Joint Sunset Committee
Thursday, May 3, 2012, 10:00 a.m.
JFC Hearing Room, Legislative Hall, Ground Floor
Progress Reports: Child Placement Review Board; Board of Dentistry & Dental Hygiene
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JSC and Staff: Rep. John A. Kowalko, Jr., Chair; Sen. George H. Bunting, Jr., Vice Chair; Rep. John C. Atkins; Rep. Edward S. Osienski; Rep. Michael Ramone; Rep. Daniel B. Short; Sen. David G. Lawson; Sen. Liane M. Sorenson; Sarah Wootten, Joint Sunset Committee Analyst; and Judi Abbott, Legislative Council.
Absent: Sen. Michael S. Katz; Sen. Robert I. Marshall
In attendance: Lisa Cookson, CPRB Staff; Robert Director, Brd. of Dentistry/Dental Hygiene; Bill Moyer, CPRB; Julia Pesuch, CPRB; Kay Warren, DPR; Michele Howard, DPR; Joe Fitzgerald, Fitzgerald Consulting for DDHA; Deirdre McCutcheon, Kent-Sussex Dental Hygiene Assoc. Pres.; Fay Rust, DE Dental Hygienists Assoc.; Thomas Rust, DE Dental Hygienists Assoc.; Elizabeth Garey, DE Dental Hygienists Assoc.; Nathaniel Gibbs, DE Dental Hygienists Brd.; Nancy Brohawn, DE Dental Hygienists Assoc.; Joan Madden, DDHA, BDDH; Turnor Madden, Esq., Madden & Patton, LLC; Neil McAneny, Dental Brd.; Laime Anthoney, DMD DSDS; Brian McAllistor, DSDS; Mary Trinkle, RDM; Cheryl Calicott-Trawick, Brd. Dental Ex. Public; Blair A. Jones, Brd. of Dentistry/Dental Hygiene
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Agenda:
I. Approval of JSC Meeting Minutes dated April 5, 2012
II. Child Placement Review Board progress report
III. Board of Dentistry & Dental Hygiene progress report
IV. Adjournment
Representative Kowalko called the meeting to order at 10:03 a.m.
I. Welcome; Approval of JSC Meeting Minutes dated April 5, 2012
Representative Kowalko welcomed everyone and thanked them for attending
A Motion was made by Senator Bunting and seconded by Representative Ramone to approve the April 5, 2012 JSC meeting minutes. Vote: Yes-7 (Rep. John A. Kowalko, Jr.; Sen. George H. Bunting, Jr.; Rep. John C. Atkins; Rep. Edward S. Osienski; Rep. Michael Ramone; Rep. Daniel B. Short; Sen. David G. Lawson). Motion carried.
II. Child Placement Review Board progress report
Background:
The Joint Sunset Committee reviewed the Child Placement Review Board in 2011; Committee members voted to holdover the Child Placement Review Board sunset review for 2012. The Child Placement Review Board is in compliance with all of the 2011 JSC Recommendations, with the exception of the two listed below:
B1: Establish a task force comprised of various parties involved in the Child Placement Review process with the mutual goal of:
a. Identifying mechanisms to improve coordination between the Child Placement Review Board reviews and those conducted by Family Court to create a more integrated review process.
b. Examining ways to empower and help the Child Placement Review Board become more effective.
c. Examining ways to make the child placement review process in Family Court more efficient and less redundant.
B2: Adopt and promulgate rules and regulations regarding the administration of the Ivyane D. F. Davis Memorial Scholarship Fund.
Per the attached documents submitted by the Child Placement Review Board, the Board is working to address the recommendations listed above and has formulated a plan of action and timeline for both to be completed.
In regards to the Child Placement Review Board Task Force established pursuant to Recommendation B1, the Board is planning to submit a final report to the JSC by August 31, 2012, which will include recommendations to be considered by the Committee when the General Assembly reconvenes in January 2013.
Per Recommendation B2, the Child Placement Review Board is in the process of drafting the rules and regulations for the administration of the Ivyane D. F. Davis Memorial Scholarship Fund. The Board anticipates that a draft of the regulations will be submitted to the Registrar by September 2012 for consideration, and the Board will follow the steps enumerated in the Administrative Procedures Act to have these regulations officially recorded and published.
Action Item(s)
1) Determine the Child Placement Review Board’s review status for 2013; JSC can do one of the following:
· Motion to release with reporting requirements.
