Professional Licensing Division of the Department of
Commerce and Consumer Affairs (DCCA) testified in support of the
bill and countered the arguments previously made by proponents of
an amendment to allow dental hygienists to administer anesthesia
only "in conjunction with the practice of dental hygiene" (the
restrictive amendment).  DCCA also presented a Deputy Attorney
General's recommendations against adding the restrictive
amendment, on the grounds that it invites confusion and
potentially restricts the practice of dental hygienists and

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                                 Page 2

     The Hawaii Dental Association (HDA), the Maui County Dental
Society, the Hawaii Dental Hygienists Association (HDHA), and
numerous individual dentists, dental hygienists, and a registered
pharmacist supported the bill in its present form.  HDHA also
highlighted relevant opinions from the supporting testimony of
Dr. Stanley F. Malamed, Professor and Chair of Anesthesia &
Medicine at the University of Southern California, one of the
foremost authorities in this field and an author of the textbook
entitled Handbook of Local Anesthesia, a required textbook in 45
out of 52 dental schools in the United States.

     A member of the Board of Dental Examiners (Dental Board)
testified in support of the bill, explaining that the Dental
Board has not had the opportunity to meet to discuss this current
bill, but stating that this bill's educational requirements,
including the categories of intra-oral infiltration local
anesthesia and intra-oral block anesthesia (except for the
deletion of blocks 11-13), the course of study of at least
thirty-nine hours with a minimum of fifty successful injections
and administration of course examination, as well as the
curriculum of the course of study, are all consistent with the
administrative rules that were adopted by the Dental Board in
January 1999.  He also requested that this committee report
clarify a provision in the educational requirements, that it is
not intended that the Dental Board develop an examination
separate from any examinations given as part of the course of
study at accredited dental hygiene schools to determine clinical
proficiency in administering intra-oral block anesthesia.

     Numerous individual dentists and dental hygienists opposed
the measure.  These testifiers expressed concerns for the safety
of patients, particularly of the young and the elderly, and many
questioned the adequacy of the training and course requirements
in this bill.  

     The testimony at the hearing clearly indicated that the
central issue is whether the bill provides sufficient safeguards
for the safety of patients, the consumers of dental and dental
hygiene services.

     Your Committee shares the concern of all testifiers whose
priority is the safety and health of consumers.  Therefore, in an
effort to achieve consensus on this bill, your Committee
initially deferred decisionmaking in order to allow
representatives of the interested parties to meet and work out a
compromise that would address the safety concerns in dispute.
Through an intensive collaborative effort, a proposed S.B. No.
779, S.D. 2, H.D. 2 (House Draft 2), was crafted and presented
for your Committee's consideration.  Your Committee understands

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                                 Page 3

that this House Draft 2 has the support of DCCA, HDA,and HDHA.
Moreover, two dentists who were participants in these
discussions, Dr. Angela Chinn and Dr. Martin Oishi, have
indicated that they do not oppose House Draft 2.  Both dentists
had been strongly opposed to the original version of the bill.
Your Committee commends these parties for their hard work and
commitment in attempting to break through any impasse and find
creative solutions.

     Upon consideration of the proposed House Draft 2, your
Committee notes that the amended draft includes continuing
education requirements that are intended to address concerns
regarding the adequacy of education, training, and experience of
dental hygienists to administer anesthesia under various
circumstances.  Your Committee recognizes that the dental
hygienist's practice is closely tied to the dentist under whose
supervision and at whose direction the dental hygienist provides
all services.  Hence, continuing education programs for both of
these related professions would be highly beneficial to the
safety and health of consumers.  Accordingly, your Committee has
amended the bill to reflect the contents of House Draft 2.

     Specifically, the amendments made to the bill as received
are as follows:

     (1)  Addition of a new section that requires the Dental
          Board to develop rules for a continuing education
          program for dentists and continuing education program
          for dental hygienists, and provides that after
          January 1, 2002, at the time of reregistration of a
          dentist's or dental hygienist's license, the licensee
          shall present evidence of compliance with the program
          of continuing education applicable to the licensee's

     (2)  Addition of a new section providing for severability of
          provisions of the Act, in the event of the invalidity
          of any provision or its application to any person or

     (3)  Deletion of provisions pertaining to the repeal of the
          Act upon the adoption of superseding rules by the
          Dental Board; and

     (4)  Insertion of a technical, nonsubstantive amendment to
          subsection (d) of section 447- , entitled "Educational
          requirements for intra-oral block anesthesia", in order
          to clarify that the required examination on proficiency
          to administer intra-oral block anesthesia is one that

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                                 Page 4

          is part of the course of study in an accredited dental
          hygiene school, and not a separate examination
          developed by the Dental Board.

     With respect to the continuing education requirements, your
Committee requests that the Dental Board adopt, at a minimum,
rules that address the following subject matters: 

     (1)  Cardiopulmonary resuscitation;

     (2)  Updates in local anesthesia; and

     (3)  Management of medical emergencies.  

     Your Committee emphasizes that, by allowing dental
hygienists to administer intra-oral block anesthesia, it is not
the intent of this bill to encourage the development of
production-line dentistry in any form. 

     On the other hand, it is not the intent of this bill to
restrict the current and accepted practice of dentists utilizing
dental hygienists to assist the dentists in performing dental
procedures under the dentist's direct supervision.  Hence, this
bill does not restrict the dental hygienist's administration of
intra-oral block anesthesia to the scope of practice of dental
hygiene services.  However, your Committee intends that, when a
dental hygienist administers intra-oral block anesthesia in
response to the direction of a licensed dentist, it must be done
under the direct supervision of the dentist consistent with
current law and with the rules of the Dental Board defining
"direct supervision."
     On the overall questions of safety for consumers and
adequacy of the minimum educational requirements for intra-oral
block anesthesia, your Committee finds it persuasive that no
statistics, study, or other evidence were presented indicating
any genuine danger to the health and safety of consumers of
dental and dental hygiene services.  To the contrary, apparently
there is a long-standing history of dental hygienists performing
these services safely and competently in other states.  Dr.
Stanley F. Malamed stated, of the provisions in this bill, that
"[a]ll three areas: the hours, course content, and number of
injections are more than adequate to ensure didactic studies
preparation and clinical competency in the safe and effective
delivery of intra-oral nerve block anesthesia.  He further stated
that "with exactly these same guidelines", the experience in
California since 1975 "has been that these educational programs
will produce a dental hygienist who is extremely capable of
administering all of the injections listed in SB #779 in a safe

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                                 Page 5

and effective manner.  Almost a quarter century of clinical
experience in California has demonstrated the effectiveness of
this curriculum." 

     Furthermore, your Committee reiterates that the first line
of protection for the consumer is comprised of dentists, since
anesthesia must be administered under the direct supervision of a
licensed dentist.  It should be emphasized that, under this bill,
the decision of whether to permit a dental hygienist to
administer such anesthesia is within the control of the dentist. 

     As affirmed by the record of votes of the members of your
Committee on Consumer Protection and Commerce that is attached to
this report, your Committee is in accord with the intent and
purpose of S.B. No. 779, S.D. 2, H.D. 1, as amended herein, and
recommends that it pass Third Reading in the form attached hereto
as S.B. No. 779, S.D. 2, H.D. 2.

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

                                   RON MENOR, Chair