BILL REQ. #:  H-0127.3 

Read first time 01/22/2003.   Referred to Committee on Health Care.

     AN ACT Relating to dental hygienists; amending RCW 18.29.005, 18.29.050, 18.29.021, 18.29.045, 18.29.071, 18.29.120, 18.29.140, 18.29.150, 18.29.160, 18.29.190, and 18.29.210; adding new sections to chapter 18.29 RCW; creating a new section; and repealing RCW 18.29.110, 18.29.130, 18.29.170, 18.29.190, and 18.29.200.

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

Sec. 1   RCW 18.29.005 and 1969 c 47 s 6 are each amended to read as follows:
     ((The term)) The definitions in this section apply throughout this chapter unless the context clearly requires otherwise.
     (1) "Board" means the board of dental hygiene created in section 9 of this act.
     (2) "Dental hygiene diagnosis" means the identification of, and the discrimination between, a person's physical and oral signs and symptoms that are essential to effective execution and management of the dental hygiene care regimen.
     (3) "Department" means the department of health.
     (4) "Licensed dental hygienist" means a preventive oral health professional who has graduated from an institute of higher education's accredited dental hygiene program and is licensed under this chapter.
     (5) "Licensed dental hygienist--advanced practice" means a preventive oral health professional licensed under this chapter with a baccalaureate degree in dental hygiene from an institute of higher education approved by the board, or a preventive oral health professional licensed under this chapter with a baccalaureate degree in a related field from an institute of higher education approved by the board.
     (6) "Secretary" means the secretary of health.
     (7) "Surfaces of the teeth" ((as used in this chapter)) means the portions of the crown and root surface to which there is no periodontal membrane attached.

Sec. 2   RCW 18.29.050 and 1997 c 37 s 1 are each amended to read as follows:
     Any person licensed as a licensed dental hygienist in this state may remove deposits and stains from the surfaces of the teeth, may apply topical preventive or prophylactic agents, may polish and smooth restorations, may perform root planing and soft-tissue curettage, may administer local anesthetic and nitrous oxide analgesia under the general supervision of a licensed dentist, may place restorations into the cavity prepared by the licensed dentist, may carve, contour, and adjust contacts and occlusion of the restoration under the close supervision of a licensed dentist, and may perform other dental operations and services delegated to them by a licensed dentist: PROVIDED HOWEVER, That licensed dental hygienists shall in no event perform the following dental operations or services:
     (1) Any surgical removal of tissue of the oral cavity;
     (2) Any prescription of drugs or medications requiring the written order or prescription of a licensed dentist or physician;
     (3) Any dental diagnosis for treatment or treatment planning; or
     (4) The taking of any impression 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.
     Such licensed dental hygienists may perform dental operations and services only under the general supervision except where otherwise provided in this section, of a licensed dentist, and under such supervision may be employed by hospitals, boards of education of public or private schools, county boards, boards of health, or public or charitable institutions, or in dental offices.
     For the purposes of this section, dental hygienists may delegate certain functions to unlicensed persons as established by the board by rule. The unlicensed person may only perform the delegated function under the close supervision of a dental hygienist.

NEW SECTION.  Sec. 3   A new section is added to chapter 18.29 RCW to read as follows:
     (1) A licensed dental hygienist--advanced practice may perform all dental operations and services authorized under RCW 18.29.050 without dental supervision. A licensed dental hygienist--advanced practice may also perform the following authorized dental hygiene operations and services without dental supervision, regardless of setting: Removing deposits and stains from the surfaces of the teeth, applying topical preventive or prophylactic agents, polishing and smoothing restorations, performing root planning, soft-tissue curettage, and applying temporary cementation.
     (2) For the purposes of this section, licensed dental hygienists--advanced practice may, under close supervision delegate certain functions to unlicensed persons as established by the board by rule.
     (3) For the purposes of this section, licensed dental hygienists--advanced practice may place permanent antimicrobials and antibiotics.
     (4) The board may authorize advanced practice designation for licensed dental hygienists practicing in identified critical shortage areas.

NEW SECTION.  Sec. 4   The legislature recognizes that while Washington state licenses dental hygienists, the majority of the states and professional organizations still refer to dental hygienists as "registered dental hygienists." Section 5 of this act takes cognizance of this fact, and requires persons licensed under chapter 18.29 RCW to wear name badges that refer to their status "registered dental hygienists," or "R.D.H."

NEW SECTION.  Sec. 5   A new section is added to chapter 18.29 RCW to read as follows:
     A person licensed under this chapter must wear a name badge that identifies the licensee as an "R.D.H." when practicing dental hygiene.

