As the new dental anesthesia rules take effect and Washington state dentists navigate the complexities of the new regulations, WSDA remains committed to advocating for transparency and accountability at every level of decision-making. In this feature article, WSDA delves into the voting processes of the Dental Quality Assurance Commission (Commission) when developing the new rules, which became effective Jan. 11, 2024.
Despite the at times contentious issues discussed throughout rulemaking, a surprising number of decisions were unanimously settled, calling into question whether there was adequate consideration for the practical implications for different practice settings, including those in rural or underserved communities who may face challenges implementing the new rules effectively.
The Road to Reform
- Aug. 17, 2017: The Commission files a preproposal statement of inquiry, which is the first step in the rule-making process.
- Nov. 10, 2022: The Commission files a statement of proposed rulemaking as well as small business impact review, and the public is notified and invited to comment on the proposed rule changes.
- Dec. 21, 2022: The Commission rescinds the original statement of proposed rulemaking and cancels the rule hearing to revise the language and incorporate additional comments received from interested parties.
- July 31, 2023: After revising the rule language, the Commission files a second statement of proposed rulemaking, allowing stakeholders and interested parties the opportunity to submit formal comments and testify on the proposed rules before the Commission makes a final decision to adopt rules.
- Sept. 8, 2023: The Commission holds a public hearing on the adoption of proposed rules for administration of anesthetic agents for dental procedures.
- Dec. 11, 2023: The Commission files a CR-103, the final step in the rule making process that signifies adoption of the rule and notifies the public of the newly adopted rule.
- Jan. 11, 2024: New anesthesia rules are effective.
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Voting Overview: Unanimous vs. Roll Call
Throughout the rule-making process, WSDA consistently raised concerns, emphasizing the need for practicality and consideration of varied dental practice settings. Amongst those concerns raised, most notably WSDA advocated for offices that carry only topical anesthetic to be exempt from AED requirements, and that when only topical anesthetic is administered the requirement to obtain vitals be at the discretion of the provider, regardless of the patient’s age.
Despite the depth of these issues and the numerous concerns brought forward by WSDA, the responses from the Commission Anesthesia Committee members were often homogenous and without any disagreement amongst members. The uniformity in decision-making, particularly on complex and divisive topics, highlights a critical need for diversity and active engagement in the Commission. This process has raised questions about the depth of individual participation and the potential for passive conformity. In fact, over the entire 6 years of anesthesia rulemaking, only three issues were subject to a roll call vote:
- March 11, 2022 Commission Business Meeting
- Vote (not roll-call) unanimous approval of rules
- Dec. 9, 2022 Commission Business Meeting
- Roll-call vote re: AED unanimously passed (8-0)
- Vote (not roll-call) re: vital signs, unanimously passed
- Vote (not roll-call) re: CE, changes approved
- March 10, 2023 Commission Business Meeting
- Roll-call vote re: Topical unanimously passed (14-1)
- Vote (not roll-call), unanimous approval of rules
- Sept. 8, 2023 The Commission Business meeting rules hearing
- Roll-call vote unanimously passed (11-0)
- Oct. 27, 2023
- Vote (not roll-call), unanimous approval of modifications to rules
What's Next?
In a letter sent to the Commission in June 2023, WSDA called for greater transparency, and an agreement was reached with the Commission to include individual roll call voting records in the Commission Business Meeting minute notes, available to the public online.
While this was a step towards openness, WSDA’s pursuit of transparency is meant to reveal not only the decisions made but the vibrancy of the decision-making process itself. “The lack of varied viewpoints and robust debate in such votes may suggest that some Commissioners are taking a ‘back seat,’ or simply aligning with the prevailing direction without sufficient scrutiny,” said WSDA Executive Director Bracken Killpack. “Regardless, the need to evaluate the dynamics of participation and dissent within the Commission is apparent, and it is of the utmost importance that we advocate for diversity if we are to ensure that every voice is truly heard and considered.”
How to Influence Rulemaking
Are you wondering how you can get involved, and influence rule-making decisions? WSDA operates one of the most robust grassroots lobbying networks in the state. Grassroots dentists are dentists who follow dental legislative issues and are willing to communicate the positions of organized dentistry with legislators through in person meetings, phone calls, and emails.
This is dentistry’s most effective tool in influencing the outcome of legislation that will impact the way you practice, protect the public’s health, provide the highest quality oral health care and run your business!
Start on the path of effective dental lobbying as a grassroots dentist! There is no obligation, participate as little or as much as you like.
For more information, contact WSDA Advocacy Director Kevin Schilling at kevin@wsda.org.
This article originally appeared in Issue 1, 2024 of the WSDA News.