· Motion to release with no reporting requirements.
· Motion to holdover the review for 2013.
A motion was made by Representative Ramone and seconded by Senator Bunting to release the Child Placement Review Board from JSC review with reporting requirements. Vote: Yes-6 (Rep. John A. Kowalko, Jr.; Sen. George H. Bunting, Jr.; Rep. Edward S. Osienski; Rep. Michael Ramone; Rep. Daniel B. Short; Sen. David G. Lawson). Motion carried.
III. Board of Dentistry & Dental Hygiene progress report
Background:
The Joint Sunset Committee reviewed the Board of Dentistry and Dental Hygiene in 2010; Committee members voted to holdover the Board for both 2011 and 2012. The Board of Dentistry and Dental Hygiene is in compliance with all of the 2010 JSC Recommendations; however the recommendations listed below required the various stakeholders to meet and further discuss two issues identified in the 2010 JSC review:
B5: The dentists and dental hygienists discuss the delivery of local anesthesia by dental hygienists and report back to the JSC.
B7: The dentists and dental hygienists continue to meet to discuss the dental hygienists’ examination/licensure, including issues concerning whether a dental hygienist can be newly licensed in Delaware, either upon satisfactory completion of a regional exam or satisfactory completion of the Delaware exam and report back to the JSC regarding these discussions.
Stakeholder Meeting Summary:
A stakeholder meeting was held on Friday, April 20, 2012 in accordance with the outstanding JSC recommendations. Present at this meeting were representatives from the Delaware Dental Hygienists’ Association, the Delaware State Dental Society, the Board of Dentistry and Dental Hygiene, and the Division of Professional Regulation. Also present on behalf of the Joint Sunset Committee to record the discussion and moderate as needed were Senator David G. Lawson and Sarah E. Wootten.
The general consensus of the parties present at the meeting was to focus the discussion on the examination/licensure issue, as feedback from other members of the General Assembly regarding the delivery of local anesthesia suggests that this issue is not likely to receive enough legislative support at this time to amend the statutory limitations currently in place. A detailed outline of the various points that were raised and discussed by all parties present in regards to the examination/licensure issue can be found on the following pages.
Despite a very spirited discussion by all parties in attendance, a consensus could not be reached in regard to the continued use of the Delaware clinical exam. Those present representing the dentists felt that it was in the best interest of the profession and ultimately the patients under their care to continue to evaluate candidates for licensure through the use of the Delaware clinical exam. They argued that Delaware is in a unique position as a small state with an active and engaged dental community who are committed to investing the time and effort needed to ensure all candidates for licensure are vetted and deemed qualified to receive a license to practice in Delaware.
Those present representing the dental hygienists enumerated a number of issues of concern with the Delaware clinical exam and the way it is currently administered. These include, but are not limited to license portability, lack of anonymity for licensure candidates and problems with ensuring the exam is properly calibrated. At this time, they strongly feel it makes sense to move forward with making the option available for those candidates seeking licensure as a dental hygienist to take the Delaware clinical exam or any of the five regional exams currently recognized and accepted in 49 states.
The dentists conceded that improvements could be made to the Delaware’s exam and the Board of Dentistry and Dental Hygiene has taken steps to address some of these issues. Those serving on the Board expressed their willingness to continue to work on these issues and that the Board will make all the necessary changes regarding the administration of the Delaware clinical exam, including how candidates are evaluated and scored, as needed. Ultimately the dentists felt the best course of action was to maintain the current requirement for the Delaware clinical exam; however the hygienists believe the more prudent course of action would be to continue to allow candidates for licensure as a dental hygienist to take the Delaware clinical exam while also accepting one of the five regional exams in lieu of the Delaware clinical exam as a recognized means for testing clinical competency. Below please find an outline of the various points for consideration from the dentists, dental hygienists and the Division of Professional Regulation which were discussed at the April 20, 2012 stakeholder meeting.
Points for Consideration Provided by the Division of Professional Regulation:
· Delaware is the only state in the country which administers its own clinical exam for dentists and dental hygienists. Additionally, the Board of Dentistry and Dental Hygiene is the only profession regulated by the Division of Professional Regulation charged with conducting its own clinical/practical exam.
· In the last decade, there has been a significant shift from states administering licensing exams to states now contracting with professional, unbiased third party vendors.
· Some would argue that there is an inherent conflict of interest (either perceived and/or real) when licensed professionals who are primarily engaged in actively practicing their profession are required to administer and evaluate exams for their potential future competitors.