Sec. 6   RCW 18.29.021 and 1996 c 191 s 10 are each amended to read as follows:
     (1) The ((department)) secretary shall issue a license to any applicant who((, as determined by the secretary)):
     (a) Has successfully completed an educational program approved by the ((secretary)) board. This educational program shall include course work encompassing the subject areas within the scope of the license to practice dental hygiene in the state of Washington;
     (b) Has successfully completed an examination administered or approved by the ((dental hygiene examining committee)) board; and
     (c) Has not engaged in unprofessional conduct or is not unable to practice with reasonable skill and safety as a result of a physical or mental impairment.
     (2) Applications for licensure must comply with administrative procedures, administrative requirements, and fees established according to RCW 43.70.250 and 43.70.280.

Sec. 7   RCW 18.29.045 and 1991 c 3 s 47 are each amended to read as follows:
     An applicant holding a valid license and currently engaged in practice in another state may be granted a license without examination required by this chapter, on the payment of any required fees, if the secretary in consultation with the ((advisory committee)) board determines that the other state's licensing standards are substantively equivalent to the standards in this state: PROVIDED, That the secretary in consultation with the ((advisory committee)) board may require the applicant to: (1) File with the secretary documentation certifying the applicant is licensed to practice in another state; and (2) provide information as the secretary deems necessary pertaining to the conditions and criteria of the uniform disciplinary act, chapter 18.130 RCW and to demonstrate to the secretary a knowledge of Washington law pertaining to the practice of dental hygiene.

Sec. 8   RCW 18.29.071 and 1996 c 191 s 11 are each amended to read as follows:
     The ((secretary)) board shall establish the administrative procedures, administrative requirements, and fees for renewal of licenses as provided in this chapter and in RCW 43.70.250 and 43.70.280.

NEW SECTION.  Sec. 9   A new section is added to chapter 18.29 RCW to read as follows:
     (1) The board of dental hygiene is created. The board consists of five members who shall be appointed by the governor. Of the initial appointments, two shall be appointed for a term of two years, two for a term of three years, and one for a term of four years. Thereafter, all appointments shall be for terms of four years. Four members of the board shall be dental hygienists licensed under this chapter and residing in this state, shall have not less than five years' experience in the practice of dental hygiene, and shall be actively engaged in practice within two years of appointment. The fifth member shall be appointed from the public at large, shall have an interest in the rights of consumers of dental services, and shall not be or have been a member of any other licensing board, a licensee of any dental related board, an employee of any dental services facility, nor derive his or her primary livelihood from the provision of dental services at any level of responsibility. In the event that a member of the board cannot complete his or her term of office, another appointment shall be made by the governor in accordance with the procedure stated in this subsection to fill the remainder of the term. No member may serve for more than two successive four-year terms.
     (2) The secretary of health shall furnish such secretarial, clerical, and other assistance as the board may require. Each member of the board shall be compensated in accordance with RCW 43.03.240, and be reimbursed for travel expenses in accordance with RCW 43.03.050 and 43.03.060.

NEW SECTION.  Sec. 10   A new section is added to chapter 18.29 RCW to read as follows:
     In addition to other duties specified in this chapter, the board has the following powers and duties:
     (1) To develop and administer, or approve, or both, examinations to applicants for licensure under this chapter;
     (2) To pass upon the qualifications of applicants for a license and to certify to the secretary duly qualified applicants;
     (3) To adopt rules not inconsistent with the laws of this state as may be deemed necessary or proper to carry out the purposes of this chapter;
     (4) To establish and administer requirements for continuing competency, which shall be a prerequisite to renewing a license under this chapter;
     (5) To keep an official record of all board proceedings, which record shall be evidence of all proceedings of the board that are set forth in the official record; and
     (6) To adopt rules not inconsistent with the laws of this state, when it deems appropriate, in response to questions put to it by professional dental related associations, dental hygienists, and consumers in this state concerning the authority of dental hygienists to perform certain acts.

NEW SECTION.  Sec. 11   A new section is added to chapter 18.29 RCW to read as follows:
     The board shall elect from its members a chair and vice-chair/secretary, who shall serve for one year or until their successors are elected. The board shall meet at least once a year and upon the call of the chair at such times and places as the chair designates. Three members constitute a quorum of the full board for the transaction of any business. Meetings of the board shall be open and public, except the board may hold executive sessions to the extent permitted by chapter 42.30 RCW.

Sec. 12   RCW 18.29.120 and 1995 c 198 s 5 are each amended to read as follows:
     The ((secretary in consultation with the Washington dental hygiene examining committee)) board shall:
     (1) Adopt rules in accordance with chapter 34.05 RCW necessary to prepare and conduct examinations for dental hygiene licensure;
     (2) Require an applicant for licensure to pass an examination consisting of written and practical tests upon such subjects and of such scope as the ((committee)) board determines;
     (3) Set the standards for passage of the examination;
     (4) Administer at least two examinations each calendar year. Additional examinations may be given as necessary; and
     (5) Establish by rule the procedures for an appeal of an examination failure.

