Thursday, September 20, 2012

Besides state Dental Boards not policing their dentists as they should, the Department of Health and OSHA are failing as well.

Dr. Thomas Floyd, the brute dentist in Florida, arrested two weeks ago for beating up a 4 year-old child, was also found to operate a dental clinic in extremely unsanitary conditions.  One parent I spoke with said Dr. Floyd would not sanitize the stainless steel crowns when he was trying to find the right fit – in one child’s mouth, then another’s. He didn’t change gloves from patient to patient, nor did he sanitize his instruments. When the state finally got off their butts and went to check on these allegation – allegation that had gone on for 5 years – they discovered his facility to be a hazard. (I hope all the children who have seen this dentist are receiving blood tests!)
It appears Florida is not the only state NOT checking on dental offices. South Carolina, another state that allows dental mills to run amok doesn’t check either. I bet they check tattoo parlors!

Written by 
Mike Foley
Staff writer
The South Carolina Department of Labor, Licensing and Regulation last year conducted 4,626 routine inspections of cosmetologists and barbers.
During that same time, the agency conducted zero routine inspections of the state’s dentists. The South Carolina Board of Dentistry — which falls under the agency’s jurisdiction — also conducted no routine inspections. The hands-off situation extended to two other state agencies: The Department of Health and Environmental Control and the Occupational Safety and Health Administration.
Yet right now, while each of those regulatory boards handles some regulatory aspect over dentists or dental practices, routine inspections are not included.
The Board of Dentistry conducts licensing exams and annual registration of dentists, dental hygienists, dental laboratory technicians and ortho-technicians. It also, investigates complaints and conducts disciplinary hearings.
Under the South Carolina OSHA, dentist offices are subject to the federal safety standards such as the “Bloodborne Pathogens Standard” and guidelines for X-ray machines. Employees must safeguard themselves with gloves, face and eye protection and gowns, but no routine inspections are conducted for compliance.
This leaves the state’s dentists solely responsible for infection control in their own facilities, responsible for patient safety, for their own safety and for the safety of their staff. Yet, while some local dentists interviewed said precautions and regulations in place protect patients, they wouldn’t be averse to routine inspections.

South Carolina’s dentists, said Phil Latham, executive director of the South Carolina Dental Association, aren’t indifferent.
“We definitely want patients walking into a safe, healthy dental practice,” he said. “If we did get a lot of complaints, I believe either the state board or the dentists would ask for legislation” on inspections.
With few public cases of dentist misbehavior or malfeasance in South Carolina,[WHAT!? FEW!? I think the operative word would be “public”] the dentists have a point. It could simply be that the industry needs no additional oversight. Yet, there are reports in other states of dentists who have violated safety practices.

[At this point in reading this article, I fainted! Let me get this line of thinking straight. If you don’t check, then it doesn’t happen? So, if police radar didn’t check for speeders on our highways, that means there is no one breaking the speed limit laws? Interesting. If no one looks for a fallen tree in the woods, then none fell? Hmmm…  Very interesting. No, it’s not interesting, it’s INSANE!]
Many of those violations found elsewhere are a result of routine inspections of dentist offices. In fact, in more than a dozen other states, routine inspections of dentists’ offices are the norm.
Already this month, six dentists in Ohio, plus a radiographer and a registered dental hygienist have been cited by the Ohio State Dental Board for infractions and violations of that state’s laws and safety precautions, according to public records. Those citations were due to routine inspections conducted by that state’s Dental Board.
Lili Reitz has been the executive director of the Ohio State Dental Board since 1996. The governmental agency oversees the state’s dentists, hygienists, assistants, radiographers and other staff. Dentists in Ohio are not only subjected to random inspections from the state’s six enforcement officers, but also by that state’s OSHA, which concentrates on workplace safety.
“When we developed our rules, they were the gold standard for how a regulatory board can [ensure] patient safety,” Reitz said. “Our view is we need to protect patients and providers.
“I’m shocked the South Carolina board doesn’t inspect.”

[Not a fan of Reitz, but I’m with her, here…  I’m SHOCKED!]
Inspections elsewhere
Dr. White Graves is a dentist in Monroe, La., and president of the American Association of Dental Boards executive council.
Asked by how many states perform routine inspections, Graves said by e-mail that the information was unavailable. But he sent a survey to the nation’s 48 state boards asking for that information.
[Seriously, no one has a clue! How on earth is this happening? Or should I say, NOT happening!]
From the responses received and from additional information provided by Bayley Milton, an administrator for the AADB, at least 15 states conduct routine inspections. Nine more — including South Carolina — conduct inspections only if a consumer complaint is lodged.
[“only if a consumer complaint is logged”??!! WHAT!! How is the “consumer” supposed to know? This is NOT the job of John Q. Public, it’s the job of our state agencies!! ]
Graves’ home state of Louisiana is one of the states that routinely inspects. There, Pete Burkhalter is executive director of the Louisiana State Board of Dentistry. The board inspects the state’s dentists on a roughly three-year rotation, he said.
The announced inspections originated, Burkhalter said, after HIV and hepatitis outbreaks in the 1990s and resulting state and federal Centers for Disease Control guidelines were established to protect citizens.
“We’re not raking them over the coals,” he said. “It’s just good to have a different set of eyes to watch what you do.”

