March

March 2012

State Board of Dentistry Meeting March 9th, 2012


Submitted by Michael Kaner DMD, JD, FAGD


Dr. Shawn Casey and myself attended the meeting in Harrisburg. After approving the minutes, the Board counsel submitted four cases in which there were consent agreements to the Board for their approval.

DISCIPLINE

1) The case of a dentist who employed an EFDA from 1990-2008 but allowed her to do things beyond the scope of her practice, taking impression for other than study models or doing part of endodontic treatment and removing permanent cement. A civil penalty of $4000 was imposed and a one year suspension was stayed in favor of probation.- Approved by the SBOD

2) A dentist who had two complaints against him, one for perforating the sinus during an extraction and failure to suture afterwards and a second for injuring the neurovascular bundle during an extraction . The second case resulted in a lawsuit and settlement. The respondent voluntarily submitted his license.- Approved by the SBOD.

3)A dentist who unknowingly employed an unlicensed dentist who had submitted to him a falsified copy of his dental license. Once he realized that the employee dentist was not licensed, he was immediately terminated. The hiring dentist was discipline because he failed to use the online database to verify that the employee dentist was licensed in the Commonwealth. A consent agreement of a civil penalty of $1500 was rejected by the Board as too lenient.

(EDIT- WHEN HIRING STAFF IT IS IMPERATIVE TO NOT ONLY RELY ON A PAPER COPY BUT TO GO TO THE STATE SITE TO VERIFY A LICENSE OR YOU PUT YOUR OWN LICENSE IN JEOPARDY)          http://www.licensepa.state.pa.us/

4) A dentist whose CE was audited was found to not have the required number of hours from approved CE providers. The dentist claimed to have 57.5 hours but some were obtained from unapproved providers and other were done after the required time period. The SBOD rejected a consent agreement of $1000 civil penalty.


STATUS OF REGULATIONS

The EFDA program approval was published as final after Feb 11, 2012 and all other regulations are status quo.

Mobile Vans- It is in regulatory committee and the SBOD will need final review in committees.


American Academy of Dental Boards (AADB)- In April Dr. Siegel will be attending a meeting of the AADB and he submitted to all SBOD members a report on mid-level providers and he stated that Pennsylvania is doing an excellent job providing access, and that all children at the poverty level or below are now covered for dental care by HMOs and we have SCHIP{ which is functioning and our access for children is good. In addition, he stated that other states will try to model after our access system.


COMMITTEE REPORT- CDHC

Ms. Brickley-Raab reported on the CDHC pilot study as a midlevel provider and Dr. Siegel corrected her that they were NOT midlevel providers. Ms. Brickley-Raab  noted that they were EFDAs and as such were under the Board’s purview. Their role is two fold, to be a dental assistant  and to build trust with the community especially in the WIC programs and in those with HIV. 2 students graduated  and there is one Public Health Hygienist in the program.  One board member related a question from Dean Ismail, the head of the program at Temple whether a public health Dental Hygienist can have dental assistant work with them. Dr. Siegel asked what are the oversights of the PHDH (Public Health Dental Hygienists)”

“assume non-clinical are okay, in a clinical setting acting without a dentist present, their oversight is NOT the responsibility of the PHDH. Ms. Brickley-Raab restated the issue as suctioning for sealants. Denny Charlton, President  of the PDA, stated that his understanding is that a non-EFDA dental assistant doesn’t have a scope of practice but works under the direct supervision of a dentist. Dr. Siegel opined that a licensed dentist was needed for the DA to work in a clinical setting, but  in a non-clinical setting a dentist was not needed. He stated that the statute was specific as to what they could do but he would defer to counsel. The Board counsel was reluctant to give a  legal opinion but stated that only a dentist can delegate and that a non-clinical setting was likely okay but for the dental assistnat, anything in the scope of practice goes beyond the scope of the enabling legislation that approved the pilot program. Cleaning instruments is okay but direct patient care without a dentist present crosses the line. If an injury occurred, it could be problematic as the delegation section of the approving measure did NOT mention who could be delegated.

Dr. Siegel stated that the SBOD is bound to follow the regulations as set up, “not opinion, it’s legal” and in this type of program, it’s not possible to get every nuance.


LASERS BY HYGIENISTS-Can a hygienist use a laser if they are trained?  The scope of practice will be reviewed to evaluate this fast changing area.



INCREASE IN LICENSURE APPLICATION AND RENEWAL FEE

Tom Romiecki of the Bureau of finance made a presentation. The Board is bound by law to live within their budget and non run a deficit. However the last few years, expenses have exceeded revenue necessitating action. It takes two years to enact a fee increase so the though was to do one increase which will last for up to ten years. Due to licensure being paid every two years, it is a biennial budget. Current revenues are $3.125 million and expenses of $3.420 million with a deficit of $295,000. The deficits are trending higher requiring action now for the 2014-15 renewal. The three options are, 

1) 30% increase from $250 to $325 every two years

2) a 35% increase from $250 to $339 every two years

Or 3) a 40% increase from $250 to $350 every two years .

All would put the SBOD on solid footing with the larger increases for a longer period of time.

The SBOD is investigating increasing application fees for new licensees which are currently $20 while neighboring states can run into the hundreds (Maryland -$400 +) A decision will be made at a future meeting.


ANESTHESIA UPDATE

There was a presentation by James Robbins DMD, chairman of the anesthesia committee and Jay Lehman (?sp) as Robert Lindner was ill and unable to attend..

Their report and recommendation detailed how we have become a multidisciplinary society with GPs and specialists.  There was an advisory committee  to address “multiple areas of concern and confusion”

They made several recommendations

1) The State requires anesthesia machines to be calibrated, “according to manufacturers guidelines” but the manufacturers state that there are no guidelines. The advisory committee recommended that general anesthesia machines be inspected annually and nitrous oxide machines be inspected every two years.

2) Permit renewals and in office inspections are done every six years but it causes a bottleneck at that time period. The committee recommended starting inspections one year earlier but the SBOD had concerns that it would end up potentially going seven years between inspections which would be outside the requirement.

3) There is a basic problem with the level 1 permit as it doesn’t differentiate between oral moderate sedation and IV sedation. The American Academy of Pediatric Dentistry (AAPD) differentiates based on age and recommends an EKG be used on all patients over 12 years old and licensee be PALS ( Pediatric Advanced Life Support) trained.  Further, licensee be Advanced Cardiac Life Support (ACLS)trained  for all patients over  age 18 who are sedated. In a pediatric office,  where it may be special needs patients.

This will allow standardization of pediatric dentistry sedation and would require an attestation by those offices that state that they are NOT sedating patients over 12 years old to avoid the enhanced requirements.

Dr. Siegel raised the issue of the emergency kit , its contents and that offices have the skill to use it.

Further Level ! Unrestricted and Level ! Restricted should take PALS every two year and this requirement will be phased in over a two year period.

The in office inspections involve a mock emergency and an office will be given two opportunities to pass before failing the inspection.

4)There is a lack of requirements of AEDs in offices and they recommended defibrillators in every dental office in the Commonwealth. (ED NOTE- Illinois, New York and several other states are requiring them in every dental office) for the safety of all concerned. Dr Braun recommended it go to regulatory committee.

Currently in the legislature Senate Bill 351 addresses the Good Samaritan Law for use of an AED.,

An Act amending Title 42 (Judiciary and Judicial Procedure) of the Pennsylvania Consolidated Statutes, in particular rights and immunities, further providing for Good Samaritan civil immunity for use of automated external defibrillator and for nonmedical good Samaritan civil immunity.”