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KIM REYNOLDS, GOVERNOR ADAM GREGG, LT. GOVERNOR

JILL STUECKER EXECUTIVE DIRECTOR

STATE OF IOWA IOWA DENTAL BOARD

DENTAL HYGIENE COMMITTEE MEETING AGENDA

April 17, 2020

The mission of the Iowa Dental Board is to ensure that all Iowans receive

professional, competent, and safe dental care of the highest quality.

Meeting Location: The open session portion of this meeting will held via Zoom. Board offices are not currently open due to COVID-19. To access the meeting, see details below:

Click here to join Zoom meeting Meeting ID: 986 2946 1948 Password: 42791

Call Line for Phone Access: 312-626-6799 or 646-876-9923 Members: Mary Kelly, R.D.H., Chair; Nancy Slach, R.D.H., Michael Davidson, D.D.S. OPEN SESSION: 8:00 AM

I. CALL MEETING TO ORDER – ROLL CALL

II. OPPORTUNITY FOR PUBLIC COMMENT

III. APPROVAL OF OPEN SESSION MINUTES a. April 3, 2020

IV. OTHER BUSINESS

a. Discussion on Clinical Licensure Exam for Dental Hygiene Students

V. ADJOURN NEXT REGULARLY-SCHEDULED MEETING: JUNE 5, 2020 Please Note: At the discretion of the committee chair, agenda items may be taken out of order to accommodate scheduling requests of committee members, presenters or attendees or to facilitate meeting efficiency. If you require the assistance of auxiliary aids or services to participate in or attend the meeting because of a disability, please call the office of the Board at 515-281-5157.

 

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KIM REYNOLDS, GOVERNOR ADAM GREGG, LT. GOVERNOR

JILL STUECKER EXECUTIVE DIRECTOR

STATE OF IOWA IOWA DENTAL BOARD

DENTAL HYGIENE COMMITTEE 400 SW 8th St. Suite D

Des Moines, Iowa

MINUTES April 3, 2020

Committee Members April 3, 2020 Mary C. Kelly, R.D.H. Present Nancy A. Slach, R.D.H. Present Michael Davidson, D.D.S. Present

Staff Members Jill Stuecker, Christel Braness, David Schultz, Dee Ann Argo Attorney General’s Office Laura Steffensmeier, Assistant Attorney General I. CALL TO ORDER FOR APRIL 3, 2020 Ms. Kelly called the meeting of the Dental Hygiene Committee to order at 8:01 a.m., Friday, April 3, 2020. The meeting was held by electronic means in compliance with Iowa Code Section 21.8 due to the COVID-19 pandemic. Roll Call: Member: Kelly Slach Davidson Present x x x Absent

A quorum was established with all members present. II. OPPORTUNITY FOR PUBLIC COMMENT Ms. Kelly asked everyone to introduce themselves and allowed the opportunity for public comment. Mr. Tom Cope, Iowa Dental Hygienists' Association, thanked the Board and the Iowa Dental Association (IDA) for coordinating with the Governor’s Office to assist with the order that was issued last week regarding elective procedures. Mr. Cope also thanked Ms. Kelly and Dr. Davidson for their service to the Board.

DRAFT

Dental Hygiene Committee Meeting – OPEN SESSION – Subject to final approval April 3, 2020 (Draft: 4/10/2020) 2

Dr. Ryan Stuntz, IDA, thanked everyone for the work on the mandate. Dr. Stuntz also thanked Ms. Kelly and Dr. Davidson for their service. III. APPROVAL OF OPEN SESSION MINUTES

January 24, 2020 – Quarterly Meeting MOVED by SLACH, SECONDED by DAVIDSON, to APPROVE the open session

minutes as drafted. Motion APPROVED unanimously. IV. EXECUTIVE DIRECTOR’S REPORT Ms. Stuecker thanked Ms. Kelly and Dr. Davidson for their service to the Board. Ms. Stuecker reported that the agendas for today’s meetings have been streamlined due to the need to maintain social distancing. Ms. Stuecker also noted all rulemaking was to be tabled unless it is an emergency. Ms. Stuecker reported that the Board’s legislation was signed into law before the session was suspended earlier this year. Ms. Stuecker thanked the IDA and IDHA for their assistance. Ms. Stuecker shared a comment that was made at a subcommittee meeting earlier in the session wherein the Board and the associations were commended for their collaboration. Ms. Stuecker reported that the statutory changes will be effective July 1, 2020. The committee will discuss this at the June 2020 meeting to begin the rulemaking, which would implement the changes. Ms. Kelly asked what would happen if the rules were not in place before July 1. Ms. Steffensmeier stated that rules would remain in effect until updated. Ms. Kelly asked whether the statute would supersede rules. Ms. Steffensmeier stated that rules don’t appear to be in conflict currently; therefore, the rules would remain effective. Ms. Steffensmeier will continue to review this. V. OTHER

