Assembly Standing Committee on Business and Professions

Good morning, everyone. Welcome to this morning's Business and Professions Committee hearing. We have only one item on today's agenda, SB 1453, by Chair Ashby. Please note that the Committee on Governmental Organization is meeting upon adjournment of our hearing today. I assume that's what 90% of you are here for.

So we will be doing our best to move quickly so that Committee can convene. Today, we'll be allowing primary witnesses to speak for up to no more than two minutes each. With no more than two than two primary witnesses per side.

Any additional witnesses will be limited to providing their name, position on the bill, and organization they represent, if any. For those wishing to provide further comments, we are accepting written testimony through the position letter portal on the Committee's website. And with that, we will begin today's hearing. Chair Ashby, please go ahead.

Thank you very much. I appreciate you guys. And it's one of those hard days where we're all supposed to be in like seven places at the same time, so I thought we could maybe move this one quickly. Chair and Members, we're here to present SB 1453. It's the Dental Board of California's Sunset Bill.

The bill makes a number of changes to improve the board's operations and efficiencies. Without this bill, the board would expire on January 1. Mr. Chair, I appreciate the work that you and your team have done, as always, to assist the Senate team.

This bill includes a number of changes requested by the board and dental partners throughout the state. I have with me two support witnesses, Tracy Montez, who's the Executive Officer for the Dental Board, and Dr. Turley, a Dental Director at one of our federally qualified healthcare centers.

And, as an expert, in case you have questions, we also have with us Gary Cooper, representing the oral surgeons. I respectfully ask for your. aye vote.

Thank you. You have two minutes each.

Good morning, Chair, Vice Chair, and Members of the Committee. Tracy Montez, Executive Officer of the Dental Board. The board is in support of this bill, and we are thrilled with the proposals that have been included in this bill, and thank Senator Ashby, and her team, for all the work to make this happen. Thank you. I'm here for any technical questions you may have.

Thank you very much. Go ahead.

Good morning. My name is Ariane Terlet, and I am the Chief Dental Officer for La Clínica De La Raza (CDA in Oakland, which is a federally qualified health center. I'm the past President of the California Dental Association, as well as a past Member of the Dental Board of California. I am here in support of SB 1453.

The CDA firmly believes in the board's critical role in ensuring safe dental care through effective licensee oversight. We are particularly supportive of several key positions in the bill that align with our commitment to workforce development and access to care.

Firstly, the CDA is pleased to see that the Sunset Bill included previous CDA-sponsored language aimed at creating more licensure pathways for registered dental assistants, including a new preceptorship model that offers a flexible alternative to traditional dental assisting programs, making the profession accessible to a diverse group of individuals and allowing for individuals to earn as they learn.

CDA also appreciates the dental board's willingness to address the unintended consequences and necessary cleanup for SB 501, which was legislation from 2018 focused on pediatric dental anesthesia.

While several provisions are included in this bill to help streamline the administration and oversight of the dental anesthesia permit structure, the CDA is particularly supportive of an amendment that would enable pediatric dentists to use their pediatric residencies as qualifying education to apply for adult minimal sedation permits.

This amendment corrects unintended consequences from SB 501 that would allow pediatric dentists to provide sedation to adolescent patients 13 and up, which is critical with special needs patients. CDA also supports expanding eligible CE courses license renewal to include course offerings focused on the mental health and the wellness of licensees.

In this bill, anxiety, depression, and burnout are crucial issues impacting all healthcare providers that, if left unmanaged, can lead to doctors leaving the profession and impacting patient care.

This initiative will help incentivize licensees to enroll in courses focused on these issues, further reducing stigma and equip dental professionals on the tools needed to provide the highest level of care.

And if you could wrap up, that'd be great.

This is it. Thank you. Lastly, the CDA continues to agree with the Dental Board and Legislature's consistent findings for the past half decade in determining it is most appropriate to shift the accreditation mechanism of international dental schools from the state regulatory board to an existing U.S. regulated entity.

