Report of the State Board of Dentistry Oct 19, 2012
Maryellen Brickley-Raab Acting Chairperson
Attended by Michael Kaner DMD, Shawn Casey, DMD and April Hutcheson
1) This involved an agreement with a dentist licensed in Virginia who was disciple there for failure to monitor a patient under anesthesia as well as a failure to take vitals in an emergency. Virginia imposed a $2000 civil penalty and required 16 hours of Continuing Education (CE). He has had no active Pennsylvania license since 2005 and has no plans on returning here. The Pennsylvania SBOD imposed a civil penalty of $1000.
2) This case involved representation and three pediatric patients and billing for dental treatment not actually done.. When it first came before the State Board, part of the agreement involved the dentist agreeing NOT to treat patients under 9 years old. The Board rejected in favor of a $7400 civil penalty, a return of $1014 to Department of Public Welfare for overpayment for work not done as well as a three year suspension, stayed in favor of a thirty (30) day active suspension and then probation.
3) This was a case brought before the Board last month and returned after the Board had questions for the Prosecutor. A dentist who practiced for 16 months on a lapsed license was assessed a $1600 fine , $100 for each month of practice on the lapsed license. The Board had concerns that this appeared too light but that is punishment listed in the Pennsylvania Bulletin. The Board assesses the civil penalty and a public reprimand.
Status of Regulations
1) The Proposed Rulemaking involving the fee increase was presented to the SBOD in April and July. The regulation listed the justification for the fee increase ( balance the budget). Under the proposal:
Application fee for license for dentist- by exam $200 (not raised since 2004)
Application fee for dentist- Exam by criteria $200
Application fee for dental hygiene license raised from $20 to $75
Application fee for EFDA license raised from $20 to $75.
Application fee for dental radiology raised to $75.00
Biennial Renewal fee of licenses
Dentist proposed increase from $250 to $263.00
RDH proposed to go from $40 to $42.
EFDA increase from $25 to $26
T is estimated that the increase will “ recoup the deficit and go forward on firm financial footing.” The proposed increase was voted on and approved by the Board. It now goes through the rule making process to take effect.
Mobile Van Regulation
The Board had several questions regarding the vans and their licensure:
- What happens to patient records?
- *What happens to patient care after the van leaves?
- Dental records have to be in the hands of a licensed dentist for accountability. Does this happen?
- How does a parent go about getting a copy of the records?
- What about electronic records and their requirement.
- (Edit note- There is a Federal Government requiring electronic records by 2014 for those dental offices treating Medicare patients or seeing many Medicaid patients.)
The Oversight Committee met, chaired by Dean Ismail of Temple U. His report in a letter to the Board, asked what is the future of the CDHC project?
His ideas were multi-tiered providers
a) Community Oral Health Worker- a lower level employee who would interact with the community and identify people who need care.
b) CDHC- They would interact with the community and use what they learned in school. They would have to be EFDAs and while doing more patient education than anything else. He envisioned them doing supragingival scaling, sealants and Xrays.
c) Public Health Hygienists (PHH)
Dean Ismail wanted to merge the Public Health Hygienist and have them work with the CDHC, essentially an EFDA/mid-level provider. At present, when a dental assistant goes out in the field with a PHH , they are allowed to sterilize only. This is because the PHH is NOT allowed to supervise. Dean Ismail wants legislation enacted to broaden the scope of practice of the PHH to allow EFDAs to go out with the PHH and be supervised by them. He stressed the ‘team concept”. At present a dentist might supervise the EFDAs and midlevel providers.
Dean Ismail wants to change the Scope of practice” to allow RDAs who go out with Public Health Hygienists to work in a clinical setting by suctioning. This would broaden he scope of ‘supervision” to allow the PHH to delegate and to supervise without the presence of a dentist as is currently required. Dean Ismail knows that this will require a change in the legislation. The PHH has general supervision, not
The concerns of the Board members were,
- The proposal would allow the EFDAs to work without direct supervision which would change the entire system of supervision of EFDAs and one Board member wanted to think about it.
- Another Board member noted that EFDAs practice under direct supervision “in a facility” and a dentist is there while treatment is being performed.
- One Board member stated, “there has to be direct supervision by a dentist on site.” He asked if a team is sent out without a dentist to provide care with portable equipment, “where are they going?”
- One public member of the Board had concerns that proper care be provided and with a lack of proper professionals, she struggled with a lack of supervision. She asked, how do we address the care needed, but within this program only?
- In response, another Board member noted that “you can’t limit it to this program only. Once it goes, it goes.” (Ed- That was a reference to changes in scope of practice).
- One Board member remarked, “ I don’t see why underprivileged people should accept care that might be below the standard.”
- Te Chair noted that if the proposed changes went forward in the legislature, the SBOD should have a position on it.
- April Hutcheson addressed the issue and stated that the best care is direct supervision and that Dr. Ismail’s proposal eliminates that aspect. If patient health is the number one concern of the board, the Board should take a stand. She noted that the major access issues are location of the dentist and low Medicaid reimbursement levels.
- One Board member commented that he is all in favor of access to care but he was concerned that “simplest things can sometimes go sour”, a reference to that these midlevel providers might get in over their heads.
PAGD Donated Dental Services Presentation
With just 5 members of the audience in attendance, three were from the PAGD, myself, Shawn Casey and Executive Director, April Hutcheson. April presented a video report on the Donated Dental Services Day held during the Annual AGD Conference in Philadelphia in June, 2012. Three Board members were among those who participated, Ms. Groody, Drs Lugo and DiFinis. April reported that it was the largest day of donated dental services EVER held in Pennsylvania.
*325 patients were seen
*1198 Procedures were done
*$150,000 of dentistry was performed
* An average of three procedures ( prophy, restorations or extractions) were performed per patient and up to extractions on one individual. The Program had several dentists for follow-up care, if needed. The Board was VERY impressed, one commenting that $7 million was spent on the CDHC program and this was all done for $50,000. He asked how many patients could be seen for $7 million if the numbers were extrapolated out? The answer given was about 50,000. April was asked if it could be done at University of Pittsburgh Dental School and the answer was that it could be done there.
(Editor’s note- I wish everyone could have been there to see the videos and the reactions from the Board members. It was truly a memorable day for the PAGD)
Report of Board Administrator
1) Two new Board members have been appointed and confirmed . They are Drs. Dave Ditillo and Ronald Plesco. Their first meeting will be the next State Board meeting.
2) Regarding the Periodontal Part of the NERB Examination being required for licensure in Pennsylvania, the Board amended their previous motion and approved a motion that, the clinical periodontal part of the dental examination of the Regional Boards be required for licensure in Pennsylvania effective in 2013.
Michael Kaner DMD JD FAGD
October 23, 2012