PUBLIC BOARD MEETING MINUTES

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 1                              PUBLIC BOARD MEETING MINUTES
 2                                    Friday, March 28, 2003
 3                                           8:30 a.m.
 4
 5
 6   President Freeman Rosenblum, D.D.S., called the meeting to order at 8:30 a.m.
 7
 8   Board Members present:                                   Board Staff present:
 9   Freeman Rosenblum, D.D.S., President                     Marshall Shragg, Executive Dir.
10   Marguerite Rheinberger, Vice President                   Judy Bonnell, Complaint Analyst
11   Annie Stone Thelen, D.D.S.                               Mary Dee, Complaint Unit Supr.
12
13   Linda Boyum, R.D.A., Secretary                           Deb Endly, Compliance Officer
14   Susan Gross, D.D.S.                                      Sheryl Herrick, Office Manager
15   Ronald King, D.D.S.                                      Kathy Johnson, Legal Analyst
16   Nadene Bunge, D.H.                                       Joyce Nelson, CE Program
17   Gerald McCoy                                                     Administrator
18                                                            Jackie Norlander, Admin. Asst.
19                                                            Lori Schneider, Licensing Coordinator
20
21   Others in Attendance: Rose Stokke, MDHA Jim Zenk, MDA; Patricia Glasrud, University of
22   Minnesota; Denis Zack, MACD; Dick Diercks, MDA; Carl Ebert, MACD/ATD; Amos Deinard-
23   U of M/MACD; Rosellen Condon, AGO; Pat Foy, MDA; Mildred Hottman Roesch, MDH;
24   Marge Jocelyn, MDHA.; Monica Feider, HPSP; Joan Monahan, HPSP.
25
26   Consent Agenda
27   Modifications to the Consent Agenda: remove #10 Travel Authorizations; #11 Licenses, and
28   #12 Sponsor Approvals.
29
30   Review and Approval of Minutes
31   Minutes from the January 24, 2003, public meeting were reviewed and approved with the
32   following changes:
33   Page 3-8, line 9, change should be removed to ―nitrous oxide‖;
34   Page 3-8, line 19, change tools to ―pieces‖;
35   Page 3-8, line 26, add quotation marks around ―align‖ and ―adapt‖;
36
37   MOTION: Ms. Rheinberger                  SECOND: Dr. Anne Stone Thelen
38
39   RESOLVED, that the Board approve the minutes from the January 24 public meeting, as
40   amended.
41   VOTE: For: Unanimous            RESULT: Motion carried.
42
43
44   Professional Association and University of Minnesota Reports
45   Dr. Patrick Foy, Minnesota Dental Association, reported on the ―Give Kids a Smile‖ event held
46   on Feb. 21, 2003. He estimated that more than 4,000 kids in the state of Minnesota were seen, and
47   that one million dollars worth of free dental work was done that day. Practitioners had such
48   positive responses that they are encouraged to expand this in years to come scheduling it the first
49   Friday in Feb. of 2004, and are considering making it a two-day event. Approximately 300
50   dentists participated, and referrals were made but he did not know how many.



                          Board Meeting Minutes, March 28, 2003           Page 1
                                                                                                   3.-2
 1   The ―Sealant Seminar‖(featuring Dr. Robert Neigel) was held on 1/31 which many of you
 2   attended. It was very successful and a created a good open forum; and helped formulate some of
 3   the language in the collaborative agreement /sealants, and we also came to a verbal agreement
 4   and approved an EAP for program for dental assistants. The contract is a verbal agreement with
 5   Sand Creek people who are also the EAP for the Whitehouse. It is now in contractual phase, and
 6   we hope to bring this up at the Star of the North.
 7   Legislative: MDA & area council have introduced healthy vending choices. Also, our Amalgam
 8   Separator program is not necessarily for MDA members but for every dentist in MN in
 9   cooperation with the Metro Council of Env. Safety. The separators will be on display at the Star
10   of North meeting so you can evaluate them. We encourage state-wide installation of the
11   separators.
12   On 2/28 HIPPA Seminar with cooperation with MDA so hopefully all dentists in the state of
13   MN will be compliance by April. We‘re also pleased to announce that our own Bob Branchard,
14   our tenth trustee, will be seeking the office president-elect of MDA in 2004, and we ask for all
15   your support, and think he will represent us all. Dr. Foy said the MDA is pleased to announce
16   that they‘ve hired Pat Glasrud who starts this Monday (3/31) as Director of Policy Development.
17   Also, we want to invite all of you to the Star of the North. Sunday we are having a seminar at
18   9:00 a.m. on Bioterrorism with the help of the ADA.
19
20   FR: Does anyone have any questions?
21   Q: Deinard Can you tell me relative to Feb. 21, you said there were roughly 4,00 children seen:
22   how many dentists participated; how many kids were found to need referrals; and how many of
23   those referrals were successfully set up?
24   Foy: I don‘t have the numbers (approx. 300 dentists).
25   MS: I apologize. I had been asked to indicate both Dr. Foy‘s and Dr. Zenk‘s names on the
26   agenda and we neglected to do that. We appreciate their presence here.
27   FR: Can you in any way summarize the lecture on sealants or the conference you had on
28   sealants? Was there a bottom line that came out of that is important that we should all know?
29   Foy: I think that Dr. Feigel represented the study regarding sealants dentists placing sealants vs
30   hygienist—the bottom line to that was that the hygienists could do it better than the dentist. But
31   the important part of any sealant program is not just the physical act of placing the sealant
32   because it is not successful unless it is maintained. Unless there is a follow-up where the sealants
33   are constantly maintained, to throw money into the sealant program without the maintenance is a
34   waste of time and money and it is counterproductive; hopefully that message was brought home
35   by that seminar.
36   RF: Did he talk about why they are applying sealants in patients who have shallow grooves? the
37   cost effectiveness? etc.
38   Foy: Another thing he said there are times not to use sealant and there are times and again you
39   are talking about this preventive resin administration; there is the aspect of misdiagnosing the
40   presence of decay in placing a sealant, and sometimes it does stop out and starve the decay
41   process. If a sin is committed and if we happen to seal over a decay it doesn‘t necessarily mean a
42   devasting procedure.
43   FR: On the amalgam separator this is not legislated so we are going to be promoting and
44   encouraging it but people don‘t have to necessarily do it.
45   Foy: If the voluntary program is not successful in the metro area, then we run the risk of
46   mandate.
47   FR: On the HIPPA it is my understanding that program has to be regulated, if it not regulated by
48   any state agency. Who is going to regulate it?
49   Foy: Currently you have the responsibility to self-regulate within your own practice. There are
50   state laws, MN is going to be a little different than other states because there are some precedents
51   in state law; for example in our HIPPA kit what consent form or authorization form is signed is