Thank you very much. Go ahead.

Thank you very much. Any additional witnesses in support who want to add on in support of the Bill? Now is your time.

Mr. Chair, Gary Cooper, representing the California Association of Oral and Maxillofacial Surgeons. We want to thank Chair Ashby for working with us on some of our concerns, and we certainly support SB 1453.

Samantha Johnson, on behalf of the California Association of Orthodontists and Support.

Thank you very much. So now we'll have two primary witnesses in opposition if we just make sure that there's space for the two primary witnesses in opposition. Coming up. You have two minutes each.

Good morning, Chair and Members. Jennifer Tannehill with Aaron Reed and Associates on behalf of the California Dental Hygienists Association (CDHA). CDHA is opposed to the June 24 amendment to Senate Bill 1453 and is taking an opposed and less amended position on the Bill.

As recently amended, SB 1453 would remove the registered dental hygienist from the dental board to make room for another registered dental assistant. We support the registered dental assistants having a stronger voice on the dental board.

However, the California Dental Hygienist Association is opposed to removing the hygienist from the dental board, so long the dental hygiene board is required to obtain approval from the dental board for scope changes as required in section 1905.2 Dental hygienist should have a voice on the dental board if hygienist scope decisions are required to approval from the dental board.

However, CDHA would not oppose removing the RDH from the dental board if 1905.2 is stricken from the dental hygiene code. Striking 1905.2 actually makes the most sense, as dental hygiene board is entirely responsible for the regulatory oversight of the dental hygiene profession. No other boards are required to gain approval from a separate board for scope changes.

1905.2 is a relic of when hygienists were regulated by the dental board. Simply striking 1905.2 would clean up the code to reflect the Dental Hygiene Board's true oversight responsibility. We look forward to working with the author and committee to resolve the issue and thank you for your consideration.

Thank you, and Ms. Huerta, you have two minutes. It's always an honor, although I think I'm getting notice--okay, I guess we're going to do one minute each. But, unfortunately, that means I'm going to have to keep you to a very strict 1 minute. As you can see, there are a lot of folks here for the next hearing, so please go ahead.

Thank you. Dolores Huerta Foundation. I wanted to bring attention that there are--that this bill does not go far enough. There were two schools, Moldova and La Salle, which are international schools that graduated 800 dentists here from the United States of America. Those dentists now work in low-income areas.

When we see the number of dentists in California, 30,000 dentists, only 8% of those dentists are Latino. And of course, the number of Blacks is even less, considering that 40% of the population in California are people of color, with Latinos making up a significant portion. These are health issues that are not being addressed.

The California Dentist Board is depriving our communities of the needed dentists that they need, and this is, of course, impacting their health, and this has to be corrected. So when you had a program that actually worked that brought more dentists into our community, and now they are being deprived of that--this needs to be fixed. So, I think the California Dental Board needs to look at this issue and fix it.

Thank you. Thank you very much. And Senator Polanco, I believe you want to come up for 1 minute in testimony.

Absolutely. Thank you, Mr. Chair and Members.

Go ahead, please.

This Bill was established for the purposes of increasing a pool of qualified California students who get trained abroad in dentistry. It is a measure that has proven itself. When it was sunsetted out. A couple of years ago, it was sunsetted out without any data. This program has graduated and have licensed 800 students from California.

They are trained. We were recently informed that there is a dental school that did not go through the CODA process that the dental board did allow to proceed in accepting students.

We ask that we explore a pathway that creates a permanent pool of qualified dentists that can come back at no cost to the California budget we hope to work with in the future. With the author of this Bill, we know that the issue of dentists in medically underserved areas is critical. Thank you so much for the opportunity to address you all.

Thank you, Senator. Appreciate it. We have a quorum, so we're going to break real quick to establish quorum, madam? Well, we're not breaking. We're just going to break the presentation. Madam Secretary, please call the roll.

[Roll Call]

Great, great. We have a quorum. Anybody else who wants to testify in opposition as an add on witness?

