AN ACT Relating to independent denturistry; amending RCW 18.32.030; adding a new chapter to Title 18 RCW; creating a new section; prescribing penalties; and providing an effective date.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:

NEW SECTION. Sec. 1. The purpose of this chapter is to promote the public health and welfare and to provide independent denture services at affordable prices by making individual denturists directly accountable and responsible to individual consumers for the quality of denture care. Any person practicing or offering to practice denturistry in this state shall hereafter be required to submit evidence that he or she is qualified to practice denturistry, and shall be licensed under this chapter.

NEW SECTION. Sec. 2. Unless the context clearly requires otherwise, the definitions in this section apply throughout this chapter.

(1) "Denture" means any removable, full upper or lower prosthetic dental appliance to be worn in the human oral cavity.

(2) "Partial denture" means any removable, partial upper or lower prosthetic dental appliance to be worn in the human oral cavity.

(3) "Denturist" means any person who is licensed to provide denturistry services as defined in this chapter.

(4) "Denturistry" means:

(a) Constructing, supplying, fitting, repairing, or altering any denture or partial denture with respect to which a service is performed under (b) of this subsection; and

(b) The taking of impressions, bite registrations, try-ins, and insertions of or in any part of the human oral cavity for any of the purposes listed in (a) of this subsection.

(5) "Board" means the denturistry board established in section 4 of this act.

(6) "Director" means the director of licensing.

(7) "Department" means the department of licensing.

NEW SECTION. Sec. 3. (1) After January 1, 1986, a person shall not practice or offer to practice denturistry, or hold himself or herself out as a denturist, or use the word "denturist," "licensed denturist," or any other name, title, initial, description, or device to indicate that the person is practicing as a licensed denturist in this state unless the person is licensed by the board as a denturist.

(2) This chapter shall not be construed to prohibit any person from practicing any profession for which a license has been issued under the laws of this state or which is specifically authorized by any other law of this state.

NEW SECTION. Sec. 4. (1) The state board of denturistry shall consist of five members to be appointed by the governor, three of whom shall be licensed denturists and two of whom shall be members of the public.

(2) Board members shall have the following qualifications:

(a) Each member of the board shall be a citizen of the United States and a resident of this state;

(b) Denturist members shall be licensed and engaged in the active practice of denturistry in this state, except that the first denturist members appointed after enactment of this legislation need only meet the requirements of sections 4(2)(a) and 17 of this act;

(c) The public members shall neither be nor have been a member of any other licensing board, a licensee of any health occupation board, or an employee of any health facility, nor derive his or her primary livelihood from the provision of health services at any level of responsibility.

NEW SECTION. Sec. 5. The members of the state board of denturistry, beginning January 1, 1986, shall hold office as follows:

(1) Two members for an initial term of four years;

(2) Two members for an initial term of three years; and

(3) One member for an initial term of two years.

!ixThereafter all appointments shall be for four-year terms. Board members shall not be appointed for more than two consecutive terms.

NEW SECTION. Sec. 6. The governor may remove any member from the board for neglect of a duty required by law, or for dishonesty, incompetency, or unprofessional conduct, or for other good cause. Vacancies on the board shall be filled for the unexpired term by appointment by the governor as provided in section 4 of this act.

NEW SECTION. Sec. 7. The board shall meet annually. At its annual meeting it shall choose one of its members as president and one as secretary. The first annual meeting shall be held within ninety days after appointment. The board shall also meet at least twice annually thereafter for the purpose of approving or disapproving applications for licenses under this chapter as well as conducting such other business as is authorized in this chapter. A majority of the members of the board, including one officer, shall constitute a quorum at any meeting. All meetings of the board shall be open to the public except the board may hold executive sessions to the extent permitted by chapter 42.30 RCW.

NEW SECTION. Sec. 8. (1) In accordance with chapter 34.04 RCW, the board may conduct hearings and may adopt rules consistent with the law as may be necessary. These rules and hearings may include but are not limited to:

(a) Procedures and qualifications for the licensing of denturists;

(b) Education and technical requirements for denturists and an examination procedure covering each category of dentures and partial dentures in accordance with section 11 of this act;

(d) Services and procedures that may be performed by a denturist;

(e) Periodic inspection of all denturist practices;

(f) Establishing and recognizing such specialties as may assist implementing this chapter; and

(g) Disciplining denturists and revoking licenses as provided in this chapter.