                           Board Meeting Minutes, March 28, 2003           Page 2
                                                                                                   3.-3
 1   actually mandated by state law and not necessarily by federal law so some state laws do cross
 2   over. That has probably been the biggest point of confusion—what forms can we have our
 3   patients sign and really what does that mean.
 4   Diercks: At the federal level it is the Dept. of Health and Human Services.
 5   FR: Is this something that we as a state Board should be concerned about?
 6   Foy: At some point all consult forms could be merged into one document.
 7   Diercks: You could get some complaints from patients. Board‘s job would not be to enforce the
 8   federal law but to enforce ―standard of care‘. You have to be careful to identify the ―standard of
 9   care‖ regarding privacy given the new federal regulation which doesn‘t necessarily apply to all
10   dental offices but to many of them.
11   MS: We will do that and follow up with a discussion with Rosellen.
12   FR: President thanked Dr. Foy for his report.
13
14   HPSP Presentation—MonicaFeider
15   Feider: I‘d like to introduce our new case manager, Joan Monahan, who will do presentations
16   and has been here a year. Sally Gillette, case manager, resigned about a month ago, and we are
17   hoping to replace her position in about a month or so.
18
19   Asked if there are any new Board member. Described their mission as enhancing public safety in
20   health care. Our goals are to promote early intervention, treatment and diagnosis of health
21   professionals and to provide monitoring as an alternative to court discipline.
22
23   Case manager role in this:
24       1) went over the process: intake assessment, social, psychological, cd assessments, etc.
25       2) develop a monitoring plan: based on what treatment providers recommend.
26       3) Work site monitor: within their work setting that will monitor their work performance;
27           dentists and chiropractors are difficult to find work site monitor because they are often in
28           private practice so in this case, we ask that they set up a contractual relationship to
29           monitor performance, record keeping and talk with office staff about attendance,
30           punctuality or any problems at work.
31       4) Monitor CD Drug dependence (tox screens, AA or NA attendance) dentists need to attend
32           DCD and provide documentation of that.
33   Try to develop monitoring plans that are consistent with their illness and their treatment plan.
34
35   After people complete the terms of their agreement and will discharge them; if they report
36   themselves to the program the Board may never know they were involved in it. If they are not
37   compliant with monitoring, we would report them to the Board and they could choose to take
38   disciplinary action.
39
40   (handout) get yellow handout
41   Highlights what HPSP has done over the past few years
42   HPSP –
43       1) quality assurance things have changed quite a bit over the years. We are still developing
44          guidelines for monitoring. We are asking for more recommendations for monitoring
45          (common place to start and take input from treatment providers). In addition, Sheryl
46          Jones, our office manager, has helped us to utilize our database more effectively assist
47          case managers in monitoring compliance. We get weekly printout of people who have
48          missed screens or missed their quarterly compliance date.
49
50       2) Challenging Opportunities: We are trying to figure out ways to manage our growing case
51          load. There is a maximum we can maintain and still provide quality services. We‘re


                           Board Meeting Minutes, March 28, 2003           Page 3
                                                                                                     3.-4
 1           looking at people who have had positive outcomes in terms of not relapsing and
 2           completing the program. What we found is that people who suffer from both bipolar and
 3           a substance abuse do worse in the program than who do not have those diagnoses.
 4           People who are opiate dependent do worse than those who are alcohol dependent. In
 5           terms of our length of monitoring if people who are alcohol dependent have done fairly
 6           well in the program for 2-2.5 years we would discharge them early from monitoring. If
 7           people who are opiate dependent we would keep the full length of time because of those
 8           risks.
 9
10   Explained two graphs on p. 1 show growth of program since 1998. Right graph shows difference
11   between increase in new cases and those which are closed. Also listed the number of
12   participating boards. Three years ago legislation was passed that made it mandatory for all health
13   licensing boards and programs that are administered by Dept. of Health to participate in HPSP.
14   So this has increased our referrals especially from drug and alcohol counselors. However, the
15   vase majority of licensees in our program continues to be nurses and physicians who make up
16   80% of our program participants.
17
18   Benefits of HPSP promotes early intervention, diagnosis and treatment for folks so that hopefully
19   patient care is not comprised. It is a pro-active alternative to court discipline. insurance licensees
20   are getting important level of care. Many times people who are referred to us are being
21   undertreated for their illness. Part of our job is to get them adequate level of treatment. We
22   provide long-term monitoring which follows aftercare (after treatment). Our requirements
23   provide them with more structure.
24
25   HPSP is a single-point of contact as we get referrals from hospitals, clinics, dental settings, etc.
26   We monitor chemical dependency, mental health issues, and medical illnesses (most common are
27   neurological disorders).
28
29   Page 3. Participation from BOD. Discharge type:
30   Explained tables: Total Board of Dentistry Cases Closed since HPSP‘s inception:
31   No contact means we rec‘d a report the individual never followed up
32   Non-cooperation: started with intake process but would not sign releases, etc. never signed
33   monitoring plan
34   Non-compliance: did sign monitoring plan but would not comply and we could not guarantee
35   public safety so we discharged that person.
36
37   Non-jurisdictional: does not have an identified illness to monitor or they were referred and are
38   not regulated by the BOD.
39   Ineligible: are not able to practice safely because of their illness
40
41   Cases by Referral Source & Profession
42   Cases by Illness Monitored & Profession (six persons monitored by a substance disorder are also
43   being monitored by a psychiatric disorder)
44
45   p. 4 Feedback to HPSP. 20% of our clients take up 80% of our time. Wanted Board to know
46   what positive comments.
47
48       Q. What is budget for this program and where in the Gov‘s process now are you slated for
49          decrease or increase; how much per client does it cost?
50       Monica:



                           Board Meeting Minutes, March 28, 2003             Page 4
                                                                                                       3.-5
 1   Our budget is roughly $514,000; each board pays $1,000 annual fee to participate as well as a per
 2   rata share based on the number of people they have in the program.
 3   Governor‘s plan: our budget stays the same. If there are no salary freezes, we‘ll have to cut our
 4   medical consultant use so we can follow the union contracts.
 5
 6   Board of Nursing make up 50-60% of our clients.
 7   MS: BOD and other boards want to continue utilizing and make sure it was viable and to
 8   minimize the cuts.
 9
10   Comment: What criteria do you have in place to determine which cases you will take and which
11   you will not?
12   Monica: At this point, Affects outside end of discharging people early from monitoring, not on
13   accepting people.
14
15   She emphasized importance of reporting prescriptions – patients should tell their dentist that they
16   are chemically dependent.
17
18   FR: P. 2 question about 214.33 I noticed last year BOD changed the Dental Practice Act to have
19   shall report and I wonder why this statute says may report. Your statute is different than ours.
20   Has there been any change in our contact as a profession since that statute changed? After two
21   weeks to a month since you sent out the information to your licensees, we got a number of phone
22   calls and people took it very seriously. It was good for us to see how changing the law and the
23   way you communicated it to your licensees impacted referrals to the program.
24   FR: Self reporting from all professions really increased this year.
25   MF: Self-referrals make up 50% of our referrals; 15% are third-party referrals; boards only refer
26   35% to our program. Another particular problem is those dentists in a rural setting where there
27   really aren‘t other dentists or dental hygienists around to call. If someone is actively using, we
28   ask that they refrain from practice until they have completed treatment. We know that people in
29   rural settings this is really difficult. The same is true for other professionals (pharmacists, etc.) so
30   we hope to work with Boards to address those issues.
31   Q. Deinard: Do you get any referrals for suspected dementia?
32   Monica: We have for physicians but not for dentists.
33
34   Her presentation ended about 9:15 a.m.
35   The chair thanked her for her presentation.
36
37   MDHA—no report from Rose Stokke
38   MDAA—Tammy Erickson—no report (unable to attend MS said; no formal meetings held but
39   their annual meeting will occur at Star of North so will report in June)
40   MEDA—Terry Anderson—no report (called MS; not available)
41   MN Dental Hygiene Educators Association—Pat Johnson [p. 5.-1]
42   U of MN –Pat Glasrud, MPH
43   Budget deficit and search for a new dean. Need to cut 2 million. Comm. Might be asked by that.
44   Dr. Frank Cerra has laid out a plan for the process that will be followed to name an interim dean
45   and hopefully we‘ll know that in about a month. He has recently appointed his search committee
46   for the permanent dean which will take several months to complete. A difficult and turbulent
47   time to find a dean because there are several openings throughout the country. We are moving
48   ahead with that anyway.
49   Budget deficit: we need to cut 2 M. We are going to hit by that at least. One of the most
50   immediate things that could happen is that our community dentistry, our outreach efforts might be
51   affected by that.


                            Board Meeting Minutes, March 28, 2003             Page 5
                                                                                                    3.-6
 1   FR: Dr. Cerra is keeping us in the loop as he called me recently. If we want some input in the
 2   process, he‘d invite us to be involved. Thanked Pat.
 3
 4   MN Association for Community Dentistry—Denis Zack, DDS-(had been out of town for a
 5   month so he deferred to Carl Ebert to give a report).

