[1]
Editor's Note: The article numbers for the headings in Ch. 23.04 were added by the codifier for organizational purposes only and were not part of the original legislation.
The general purposes of this Chapter are:
(a) 
To establish a regulatory and licensing system for dental health providers that is based on and reflects the priorities and values of the Port Gamble S’Klallam Tribe;
(b) 
To regulate dental health providers to protect the health, safety and welfare of the Tribe and its members;
(c) 
To ensure that adequate minimum standards are established, maintained and adhered to by all of the Tribe’s dental health providers;
(d) 
To set standards for dental health providers;
(e) 
To require certain dental health providers to have a Tribal License and engage in specific scopes of practice as authorized under this Chapter and their Tribal License;
(f) 
To assure dental health services are culturally relevant and comply with best practices;
(g) 
To promote and expand access to adequate numbers of dental health providers;
(h) 
To establish a legal and regulatory structure that will enable operation of the Port Gamble S’Klallam Tribe’s dental program, to provide the highest quality dental services in the most efficient and culturally competent manner, making optimal use of the skills of Tribal employees, in order to maximize the health care resources available to the Tribe; and
(i) 
To reduce and then eliminate disparities in access to dental health care and in oral health experienced among Tribal members and other American Indians and Alaska Natives.
(Res. 18-A-012, 1/22/2018)
The authority of the Tribal Council of the Port Gamble S’Klallam Tribe to adopt this ordinance as codified in this title is found in the Constitution of the Port Gamble S’Klallam Tribe and in the inherent sovereignty of the Port Gamble S’Klallam Tribe to regulate its own territory and activities therein.
(Res. 18-A-012, 1/22/2018)
The Port Gamble S’Klallam Tribe finds that:
(a) 
The Tribe is a Federally-recognized sovereign with the right and responsibility to promote, protect, and improve the health and welfare of its members, and to enhance the quality of the lives of all of its members by providing a combination of economic opportunities and a safety net of social services.
(b) 
The Tribe provides health care services and programs for Tribal members, including a comprehensive dental program under the Indian Self-Determination and Education Assistance Act.
(c) 
Oral health is necessary for overall health. Chronic pain, missing teeth, infections, and life-threatening emergencies can result from poor oral health care.
(d) 
American Indian and Alaska Native people have a higher prevalence of dental caries and untreated tooth decay in all age groups compared to the general population. American Indian and Alaska Native children ages two to five have nearly three times the United States average rate of dental decay.
(e) 
Indian Health Services (IHS) data from 2014 shows that in the Portland, Oregon IHS Area, 68 percent of those American Indian and Alaska Native children ages three to five screened had decay experience, and 35 percent had untreated decay.
(f) 
Oral health care disparities are attributable to factors including a lack of consistently available dental health professionals in the Indian health system.
(g) 
The Port Gamble S’Klallam Tribe wishes to increase the number of Native health care providers generally and Tribal health care providers in particular who provide services to Tribal members and other eligible Native Americans.
(h) 
The Alaska Native Tribal Health Consortium (ANTHC) developed a program to train and utilize dental health aide therapists in Alaska Native tribal health programs, which has operated successfully since 2003. A study by the University of Washington School of Dentistry published in 2016 found that since 2003, villages in the Yukon Delta in Alaska with DHATs, when compared to villages without DHATs, experienced the following outcomes:
(1) 
284% decrease in first four front teeth extractions for children under 3 years old;
(2) 
26% decrease in extractions for adults;
(3) 
60% increase in access to preventative care for children;
(4) 
75% increase in access to preventative care for adults; and
(5) 
44% decrease in the need to put children under general anesthesia for full mouth rehabilitations.
(i) 
The IHS’s Community Health Aide Program Certification Board (CHAPCB) standards for Dental Health Aides, including dental health aide therapists, were adopted in 2002. Dental health aide therapists have practiced in accordance with international and IHS standards for mid-level dental practice since 2004. The ANTHC training program, which developed its two-year curriculum in conjunction with the University of Washington, satisfies all of the CHAPCB Standards and Procedures.
(j) 
The Alaska Tribal Health System Dental Health Aide Program and the CHAPCB standards are consistent with and will further the Port Gamble S’Klallam Tribe’s goals for a tribal dental health program, to help increase the number of Native health care providers and to address oral health care disparities attributable to the lack of consistently available, culturally competent, long-term dental health professionals in the Indian health system.
(k) 
The CHAPCB Standards and Procedures, initially developed by IHS consistent with international standards for mid-level dental providers, have evolved since 2002 as experience has been gained utilizing such providers in Native communities. The CHAPCB Standards and Procedures serve as a well-informed and time-tested resource and inspiration for development of, and partial incorporation into, the licensing standards which have been developed by the Swinomish Indian Tribal Community.
(l) 
Oral health care services are most appropriately delivered by an effective, safe, and culturally competent workforce.
(m) 
More than half of the procedures that are currently performed by a dentist at tribal dental health care programs can be performed at lower cost by a dental therapist acting within the scope of his or her certification or Tribal license. A dental therapist meets the same standard of care as a dentist and provides services at a lower cost to the Tribe. By using dental therapists, the Tribe can use the limited financial resources of tribal dental health care programs more efficiently and increase the number of tribal members who can access and use the dental health care program.