· All professional regulatory boards in Delaware which require a clinical exam as part of their licensure process, with the exception of the Board of Dentistry and Dental Hygiene, have outsourced the administration of their clinical exam to a professional testing agency.
Points for Consideration Provided by the Dental Hygienists and Dentists:
The Delaware Dental Hygienists’ Association proposes that Delaware accept any of the five regional clinical exams offered across the country in lieu of the Delaware clinical exam. Outlined below are key points provided by hygienists in regards to why a regional exam should be recognized and considered as part of the licensure process.Ø Portability of license
o Currently licensees moving out of state cannot receive a license in a new state, as Delaware’s clinical exam is not recognized by any other state in the country with the exception of those relocating to Kansas. Potential licensees moving to Delaware with fewer than three years professional experience are unable to seek immediate employment as they are required to take the Delaware exam regardless if they hold a license in good standing from their previous home state.
Ø Lack of calibration
o Per the hygienists, the current exam is biased due to a lack of inter and intra-rator reliability of the exam team. Examiners charged with conducting the various regional exams must complete and pass calibration exercises prior to conducting an exam. If an examiner does not qualify the calibration, they are dismissed.
o A review of the test scores from the most recent Delaware clinical exam indicate a disparity in the scores individual candidates received from the multiple examiners evaluating them, with some candidates receiving scores with a 40 point range from the those evaluating the same clinical performance by a candidate for licensure.
Ø Both the regional exam and Delaware exam only test to a minimal competency level on a one-day's performance; both have a 95% pass rate.
Ø Lack of anonymity
o Candidates are being examined by their competitive peers and potential employers, which leads to an inherent conflict of interest. / The Delaware State Dental Society does not oppose taking any of the regional exams; however they are advocating that Delaware keep the requirement of the state’s clinical exam administered by the Board. Per the dentists, outlined below are response(s) to some of the issues/concerns raised by the hygienists, as well as other information they believe supports keeping the Delaware exam.
Ø Portability of license
o The dentists recognize the obstacles that hygienists moving in to and out of the state face when trying to obtain a license. The dentists currently serving on the Board have expressed interest in working with neighboring states to have Delaware’s exam recognized and accepted as part of these state’s licensure process. Preliminary outreach has taken place in an effort to start this process as soon as possible.
Ø Lack of calibration
o The Board conducted calibration exercises prior to giving the 2011 clinical exam. The dentists serving on the Board indicated their commitment to continuing to improve their efforts regarding calibration, however they recognize this process can take time.
o In 2010, dentists serving on the Board travelled to Boston University to observe the Regional Clinical Dental/Dental Hygiene Exam meeting. Three dentists attended and each concluded that the exams were well organized; however they felt critical deficiencies in some areas of the exams were not adequate demonstrations of clinical competency.
Ø By keeping the current clinical exams administered by the Board, the Delaware dental community retains control over and can make changes to the content and administration of the exam.
Ø The Delaware Dental Hygienist Exam fee is $100 versus regional clinical exam fees which range between $900- $1,250.
At this point in the meeting, Representative Kowalko requested a brief summation from the perspective of the dentists and hygienists in attendance at the April 20, 2012 stakeholder meeting. Dr. Blair Jones, President of the Board of Dentistry and Dental Hygiene followed by Fay Rust, RDH, Legislative Chair of the Delaware Dental Hygienists Association, each gave a brief summary of their points of view coming away from that meeting.
Action Items
1) Representative Kowalko then entertained a motion relating to B5 above which states:
B5: The dentists and dental hygienists discuss the delivery of local anesthesia by dental hygienists and report back to the JSC.
A motion was made by Senator Bunting and seconded by Representative Ramone that the dentists and hygienists no longer engage in discussing the delivery of local anesthesia by dental hygienists. Vote: Yes-7 (Rep. John A. Kowalko, Jr.; Sen. George H. Bunting, Jr.; Rep. John C. Atkins; Rep. Edward S. Osienski; Rep. Michael Ramone; Rep. Daniel B. Short; Sen. David G. Lawson). Motion carried.
2) The Delaware Dental Hygienists’ Association proposes that candidates seeking licensure as dental hygienists be permitted to take either the Delaware exam administered by the Board or any of the five (5) regional exams to demonstrate clinical competency. The Delaware State Dental Society supports keeping the current statutory requirement for the Delaware clinical/practical exam as part of the licensing process.