Dental hygienists’ hope for a wider role in Georgia put on hold

Mary Otto

About Mary Otto

Mary Otto, a Washington, D.C.-based freelancer, is AHCJ's topic leader on oral health and the author of "Teeth: The Story of Beauty, Inequality, and the Struggle for Oral Health in America." She can be reached at mary@healthjournalism.org.

Image by Official U.S. Navy Page via flickr.

Photo: Official U.S. Navy Page via Flickr.

In recent weeks, advocates were hopeful for the passage of legislation that would have allowed Georgia dental hygienists to work in safety net settings, such as long-term care facilities, schools and nonprofit clinics, without a dentist present.

The state has roughly 150 federally designated dental provider shortage areas, and supporters of the measure said the auxiliaries would bring care to people who are otherwise going without.

They were pleased in February when the bill cleared an important hurdle, winning approval from the state House of Representative’s Health and Human Services Committee.

The legislation also got a boost from the Federal Trade Commission (FTC) which stated that the measure would “particularly benefit underserved populations with limited access to preventive care,” Donna Domino reported for DrBicuspid.com.

“Laws and regulations that require hygienists to work under the direct supervision of dentists to provide preventive services are a significant barrier to the use of dental hygienists outside of dentists’ offices and in dental shortage areas,” the FTC noted in its comment.

The Georgia Dental Association (GDA) even seemed to be warming to the bill. The group originally was opposed, but seemed pleased by amendments that barred hygienists from working more than 100 miles from the supervising dentist’s office and that required supervising dentists to be located in the state.

“We are in support of the bill,” Frank Capaldo, the GDA’s executive director, told the committee, according to the Florida Times Union. “We’re 99.9 percent there.”

But earlier this month, the fate of House Bill 684 took a sudden turn.

The chamber’s Rules Committee blocked the bill from a vote, “effectively killing it for the year,” Georgia Health News editor Andy Miller reported on March 11.

Two supporters of the legislation are claiming that, in spite of Capaldo’s encouraging words, the state dental association ultimately worked to shut down the bill.

Kathy Floyd

Kathy Floyd

In a Georgia Health News commentary, Kathy Floyd, executive director of the Georgia Council on Aging, and Misty Mattingly, president of the Georgia Dental Hygienists’ Association, said that the GDA “alerted dentists to phone members of the Rules Committee and urge them to kill HB 684.”

The two advocates went on to voice their frustration with what they called GDA’s “last minute betrayal.”

“HB 684 amounted to a simple statutory change, allowing dentists to authorize hygienists to perform preventive care services without the dentist present in more safety-net settings, such as nursing homes,” the advocates wrote, adding:

“Hygienists have been performing these same services without a dentist present for 25 years in Georgia’s public health clinics and prisons. The use of hygienists in the additional settings is already permitted in 45 other states, for obvious reasons. There are more hygienists than dentists nationwide — nearly 30 percent more in Georgia – so hygienists can reach many more patients if the dentist who manages them is not always required to be present.”

In a statement in response to the commentary, the GDA said it was working in the best interest of patients.

“Why did the Georgia Dental Association, after making suggestions for numerous amendments, change its support on Georgia House Bill 684 when it reached the House Rules Committee? Simple! At the end of the day our member dentists could not compromise their first order of ethical care, to do no harm – as would have inevitably result from patients believing that a cleaning was the same as an exam. Yes, the passage of HB 684 would have benefited many dental practices financially who could have deployed unsupervised hygienists to provide cleanings to Medicaid patients. Instead, to their selfless credit, dentists chose the safety of the most vulnerable citizens of Georgia over themselves,” the group said, expressing concerns about the lack of adequate equipment in nursing homes and the persistence of continuing barriers to care, such as transportation, parental consent and fear.

Supporters of HB 684 concede their bill is dead for the year. But they promised to try again in 2017.

Is there a similar debate unfolding in your state?

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