Source: https://www.azag.gov/sgo-opinions/I05-008?page=1
Timestamp: 2015-05-29 16:20:18
Document Index: 765159453

Matched Legal Cases: ['§ 32', '§32', '§ 32', '§ 32', '§ 1', '§ 32', '§ 32', '§ 32', '§ 32', '§ 32', '§ 32', '§ 32', '§ 32', '§32', '§ 32', '§ 32', '§ 32', '§ 32', '§ 32', '§ 32']

Affiliated Practice Relationships Between Dental Hygienists And Dentists | Arizona Attorney General Skip to main content
HomeAffiliated Practice Relationships Between Dental Hygienists And Dentists Affiliated Practice Relationships Between Dental Hygienists And Dentists
Opinion No:I05-008 (R05-013)
Julie Chapko, Executive DirectorArizona State Board of Dental Examiners
Does A.R.S. § 32-1289(G) authorize the Board to adopt a rule limiting the number of affiliated practice relationships in which dentists and/or dental hygienists may participate? Summary Answers
The general and direct supervision requirements in Arizona Revised Statutes (“A.R.S.”) §32-1281 do not apply to affiliated practice relationships. Instead, A.R.S. § 32-1289(H) requires a dentist in an affiliated practice relationship to “be available to provide an appropriate level of contact, communication, and consultation with the affiliated dental hygienist.” The supervision limitation in Arizona Administrative Code (“A.A.C.”) R4-11-603 does not apply to affiliated practice relationships which are governed by A.R.S. § 32-1289.
In 2004, the Legislature authorized dental hygienists to enter into affiliated practice relationships with dentists. 2004 Ariz. Sess. Laws, Ch. 6, §§ 1, 3. Pursuant to this legislation, a qualified dental hygienist may “provide dental hygiene services under an affiliated practice relationship with a dentist as prescribed in section A.R.S. § 32-1289.” A.R.S. § 32-1281 (H). Section 32-1289, A.R.S., allows a public health agency or institution or a public or private school authority to employ dental hygienists to perform dental hygiene procedures under either general or direct supervision, or to enter into a contract for dental hygiene services with licensees who have entered into an affiliated practice relationship with a licensed dentist. A.R.S. § 32-1289(A) and (C). A dental hygienist in an affiliated practice relationship may perform dental hygiene procedures within the scope of a dental hygiene license, with three exceptions. A.R.S. § 32-1289(J).(2) The procedures must be performed in specified practice setting(s) pursuant to a written agreement, written procedures and standing orders established by the affiliated dentist. A.R.S. § 32-1289(F). Analysis
Section § 32-1281(E) provides that all dental hygienists shall practice under the general supervision of a licensed dentist, “[e]xcept as provided in subsections F and H of this section.”(3) Subsection H provides that “[a] dental hygienist may provide dental hygiene services under an affiliated practice relationship with a dentist as prescribed in § 32-1289.” Section § 32-1289(C), whichauthorizes public health agencies and institutions, school authorities and government sponsored programs to contractwith dental hygienists who have entered into an affiliated practice relationship, does not require the hygienist to work under general or direct supervision. A.R.S. §32-1289(C). Instead, the affiliated dentist must be “available to provide an appropriate level of contact, communication and consultation with the affiliated dental hygienist.” A.R.S. § 32-1289(H). Similarly, a dental hygienist in an affiliated practice relationship is required to “maintain an appropriate level of contact, communication and consultation with the affiliated dentist.” A.R.S. § 32-1289(I)(2). The absence of the terms, or any reference to the terms, “general” and “direct” supervision in § 32-1289 (C), (H) and (I) indicates that the Legislature did not intend them to apply to affiliated practice relationships.(4)
The Board is mandated to adopt rules regarding participation in affiliated practice relationships by dentists and dental hygienists. A.R.S.§ 32-1289(G). The rules must specify additional standards and conditions that may apply to affiliated practice relationships. A.R.S. § 32-1289(G) (2). The Legislature, however, did not define the terms “standards” or “conditions.” Undefined words in a statute may be interpreted according to their ordinary meaning. Circle K Stores, Inc. v. Apache County,199 Ariz. 402, 406, 18 P.3d 713, 717 (App. 2001). A “condition” is defined as something that “restricts.” Webster’s II New Riverside University Dictionary 295 (1994). “Restrict” means to “hold within limits.” Id.at 1002. Accordingly, A.R.S. § 32-1289(G) (2) allows the Board to restrict by rule the number of affiliated practice relationships in which dentists and hygienists may participate. The nature of any restriction would be a policy decision of the Board, subject to the statutory rulemaking process. Conclusion
Hygienists in affiliated practice relationships are prohibited from performing root planing, administering local anesthetics and nitrous oxide, and placing periodontal sutures.
This conclusion is reinforced by the legislative history, which indicates that the affiliated practice relationship legislation was intended to create a new degree of supervision and was intended to allow dental hygienists to perform dental hygiene procedures without general supervision on children 18 years and younger in public health settings. ArizonaStateSenate Staff, Fact Sheet for H.B. 2194; Dental Hygienists: Meeting on H.B. 2194 Before the H. Comm. On Health, 46th leg., 2nd Reg. Sess. 7 (2004). 46th Leg., Second Reg. Sess. at 1 (2004), Committee on Health, March 4, 2004.