Thank you, Chair and Members. Tim Madden, representing the California Society of Plastic Surgeons. We actually removed our opposition with the recent amendments, so just want to thank the author, her staff, as well as Committee staff listening to our concerns. Thank you.

Thank you very much. Just please provide your name, organization you're with, and position on the Bill.

Good morning, everyone. My name is Ana Maria Quintana, I'm councilwoman for the City of Bell. I firmly oppose this Bill unless it's amended to include the foreign dental school program. We need dentists. My community is in Dallas--

Thank you very much. Thank you very much.

My name is Juanita Chavez, and I'm with the Dolores Huerta Foundation and an organization called Justice for My Sister. And we would like to oppose this bill if it is not amended to include the foreign dental school program as a pilot.

Thank you very much.

Good morning. Francisco Leal, on behalf of Ultimate Health Services, opposed unless amended to include the 400 dental school program. I also have proxy votes from Arroyo Vista Family Health Center, Clínicas Del Campo Real, Clínicas Oscar Romero, Pietro Del Barrio, and South Central Family Health Center.

Thank you. Thank you very much.

Dwayne Goff, United Veterans of Placer County, and we oppose unless amended.

My name is Carlos Alcala. I'm the Chair of the Chicano Latino Caucus of the California Democratic Party. Title for identification purposes only. I am opposed to this Bill.

Thank you very much. Any additional witnesses? Seeing none, bring it back to colleagues for questions or comments. Motions and seconds from colleagues? Got a motion. A second? Got a second, someone. Soria, you want to make comments? Please do.

Thank you. Thank you. And good morning, everyone. I just did want to ask some questions because, obviously, what the opposition presented is extremely concerning to me, especially coming from the Central Valley, where we're significantly medically underserved. Just wondering, from the Executive Office's position, what are we doing to improve access in our communities?

And I also just want to speak from a, a personal note. Both of my parents, farmworkers, former farm workers, now retired, having to travel to Tijuana, you know, pretty regularly to just get my mom's dental work done because of the access issue in our communities. Also, obviously, the affordability issue that exists in our community.

And so my family story is not, you know, a unique story. I think it's very common. I've heard it in my district when I, you know, connect with folks at roundtables and meet with my local residents. One, the lack of dentists and then the affordability piece, especially for our communities.

I do believe that the opposition presents some very compelling arguments. I'm seeing it in my district, and so I'm just wondering, what is the plan to move forward? I get it that it's not included in this piece of legislation, but it's an issue that we can't ignore.

Thank you. I'm happy to respond to this. So, I believe, again, Tracy Montez, Executive Officer of the Dental Board, I think it's very important that we remember that these are two distinct issues: foreign dental school approval and access to care.

The board has spoken for over a decade that their belief is that foreign dental schools should still achieve the same level of competence their graduates as other graduates across the United States and on an international level, we should not be lowering the standards in order to graduate dentists.

And so the board again has spoken many times on this issue and been very clear. In order to protect consumers of dental services, they should have the same standards. And we are seeing schools get code approved both in the United States and internationally. So we know the process is working.

As far as access to care, I too grew up in the Central Valley, grading peaches. That was my summer job. So I'm very familiar with having to drive long distances to go to the doctor or the dentist.

The board itself has reinstituted its Access to Care Committee and it is working very hard right now, specifically focused on registered dental assistants because that's where we see the greatest need. We have updated the exam. We are looking at translating the exam. We are also conducting surveys to better assess how to hire those.

As far as the dentists go, in our sunset bill, we are clarifying the various pathways to become a dentist. This was also part of the past sunset bill. So we have five pathways to become a dentist. We are trying to reduce any artificial barriers to licensure and get those dentists out there.

We're also working to evaluate demographic data. Long before boards were required to collect this data, we have been doing it as a Healing Arts Board. Now we're working with other agencies to see how we can use this data, because of course, we cannot force individuals to go practice in a certain area.

