August 17, 2005, Meeting of COMDA

Agenda
Agenda Item Information
Minutes

Agenda

Notice of PUBLIC MEETING - Notice is hereby given that a public meeting of the Committee on Dental Auxiliaries will be held as follows

Wednesday, August 17, 2005 – 10:30 a.m.

San Francisco Airport Doubletree Hotel, 835 Airport Boulevard, Burlingame, CA 94010, (650) 344-5500

Agenda

1. Call to Order/Roll Call/Establishment of Quorum
2. Approval of May 4, 2005, Meeting Minutes
3. Report of the Chair
4. Report of the Executive Officer
5. Legislation of Interest to COMDA

1. SB248 (Figueroa) – Board and COMDA sunset dates
2. SB1111 (Figueroa) – Clean-Up to SB1546 (dental assisting scopes of practice)
3. AB1334 (Salinas) – RDHAP Scope of Practice and Prescription Requirement
4. Other legislation of interest to COMDA

RDA Program
6. Review of RDA Educational Programs and Radiation Safety Courses/Recommendations to Board
7. Discussion of Proposed Changes to Title 16 CCR Section 1070, 1070.1, and 1070.2, Approval of RDA Educational Programs to Implement SB1546
8. Discussion of Two Paths to RDA Educational Program Approval – COMDA Evaluation vs. Commission on Dental Accreditation

EF Program
9. Establishment of Ad Hoc Subcommittee to Revise EF Clinical Examination and Associated Regulations to Implement SB1546

All Programs

10. Consideration of Revised Strategic Plan
11. Agenda Items for Future Meetings
12. Public Comment
13. Adjournment

The Committee may take action on any item listed on the agenda unless listed as information only. All times are approximate and subject to change. Public comments will be taken on agenda items at the time the specific item is raised. Items may be taken out of order to accommodate speakers and to maintain a quorum. The meeting may be cancelled without notice. For meeting verification, call (916) 263-2595 or access the Committee’s website at www. comda. ca.gov. The meeting is accessible to the physically disabled. A person who needs disability-related accommodations or modifications in order to participate in the meeting shall make a request to the Committee by contacting Karen Wyant at (916) 263-2300 or sending a written request to the person at the Committee on Dental Auxiliaries, 1428 Howe Avenue, Suite 58, Sacramento, CA 95825, one week prior to the day of the meeting. Contact: Karen Wyant, (916) 263-2595 or email Karen_Wyant@dca.ca.gov.

Agenda Item Information

Committee on Dental Auxiliaries State of California

Dental Board of California Department of Consumer Affairs

TO: COMDA Members

Meeting Date: August 17, 2005

Re: Agenda Item 5. Legislation of Interest to COMDA

a. SB248

SB248 extends the sunset dates for the Board and COMDA from the current sunset date of July 1, 2006, to July 1, 2010. The Governor has indicated he is opposed to SB248 unless amendments are included that will make the Dental Board a public member majority, and would make COMDA a Bureau within the Department. It has passed out of the Assembly Appropriations Committee, and it is unknown whether the Governor intends to veto the bill.

b. SB1111

SB1111 will be the vehicle that will contain the clean-up provisions to SB1546. The bill will be heard in the Assembly Appropriations Committee on August 17, but amendment to the bill have not been made as of this writing.

c. AB1334

AB1334 would eliminate the RDHAP prescription requirement, and would specify that RDHAPs can perform all duties that RDHs are allowed to perform. The bill is on the inactive file and will not be heard this year.

d. Other

Any other legislation of interest to COMDA that arises prior to the meeting will be presented at the meeting.

Committee on Dental Auxiliaries State of California

Dental Board of California Department of Consumer Affairs

TO: COMDA Members

Meeting Date: August 17, 2005

Re: Agenda Item 6. Review of RDA Educational Programs and Courses

RDA Educational Programs

Staff recommends that COMDA recommend that the Board approve the new RDA educational program of the following, as well as their proposed radiation safety and coronal polishing courses:

1. United Education Institute, Chula Vista

Staff recommends that COMDA recommend that the Board grant full, rather than provisional, approval of the existing RDA educational programs of:

2. Bryman College, City of Industry

3. Bryman College, West Los Angeles

Coronal Polishing Course and Radiation Safety Course

Staff recommends that COMDA recommend that the Board approve the coronal polishing course of:

4. Lisa Klockenteger, Paso Robles

Staff recommends that COMDA recommend that the Board approve the radiation safety course of:

5. California Dental Certifications, Del Mar

RDA Pit and Fissure Sealant Courses

Staff recommends that COMDA recommend that the Board approve the pit and fissure sealant course of:

6. Health Personnel Resources, Anderson

Other Programs and Courses

Any other programs or courses that are ready for consideration by the meeting date will be presented at the meeting.