(2) The board shall approve curricula and shall establish criteria for minimum standards for schools that prepare persons for licensure under this chapter.

(3) The board shall approve such schools of denturistry as meet the requirements of this chapter and the board, and the board shall approve establishment of basic denturistry education programs and shall establish criteria as to the need for and the size of a program and the geographical location.

(4) The board shall examine all applications for registration under this chapter, and shall certify qualified applicants to the director.

(5) The board shall establish criteria to determine whether an applicant who has held a nonpracticing status has sufficiently current knowledge and skill to engage in a safe practice.

(6) The board may adopt other regulations in response to questions put to it by professional health associations, denturists, dentists, and consumers in this state concerning the authority of denturists to perform particular acts.

(7) The board shall keep a record of its proceedings and make reports to the governor as may be required.

NEW SECTION. Sec. 9. (1) The department shall furnish the board with secretarial, clerical, and other assistance as is necessary to administer this chapter effectively.

(2) While away from home, each board member shall receive twenty-five dollars compensation for each day engaged in his or her duties in addition to travel expenses provided under RCW 43.03.050 and 43.03.060.

(3) The board shall have the power to employ competent persons on a temporary basis to assist in conducting examinations for licensure.

(4) The board and its panels shall have the power to appoint an examiner to inspect the place of business of any licensed denturist to assure compliance with this chapter.

NEW SECTION. Sec. 10. (1) At the board's request, the director is authorized to appoint members pro tem to participate as members of one or more panels of the board in connection with proceedings specifically identified in the appointment.

(2) Persons serving as denturistry disciplinary board members pro tem have the authority, duties, and immunities of regular board members, and are entitled to travel expenses in accordance with RCW 43.03.050 and 43.03.060.

(3) The chairperson of a panel shall be a regular member of the board. Panels have authority to act as directed by the board with respect to all matters concerning the review, investigation, and adjudication of all complaints, allegations, charges, and matters subject to appeal as provided in sections 24, 25, and 26 of this act.

(4) The authority to act through panels shall not restrict the authority of the board to act as a single body at any phase of a proceeding within the board's jurisdiction.

(5) Board panels shall have authority to make interim orders and to issue final decisions with respect to matters delegated to a panel by the board. Final decisions may be appealed as provided in chapter 34.04 RCW.

NEW SECTION. Sec. 11. The board shall establish requirements for a formal training program for denturists consisting of programs of study and practical experience to provide knowledge and experience in the practice of denturistry. The full training program shall include, but not be limited to:

(1) Two years of training in the subjects of:

(a) Anatomy and physiology of the head and neck, and of oral pathology, in order to enable the denturist to observe, recognize, and refer patients with possible oral health problems to a physician or a dentist; and

(b) Denture technology and clinical technology as related to partial dentures and dentures; and

(2) A two-year apprenticeship with a licensed practicing denturist.

NEW SECTION. Sec. 12. An applicant for a license to practice as a denturist shall submit to the board:

(1) An attested written application on a department form;

(2) Written official evidence of a diploma or certificate of completion of educational requirements established by the board under section 11 of this act;

(3) A birth certificate or other official document verifying that the applicant is at least eighteen years of age; and

(4) Any other official records specified by the board. At the time of admission, the applicant shall not be in violation of this chapter.

NEW SECTION. Sec. 13. (1) Applicants are required to pass an examination in such subjects as the board shall determine. Each examination shall include written, oral, and practical examinations in denture technology, oral health, and clinical procedures, as determined by the board. The board shall determine the standards for passing.

(2) Those applicants who fail the examination shall be allowed to submit themselves to one reexamination without payment of any additional fee if the examination is held within one year of the failure. The board shall establish, by rule, the requirements necessary to qualify for reexamination for applicants who have failed.

NEW SECTION. Sec. 14. Under such rules as the board may establish, the department shall issue a license to practice denturistry to an applicant who has been licensed as a denturist by examination under the laws of another state, territory, or possession of the United States. These regulations shall not impose requirements greater than those imposed upon applicants under sections 12 and 13 of this act.

NEW SECTION. Sec. 15. Each applicant for a license to practice denturistry shall pay to the board a fee determined by the director as provided in RCW 43.24.086.