[You bet it’s a good idea, it’s called “oversight”. Something clearly lacking on every level in the dental community.]
To help the dentists, the Louisiana board has an inspection form on its website. Dentists can download it and do a self-inspection before the board’s inspectors arrive.
“We’re telling them, this is what you need to do,” he said, “and if you do this, you’ll be fine. Our goal is to educate them on what you have to do.”
The Louisiana board is funded through fees from initial licenses and license renewals of the state’s 2,600 dentists, as well as fees from hygienists and dental assistants, he said.
In North Carolina, routine inspections do not occur, said Terry Friddle, deputy operations officer for the North Carolina State Board of Dental Examiners. A lack of staff and funding prevent such wholesale inspections, she said.

[I’m sick to death of the excuses. Lack of Staff, Lack of Funding…. it’s Lack of giving a shit!]
“Our inspections are all complaint-driven,” she said. “If we do get a complaint, we make an unannounced inspection.”
[Ok, so if it takes a formal complaint to get sanitation conditions in dental offices inspected, I suggest everyone get their phone book out and start filing complaints about every dentist office in your city until we get all inspected]
Complaints bring inspections
In South Carolina, Lesia Kudelka, LLR communications director, said that the agency does not routinely inspect dental offices. The South Carolina Board of Dentistry is a department under the LLR, and Kudelka is the spokeswoman for the Dental Board.
“We do not do routine inspections of dental offices or dentists,” Kudelka said. Inspections, spurred by complaints from the public, do occur.
While dentists operating in traditional dentist offices are not inspected, those operating in a mobile lab or portable facility are inspected. Under a 2009 state statute, the Dental Board does perform “an initial inspection of each mobile dental facility or portable dental operation” before it’s licensed by the state.
DHEC treats dentist offices differently than other health facilities.
“We only inspect public health facilities such as hospitals and nursing homes,” said DHEC spokesman Adam Myrick. He added that the closest DHEC comes to conducting routine inspections is for the X-ray machines located within dentists’ offices.
An examination of the latest LLR annual report, from 2010-11, shows the state has 2,700 dentists, 3,300 hygienists and 3,600 dental assistants. Those individuals were subject to 86 complaints during the fiscal year. Those complaints prompted 71 investigations. From those, two licensees — not necessarily dentists — were ordered to cease and desist; one entered into a consent agreement; and nine received letters of caution.
In the 2011-12 fiscal year, South Carolina now has 2,918 dentists licensed. The total number of all types of licenses, including dentists, dental hygienists and dental assistants is 10,565, Kudelka said.
In comparison, Ohio has more than twice as many dentists at 6,055, according to the Henry J. Kaiser Family Foundation and its website. Yet with double the number of dentists, Quentin L. Holmes, enforcement supervisor for the Ohio State Dental Board, said every dentist and the staff at each dental office is inspected at least once every three years.
“We get complaints all the time and then we check again,” Holmes said. “All dental practices across the country should be checked on. It’s a safety issue.

[Hell yes, they should!!]
“There is a dental board in each state and that’s expected. You expect that when you go to a surgeon, and you expect that of your dentist.”
[Yes, one does “expect”. But as this blog has pointed out for 5 years, don’t expect anything from your state dental boards, look at the mess in Texas!]
Just as restaurants post safety inspections, dentists in Ohio also receive certificates they post in their offices showing they adhere to state safety practices and have passed inspection, Holmes said.
The goal isn’t to cite or harass dentists, but to educate, Holmes said.
“We don’t want to be the enemy,” he said. “The dentists don’t always run the office, sometimes it’s the office managers. And they may not even know they’re doing anything wrong. If we can teach, we want to do that.”
Mauldin dentist Daniel Halasz said his education at the Medical University of South Carolina didn’t specifically include hygiene classes, operational standards, infection control or classroom instruction on safe practices. Yet, from the minute he stepped into his first clinic, safe procedures were emphasized to all the students.