Committee on Dental Auxiliaries State of California

Dental Board of California Department of Consumer Affairs

TO: COMDA Members

Meeting Date: August 17, 2005

Re: Agenda Item 7. Discussion of Proposed Changes to Title 16 CCR Sections 1070, 1070.1, and 1070.2, Approval of RDA Educational Programs to Implement SB1546

At its November meeting, the Board will hold a regulatory hearing on the proposed educational course regulations for Registered Orthodontic Assistant, Registered Surgery Assistant, and Registered Restorative Assistant.

The next step in order to meet the deadlines of SB1546 is to amend the regulations that govern full Board-approved RDA educational programs. Attached is a draft of proposed changes that staff can finalize by the November meeting by including more detail regarding actual curriculum content and testing requirements, as do the proposed regulations governing the specialties.

The earliest that a regulatory hearing could be held by the Board would be January, 2006. Even in the best circumstances, it is unlikely that regulations will be finalized before September of 2006.

Since programs must begin teaching the new duties January 1, 2007, it is not possible for COMDA staff and consultants to evaluation all programs between the effective date of the regulations and January 1, 2007. Therefore, staff is working with the Alliance and CDA to insert a provision into legislative clean-up language to require existing approved programs to self-certify that they will teach all allowable duties beginning January 1, 2007. COMDA can then evaluate each program as soon as it is possible.

 Committee on Dental Auxiliaries State of California

Dental Board of California Department of Consumer Affairs

TO: COMDA Members

Meeting Date: August 17, 2005

Re: Agenda Item 8. Discussion of Two Paths to RDA Educational Program Approval – COMDA Evaluation vs. Commission on Dental Accreditation

Issue: Should the Board continue to recognize dental assisting educational programs accredited by the Commission on Dental Accreditation?

Discussion:

Business and Professions Code Section 1753 provides, in part, that the Board shall license as an RDA a person who has graduated from an educational program in dental assisting approved by the Board. Regulation section 1070 provides, in part, that a new educational program for RDAs shall apply for approval prior to operation and that the Board may, in lieu of conducting its own investigation, accept the findings of any commission or accreditation agency approved by the board and adopt those findings as its own.

It is not known exactly and by what means the Board determined that it would recognize dental assisting educational programs throughout the United States that are accredited by the Commission on Dental Accreditation, but it has been the practice for at least the last 20 years.

Currently there are 74 Board approved registered dental assisting educational programs in California, of which 21 are CODA accredited and 53 are evaluated for the Board by COMDA. Historically, COMDA has not been involved at all in the evaluation process that CODA uses to initially accredit or to re-accredit these programs, although it is believed that a Dental Board member is generally invited to accompany the CODA accreditation team.

However, the standards that CODA uses and those used by COMDA, as contained in Board regulations, differ substantially. As far as is known, CODA does not evaluate, for example, the radiation safety component nor the coronal polishing component of programs, does not have the specific equipment requirements that are contained in the Board’s regulations, and it is unknown whether programs are evaluated based upon all the procedures that RDAs are allowed to perform in California.

While very few new programs have been approved in the last 20 years via CODA accreditation, this apparent "double standard" should be evaluated, particularly in light of the new duties that RDAs will be allowed to perform by the provisions of SB1546. In addition, SB1546 will eliminate the RDA written and practical examinations, allowing persons to become licensed immediately after completing their education, making oversight of these program even more important.

If COMDA were to become responsible for periodically re-evaluating CODA accredited programs (as it does the other approved programs), additional staffing and monies would be needed to do so.

A secondary issue is whether the Board should continue to recognize CODA approved programs in other States, since the scope of practice in other states is generally more restricted than in California, and the disparity will only increase when the provisions of SB1546 become operative.

Committee on Dental Auxiliaries State of California

Dental Board of California Department of Consumer Affairs

TO: COMDA Members

Meeting Date: August 17, 2005

Re: Agenda Item 9. Establishment of Ad Hoc Subcommittee to Review EF Clinical Examination and Associated Regulations to Implement SB1546

A regulatory hearing on proposed changes to current regulations will be heard by the Board in November amending the requirements that EF educational programs must meet to obtain and maintain Board approval, to reflect the new duties that will be allowed by the provisions of SB1546.