 6   1) We‘re planning a meeting on April 25, 1:00 p.m. at Health Partners to discuss denturism.
 7   We‘ll have an actual denturist to present their case. We thought in light of the fact that we have
 8   legislation on denturism, that this has become controversial, and that there is a great deal of
 9   interest in the topic, we thought this is a good way to open up the discussion (giving information
10   about training, profession, and what denturists could add to access situation in MN)
11   2) Second issue that has recently come up it appears that the House of Rep is going to be
12   working on a bill that would further reduce budget in Health and Human Services—one of
13   targeted areas is dental services for adults.
14
15   6. Committee
16       A. Executive Committee Report—Freeman Rosenblum
17   We met on 3/25. Guest Jim Gambucci, director of two of the residency programs at the U of M
18   to enlighten the members of the board about the residency programs because there is legislation
19   now to replace licensure with a residency so we wanted to find out more about. We also
20   discussed the budget and Mr. Shragg will be talking about that later in this meeting.
21
22       B. Policy Committee Report—Ron King wanted to defer until after Marshall and Kathy talk
23          about legislation.
24
25   Nadene asked about Gambucci‘s presentation: are there lots of competencies in place because
26   I‘ve heard rumors that the GPR and the AEGD programs did not have competencies. Did
27   Gambucci talked about evaluations of outcomes.
28   FR: his handouts illustrated the point that at different times instructors involved with the
29   residents they will have assessments of those students; at the outset they will treat them as a
30   senior dental student to evaluate their clinical skills and if they have competency, then it‘s just a
31   matter of tracking them as move along; He emphasized Residency is different in dental school as
32   they learn about total patient care: have to learn how to make decisions based on diagnosis and
33   have small conferences where they talk about these things with the faculty as well, at the end they
34   have to reach a certain level of competency before they receive a certificate.
35
36   Nadene: Do they get exposed to specialties? They have lectures from specialists but there are no
37   specialists in the U of M program, only general dentists.
38
39   Q: To get into that program right after dental school or is their requirement that they spend a
40   couple of years in practice before they may apply for the residency? Only foreign-trained dentists
41   must have the two years of practice before entering the program.
42
43   Bunge: asked about the handouts from Gambucci and asked for one. We‘ll get them from Dr.
44   Gambucci.
45
46       C. Jurisprudence Committee—Freeman Rosenblum (no report)
47
48       D. Licensure & Credential‘s Committee—Freeman Rosenblum [p.6.-1]
49   Lori Schneider, licensure credentials coordinator prepared this report. Gives an overview of what
50   has taken place since legislation was passed. We have had 198 applications rec‘d to date since


                           Board Meeting Minutes, March 28, 2003            Page 6
                                                                                                  3.-7
 1   August 2001 (19-20 months). We have been trying to keep the number of applications for review
 2   to 12 or 14 a month because it is so time consuming to go through besides reviewing the people
 3   who are trying to get credentialed. Of the 198, 56 there have been no action taken; 16 requires
 4   further education review equivalency; pretty self explanatory. There have been 27 licenses that
 5   have been issued to help with the access issue.
 6
 7   Bunge: FYI. We do have 12 apps that we go through at every credentialing meeting but we have
 8   a number of apps that have not been completed where people have submitted additional info;
 9   some more may submit additional info if they protest their denial but it not just 12 that we are
10   dealing with.
11   FR: We have some concerns about foreign-trained applicants. Uof M has the only general
12   residency which accepts foreign students; the VA does not; JG was very impressed with most of
13   the foreign applicants.
14   Glasrud: Can we assume that these applicants are coming from all over the country; FR: all over
15   the world. Glasrud: is their a particular part of the US where they are coming from? FR: there
16   are a lot from South America, India, Iran, Eastern Europe; Glasrud; are all of these already in the
17   US? FR: yes; Lori: not all of them are in the US; some are from abroad.
18   Rose: Have there been any internationally trained dentists applying for dental hygiene licenses?
19   Lori: We‘ve had requests for that but at this time we don‘t have the legal capacity for that. The
20   Board has been asked by the Leg. to look at.
21
22       E. AADE—Annie Stone Thelen (no report since meting just took place last week.
23       F. CRDTS Report—Susan Gross (that just took place recently so no report)
24       G. CDE/Prof. Development—Susan Gross [6.-2 thru 6.-3]
25       Committee is active, it‘s ongoing and she wanted your permission to continue on working on
26       different formats for competency assessment.
27       MS: My understanding was that the request from the committee but a consensus that they
28       were proceeding in a direction that the Board wanted.
29       H. Council of Health Boards—Jerry McCoy (did not attend meeting so no report)
30       There was no meeting held to report on.
31       I. Complaint Committee Reports [6.-4 thru 6.-9]
32       J. Survey of Licensee/Registrants—Marshall Shragg
33       Brief report that have rec‘d a large number of responses and have developed database; data
34       input will be completed within a week. Sheryl reported over 2,000 survey were returned.
35       Report will be available in June; something in April newsletter, also.
36       FR: Margo will be writing an article on the subject.
37       Margot wanted a copy of a blank survey; Sheryl—copies went out to everyone who renewed
38       licenses. Sheryl will give a copy to Margot.
39       K. Allied Dental Education Committee—Nadene Bunge [p.-12 thru 6.-13]
40       Summary of March 4, 2003 meeting and some recommendations.
41       Bunge presented background information. Recommend that the education requirements for
42       the restorative functions be changed to a continuing ed courses and can be offered within the
43       regular curriculum of the dental hygiene program. The dental hygiene educators thought they
44       could offer this course the summer between the two academic years so that the student could
45       work and do restorative functions during their last year of dental hygiene training and treat
46       patients and still do their regular dental hygiene curriculum; optional offering.
47
48       Recommendation to be voted on from item 1 of their report:
49       Therefore, the Allied Dental Education Committee recommends the educational
50       requirements of the Restorative Functions be changed to a continuing education course/s
51       or can be offered with the regular curriculum of a dental hygiene program.


                          Board Meeting Minutes, March 28, 2003            Page 7
                                                                                                    3.-8
 1       Vote: Unanimous         Yes
 2
 3       Nadene indicated in item 2) Recommend that the qualifications of the professional be
 4       changed to read:
 5          a. RDA (because an RDA is already a graduate; remove ―graduate‖
 6          b. Licensed DH or DH student currently (remove the 4-year) enrolled in a dental
 7              hygiene program
 8          c. Therefore, the Allied Dental Education Committee recommends the qualifications
 9              be changed to a RDA or Licensed DH or DH student currently enrolled in a dental
10              hygiene program.
11
12       Vote: Unanimous yes
13
14           Nadene said the educators felt strongly about having composites added back into the
15   course for several reasons outlined in her report.
16           Therefore, the Allied Dental Education Committee recommends that the Board of
17           Dentistry expand the Restorative Functions to include Class I composites.
18
19           MS: I ask that the Board defer a determination on this until we have further discussion
20           this because this is a procedure integrated into some other legislative language that we‘ll
21           be discussing.
22
23           Glasrud: In trying to clarify these issues for myself I talked with Tom Larson, I
24           understood him to say when he talked to me about composites that it would require
25           ―substantially more training for Allied Dental personnel to use‖. I haven‘t been involved
26           in those meeting or if that is consistent with those meetings but I do think it is important
27           for the Board to consider if that is accurate.
28           Nadene: The educators thought the prep part that the dentist does in putting the material
29           in place for a Class I was not that much different.
30           Glasrud: Then maybe Tom wasn‘t limiting it to a Class I.
31
32          Brief discussion ensued between Bunge, Annie, and FR and then they deferred to a later
33   time when legislation is discussed.
34
35   Bunge had a few more points. We have dismissed web based vs traditional course format (lab
36   and clinical) for the course. We will do this in the traditional means and perhaps later go to a web
37   based course.
38
39
40   Next meeting will be fairly soon of the educators. The U was receptive; they might offer the
41   restorative functions because they have the clinic capacity and patient base and have someone in
42   from, like the state of Washington, to do the teaching.
43
44   Bunge: Policy Committee meeting discussion of restorative functions and bringing someone in
45   from the outside. This does not coincide with what the Board had decided. FR: composites will
46   be discussed later.
47
48   Diercks: If you are ahead on the agenda, I have just one quick comment on the MDA report that I
49   was going to make. He distributed 3/28/03 St. Paul Pioneer Press Editorial on ―Healthy Vending
50   Choices in Schools‖. What happened to generate this editorial was that the soft drink industry
51   won a vote a couple of days ago.