Sec. 13   RCW 18.29.140 and 1991 c 3 s 54 are each amended to read as follows:
     The ((secretary)) board shall establish by rule the standards and procedures for approval of educational programs and may contract with individuals or organizations having expertise in the profession or in education to report to the ((secretary)) board information necessary for the ((secretary)) board to evaluate the educational programs. The ((secretary)) board may establish a fee for educational program evaluation. The fee shall be set to defray the administrative costs for evaluating the educational program, including, but not limited to, costs for site evaluation.

Sec. 14   RCW 18.29.150 and 1991 c 3 s 55 are each amended to read as follows:
     (1) The ((secretary)) board shall establish the date and location of the examination. Applicants who meet the education requirements for licensure shall be scheduled for the next examination following the filing of the application. The ((secretary)) board shall establish by rule the examination application deadline.
     (2) The examination shall contain subjects appropriate to the scope of practice and on laws in the state of Washington regulating dental hygiene practice.
     (3) The ((committee)) board shall establish by rule the requirements for a reexamination if the applicant has failed the examination.
     (4) The ((committee)) board may approve an examination prepared or administered by a private testing agency or association of licensing authorities.

Sec. 15   RCW 18.29.160 and 1991 c 3 s 56 are each amended to read as follows:
     The secretary, members of the ((committee)) board, and individuals acting on their behalf are immune from suit in any action, civil or criminal, based on any acts performed in the course of their duties.

Sec. 16   RCW 18.29.190 and 1993 c 323 s 2 are each amended to read as follows:
     (1) The department shall issue a temporary license without the examination required by this chapter to any applicant who, as determined by the ((secretary)) board:
     (a) Holds a valid license in another state that allows the scope of practice in subsection (3)(a) through (j) of this section;
     (b) Is currently engaged in active practice in another state. For the purposes of this section, "active practice" means five hundred sixty hours of practice in the preceding twenty-four months;
     (c) Files with the ((secretary)) board documentation certifying that the applicant:
     (i) Has graduated from an accredited dental hygiene school approved by the ((secretary)) board;
     (ii) Has successfully completed the dental hygiene national board examination; and
     (iii) Is licensed to practice in another state;
     (d) Provides information as the ((secretary)) board deems necessary pertaining to the conditions and criteria of the uniform disciplinary act, chapter 18.130 RCW;
     (e) Demonstrates to the ((secretary)) board a knowledge of Washington state law pertaining to the practice of dental hygiene, including the administration of legend drugs;
     (f) Pays any required fees; and
     (g) Meets requirements for AIDS education.
     (2) The term of the temporary license issued under this section is eighteen months ((and it is)). An applicant may renew the temporary license for an additional eighteen months solely for the purpose of completing the licensing requirements in restorative procedures, otherwise the temporary license is nonrenewable.
     (3) A person practicing with a temporary license granted under this section has the authority to perform hygiene procedures that are limited to:
     (a) Oral inspection and measuring of periodontal pockets;
     (b) Patient education in oral hygiene;
     (c) Taking intra-oral and extra-oral radiographs;
     (d) Applying topical preventive or prophylactic agents;
     (e) Polishing and smoothing restorations;
     (f) Oral prophylaxis and removal of deposits and stains from the surface of the teeth;
     (g) Recording health histories;
     (h) Taking and recording blood pressure and vital signs;
     (i) Performing subgingival and supragingival scaling; and
     (j) Performing root planing.
     (4)(a) A person practicing with a temporary license granted under this section may not perform the following dental hygiene procedures unless authorized in (b) or (c) of this subsection:
     (i) Give injections of local anesthetic;
     (ii) Place restorations into the cavity prepared by a licensed dentist and afterwards carve, contour, and adjust contacts and occlusion of the restoration;
     (iii) Soft tissue curettage; or
     (iv) Administer nitrous oxide/oxygen analgesia.
     (b) A person licensed in another state who can demonstrate substantively equivalent licensing standards in the administration of local anesthetic may receive a temporary endorsement to administer local anesthesia.
     (c) A person licensed in another state who can demonstrate substantively equivalent licensing standards in restorative procedures may receive a temporary endorsement for restorative procedures.

Sec. 17   RCW 18.29.210 and 1993 c 323 s 4 are each amended to read as follows:
     The ((secretary in consultation with the dental hygiene examining committee)) board shall develop rules and definitions to implement this chapter.

NEW SECTION.  Sec. 18   The following acts or parts of acts are each repealed:
     (1) RCW 18.29.110 (Dental hygiene examining committee--Generally) and 1991 c 3 s 51 & 1989 c 202 s 3;
     (2) RCW 18.29.130 (Secretary's authority--Generally--Continuing education) and 1991 c 3 s 53 & 1989 c 202 s 5;
     (3) RCW 18.29.170 (Committee meetings--Quorum--Effect of vacancy) and 1989 c 202 s 9;
     (4) RCW 18.29.190 (Temporary licenses) and 1993 c 323 s 2; and
     (5) RCW 18.29.200 (Temporary licensees--Requirements for regular examination) and 1993 c 323 s 3.