NEW SECTION. Sec. 16. (1) In addition to the training program established under section 11 of this act, the board shall establish an alternative training program for denturists that shall consist of programs of study and practical experience providing knowledge and experience in the practice of denturistry. This alternative program shall include, but not be limited to:

(a) A five-year apprenticeship with a licensed practicing denturist; and

(b) Courses in anatomy and physiology of the head and neck, and of oral pathology, in order to enable the denturist to observe, recognize and refer patients with possible oral health problems to a physician or dentist.

(2) The board shall establish criteria for approval of licensed denturists to operate apprenticeship programs, and for qualifications to be met by applicants for these programs, including but not limited to the requirements of section 12 (1) and (2) of this act, or their equivalent, as recognized by the board. Upon completion of an apprenticeship program established under this section, the applicant shall be required to pass the examination described in section 13 of this act, and shall pay the fee established under section 15 of this act. The alternative training program established under this section shall expire January 1, 1996, unless, at the option of the board, it is extended by the board to January 1, 2001.

NEW SECTION. Sec. 17. (1) Notwithstanding the requirements of sections 13 and 14 of this act, a license shall be issued to any person who applies prior to April 1, 1986, and who:

(a) Demonstrates to the satisfaction of the board that he or she has, by January 1, 1986, had at least four years full-time experience in the art and manufacture of dentures and partial dentures;

(b) Submits, on a department form, two attested statements from persons the board determines capable of evaluating the applicant's experience and competency; and

(c) Passes a written, oral, or practical examination, as determined by the board, in denture technology, oral health, and clinical procedures.

(2) A license issued under this section shall not be renewed unless the person has, prior to the renewal of the license, also completed and passed course work as may be specified by the board, which shall include head and neck anatomy and physiology, oral pathology, and related subjects, to enable the denturist to refer patients with oral health problems to a physician or dentist.

NEW SECTION. Sec. 18. Every license issued under this chapter shall be valid for a period of two years, which period shall commence and expire on the applicant's birthdate: PROVIDED, That the first license issued to an applicant, and any license renewal after a lapse, shall be for a period not less than one year nor more than two years, commencing on the date of approval by the board, and ending on the applicant's birthdate.

NEW SECTION. Sec. 19. Upon payment of a license renewal fee to be determined by the board, and upon satisfaction of any rules as may be determined by the board to ensure the licensee's continuing competence, the department shall renew the license. At least thirty days prior to expiration of the license the director shall mail a notice for renewal of license to the licensee. The licensee shall return the notice and proof of compliance with such other rules as may be determined by the board to the department with the renewal fee. Upon receipt thereof, the department shall renew the license, rendering the licensee a legal practitioner of denturistry for the two-year period.

NEW SECTION. Sec. 20. Any licensee who allows his or her license to lapse by failing to renew the license shall upon application for renewal pay a penalty determined by the board. If the license has not been renewed for a period of three years, the applicant shall be issued a license only upon successfully retaking a qualifying examination as may be established by the board under section 8(5) of this act, and upon providing other evidence of knowledge and skill of current practice as may be required by the board under this chapter.

NEW SECTION. Sec. 21. A license that has been lost or destroyed shall be replaced by the director upon receipt of a fee as may be established by the director.

NEW SECTION. Sec. 22. Fees under this chapter shall be established in an amount that matches the anticipated cost of administering the chapter, in accordance with RCW 43.24.086.

NEW SECTION. Sec. 23. Upon recommendation of the board, the department shall deny, or after a hearing by the board, shall revoke or suspend the license upon finding that a person:

(1) Procured or attempted to procure the license by fraud or deceit; or

(2) Has been convicted of a crime if such crime bears a demonstrable relationship to the practice of denturistry; or

(3) Is habitually intemperate in the use of or is addicted to any habit-forming or other dangerous drugs; or

(4) Has engaged in distribution of drugs for any other than legitimate purposes; or

(5) Exhibits behavior which may be due to poor physical or mental health which creates an undue risk that the person, as a denturist, would cause harm to other persons; or

(6) Has previously had a denturistry license revoked or suspended in this or any other state, territory, possession of the United States, or country, unless reinstated; or

(7) Has been guilty of gross negligence in the performance of acts of denturistry practice; or

(8) Has engaged in any act inconsistent with generally accepted professional standards of good denturistry practice; or

(9) Has wilfully violated any of the provisions of this chapter or rules adopted thereunder.