                           Board Meeting Minutes, March 28, 2003           Page 8
                                                                                                     3.-9
 1   Is important for public to be continue to be aware of the oral health side of the issues not just the
 2   osteoporosis.
 3   FR: American Academy of Pediatric Dentistry has signed an agreement with the Coca-Cola
 4   corporation and they have received a lot of negative feedback, but they are going ahead. They
 5   may work to find alternative beverages.
 6
 7   Amos: Q. Does your Board know about activities at North HS? Concerned about obesity in
 8   student population so about a year ago decided to eliminate all the pop machines. Replaced all
 9   Coke machines (except one pop machine in the staff lounge with machines containing milk, fruit
10   juice, water. Sales went up; revenue increased twice as much from the year before; easy clean
11   up; too early to tell is weight reduction has been achieved. Hope they can find
12   Diercks: The MDA held a press conference at North HS to announce the introduction of this
13   legislation in order to bring attention to a successful example of what a school can do.
14   The soft drink industry would say the reason North High is doing as well revenue wise as before
15   is that they went from not having an exclusive contract to having one. It‘s not because it‘s equal
16   moving from pop to water or juice or milk—it‘s that they went from non-exclusive to exclusive.
17   Financially it‘s a good deal for the schools. Our goal with the legislation is not to make a revenue
18   impact. The representative of the school board‘s association, dr. McCoy was quite concerned
19   with my comments and didn‘t agree that there certainly wasn‘t a significant revenue impact to the
20   schools from attempting to switch to such an emphasis on non-nutritional beverages to healthly
21   ones.
22
23   Jerry: I think this is a local issue. Locally we could push hard and share those beyond the
24   legislative move, which I think will fail, to notify people about ‗down side‘ of it.
25   community officials about issue.
26
27   FR: Does MDA plan to do something with this?
28   Diercks: For the moment, they couldn‘t get very far in the House. Senate committee voted it
29   down, but more meetings are occurring behind the scenes and we should know more this next
30   week.
31
32       7. Licensing Software—
33       Chris Luhman, ASU—IT Tech Support,
34       Andy Ager, Emergency Medical services
35       Sheryl Herrick, Office Manager, BOD
36       Deb Endly, Compliance Offier, BOD
37
38       MS: BOD has utilized a licensing software that was developed locally. It definitely provided
39       some advances over what we had previously, but in order to make improvements to it, it‘s
40       been quite difficult and expensive to work with that local vendor. We‘ve gotten to the point
41       now in order to make advancements to get the point where we can do on-line renewals and
42       other on-line activity, we had seen it was going to be quite expensive with that vendor and
43       decided to start looking at alternatives. We have decided to look at other alternative
44       companies for software. SRM: current company has discontinued their State contracts and
45       we not longer have support from that vendor. There are some problems that have to be fixed.
46       We‘ve looked at number of different systems. We‘ve narrowed it down to GLSuite: have
47       had on-line demo several weeks ago and recently Deb and Sheryl made a site visit.
48
49       Chris Luhman is now on staff with ASU as tech support
50       Andy Ager, he‘s full time with EMS but is consulting with us in this transition process.
51


                           Board Meeting Minutes, March 28, 2003             Page 9
                                                                                                 3.-10
 1       Sheryl outlined problems with SRM early on when it was installed near the renewal time
 2       1) Accounting system problems and inability to reconcile deposits which can‘t be cleared
 3           out
 4       2) renewal licensure cumbersome—need to go through several screens to enter the data
 5           which impacts the backlog
 6       3) From time we get request to deposit time, we‘re barely able to keep up with legislative
 7           auditors‘ request of getting this money in within 4-day process
 8       4) Problems with recording CE information and printing problems at renewal time
 9           (reprints over printing on hundreds of certicates)
10       5) Faulty data with the complaint/compliance process; making it necessary to go to a paper
11           trail
12       6) Queries difficult; have had to go through program access
13       7) Reports – difficult to process
14       8) No support from SRM; have dropped state contracts
15   MS: The essential part of the background that I need to mention is the price tag proposal from
16   GLSuite which is high so this detail provides info on the issues and what the cost of the possible
17   solutions is in order to give us the authority to procede with this.
18
19   Andy Ager:
20        1) GLSuite is different from GLS because it is developed by former government licensing
21   workers; don‘t need to explain the business rules—they already have that info and history;
22        2) GLSuite has the same application with many different state agencies across the U.S. so
23   updates made are realized by all clients in all state systems; has same core or development;
24   similar to when develop a neighborhood and every house that you build in that neighborhood has
25   same services, so any updates made go to all houses. (SRM only updated BOD which made
26   updates more expensive.)
27        3) Another problem with GLS is right now there is a proprietary client which has to be
28   installed on each machine and some of the problems I‘ve seen is that different people have
29   different versions of that client which causes problems.
30        Whereas GLSuite uses just a web browser to make the connections so any authorized
31   computer with a web browser is able to access the licensing database. You don‘t have to have
32   that extra client installed – that extra piece.
33
34   TAPE change Chris ―also some others changes‖
35   We are already familiar with. Some of the other systems I‘ve looked at. Some other systems I
36   looked at took advantage of other process such as Oracle and was very similar to SRM but the
37   price tag was about the same; GLSuite has also been extremely responsive; they get back to me
38   that day or within a day and that is not something I‘ve dealt with vendors in trying to get
39   information.
40
41   Andy: this time around IT staff has also looked at licensing system. We didn‘t have IT staff 5 or
42   6 years ago when GLS was purchased/developed. There is buy in from IT. The main reason
43   we‘re doing this is because we want to get to ‗on-line renewals‘. We need a licensing system that
44   works.
45   I‘ve worked on three health licensing board applications for on-line renewal systems in this
46   building. A lot of work has been done already re processing of payments. All we need now is a
47   licensing system that works.
48
49   Andy: IT staff has looked at option and we agreed that GLSuite is imp. Now for ―
50   on-line renewals‖ Only need a licensing system and software that works.
51