Update on Dental Hygiene Programs Ms. Kelly reported that she has been in contact with the Iowa dental hygiene programs regarding the upcoming exams. Everyone agreed that examinations would need to be completed; however, all testing has been delayed. All but one program is on the same testing schedule. Ms. Stuecker thanked Ms. Kelly for taking the lead on this.

Other COVID-19 Updates Ms. Stuecker reported on the proclamation issued by Governor Reynolds on March 26, 2020 which offers regulatory relief from renewal requirements. The regulatory relief will apply to the 2020 and 2021 renewal periods.

DRAFT

Dental Hygiene Committee Meeting – OPEN SESSION – Subject to final approval April 3, 2020 (Draft: 4/10/2020) 3

Ms. Stuecker reported that Governor Reynolds also extended the Proclamation of Disaster Emergency through April 30, 2020. Ms. Stuecker noted that Board staff were receiving a high volume of phone calls and emails as a result. Ms. Stuecker asked for patience during this period. Ms. Stuecker asked those in attendance to let staff know if there were things that need to be addressed. Ms. Stuecker thanked Ms. Braness for her assistance during this time. Ms. Slach stated that it may take some time for dental practice to return to normal once the mandate is lifted. VII. CLOSED SESSION MOVED by KELLY, SECONDED by SLACH, to go into closed session pursuant Iowa

Code section 21.5(1)(a), to review or discuss records which are required or authorized by state or federal law to be kept confidential; pursuant to Iowa Code section 21.5(1)(d) to discuss whether or initiate licensee disciplinary investigations or proceedings; and pursuant to Iowa Code section 21.5(1)(f) to discuss the decision to be rendered in a contested case conducted according to the provisions of chapter 17A.

Roll Call: Member: Kelly Slach Davidson Yes x x x No

Motion APPROVED by roll call.

The Dental Hygiene Committee convened in closed session at 8:16 a.m. MOVED by KELLY, SECONDED by SLACH, to RETURN to OPEN SESSION. Motion

APPROVED unanimously.

The Dental Hygiene Committee reconvened in open session at 8:28 a.m. OPEN SESSION VIII. ACTION, IF ANY, ON CLOSED SESSION AGENDA ITEMS

a. Closed Session Minutes MOVED by KELLY, SECONDED by DAVIDSON, to APPROVE the closed session

minutes of the January 24, 2020 meeting as drafted. Motion APPROVED unanimously.

b. Other Closed Session Matters MOVED by KELLY, SECONDED by SLACH, to APPROVE the order in response to file

#20-0003. Motion APPROVED unanimously.

DRAFT

Dental Hygiene Committee Meeting – OPEN SESSION – Subject to final approval April 3, 2020 (Draft: 4/10/2020) 4

MOVED by KELLY, SECONDED by SLACH, to CLOSE file #20-0004. Motion APPROVED unanimously.

MOVED by KELLY, SECONDED by SLACH, to CLOSE file #20-0005. Motion APPROVED unanimously.

MOVED by KELLY, SECONDED by SLACH, to CLOSE file #19-005. Motion

APPROVED unanimously. IX. ADJOURN MOVED by KELLY, SECONDED by SLACH, to ADJOURN. Motion APPROVED

unanimously. The meeting of the Dental Hygiene Committee adjourned at 8:30 a.m. on April 3, 2020. NEXT MEETING OF THE COMMITTEE The next meeting of the Dental Hygiene Committee is scheduled for June 5, 2020, in Des Moines, Iowa. These minutes are respectfully submitted by Christel Braness, Program Planner 2, Iowa Dental Board.