The next step in the process is to determine how the current EF clinical licensure examination should be modified considering the changes in allowable duties, and how the regulations governing the examination should be changed accordingly.

Staff recommends that COMDA allow the Chair to appoint an Ad Hoc Subcommittee to begin this process. It is recommended that representatives from each of the current two approved programs be included, as well as Rhona Lee, COMDA’s current EF Examination Coordinator, and perhaps one of the Chief Examiners of the existing EF clinical examination.

10. Consideration of Revised Strategic Plan

COMMITTEE ON DENTAL AUXILIARIES

Draft Meeting Minutes - August 17, 2005

Members Present: Shanda Wallace, RDH, Chairperson, Linda Gipson, RDH, Secretary, Teresita Churchill, RDA, Coragene Savio, DDS

Members Absent: Kevin Biggers, Public Member, Darla Dale, RDH, Marlyn Hiroto, RDA, Sonia Molina, DDS

Staff Present: Karen R. Wyant, Executive Officer; Dyna Leonard, Associate Analyst; LaVonne Powell, DCA Legal Counsel; Lori Hubble, Staff Analyst, Donna Kantner, Staff

1. Call to Order/ Roll Call/ Establishment of Quorum

Chair Wallace called the meeting to order at 11:05am, Secretary Gipson called the roll, and announced that there was not a quorum. DCA Counsel LaVonne Powell advised that recommendations may still be brought forward as a subcommittee to the Board.

2. Approval of May 4, 2005 Meeting Minutes

This item was tabled due to the absence of a quorum.

3. Report of the Chair

Chair Wallace reported that she had attended and worked the Registered Dental Hygiene Boards at University of Southern California in June and July and University of the Pacific in San Francisco in July. She commended staff on doing an excellent job at the exams.

4. Report of the Executive Officer

Executive Officer Wyant reported that we have entered the new fiscal year, and that COMDA’s budget came in very close to the final appropriation, within one thousand dollars. She noted that part of this is due to a slight increase in examiner pay. She noted that she has concerns regarding reduced revenue projections for 06-07, and will return with a proposal for a fee increase in November.

She reported that in the packet is an update of the status of pending regulations, indicating that most are still under review by the Department. She reported that the regulatory hearing was not noticed properly, so those regulations cannot be heard at this meeting, but will be heard at the November COMDA meeting. She noted that examination statistics are included in the packet, with the addition of statistics by qualifying method, which staff has always tracked, and will now provide to the Board at their request. Wyant reported that the pass rate, regardless of the qualifying method, is relatively consistent over the years.

5. Legislation of Interest to COMDA

1. SB 248 (Figueroa) – Board and COMDA Sunset Dates

Wyant reported that this bill is on the Assembly floor, and would extend the Sunset dates of both COMDA and the Dental Board. She noted that the Governor opposes the bill, preferring that the Department take over the functions, and change the Board’s composition to a public member majority. She reported that since the Governor has taken this position, many Boards face this same issue. If the bill passes, it may be signed or vetoed by Governor, and if vetoed COMDA may cease to be a Board as of July 1, 2006.

2. SB 1111 (Figueroa) – Clean Up to SB 1546 (dental assisting scopes of practice)

Wyant reported that this bill is specific clean-up language to SB 1546, adding the fees for new specialty categories, and other changes that COMDA has previously approved.

3. AB 1334 (Salinas) – RDHAP Scope of Practice and Prescription Requirement

Executive Officer Wyant noted that this bill will be heard next year.

4. Other Legislation of Interest to COMDA

Executive Officer Wyant reported that there was no other legislation of interest to COMDA.

1. Review of RDA Educational Programs and Courses/Recommendations to the Board

Wyant reported that staff recommends that COMDA recommend that the Board grant provisional approval to the new RDA educational program, as well as the proposed radiation safety and coronal polishing courses of United Education Institute, Chula Vista. In response to a question by Wallace regarding provisional approval, Wyant explained that new programs are always approved provisionally before obtaining full approval. M/S/P(Savio/Gipson) to recommend provisional approval to the Board.

Wyant reported that staff recommends that COMDA recommend that the Board grant full, rather than provisional, approval of the existing RDA educational programs of Bryman College in City of Industry and Bryman College in West Los Angeles. M/S/P(Gipson/Savio) to recommend full approval to the Board.

Wyant reported that staff recommends that COMDA recommend that the Board approve the radiation safety course of California Dental Certifications, Del Mar. M/S/P(Savio/Churchill) to recommend approval to the Board.