                          Board Meeting Minutes, March 28, 2003           Page 10
                                                                                                  3.-11
 1   Sheryl & Deb: Trip to Reno
 2   Before we went down there I called four different Boards that use GLSuite down there and got
 3   very, very good response from all four. Their response has been any problems they‘ve been very
 4   helpful. Deb and I checked the Board of Pharmacy which is pretty close to the same size as us
 5   with the number of licenses and the Board of Chiropractic is much smaller group. They did have
 6   some problems and we were able to get some good info from that. Bd. Of Pharmacy renewal
 7   process is better (not so many screens); They also have Cantra (form letter that goes to all the
 8   licensees) and when it is returned it can be scanned into the database. Take the check and deposit
 9   it. Their process is from 1-2 days where it takes us over a week at times.
10
11   Q: How much money you would anticipate saving in doing it in 2 days instead of a week? That
12   could offset the cost in saving the money.
13   Sheryl: before we got GLS the process took 2 days with 2-3 people handling it; if we don‘t have
14   to have temporary staff and our regular staff doing this.
15   FR: we may not have the ability to hire temp help—after we look at the budget today.
16   Am assuming that this will run off the existing hardware?
17
18   Chris or Andy: No, the hardware we have is barely able to do the job. The work stations are new
19   and will work but we need to purchase a new server.
20
21   FR: Third page talks about adding 3 PCs (in addition to what we already have?)
22
23   Andy or chris: Just purchasing the licensing--
24   not new computers; first two pages talk about subscription and extra service contracts, etc.
25   Deb: The first estimate on the last page idicates the amounts for the licenses for the current
26   amount of NCs we have.
27
28   Chris or andy: Cost of new server (Jan. quote) about $5,600 (hardware and operating system and
29   database is one-time cost) Not included in info.
30
31   FR: Is there a top side? Is GLSuite willing to come to a figure for us? We don‘t want to get
32   involved in GLSuite and then can‘t afford it in future years.
33
34   Chris: The President, BillMosley, was from $66,000-$97,000 which includes the web site.
35   MS: When they did the demo that the cost of the service of the software program for the first 10
36   PCs was at a higher level and each subsequent one was at a lower cost, but that if some other
37   board were also to buy into GLSuite we could combine that and reduce it. Chris quote is if we do
38   this independently. The Board of Pharmacy is also very interested.
39   Chris: main reduction could split cost to the server and the first 10 licenses are $4,000 and then
40   anything after that up to 50 would be $1,000 per license. I believe they have 13 employees and
41   we have 11 cost would go down.
42
43   Q: How do we keep our data private if we share?
44   Chris: the server that is we have now with GLS is begin shared with the Board of Social Work.
45   They are completely separate and that would be the case.
46
47       Bunge: If we didn‘t do this with another Board would we be able to use it longer because we
48       wouldn‘t be using it to capacity?
49       Chris: I don‘t think it would run out of capacity much sooner sharing it with another Board.
50
51       FR: how did you get the $43,666?


                          Board Meeting Minutes, March 28, 2003            Page 11
                                                                                             3.-12
 1   Chris: look at footnote on third page #1( cited footnotes)
 2
 3   Pat Glasrud: Important that Board has to be able to rely on its data. Typically this Board is
 4   the repository of work force data and with the situation we‘re in now, money aside, it‘s
 5   extremely important to do this; in my new position I‘m going to be relying on this Baord‘s
 6   data.
 7   FR: What kind of timeframe are you talking about to be up and running?
 8   Chris: Bill Mosley said 90% of his conversions take about 90 days. And so when I spoke
 9   with him on the phone yesterday we need this done by June 30 this would not be a problem.
10   FR: any problem with retrieving existing data? How does conversion take place?What
11   would it mean for staff time?
12   Deb: They send out questionnaires to staff on what particular processes our board does and
13   how we do them and what we are looking for and the end product. We would go through
14   them with Andy and Chris and then the company develops the system. There are always
15   problems with ‗dirty data‘ during the conversion such as we had when we converted from
16   FoxPro to GLS. A lot of those kinds of things are found relatively quickly; there are always a
17   few bugs to work out. Right now we still have bad data in GLS. Working with an antiquated
18   system causes a lot of stress to?
19   Pat: or ?
20   Question may have been do we have to input every single licensee or can we mask?
21
22   Deb: they will convert.
23   We will put our data on a CD, send it to them, and they will convert it to the new data and
24   that is in the estimated initial cost of ownership—that conversion process is part of the quote
25   that I gave you.
26   Pat: How long has the company been in existence?
27   Chris: Over 5 years.
28
29   Ron: Updates that we would benefit from: are these included--are upgrades included? Do
30   you have to have a subscription to get the upgrades?
31   Chris: About every 16 months they release a new verision; about 6 months ago they released
32   version 4 which is what dentistry would be looking at and all people who had version 3 got
33   the upgrade at a discount. The updates that regularly come out are in the service contract.
34   Ron: Is there any recourse to SRM which sounds like a system that was misrepresented or
35   improperly configured?
36   MS: I think it would be really difficult to challenge it since the system was accepted; we‘ve
37   attempted to work with them, but I think it is just a loss. We certainly can look into that.
38
39   FR: When we talk about the budget, you want a vote on this?
40
41
42   The Board adjourned for a break at 10:15 a.m and resumed at 10:25 a.m.
43
44   Reversed 8 & 9
45
46   8. Executive Director‘s Report
47   MS: 9.1-1 reviewed the budget summary through January and the past couple of days the
48   February report has been distributed today. It indicates we are pretty close to all of the
49   income that we anticipated. The costs have been less than anticipated. The AG‘s fees are
50   continually going down so we‘ve all been managing that quite well.



                      Board Meeting Minutes, March 28, 2003           Page 12
                                                                                             3.-13
 1   Big piece is look at total year to date is $455,000 additional surplus; we have additional
 2   reserve.
 3   You all received a copy of the color coded budget report—Governor‘s Projections. On
 4   Tuesday night at the Exec. Cmte meeting we had the opportunity to talk with Julie Vangness
 5   Who is the budget analyst for the ASU for each of the Baords. Basically if you look at the
 6   horizontal yellow line—Gov‘s proposed Budget—Blue columns for 04 & 05 are based on the
 7   FY 03 budget and those numbers do anticipate a salary increase for state employees. The
 8   important piece to note is that on that yellow lindeof the gov‘s proposed budget that intersects
 9   the blue the numbers in red are the deficits. What that indicates to us is that what the Gov‘s
10   proposed compared what we had proposed for a budget—these are the additional cuts for
11   each of those years that we would be need to make in order to reach the Gov‘s proposal.
12   That would be $48,000 in 04 and $___ in 05.
13
14   The other significant piece has to do with the next horizontal yellow line down below which
15   shows the transfer of reserve funds from the special revenue funds of the health-related
16   boards to the general fund and essentially what we‘re being told is that the reserve fund that
17   each of the boards has is being wiped out and is being acquired by the governor‘s budget into
18   the general fund. There are number of ways to look at that—any way we look at it there is
19   concern. We‘ve been diligent about how we managed our resources and we‘ve been able to
20   acquire a significant reserve to protect us from unforeseen expenses and contested cases.
21   That money will no longer be there for those purposes. The money that we have saved and
22   has been paid by licensees and registrants for the Board‘s operations now has been converted
23   to a tax which is used for other purposes within the state. So there are implications for others
24   who contribute to the Board‘s budget.
25   I‘ve also handed out is a one-page sheet looking at the numbers that need to be additionally
26   cut for 04 and 05. First column shows with salary increases that we need to cut $48,000 first
27   year and $81,000 the second year. There has been a lot of talk in the leg. is freeze state
28   salaries; if this does go into effect it will be a much easier job for us to manage. Our cuts
29   would be reduced to $18,000 for the first year and $19,000 for the second year.
30
31   What I‘ve done is suggest some reductions, we need to look at the way we do business. One
32   of the ways would be to reduce the staffing—primarily with our admin assistant and
33   receptionist—would be reduced to three-quarters time instead of full time. We woujld make
34   significant reductions the first year in cutting in half in 04 and eliminate overtime in 05.
35   Printing costs would also be reduced significantly. We could do this in a number of ways.
36   Two ways: CE proposal would be that instead of sending annual transcripts to everyone,
37   we‘d just send to those whose cycles are ending and eventually we are moving to a CE
38   process when we won‘t be providing transcripts because we‘d be looking at portfolior and
39   doing periodic audits. That would cut down printing costs.
40   Possibly cutting down on CE cards.
41   Also, the other big printing cost si newsletter which is sent out 4 times a year; we might make
42   it smaller 8 to 4 page or send it out fewer times a year.
43   Profesisonal Technical services (computer service contracts) only got GLSuite this a.m.
44   The biggest costs in this section are contracts with experts for complaint review; we negotiate
45   contracts each year and we‘d have to reduce our reliance on them or reduce the dollar amount
46   per hour.
47   Communications: newsletter, phone service
48   Travel: proposal is that we would look at each conference, we‘d send fewer numbers of staff
49   or board members to conferences
50   Employee development: primarily training for staff
51   Other (food): reduce provided at various meetings