[Why did his education not include hygiene, operational standards and infection control? This is mind boggling! ]
“It’s always hit upon,” he said. “You’re educated on cleanliness, you learn it as you go in every situation.”
[Educated in “cleanliness”??  OMG! I don’t even know what to say.]
In addition, once you’re in private practice, each dental office has an OSHA manager, specifically trained to comply with safe work practices. South Carolina OSHA requires an annual class for each of the managers, who is responsible for cleanliness and safety of the entire facility.
[OSHA Manager? So the sanitation of dental offices in South Carolina is left up to a non-professional employee? Not the doctor? Lord help us all! ]
All of the stainless steel dental tools at Mauldin Family Dentistry go through a rigorous three-step process to clean them for re-use, Halasz said. His staff scrubs visible debris from the equipment after each patient’s visit. Disposable items are thrown away and sharp objects such as needles are placed in a “sharps” box for proper disposal.
Re-usable tools are then placed in an ultrasonic bath. Halasz said that kills bacteria, “but it doesn’t kill everything. It can appear clean, but it’s not clean yet.”
Instruments are then placed in sealed packaging. The package is placed in an autoclave and heated — depending on whether it’s a steam autoclave or any of a variety of dry-heat machines — up to to 375 degrees, and as long as 2 hours. To ensure the autoclave is working correctly and the correct temperature is reached, the packaging changes color when it reaches optimal temperature.
Biological monitoring is also performed to determine if the sterilization process works. Federal CDC rules require that spore test strips — which must be effectively cleansed — are run through the autoclave weekly.
With all the protections and testing in place, Halasz doesn’t see how a patient could be infected or how himself or staff could be harmed.
“About the worst thing we do is pull a tooth,” he said. “There is so much bacteria in your mouth. It’s hard to keep that wound completely clean. We just want to be sure we’re not adding anything new in there.”
Halasz said he’s indifferent about requiring inspections.
“It wouldn’t be a bad idea, but I don’t know if more time away from our practice is worth it,” he said. “But if there is someone out there not complying, we need to get them to.”

[ “Not a bad idea”?  “More time away from our practice”…  SERIOUSLY??!! ]
Dr. Ann Bynum is an enthusiastic supporter of routine inspections of dental offices. The owner of Holly Tree Pediatric Dentistry in Simpsonville, Bynum said she’d prefer South Carolina adopt routine inspections.
She’d welcome such checks and said she’d be happy to pay to have it done.
“My guess is it’s incorporated into the state dues” to pay for the cost of inspections in other locations, she said. “Maybe your number wouldn’t come up for five years, but maybe that would raise the bar for everyone.”
Since South Carolina doesn’t inspect her practice, Bynum pays for a consultant to inspect her facility every few years.
“She’s like a drill instructor,” Bynum said. “If she sees us brush our hair off our face, or scratch our nose, it gets noted. She sees what we don’t in the midst of our busy day.
“I bring her in to raise the bar. We want a better experience for our patients. We want them happy when they leave.”
Toward safeguarding her patients and her employees, she has “treatment rooms” where procedures are performed and then an open bay for exams and general cleanings.
“In the separate, closed rooms, it’s just myself, my team and the patient,” she said. She also opens sterilized packets of dental tools chairside so there is no doubt each patient is being treated in a germ-free environment.
At the University of Iowa’s dental school, Bynum said, she and her fellow students went through a class specifically dealing with infection control. From that training, Bynum said, everyone on her staff knows to wear gloves, safety glasses, gowns, and have their hair pulled back. She said the use of universal precautions helps “build trust on the front end of the relationship.”
Gold standard
Dentists and their staffs face a veritable ABCs onslaught of infectious disease while working on patients: hepatitis; HIV; cytomegalovirus; as well as herpes simplex; tuberculosis; staphylococci; streptococci; and other viruses and bacteria that infect the mouth and respiratory system.
In a dental setting, organisms can be transmitted through direct contact with blood, oral fluids or other patient materials; contaminated objects such as instruments, equipment or surfaces; or even airborne droplets from coughing, sneezing or talking.
Bynum said her practice not only is pediatric-oriented, but she also handles children with cancer, celiac disease and other ill children with special needs. She not only needs to protect them, but herself and her staff.
“That’s part of our extra training,” she said. “You have a greater chance of getting sick walking into a mall bathroom than you do in our dentist office.”
The routine inspections in Ohio, Reitz said, are to prevent slips or lapses — or even outdated methods — from occurring. She prefers not to think dentists would deliberately break safety guidelines, even though she knows that happens.
“We’ve had everything from dentists bringing pets into the office to them sterilizing instruments in toaster ovens,” she said. “We have a checklist for them to follow. A dentist can’t say they’re caught off-guard.
“But in 90 percent of the cases, we’ll find a violation or two. When we do, we’ll be back.”
Reitz said violations occur regularly in Ohio. Recently, her inspectors visited a Veteran’s Administration hospital after a consumer complaint. VA facilities don’t usually fall under the board’s jurisdiction, but they conducted an emergency inspection regardless.
“We discovered a dentist had potentially infected 600 patients with Hepatitis C because he wasn’t sterilizing properly,” she said. “He wasn’t using gloves, he wasn’t meeting standards. He was 81 years old and that’s how he’d always done it.
“How would you ever know this if you’re not going out there to inspect?”

I am never disappointed to find out the extent in the lack of oversight in the dental profession.
South Carolina is always ranked among the worst in the country for dental disease, access to care and all those other statistics that appear to be so important. Has anyone ever looked at the correlation between lack of oversight compared to the lack of quality care?
We are berated with information about the need to brush, swish and keep our teeth clean to  remove all the bacteria and germs.  Just saying…