Wyant reported that staff recommends that COMDA recommend that the Board approve the pit and fissure sealant course of Health Personnel Resources, Anderson. M/S/P(Gipson/Churchill) to recommend approval to the Board.

Chair Wallace noted that these recommendations will go forward to the Board.

2. Discussion of Proposed Changes to Title 16 CCR Sections 1070, 1070.1 and 1070.2, Approval of RDA Educational Programs to Implement SB 1546

Executive Officer Wyant noted that this was agendized for discussion by interested parties, stating that regulatory language must be implemented by 1/1/07. She proposed the beginning changes to incorporate amendments so that fully approved RDA programs must also teach everything that the three new specialties teach because those will be the new duties allowed.

She added that further amendments will be required to delineate the additional duties, and how they will be taught, and those are set for hearing hopefully in January, but even so, it is a very tight timeframe. She reported that the process will take at least one year, because that is the timeframe to change regulatory language. She stated that even if the regulations do not take effect in time, SB 1111 will essentially establish a self-certification process, and as we go forward we will of course do the full evaluation. Chair Wallace asked what the self-certification would entail. Wyant noted that the programs will be notified that if the specialty courses are not taught, their approval will expire on 1/1/07.

Lori Gagliardi, Pasadena City College, stated that curriculum changes are more difficult for the community colleges. She reported that she must make changes in curriculum now for the 2006/2007 program year. She felt that her program would not be able to self certify, but would want her students to be equivalent to others. She asked if the date for showing implementation might be extended. Wyant noted that current regulations require that approved programs teach all the duties that will be allowed. Gagliardi noted that additional hours must be added into the curriculum for both lecture and lab components. Wyant reported that discussions are currently continuing to determine the number of hours to be required, adding that COMDA can make input, but must defer to the sponsors of the bill – The Alliance and CDA.

Kim Soares, San Joaquin Valley schools, stated that theirs is a 2 year program, they will need time to prepare a new curriculum. She added that they are enrolling students now, but a new curriculum takes time to implement. She is unsure how they can self certify if there are no educational requirements and hours specified.

Kathy Mudge, CDA, stated CDA’s awareness of programs’ concerns and their intent not to make the process difficult. She indicated that they intend that it will work out for all those concerned.

3. Discussion of Two Paths to RDA Educational Program Approval – COMDA Approval vs, Commission on Dental Accreditation

Chair Wallace noted that Executive Officer Wyant has laid out the discussion on the issue. Wyant noted that the issue has been on her mind for some time, adding that COMDA has traditionally recognized programs approved by CODA as well as those approved by the Board. She reported that she has always been concerned that there might be a double standard. She understood that the process is very much different for CODA approval than ours. She reflected that as we get into implementation of SB1546, CODA may not be assuring that there is proper instruction in all allowed functions. She noted that it is possible that CODA approval may limit the duties allowed by out of state trained applicants. She asked if all programs must be evaluated by COMDA, or what might be the alternative. Member Savio asked if CODA is interested in working together with California on program approvals. Chair Wallace noted that Ms. Lori Gagliardi, Pasadena City College, had shared information regarding the standards used by CODA.

Ms. Gagliardi added that she had been part of a site visit and presented information to COMDA regarding that process. She noted that there can be confusion regarding the two pathways, and encouraged COMDA to continue to recognize programs approved by CODA. She advised that only 21 CODA approved programs in other states are currently recognized by COMDA, but would like to see that recognition upheld. She stated that CODA evaluation team members must know in depth the CODA regulations as well as the state’s Dental Practice Act. Their purpose is to establish and maintain standards for public protection, serve as a guide for programs, and provide criteria for evaluation of schools. She indicated that CODA’s standards are updated regularly, and anyone can give input into those standards to suggest changes, noting the most recent were made in 2000. She reported that Standard 210 specifically states that a program’s curriculum must be tested to competency to state standards, including a massive section on radiology, even larger than California’s. She reported that seven areas of safety considerations are used in conjunction with the Dental Practice Act to determine competency before approval. She added that the program must have teaching methodology courses, teachers must be certified to teach a particular subject, and the program director must have an adequate amount of time allowed to fulfill instructional duties. She reported that five areas of education are required, including office procedures and business practice management. She stated that instructional effectiveness, infection control, health and safety and response to medical emergencies are all evaluated. She noted that programs could go through both processes, but the CODA process validates the state process, adding that the Dental Assisting National Board did a pilot to have state-approved program graduates take the same exam, and found that those completing the state-approved program fail at a higher rate than those completing CODA programs. She indicated CODA’s willingness to work together with California on standards that were acceptable to both.