Upon recommendation from the board the department shall reissue a license that has been revoked or suspended under the provisions of this section. Application for the reissuance of a license shall not be considered prior to one year after revocation and shall be made in a manner as the board may specify.

NEW SECTION. Sec. 24. (1) A licensee shall be entitled to a hearing by the board before his or her license is revoked or suspended. In all proceedings to revoke or suspend a license to practice as a denturist, the holder of the license shall be given twenty days' notice in writing by the director, specifying the offense or offenses against this chapter with which the accused is charged, and shall also give the date and place where the hearing is to be held, the place which shall be the city of Olympia, Washington, unless a different place is fixed by the board.

(2) The director or the president of the board shall have the power to issue subpoenas to compel the attendance of witnesses or the production of books or documents. The accused person shall have the opportunity to make his or her defense and may have issued such subpoenas as he or she may desire. Subpoenas may be served in the same manner as in civil cases in the superior court.

(3) Witnesses shall testify under oath administered by the president of the board. Testimony shall be taken in writing and may be taken by deposition under rules as the board may prescribe.

(4) The board shall hear and determine the charges and shall make findings of fact and conclusions of law based upon the evidence produced. The board shall file its findings with the department, together with a transcript and all the evidence. A duplicate copy of the board's filings shall be served upon the accused.

(5) The revocation or suspension of a licensee to practice shall be in writing, signed by the director or president of the board, and state the grounds upon which the order is based.

(6) The board is not bound by strict rules of procedure or by the rules of evidence in the conduct of its proceedings, but its determination shall be based upon sufficient legal evidence.

NEW SECTION. Sec. 25. Any person feeling aggrieved by the refusal of the department to issue a license provided for in this chapter, or to renew it, or by the revocation or suspension of the license issued under this chapter, or any law being administered under this chapter, shall have the right of appeal in the manner provided by the Washington administrative procedure act, chapter 34.04 RCW.

NEW SECTION. Sec. 26. Reported violations of this chapter shall be investigated by the department, the attorney general, a pro tem disciplinary panel, or the board, as appropriate. In any case in which the department, the attorney general, a pro tem disciplinary panel, or the board finds that a violation has occurred, it shall immediately report it to the board for appropriate action or to the prosecuting attorney for the county in which the violation took place to be prosecuted.

NEW SECTION. Sec. 27. The board of denturistry may, at its option, by injunctive proceeding instituted by the attorney general, prevent a person not validly licensed from practicing denturistry.

NEW SECTION. Sec. 28. It is a gross misdemeanor for any person to:

(1) Sell, barter, offer to sell or barter, or fraudulently use, alter, obtain, or furnish any denturistry diploma, license, record, or registration, or aid or abet another in doing any of these activities;

(2) Practice denturistry as defined by this chapter under cover of any diploma, license, record, or registration illegally or fraudulently obtained or signed, or issued unlawfully or under fraudulent representation or material mistake of fact;

(3) Practice denturistry as defined by this chapter, unless licensed to do so under this chapter;

(4) Employ an unlicensed denturist unless that person is in an apprenticeship program approved under this chapter;

(5) Use in connection with his or her name any designation tending to imply that he or she is a licensed professional denturist unless licensed to practice under this chapter;

(6) Practice as a denturist during the time his or her license issued under this chapter has been suspended or revoked;

(7) Practice denturistry without conspicuously displaying in the place of business the name of each licensed denturist practicing therein; and

(8) Otherwise violate any of the provisions of this chapter.

NEW SECTION. Sec. 29. No partial denture shall be fitted without (1) prior examination of a patient by a dentist, and (2) the receipt by the denturist of the dentist's statement certifying that the patient's natural teeth are able to receive a partial denture. This examination and certification shall be provided no more than six months before the fitting.

NEW SECTION. Sec. 30. Members of the board and any pro tem panels for the board are immune from suit for any action, civil or criminal, based upon any proceedings commenced under this chapter or other official acts performed in good faith as members of the board.

NEW SECTION. Sec. 31. (1) Notwithstanding any provisions of an insurance policy covering dental health, if the policy provides for reimbursement for any service which is within the legal scope of the practice of denturistry under this chapter, the insured under the policy is entitled to reimbursement for the service whether it is performed by a licensed denturist or by a licensed dentist.