(n) 
The Port Gamble S’Klallam Tribe desires for its dental program to provide the highest quality dental services in the most efficient and culturally competent manner, making optimal use of the skills of Tribal employees in order to maximize the health care resources available to the Tribe and its Tribal members. After reviewing the situation carefully, the Port Gamble S’Klallam Tribe has concluded that the licensing and employment of dental therapists and supervising dentists will substantially and materially assist in reaching that goal.
(o) 
Since 2015, the Swinomish Indian Tribal Community, Division of Licensing, has developed and is implementing a comprehensive dental licensure scheme under its inherent sovereign authority and its tribal health program to certify qualified dental health providers. The Swinomish Indian Tribal Community has successfully licensed dental health providers practicing at the Swinomish Dental Clinic, and the Swinomish Indian Tribal Community serves as a regional licensing body for tribal dental health programs operated by federally recognized tribes in Washington and Oregon.
(p) 
The Tribe does not wish to duplicate the same comprehensive licensure scheme put into place by the Swinomish Indian Tribal Community for Tribal Dental Health Providers, as doing so would be resource intensive and would create delays in the Tribe’s ability to hire Dental Health Aides to begin providing services as quickly as possible, and thus the Tribe finds that implementing its own dental licensure scheme beyond what is provided in this Code is not feasible.
(q) 
The Port Gamble S’Klallam Tribe desires for the Swinomish Indian Tribal Community, Division of Licensing and the Dental Health Provider Licensing Board, to license the Port Gamble S’Klallam Tribe’s employees who are Dental Health Aides and Dentists.
(Res. 18-A-012, 1/22/2018)
Unless stated otherwise or inconsistent with any provision of this Code, the requirements for certification and practice of Dental Health Aides in the CHAPCB Standards and Procedures, as amended, are incorporated by reference into this Code where indicated and shall apply as if set forth herein; provided, however, that in the event of a conflict or inconsistency between the CHAPCB Standards and Procedures and the Swinomish Indian Tribal Community’s Dental Health Provider Licensing Code, under which the Port Gamble S’Klallam Tribe’s Dental Health Aides and supervising dentists must be licensed in accordance with this Code, the provisions of the Swinomish Indian Tribal Community’s Dental Health Provider Licensing Code shall control. These Standards and Procedures may be referred to as “CHAPCB” and shall be cited as “CHAPCB” followed by the applicable section number. The Standards and Procedures may currently be accessed online at the following link http://www.akchap.org/html/chapcb.html or by contacting the Alaska Community Health Aide Program (CHAP) directly.
(Res. 18-A-012, 1/22/2018)
For the purposes of this Chapter, unless explicitly stated otherwise, the following definitions shall apply:
(a) 
“Atraumatic Restorative Treatment”
means a maximally preventive and minimally invasive approach to stop further progression of dental caries. It involves the removal of soft, completely demineralized carious tooth tissues with hand instruments, and is followed by restoration of the cavity with an adhesive dental material that simultaneously seals the remaining tooth structure that remains at risk.
(b) 
“Dental Health Aide”
means primary dental health aides I and II, dental health aide hygienists, expanded function dental health aides I and II, and dental health aide therapists, except as used in CHAPCB Article 30 of Chapter 2 regarding requirements for special classes of dental health aides.
(c) 
“Dentist”
means a person who is:
(1) 
In the employ of the United States government, providing dental services in the discharge of official duties and licensed as a dentist in one of the States of the United States;
(2) 
In the employ of the Tribe, providing dental services in the discharge of official duties and licensed as a dentist in one of the States of the United States; or
(3) 
Licensed as a dentist by the State of Washington.
(d) 
“Preceptorship”
means a period of practical experience and training under either the direct supervision of a Dentist or a dental health aide therapist, dental hygienist or dental health aide hygienist who is under the overall supervision of a Dentist.
(e) 
“Reservation”
means all lands and waters within the exterior boundaries of the Port Gamble S’Klallam Tribe Reservation.
(f) 
“Tribal Dental Health Aide”
means a Dental Health Aide (including a primary dental health aide I and II, dental health aide hygienist, expanded function dental health aide I and II, and dental health aide therapists), as these terms are defined in CHAPCB 1.20.010, who is employed by the Tribe and licensed in accordance with this Code.
(g) 
“Tribal Dental Health Provider”
means a person who is employed by the Tribe and licensed as a Tribal Dentist or a Tribal Dental Health Aide in accordance with this Code.
(h) 
“Tribal Dentist”
means a Dentist, as that term is defined under this Section, who is employed by the Tribe and licensed in accordance with this Code.
(i) 
“Tribal License”
means a license issued under the Swinomish Indian Tribal Community’s Dental Health Provider Licensing and Standards Code, Title 15, Chapter 11 of the Swinomish Indian Tribal Community’s Tribal Code.
(j) 
“Tribe”
means the Port Gamble S’Klallam Tribe.
All other words and phrases have their ordinary and customary meanings.
(Res. 18-A-012, 1/22/2018)