                      Board Meeting Minutes, March 28, 2003            Page 13
                                                                                            3.-14
 1   Admin. Hearings: cost varies from year to year ; don‘t always use full $10,000.
 2   First year reduce to $5,000 and second year eliminate this item.
 3
 4   Asked for your concerns in specific areas in light of gravity of cuts.
 5
 6   Ron: If there was a new computer system, could we put newsletter on web?
 7
 8   MS: Access to that universally and a ‗touch‘ value to it—whereas web site you have to be
 9   more intentional to find it. The newsletters are up there now.
10   Margot: Wants it kept to at least 3 times a year publications; we need to stay in touch and we
11   may to cut something else to keep it.
12   Jerry: What are the number of issues and pages? What is this recommendation based on?
13   MS: it is an arbitrary reduction. We didn‘t specifically say we‘d cut to a certain number of
14   issues or reduce the number of pages. There is the postage issue—we‘re currently sending it
15   our first class; it hasn‘t been terribly successful but it‘s been more successful than when we
16   were sending it out in bulk. Going to bulk mail would provide significant savings.
17
18   Annie: What is involved in raising our fees that we charge our constituents?
19   MS: What the budget reductions would require us to do is to look at that. They are putting
20   the boards into deficit spending if not within this biennium, the next. This would require us
21   to raise our fees. The problem is that we have governor who has made commitment to no
22   taxes increases and he regards these fees as a tax. If indeed, we no longer we don‘t have the
23   ability to spend that money, rather than increase fees, we‘d have to reduce services. This is
24   one issue.
25   The other is that there is no need to raise fees because we have the additional reserve. If we
26   raise fees we‘d be transferring the surplus to the general fund.
27   FR: The number of $89 is figure which is an annual increase in licenses. If your practice has
28   to pay this increase, it would be a significant amount.
29   Bunge: What if we have a contested case?
30   MS: Attorney General‘s office has advised us that we should not back down from this need.
31   We can pursue those. The special revenue fund has $22M and they are wiping away all but
32   $2M, part of which would be available to us.
33
34   FR: GLSuite—if we commit $66,000-$99,000 and hopefully we‘d up and running by June,
35   does that mean the reserves would be totally spent by the end of this biennium?
36   MS: My intent when we started looking at GLSuite, I‘d planned to go to the Legislature, get
37   authority to spend out of our reserves because of this unanticipated expense. That is not an
38   option now because that fund has already been dedicated through the Gov‘s budget.
39   Our Feb. budget summary we‘re building up some reserves this year andthere is money we
40   could spend for the computer system. Catch is that we need to transfer the money to Office
41   of Technology and they authorize the spending of it for purchase of the computer system.
42   Everything could be prepaid before FY 04.
43
44   What I‘m asking for with the presentation is a request for the authority to spend that money in
45   order to get a good system. Once that is authorized we‘ll set the wheels in motion to get the
46   OT to work with us.
47
48   I make a motion with a clarification—apparently there are two reserves; one reserve existing
49   this year and one which is past which is frozen so the motion would be:
50
51   Jerry McCoy made the


                      Board Meeting Minutes, March 28, 2003            Page 14
                                                                                             3.-15
 1   MOTION:
 2   To spend money within this year’s reserve to improve and update the computer system.
 3   SECOND: Margot
 4
 5   Discussion: Ron—alluded to it before that you wanted a top-end number or maximum to the
 6   installation so that is something goes wrong or unexpected problems, I‘d like a max that we‘d
 7   pay.
 8   Annie: Suggested $95,000 as the maximum price approved for purchase of new
 9   licensing software GLSuite.
10
11   Jerry accepted that as a friendly amendment:
12
13   Vote: Motion and friendly amendment: Unanimous: passed.
14
15   MS: Jackie Norlander, Admin. Ass‘t who has been temporary, has a found a permanent
16   position and next Friday will be last day. Thanked her for her work here.
17   MS: Admin. Terminations of licenses—those how have not renewed by March 31
18   terminations will become automatic April 1.
19   Sheryl: Still outstanding 50 dentists; 46 hygienists, and 202 assistants.
20   FR: is this larger than years‘s past?
21   Sheryl: dentists and hygienists were about 30 last year and close to same for assistants.
22   Ron: does staff make a last-ditch effort to contact these people.
23   Sheryl: second notice went out in Feb.
24   Ron: I mean something other than by mail; if we get 5 or 7 who do not have to go through
25   some funny process to be reinstated, wouldn‘t it be worth a phone call?
26   Lori: Two notices have gone out and those that are returned to us we try to contact them; we
27   make an effort during the process to contact them. Ultimately it is the licensees responsibility
28   to renew.
29   Ron: I‘m talking about human nature, chaotic offices, changes in staffing; a phone call takes
30   3 minutes and the payback could be huge. Can‘t we get a telemarketing feature (automatic
31   dialer) to contact them.
32   MS: They do get the notice when they are terminated. They certainly get this piece of mail.
33   FR: Board office will take this under consideration.
34   MS: Mid-April newsletter has terminations listed
35   Dr. Thelen did indicate there was no AADE report, but I wanted to indicate a number of us
36   did attend the AADE-Chicago: focus was on ‗dental access‘ and ‗licensure for foreign-
37   trained dentists‘.
38   Board appointments: I‘ve met with Governor‘s appointment coordinator; understand they are
39   close to making a recommendation to the Governor in determination of who those Board
40   members would be. I will be talking with him later this afternoon to see if he has any
41   additional questions. Maybe next week or very soon thereafter we‘ll hear.
42
43
44   FR: Policy Committee recommendations. Is there anything MS wanted to add?
45
46   Legislative/Rulemaking Update
47
48   MS: We had rulemaking first phase for expanded scope and practice and changes in the
49   supervision levels. This was adopted by the Board at its last meeting. It did go to an




                      Board Meeting Minutes, March 28, 2003           Page 15
                                                                                                3.-16
 1       Admin law judge for review, and they had some procedural concerns which we are in process
 2       of correcting. Those corrections should happen very quickly. Kathy, Rosellen & I are doing
 3       and should be relatively simple to correct.
 4       Phase 2 of rulemaking process concerned restorative functions—drafted and ready for
 5       publication.
 6
 7       MS: 2003 Leg. Summary (handout) prepared before the Policy Committee meeting last
 8       night will help lead into their discussion. This has been where we have been to date.
 9       Policy Committee‘s recommendation will help us to move forward on what our positions are.
10       The major bill with a number of different issues related to dentistry is: SF 357 and pending
11       file HF 326 (MS explained various parts of this bill)
12       1) Faculty Dentists included as an amendment to bill (full intramural & extramural practice-
13            if the individual has a 50% or more teaching or research appt)
14       2) Volunteer & retired dentists establishes classification (volunteer--we oppose waiving
15            their CE education; we recommend instead the ‗charitable provider‘ provision that we
16            talked about and authorized at the Jan. meeting which parallels the guest licensure
17            provision does require continuing education for anyone providing clinical dentistry,
18            dental assisting, or dental hygiene)
19       3) Waiver of clinical exams (introduced as amendment) also waives clinical exam
20            requirements for those completing one-year residency prior to the program. Initially my
21            position on behalf of the Board was to oppose this and suggested alternatively that rather
22            than the language saying the Board shall waive the clinical exam requirement for those
23            people who have done the one-year residency, change language to say the Board to may
24            waive that requirement.
25       4) Collaborative agreements. Discussion through Dept. of Human Services-Work Force
26            Task Force had looked at those collaborative agreements and tried to clarify language and
27            also establish more stringent requirements for dentists and dental hygienists to have in
28            order to be able to participate including maintaining currency in CPR, infection control,
29            some other issues that are incorporated into the contract.
30
31       5) Restorative functions. Takes Phase 2 of rulemaking process (allowing assistants and
32          hygienists to place amalgams, glass iometers, and stainless steel crowns) that we were
33          talking about and puts it into statute through the legislative process.
34
35       6) Donated Dental Services Program. appears only in Senate language
36   The responsibility for this was transferred from BOD to the MN Dept. of Health (not DHS).
37   We issued a request for proposals earlier this month and we received one. We should be able to
38   issue that contract with ―Foundation for Dentistry for the Handicapped‖ in Colorado in the very
39   near future. They originally copyrighted the DDS concept and operate it in 33 other states.
40
41       Other bills of interest:
42       a) Cost Recovery-would enable Board to recover costs in disciplinarycases and allow us to
43          impose civil penalties as a tool to make sure that we have the appropriate resolutions to
44          various cases.
45
46
47       Ron King said this affect the budget.
48
49       b) Licensure of Dental Assistants: Senate is moving it along. Haven‘t heard anything from
50          the House. Got a request from the Senate author Question about confusion about