Wyant asked how CODA might feel about including a COMDA evaluator on their team. Gagliardi stated that CODA always asks for a State board person to attend the evaluation. Wyant asked about the additional duties allowed by applicants coming from other states. Gagliardi noted that it could be dealt with in the same manner as coronal polishing or anasthesia, by requiring those candidates provide a certificate. Wyant felt that it was too much to evaluate all 49 other states. Gagliardi felt the burden of proof was on the candidate to prove their qualifications. Wyant noted that the burden then falls on COMDA staff to determine the equivalency of the qualifications, adding there are two separate issues, the program approval process and the graduate’s subsequent application to California.

Edmund Carolan, CDA, agreed with Gagliardi’s comments and approved COMDA’s involvement in the process, he felt that CODA standards have opened up and this is a good time for California to provide input. He asked if the elimination of the RDA exam will free up staff resources for these course approvals. Wyant felt that there would not be enough time gained from the one staff person assigned to exams, who also reviews applications. She noted that most of the personnel involved in exams are examiners, not staff.

4. Establishment of Ad Hoc Subcommittee to Review EF Clinical Examination and Associated Regulations to Implement SB 1546

Executive Officer Wyant noted that hopefully in November the Board will hear those regulations associated with the EF examination. She added that cord retraction and final impression are the duties currently tested, however there is not an EF on COMDA at this time to provide that input. She noted that COMDA cannot force an exam change until there is a regulation change. She recommended that the two currently approved programs, and perhaps Dr. Soo Hoo from the Board establish a Subcommittee for this purpose. Edmund Carolan, CDA, recommended that at least one member be a dentist involved in teaching the program. Wyant agreed.

5. Consideration of Revised Strategic Plan

Chair Wallace complimented the Executive Officer on the plan, noting that this is our plan of action and the items we will be addressing. Wyant noted a lag in the updating of the Strategic Plan, first there was no quorum for 6 to nine months, then COMDA has been in a reactive phase due to Legislation passed. She felt it was time to revisit the plan. Chair Wallace noted that she would recommend that no Handbook be printed since changes can be made immediately on the website. She felt that rather than printing and mailing a book, she favored utilizing the website, which could be accessed at any time. She stated that she felt unlicensed activity to be a very important area due to the upcoming changes, noting that she has concerns in that area.

Chair Wallace tabled the discussion due to lack of quorum, noting the item is on the next meeting agenda for approval.

JoAnne Galliano, CDHA, felt there should be some kind of newsletter to update licentiates regarding changes, noting that CDHA supports the use of COMDA’s website, but perhaps everyone does not access the website. She added that a summary of the changes would be helpful.

Lana Wright, Loma Vista/Mt. Diablo Adult Education, asked if something could go out with the license renewal to indicate the changes in duties. Wyant noted that any small change will delay the renewal process, but possibly an insert could be included with the renewal. Wright felt that people do pay attention to their renewal, and enforcement authority could come later. DCA Legal Counsel Powell noted that this may not be enforceable without a statute or regulation.

6. Agenda Items for Future Meetings

Wyant noted there will be more regulations, in addition to the tabled items and rescheduled hearings on the proposed regulations.

7. Public Comment

Audience member Teresa Guanasso asked about X-Ray licenses for non-licensed dental assistants. Wyant noted that anyone could call or write the office to obtain that information, however it is not accessible through the website. Guanasso also asked about the elimination of the RDA written and practical examinations. Wyant answered that the amendments that have gone into SB 1111 will mandate that a candidate must apply by September 2006, and the exam pool will be closed at that time. This will give those candidates until June 2007 to complete both their written and practical examinations. Wyant clarified that currently a person can apply at any time for the written or practical exam, and then the applicant has two years to complete their file. She stated that due to changes enacted by SB1546, essentially June 2007 is the deadline to take and pass the examinations or to be required to go through an educational program. Guanasso asked if the Livescan check would be eliminated. Wyant answered that the Livescan fingerprint process will still be required before a license can be issued.

Betty Davis, Summit Career College, noted that at the last meeting their program was approved, but she has not received any notification. She asked if this comes from COMDA or the Board. Wyant noted that it should come from COMDA, and she would look into that.

8. Adjournment

Chair Wallace adjourned the meeting at 12:50pm.