(2) This section shall apply to any policy covering dental health issued or renewed after January 1, 1986. Policies which are renewed after January 1, 1986, shall be brought into compliance on their anniversary or renewal date, or upon the expiration of the applicable collective bargaining agreement if any, whichever is later.

(3) Unless prohibited by pertinent federal regulation, whenever the department of social and health services, or any other agency of this state, reimburses for any service which is within the legal scope of the practice of denturistry under this chapter, reimbursement shall occur whether the service is performed by a licensed dentist or a licensed denturist.

NEW SECTION. Sec. 32. All new denture and partial dentures shall be sold with a sixty-day guarantee. If at the end of the sixty days the denture consumer is dissatisfied, upon return of the dentures or partial dentures he or she shall receive a total refund less the cost of materials within thirty days.

NEW SECTION. Sec. 33. Sections 2 through 32 of this act shall constitute a new chapter in Title 18 RCW.

Sec. 34. Section 1, chapter 130, Laws of 1951 as last amended by section 35, chapter 158, Laws of 1979 and RCW 18.32.030 are each amended to read as follows:

The following practices, acts and operations are excepted from the operation of the provisions of this chapter:

(1) The rendering of dental relief in emergency cases in the practice of his profession by a physician or surgeon, licensed as such and registered under the laws of this state, unless he undertakes to or does reproduce lost parts of the human teeth in the mouth or to restore or to replace in the human mouth lost or missing teeth;

(2) The practice of dentistry in the discharge of official duties by dentists in the United States army, navy, public health service, veterans' bureau, or bureau of Indian affairs;

(3) Dental schools or colleges approved by the board, and the practice of dentistry by students in dental schools or colleges approved by the board, when acting under the direction and supervision of registered and licensed dentists or licensed denturists acting as instructors;

(4) The practice of dentistry by licensed dentists or licensed denturists of other states or countries while appearing as clinicians at meetings of the Washington state dental association or Washington state denturists, or component parts thereof, or at meetings sanctioned by them;

(5) The use of roentgen and other rays for making radiograms or similar records of dental or oral tissues, under the supervision of a licensed dentist or physician;

(6) The making, repairing, altering or supplying of artificial restorations, substitutions, appliances, or materials for the correction of disease, loss, deformity, malposition, dislocation, fracture, injury to the jaws, teeth, lips, gums, cheeks, palate, or associated tissues or parts; providing the same are made, repaired, altered or supplied pursuant to the written instructions and order of a licensed dentist which may be accompanied by casts, models or impressions furnished by said dentist, and said prescriptions shall be retained and filed for a period of not less than three years and shall be available to and subject to the examination of the director of licensing or his authorized representatives;

(7) The removal of deposits and stains from the surfaces of the teeth, the application of topical preventative or prophylactic agents, and the polishing and smoothing of restorations, when performed or prescribed by a dental hygienist licensed under the laws of this state;

(8) A qualified and licensed physician and surgeon extracting teeth or performing oral surgery;

(9) A legal practitioner of another state making a clinical demonstration before a medical or dental society, or at a convention approved by the Washington state medical or dental association or Washington progressive dental society;

(10) Students practicing or performing dental operations, under the supervision of competent instructors, in any reputable dental college;

(11) The performing of dental operations or services by persons not licensed under this chapter when performed under the supervision of a licensed dentist: PROVIDED HOWEVER, That such nonlicensed person shall in no event perform the following dental operations or services unless permitted to be performed by him under other provisions of this chapter or chapter 18.29 RCW:

(a) Any removal of or addition to the hard or soft tissue of the oral cavity;

(b) Any diagnosis of or prescription for treatment of disease, pain, deformity, deficiency, injury, or physical condition of the human teeth or jaws, or adjacent structure;

(d) Any oral prophylaxis;

(e) The taking of any impressions of the teeth or jaw or the relationships of the teeth or jaws, for the purpose of fabricating any intra-oral restoration, appliance, or prosthesis;

(12) The practice of denturistry under chapter 18... RCW (sections 2 through 32 of this 1985 act).

NEW SECTION. Sec. 35. If any provision of this act or its application to any person or circumstance is held invalid, the remainder of the act or the application of the provision to other persons or circumstances is not affected.

NEW SECTION. Sec. 36. This act shall take effect January 1, 1986.