DRAFT

Lori Brown, RDH, MSE

Des Moines Area Community College

2006 S Ankeny Blvd.

Ankeny, IA 50021

Friday, April 10, 2020

Jill Stuecker, Executive Director

Mary Kelly, Dental Hygiene Committee Chair

Iowa Dental Board

400 SW 8th Street, Suite D

Des Moines, IA 50309

Dear Ms. Stuecker and Ms. Kelly,

At last Friday’s meeting of the Iowa Dental Board, I was a little surprised that the dental hygiene

students in the 2020 graduating class at the six schools of Dental Hygiene across our state were not

considered in the discussion regarding alternatives to the patient-based clinical boards that must be

taken in order to obtain a dental license or a dental hygiene license in Iowa. It was referenced that

there was discussion and input from all the Dental Hygiene program directors, as Ms. Kelly was thanked

for working with us. Yet, when I sent a comment via the chat option on the remote meeting site, it was

somewhat brushed off. I do understand, as it was a busy time and an important discussion.

There are about sixty-five or so, Dental Hygiene students who were on track to graduate next

month, many of whom have secured positions already. Another cohort of students are planning to

graduate in the fall. Because of the COVID-19 shut down all dental clinics, these students have not been

able to finish their clinical hours, thus, will not graduate on time. Program directors are seeking ways to

finish the spring semester online, but there are no substitutes available at this time for the patient-

based examinations that have been required by the Dental Board in the past.

At the Board meeting last Friday, April 3, it was decided that the senior dental students at the

University of Iowa be offered an avenue for licensure without taking patient-based examinations. I am

wondering if the dental hygiene students will be allowed to do the same. Both are licensed dental

professionals. If a mannequin periodontal skills test is available, allow dental hygiene students to take

that exam.

I would like to ask the Dental Board to consider that the Dental Hygiene students who, as part of

their educational program which is regulated by the American Dental Association’s Committee on

Dental Education, are required to complete over 750 clinical hours in addition to their didactic

coursework. They see patients of a variety of ages, periodontal conditions, physical conditions, and

other patient management issues. They have successfully completed evaluations for clinical procedures

as part of this coursework at a competency rate of at least 80%, which is higher than what is required for

passing a clinical examination provided by various third party testing services.

Dental Hygiene students from all over the country and the American Dental Hygienists’

Association are campaigning to eliminate the necessity of patient based exams for this class and I am

requesting that you will consider doing the same. I am receiving correspondence from dentists

requesting me to allow students to graduate and get licensed so they can get to work when the COVID-

19 crisis is over. Knowing that is not my decision to make, I am referring them to the Iowa Dental Board,

of course, with their concerns.

I would like to request a waiver to the rule that requires students to complete this one-time

exam that serves to “confirm” competency. There is no way to keep patients, clinicians, or examiners

safe during this pandemic. It is not fair to keep students waiting to begin their careers due to

circumstances beyond anyone’s control and in a situation that has never happened before! They must

still graduate from an accredited educational program, pass a national board examination, background

checks, and the state Jurisprudence exam. Additionally, even after being licensed, the candidates will

still be working under the general supervision of a dentist. I believe we need to recognize the

competency of these students and all they have accomplished.

Thank you for considering my thoughts. I know that I am not alone in my concerns.

Most sincerely,

Lori Brown, RDH, MSE

Dental Programs Director

Des Moines Area Community College

2006 S. Ankeny Blvd.

Ankeny, IA 50021

Cc: Arthur Brown, Dean of Health and Public Services, Des Moines Area Community College

Emily Boge, Program Chair, Hawkeye Community College

Shaunda Clark, Program Chair, Kirkwood Community College

Cindy DeWall, Program Chair, Iowa Central Community College

Melissa Kouba, Program Chair, Iowa Western Community College

Jody Williams, Program Chair, Indian Hills Community College

Jennifer Pierce, President, Iowa Dental Hygienists’ Association

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Full Text of ADHA Petition to US Governors Requesting Relief for 2020 Dental Hygiene Graduates https://www.votervoice.net/ADHA/Campaigns/71944/Respond#/?page=respond    US Governors Use the form below to send your message to the Governor on the need for flexibility in initial licensure for the 2020 dental hygiene graduates during the COVID‐19 pandemic.  Dental hygiene student:  Consider adding a personal message in the box provided and share how the pandemic has impacted your education and plans for the future.  Dental hygiene educator:  Consider adding a personal message in the box provided and share how your program and the lives of your students have been affected.   Licensed dental hygienist:  Consider adding a personal message in the box provided and share support for this cadre of students who are graduating from accredited dental hygiene programs and are ready and able to immediately contribute to the health care team.    Subject: Dental Hygiene Licensure and COVID‐19  Body of Message: Due to the COVID‐19 crisis, dental hygienists and their patients face unprecedented circumstances. For dental hygiene students, this includes their inability to complete the initial licensure process.  This is in part due to the requirements for candidates for dental hygiene licensure to be examined by performing specific procedures on a patient. Please know that other health professions outside of oral health are not required to demonstrate their clinical skills on a patient to be licensed to practice. We ask that initial licensure requirements be waived for 2020 dental hygiene graduates and that graduates from CODA‐accredited dental hygiene education programs be issued a license upon graduation in 2020.  Now more than ever, health care professional licensure should proceed without delay so these qualified oral health care providers can join the workforce in this time of dire need.    