But we certainly are trying to look at where the need is. So, please be reassured that our Access to Care Committee and our board understand this and are working very hard. It's in our strategic plan, it will be in our new strategic plan, and we address it at every board meeting. Our Access to Care Committee reports. Happy to continue to work with you on this issue. Thank you.

Let me just add to that really quick. And then if you have a further question, happy to take it. Obviously, first of all, two things on the opposition. On the dental hygienist issue, we'll continue to work with them. She makes an excellent point on the one provision.

We'll take a look at it after this, and I'm happy to do so. The hygienists have their own board. Makes sense that the two could communicate, and unlinking the two in always imaginable is probably the right thing to do.

On the second issue, there are foreign dental schools that are accredited and so there is an accreditation process that these schools could go through. But what I don't believe is appropriate here is to make an exception in the sunset bill that goes around the accreditation process.

And so that's why it's not in this bill, because this is a sunset bill, but there is an accreditation process for any foreign dental school, and there are some that have gone through that process that now do serve Californians.

Thank you. And for me, the point was, obviously, it is an issue that's extremely important. I think that there's more conversations to be had. I'd like to set some time up to talk to you more about what is your strategic plan. Is there a dental school plan to be in the valley? Where is that in the timeline?

Because again, dental healthcare is connected very closely to people's health. And so, I'm wondering if that's part of your guys strategic plan, and also how we're working, especially in rural communities where we don't have maybe as much access to higher institutions of education that are further away, especially from the small rural communities.

What are we doing to really strengthen the community college programs that we have available that provide more access? And then the last piece that I also care about, what are the incentives that you guys include in your strategic plan?

I get it that people are not going to want to maybe move to the valley unless you're from the valley, because you actually care about the community. I'm very interested to see. That's why I feel like probably the best solution is to build a dental school in our region.

And so hopefully you can include that as part of your strategic plan. Thank you so much for answering the question.

Thank you, Assemblymember. Points very well taken. Assemblymember Carrillo?

Thank you, Mr. Chair. Back in March, when we had this sunset review hearing, I believe Senator Roth asked a series of questions, and I also asked if there was any data available for dentists that went through these processes and where they are servicing. There was no response or information, but my understanding is that at a later point, that information was provided. And in fact, there are 10 dentists in the district that I represent that serve the high desert.

So to me, it seems like the program is working as successful not only in my district, but it was provided with information of dentists serving in the entire state, all 80th Assembly districts. He also asked the status of De La Salle Dental School accreditation status? Can you give us a status of where they are?

I can't as the dental board, because it's a confidentiality issue between CODA and De La Salle, but Doctor Terlet may know.

Yeah, thank you. I'm happy to answer the question. I want to share with you that I was on the dental board that accredited De La Salle in 22 years ago. And so, basically, one of the things is that they are in the process of CODA, and they are trying to finish up. They basically, I wouldn't say that they were ill-advised in the past in terms of the CODA process, because the U.S. system and the Latin American or any other country have a different accreditation system. So they have a full team, De La Salle's accreditation, or basically they're allowed to finish by 26.

They're not sunsetted until 26 due to prior dental board approval, and their hope is that they will have completed CODA by 26. So that is their goal in terms of doing that.

So they're far into this process, and I will actually be going there the last week of August and be meeting with everybody because it has been successful. They've done a very good job in following all of the criteria that's needed to be aboard a dental school here.

So they could potentially then be accredited by 2026, provided they follow the requirements?

Hopefully sooner, but 2026 is the actual deadline. And then just wanted to make a couple comments as an FQHC Director, one of the things CDA has done, and thank you to the Legislature for giving $10 million to us being able to rotate dental students out of the dental schools, because that has made the biggest impact for me as a dental director, to have dental students rotate, come into the community and see who we serve.

And ideally, to encourage people to graduate from high school, to get into college, to even get into dental school, cause it's hard. But, you know, as much as we can be role models and be in the community, it's really important. So I really thank you. And encourage more rotations in getting people.

I would love to have dental school in the Central Valley, but I think that encouraging people to see the communities and choosing people from the communities into professional schools is critical.