                          Board Meeting Minutes, March 28, 2003           Page 16
                                                                                                3.-17
 1           unregistered (perhaps change to ―dental aids‖ or some other title) vs licensed dental
 2           assistants
 3        Bunge: will this go before the Council of Health Boards?
 4        MS: Has not been referred. I don‘t think it will happen because it‘s been referred out of
 5        committee.
 6        C) Denturists: Extensive discussion in earlier meeting. There have been some amendments
 7           to the bill that would require a patient seeking dentures from a denturist would get a
 8           certificate that they‘d been seen by a dentist and limits care denturists can provide.
 9
10   At first we indicated to legislative committees our concerns about standardization of education,
11   standard testing and that there was a lot that was unknown and asked that it be referred to
12   Council of health Boards
13        Subsequently, there has been an amendment that the patient be seen by a dentist first this has
14        been a little bit more palatable by Board members in discussions has allowed the Board to say
15        that we support the amendment with reservations.
16        D. Specialty Licensure would allow Board greater ability to grant specialty licensure and
17             attached to that bill would be the requirement of mandatory malpractice for dental
18             professionals.
19   Amendment floating around that concerns composition of Board and could be attached to any bill
20   Composition to the Board—adding a dental assistant and a dental hygienist. My own position is
21   that I‘m opposed because you don‘t represent our professions but the public. At a time when we
22   are being asked to cut our budgets it‘s ridiculous to take on additional costs which may not be a
23   priority of the Board.
24        E. G) Another bill that has recently come out that creates secretaries of the executive
25             branches which would put the Health-related Boards under this newly-established
26             secretary of Health and Human Services. I also indicted some of my concerns about it.
27
28   FR: thanked Marshall.
29
30   Ron K. Distributed an agenda referencing SF 179 and SF 357
31   and
32   Statute 150.06 rewrite (5-page)
33   Purpose today is to clarify the Board‘s decision based on going discussion and negoations last
34   night at the Policy Committee. We need to make the decision and to find a compromise that all
35   the associations and boards can have an agreement and so when we go to the Legislature as a
36   joined effort.
37   Went over SF 357, discussed and called for a vote on the Policy Committee recommendations as
38   follows:
39
40                      BOARD OF DENTISTRY SUPPORTS S.F. No. 357
41                              With the following changes
42                                 As of March 28, 2003
43
44   RECOMMENDATION 1:
45   1. SF 357, Sec. 4, subd. 3 (b) with the following changes:
46        - line 4.12 substitutes the word ―shall‖ with ―may‖
47        - line 4.18 – 4.19 substitutes ―postdoctoral dental residency program‖ with ―general
48            practice residency program or postdoctoral general dentistry program‖
49        - add a 5-year sunset clause
50   VOTE: Unanimous-yes


                          Board Meeting Minutes, March 28, 2003           Page 17
                                                                                                 3.-18
 1
 2   RECOMMENDATION 2:
 3   2. SF 357, Sec. 6, subd. 4 with the following changes:
 4         - add class I composites to the allowable procedures
 5         - eliminate preventive resin restorations
 6   VOTE: 5 yes; 1 abstention (McCoy); 1 opposed (Dr. Thelen)                  Passed
 7
 8   Friendly amendment to second recommendation (above) SF 357, Sec. 6, subd. 4:
 9          - add class V supragingival (all margins within enamel) composites to the allowable
10              procedures
11   VOTE: 6 yes, 1 abstention (McCoy)
12
13
14   RECOMMENDATION 3:
15   3. SF 357, Sec. 3, Subd. 2d with the following changes:
16         - the exemption for CE requirements is changed to a ―minimum CE requirement in
17             board-approved courses in infection control, medical management, medical
18             emergencies, and certification in advanced or basic cardiac life support as recognized
19             by the American Heart Association, the American Red Cross, or an equivalent
20             agency‖
21         - includes dental hygienists and dental assistants
22   VOTE: Unanimous-yes
23
24   RECOMMENDATION 4:
25   4. SF 357, Sec. 2, subd. 1a with the following changes:
26         - include faculty hygienists in MN schools of dentistry, dental hygiene, and dental
27             assisting
28         - include faculty dental assistants in MN schools of dentistry, dental hygiene, and
29             dental assisting
30
31           include dental health care faculty in MN schools of dentistry, dental hygiene,
             -
32           and dental assisting
33   VOTE: Unanimous—yes
34
35   Discuss article in summer 2002 about ―Dentists must see a new patient first before an assistant or
36   hygienist can do anything‖ See Jan. 29, 2003 Policy Committee (everybody should have received
37   an e-mail). Historically this is the way it has been interpreted. What we‘re saying – maybe this is
38   no longer a correct interpretation.
39   FR: Somewhere in the statement they felt it was possible for a dental hygienist to have pre-set
40   rules on x-rays.have standing orders for recall rather than initial visit. Dentist made final
41   decision. Don‘t want it to go beyond that point. Don‘t want DH to procede with primary care
42   without having communication with the dentist.
43   Ron: does the dentist have to see the patient first?
44   Discussion with Annie about screening procedures for x-rays for patients; After some discussion
45   about how this is interpreted, does dentist have to be in the office? How dental office handles this
46    What about the assistant taking the PA before seeing the dentist; fr: I think we‘re saying they
47   both assistants and hygienists need to discuss with the doctor first.
48   Rosellen: asked they defer this discussion until June because normally when you change a long-
49   time interpretation, you go through a rule-making kind of process; it is more important in
50   situations when you are tightening things or putting additional obligations on people. This is



                          Board Meeting Minutes, March 28, 2003           Page 18
                                                                                                  3.-19
 1   reflecting practices and a loosening; we need to give this a little thought about the best way to do
 2   this and in June we can discuss again.
 3
 4
 5   SF 179 Denturism
 6
 7   Policy Committee doesn‘t really have a recommendation because there wasn‘t much time so this
 8   is just a general discussion here. We discussed modifying the bill or coming up with some
 9   alternatives. Ron would like to see this in a mid-level practitioner or expand duties of dental
10   assistants who could take final impressions because that opens it up to a lot more people. This
11   would involve a dentist‘s oversight.
12   FR: I need to know more about denturism before endorsing it as I have too many questions. I
13   know there are some states that have them, but I don‘t know what their experience has been; 4
14   educational programs in Canada but who checks the differences. How much money do we end
15   up saving?
16   Want to table it until next year.
17   Ron & Annie said it could be passed before then.
18   FR: Would pass our concerns along to the Legislature.
19   Bunge: Wants this to be referred to Council of Health Boards because they have all the
20   information you just asked for. However, Senator Kiscaden asked that it not go to Council of
21   Health Boards.
22   Ebert: very remote that it would be passed this year.
23   Bunge: Can we get it referred to Council?
24   Ebert: Need to talk with Kiscaden.
25   MS: I understand the regulation Chapter 214 the chairs of standing committee in House and
26   Senate that would refer Council of Health Boards.
27   Ebert: Said only one chair, not both, need refer to Council. Was clarified in a Senate hearing.
28   Linda: Look at allied professionals in other states ex. Colorado
29   FR: Send this denturism discussion back to Policy Committee and then assume that it‘s not going
30   anywhere this year and talk about it in a different forum.
31   Carl Ebert: one of the reasons why I‘ve been interested in bill and supportive of denturism, while
32   # may be going down, the population is aging. There is a need for removal and prosthetics; some
33   can‘t afford implants, access prevents care;
34   AHC web site has report from dean of dental School concerning Dental School being more in line
35   with the strategic plan of the AHS would be to eliminate the teaching of removable denture
36   services in favor of doing implant types of education. This is being considered across the
37   country. Clinically competent denturist could handle certain types of needs.
38   Bunge: we could create alternatives following Dr. King‘s ideas for addressing dental access.
39   RK: No recommendation but discuss later throughout the year.
40
41   Statute 2 Mandatory Malpractice Insurance (in Marshall‘s handout will be included in Specialty
42   Licensure Bill)
43
44   Rule 3 Nitrous Oxide administration—106.1 (passed in January we were going to eliminate the
45   word ‗nitrous oxide‘ from that subpart. Bill says ―dental assistant may not administer‖
46   MS: this has been corrected in ones that were adopted by the Board. Ron asked if this is being
47   corrected. MS said he thinks it will be. Rosellen said do this in phase 2 of rules.
48
49   Other
50   Ron indicated that he was bringing these two things up because of timing, he might not be on the
51   Board in a few weeks, and these issues were important for Board to be aware of.


