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Tribes push for bill they say would give them better dental access

by caprecord

Several tribal members asked lawmakers Monday to pass a bill that would allow dental health aides to treat patients on tribal land. The measure is opposed by some dentists who say the aides may not have sufficient education or training.

Watch TVW video of the hearing here.

Members from the Squaxin Island Tribe, Colville Tribe, Makah Tribe and Suak-Suiattle Indian Tribe testified in support of Senate Bill 5159 at a hearing Monday of the Senate Health Care Committee.

The bill was compared to a program in Alaska that trains and certifies dental health aides to practice limited dentistry under the supervision of a dentist within the tribe. Some aides can practice off-site, or away from the dentist.

The dental aids are “certified to practice without the direct supervision of a licensed dentist for procedures such as oral exams, preventative dental services, simple restorations, stainless steel crowns, and x-rays,” according to the bill.

The certification requires a high school diploma, graduation from a two-year educational program, and a 400-hour clinical preceptorship under the supervision of a dentist.

The prime sponsor of the bill, Sen. John McCoy, D-Tulalip, criticized the “long continuous process” of the bill, saying this was the eleventh time he has brought the bill to the Legislature.

“We are in dire need of access to the tribe throughout Washington State,” he said. “We took a hard look at the Alaska model, and the Alaska model is working. I find it difficult to understand why there’s so much opposition for Washington State over the years.”

He emphasized that the dental aides would not be working on their own, but under the supervision of a dental team and dentists. He said that a tribe in Swinomish “had to invoke their tribal sovereignty and start a program.”

But not all tribes have that ability. “There are some tribes that lack resources so they wouldn’t be able to do it by themselves,” McCoy said.

Sen. Jan Angel, R-Port Orchard, said that the Alaska program made sense because there is great distance between patients and dental care.

“The Washington reservations don’t have that distance that’s required and my concern comes back to a liability issue,” Angel said. “If a problem came up does the liability then come back to the tribe or to the dentists?”

McCoy responded saying it would be structured so aides are working in a medical facility of the tribe, which has medical director.

Brian Cladoosby, Chairman of the Swinomish Tribe said the reason that this bill is necessary is because of federal 2010 legislation.

“The Indian Health Care Improvement Act was passed, providing health care for tribal members across the nation and the American Dental Association snuck a sentence in that bill,” Cladoosby said. “That one sentence said if any tribes in lower 48 want to have a therapist program, they have to come and get the blessing from Olympia.”

Cladoosby talked about the importance of recognizing sovereign nations and the treaty of the Swinomish Tribe.

“I’m a sovereign nation and I would hope that each and everyone of you here would recognize my sovereignty and I hope each and everyone of you here would recognize that for me to have to come here year after year –this is my sixth year now — coming saying ‘please give us this program,’ it is not right,” he said.

Trent House with the Washington State Dental Association agreed that there needs to be better dental access for tribes, but said the bill isn’t the way to do it. House said that there are two problems with this bill.

“First, its been characterized that we are being protectionist and that we don’t have solution and we don’t want to work with the tribes,” he said. “Nothing could be farther from the truth.”

He also said there is an assumption that the program will save money.

“The dental therapist that will be trained and used in this situation will charge rates at the same rates as dentists, dental hygienists, dental assistants,” he said.

He said the bill leaves him hopeful that there could be a pilot project or partnership in the future between the Washington State Dental Association and the tribes.

“In our minds, what will work well and in partnership with the tribal community is a combination of community dental health coordinators, residence programs and successful in-state programs that already exists in Washington,” he said.

Yoni Ahdut, a pediatric dentist from Tacoma, also testified against the bill. He told lawmakers it was important to “understand the different levels of training” between dentists and dental aides. 

“I have doctors sending me pediatric patients because I have the ability to treat them safely in my office,” he said. “It’s the level of education and the type of education and the direction of the education that I got that allows me to treat my patients safely.”