Just one follow up question to that. So, if for any reason they're not able to get fully accredited by 2026, does that mean that they will have to start the process again past 2026?

So what happens. So what happened with De La Salle last time is that they started the process. So when you start CODA, you have these--they basically find criteria of things that you have to fix, right? So there's a number of things that they have to remediate.

They didn't choose to do it at that time because they had a new Director of the University who didn't want to do it. That's really what ended up happening. But the dental school kept going.

The director that's there, and the president is very much interested in not only having an international dental program, but also a nursing program which could benefit California since we have a nursing shortage, and so they're very much focused on it.

So if they don't pass in 26, they're going to work on whatever the deficiencies are and their intention is to continue until they pass CODA-they're not going to give it up, and that's what I've been told.

Thank you. Assembly Low.

Thank you very much. I want to also echo the comments about with respect to the sunset of this dental board, as this Committee is well aware that there have been a number of public hearings with respect to the Senate Chair of Business and Professions, as well as the Assembly Chair, in continually outlining some of these outstanding issues and acknowledging the work of both Senate and Assembly staff on ironing out any outstanding issues.

Acknowledging also the public discourse and addressing the urgent need of increasing access to care is a priority of this Legislature and at the same time maintaining the integrity also of our practices and also delivery of healthcare services and our direction to help embark on that direction.

And so to acknowledge those key points, would also like to echo support and acknowledgement of both committee chairs and the hard work before us and look forward to supporting this measure.

Thank you, Senator Low. Any additional questions or comments from colleagues? Seeing none. Senator, would you like to close?

I think Assemblymember Low did a better close than I could ever do. I asked for an aye vote.

Thank you. Thank you to Senator Ashby for your work on this, and all of the other sunset bills authored by your Committee this year, and also, of course, your fantastic committee staff.

As we've heard, there are a number of discussions on the various issues relating to the dental board and dental professions, and I look forward to partnering with, with you and your committee, the Senate Committee, on these outstanding items. Really appreciate the questions and issues that colleagues brought up.

I do want to just touch on a couple of things. This year alone, we've passed legislation to support the Mexico Pilot Program, which enables foreign trained dentists to practice in areas of need.

In California, we also passed a bill by our Health Chair, Assemblymember Bonta, to gather data needed to determine the success of initiatives to increase the healthcare workforce in underserved communities, like dental school loan repayment programs.

And we should also recognize the years of budget advocacy that has achieved historic expansions of the state's Medi-Cal dental program, which is critical to increasing access to dental care among low-income populations in California, and it was mentioned, some data that's been presented to the Committee from advocates, and my Committee staff has looked into that data.

There are a lot of questions about the accuracy of that data, and so it's important that if we do have data, that it's accurate data. And lastly, just want to note that De La Salle has not taken a position on this Bill. They have not reached out to the Committee in opposition or to express any concerns.

So with that, I'm happy to support the Bill today. I should say, I also want to acknowledge the comments we've heard, obviously, from the iconic Dolores Huerta.

And I believe I speak for both Senator Ashby and myself when I say our committees share the goals that you are advocating in terms of increasing access and will continue to make that a priority for the Legislature. With that, I will be supporting the Bill today with the one amendment outlined in the analysis.

And I guess I should confirm that you've accepted the amendments.

Thank you very much for accepting the amendments. Madam Secretary, Please call the vote.

Of course, yes.

On SB 1453. Ashby. The motion is do pass as amended, to the Committee on Appropriations. [Roll Call]

I want to thank almost everyone for being here. We will hold the roll open for three minutes for Assemblymember Zbur to come and add on to the bill. Three minutes if you are Assemblymember Zbur staff. Chair, thank you very much. Good luck with the rest of your work this morning.

SB 1453. [Roll Call]

Madam Secretary, please open the roll for present.

Colleagues on SB 1453. [Roll Call].

The Bill is out. Yeah, with 16 votes. Okay, the meeting's adjourned.