                          Board Meeting Minutes, March 28, 2003            Page 19
                                                                                             3.-20
 1
 2   1) Mercury and amalgam
 3      In CA the dental board was fired by the legislature for not addressing the issue
 4      adequately; this deals with policy. Distributed Dental Truth Newsletter (Nov. 2002)
 5      provides information for a future balanced discussion.
 6
 7   2) Holistic Dental concepts more interest in presenting these kind of topics in dental
 8      schools. In May 2003 the Holistic Dental Ass‘n is having a conference in Minneapolis.
 9
10   3) Statute 150A.06 Proposed Changes Draft (3/23/03)
11      Licensure in general (5-page handout) RonParts of this are being introduced in the
12      Legislature. Instead of our writing and presenting an entirely new statute, we can support
13      parts of this one such as faculty licensure, specialty licensure, and charitable providers.
14
15       Ron asked if everyone had a chance to review Pat Glasrud‘s presentation last night at
16       Policy Committee. No time to read it.
17       Ron: my recollection is there is not change and if there is it was unintentional. Numbers
18       may vary when it was rewritten subparts may be different but actual words are the same.
19
20       Pat: Essentially what you have done is taken one piece of whole Dental Practice Act as if
21       it could be divorced from the rest, and it can‘t. I have a very grave concern about this
22       because I strongly suspect 150.06 is referred to throughout the other sections in the
23       Dental practice Act. Not even mentioning what goes on with the rules. They are all so
24       closely intertwined that it‘s almost impossible to think that this is mutually exclusive
25       from the rest. It isn‘t. I think your discussion might be better served, and the public
26       might be better served, if you try to limit yourself to narrative and broad concepts at this
27       point rather than thinking that this can be actual language. The housekeeping thing that
28       we talked about last night. This is not in a form that the revisors would look at. It is
29       confusing to figure out what is new and what is old and you need the strikeouts, etc. This
30       really shouldn‘t be separated from the Dental Practice Act.
31
32       RK: I bring it forward now because it is still conceptual, but it is accurate based on all
33       the discussions we have had, does this look like what the Board is approving. Then we
34       go through the entire Dental Practice Act. My intent was to put on paper what I thought
35       everybody had agreed upon over the past year.
36       FR: Although it is daunting to do back and cross reference it with the Dental Practice
37       Act.
38       RK: I‘d hate to see the faculty licensure, charitable provider, and waiver of examination
39       messed up; we should add our ideas to what is there and between now and January 2004
40       work on this.
41       FR: agreed that the three would like to have included this year. We have until April 4.
42       MS: the ideal – Ron and I would get the language done and send to advisor; advisor
43       would get it jacketed with someone who would allow it to be jacketed; has to be
44       introduced for first reading in House or Senate and then get referred to committee; needs
45       to get through first policy committee by 4/4. It is possible, remote, but possible.
46       FR: Wanted them to try to do this.
47       MS: Will get Specialty Licensure draft and Mandatory Malpractice draft (we have an
48       agreement from a senator to take these two)
49       RK: Today just discuss the Specialty Licensure and the Waivers (all the other specialty
50       will do next year)



                      Board Meeting Minutes, March 28, 2003           Page 20
                                                                                               3.-21
 1           Goal would be by the end of the legislation session next year, we‘d have 8 months it all
 2           done.
 3
 4           RECOMMENDATION
 5           150.06 Licensure
 6                  Subd. 1c Specialty dentists
 7                  Called the question (thelen)
 8                  Motion: Dr. Thelen
 9                  Send entire statute 150A.06 to revisor and see what happens
10                  Second: Jerry McCoy
11
12                   VOTE: 6-yes; 1 opposed (Bunge)
13
14   Travel Authorizations:
15   10-2. Add Penny Fidalla (sp?) she has a couple exams
16          Motion: Dr. Bunge                Second: Margot
17
18   VOTE: Unanimous to accept.
19
20   MS: One thing to point out each time after public board we have a closed executive committee
21   meeting; following that the joint complaint committee meeting is held and that meeting is open to
22   the public; although I don‘t know what time that will be.
23
24   FR: Composition of the Board; RK we never talked about that in Policy.
25   FR: It may be introduced this year or it be may be attached to what we‘re doing; the Board
26   should take a position on this. Is there anyone who wants to talk about why the composition
27   should change?
28   Dr. Zak: would remove possible appearance of conflict of interest when 9 members of the Board
29   belong to the saem professional association. It looks like MDA has the ability to control the
30   BOD. Because the assistants and hygienists are spread pretty thin and sometimes they might be
31   intimidated; I haven‘t talked to them.
32   FR: It is worthy of discussion.
33   Rose: I think it would help to have another assistant and hygienist on the Board because it would
34   help on committee work and give us added input.
35   Linda: My concern is budget. We could discuss because I think there is a lot of committee work.
36   We are here to protect the public. My perceptions before I was on the Board are different now.
37   Everyone takes issues very seriously and working diligently. The one conference I attended on
38   regulatory boards was immensely helpful.
39   Nadene: I would like help (have many site visits and exams) and I enjoy doing the work.
40   FR: We are all over worked—we need more dentists on the complaint committees. Agency
41   boards, should have more public reps. We discussed what the optimum size of a board would be.
42   The cost would be about $7,000 a year per board member, per diem, for site visits, etc. and the
43   money is not there to do it. We are a very democratic group and try now to overpower anyone.
44   Annie: don‘t have to be an MDA member.
45   Linda: If we had more people, we would generate more work. Could the staff keep up then,
46   considering they are overworked now.
47   Dr. Foy: I feel there is a huge separation of powers. Commended your protection of public. We
48   are not the big elephant. Philosophically the profession of dentistry is being harmed by the
49   devisive descriptions of the MDA and the Board, etc.. The reality is that we have to find out what
50   we can agree on rather than bickering about the little things behind the scene.
51


                         Board Meeting Minutes, March 28, 2003           Page 21
                                                                                                 3.-22
 1   Dr. Zak is so pleased with the composites being included I‘ve rethought my remarks.
 2   FR: You have a good relationship with the legislature and we want to work together.
 3
 4   Zak: Last night was kind of a turning point, and if Ron doesn‘t come back I think he sure
 5   deserves compliments because the Policy Committee has never been this open before.
 6
 7   Adjourned meeting at 12:55 a.m.
 8
 9
10
11
12
13
14




                         Board Meeting Minutes, March 28, 2003          Page 22

				
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