April 9, 2020 The Honorable Larry Hogan Chair National Governors Association 444 North Capitol Street Suite 267 Washington, D.C. 20001 Dear Governor Hogan: The American Dental Education Association (ADEA) is The Voice of Dental Education. ADEA members include all 68 U.S. dental schools, over 1,000 allied and advanced dental education programs, over 60 corporations and more than 20,000 individuals. As the sole national organization representing academic dentistry, we ask you to encourage governors to suspend or modify existing state-level examination restrictions that prevent graduating dentists, dental hygienists and other oral health professionals from serving their communities during this pandemic crisis. It is vital for governors to remember that oral health is essential to overall health, as heart disease, diabetes, and certain cancers are often first detected in oral care. All states require candidates for initial licensure in dentistry and dental hygiene to pass an examination demonstrating clinical ability before they can be licensed. In many states, this exam must be administered by one of several testing agencies that require treatments to be demonstrated on live patients and evaluated. Due to the COVID-19 pandemic, these live patient clinical examinations have been suspended throughout the country, preventing graduating students from earning licenses to enter the workforce and provide needed dental care in their communities. Several states accept alternative licensure pathways, such as postgraduate education, structured decision-making assessments or a portfolio, that do not rely on patients as test subjects. Forcing graduates to wait for patient-based examinations not only deprives qualified individuals of the ability to earn a living in their chosen profession, but also limits patients in their options for dental treatment. Without suspension of or modification to clinical exam requirement rules imposed by the state boards of dentistry, the country could face a further shortage of oral health professionals when the COVID-19 pandemic has subsided. Each year, the licensure of graduating dentists and allied dental providers is necessary to maintain an adequate number of professionals who can provide care, as new dentists and allied dental professionals replace providers who retire. Furthermore, as most states have restricted dental treatment to emergency procedures only, it is likely that this policy, while necessary for preventing the spread of COVID-19, will create a backlog of patients needing treatment.

The Honorable Larry Hogan April 9, 2020 Page 2 This backlog could potentially overwhelm dental offices and community-based dental clinics. Without modification to licensing rules, this will result in delayed care for individuals, the continuation of undiagnosed oral diseases, and pain for individuals suffering from tooth decay. Licensure restrictions will also impact our armed forces, as many dental and allied dental graduates join the military and provide care to our troops. Without becoming licensed, recent graduates will not be able to serve patients in their military posts. This will result in delayed care for troops who need dental care. ADEA applauds Gov. John Bel Edwards of Louisiana and Gov. Doug Ducey of Arizona for their leadership on this issue. We believe the policies they have created are examples of a way forward for other states. In Proclamation Number 38 JBE 2020, Gov. Edwards temporarily suspended the requirement that clinical licensing exams include procedures performed on human subjects. In Proclamation Number 41 JBE 2020, Gov. Edwards permitted the Louisiana State Board of Dentistry to issue licenses based on a 2020 graduation from a Louisiana-based, Commission on Dental Accreditation-accredited dental or allied dental program. In Arizona, Gov. Ducey issued Executive Order 20200-17, which requires the Arizona State Board of Dental Examiners, and other state boards that issue licenses, to issue provisional licenses to applicants who meet all requirements but are unable to take examinations due to testing center closures and unavailability of electronic or remote testing options. These are temporary measures that will not necessarily continue when the pandemic is over. While the inability of graduating dental and allied dental students to obtain licensure in a timely manner has the potential to prevent them from joining the work force, the harm to patients and our health care system may be even greater. If governors do not act, it will exacerbate the shortage of oral health care providers. It is for these reasons that we urge all governors to suspend or modify state laws that prevent qualified dental and allied dental graduates from becoming licensed professionals. Sincerely,

Karen P. West, D.M.D., M.P.H. President and CEO