Sunday, September 30, 2012

Senator calls for dental inspections Peeler says he'll introduce legislation if need be

Written by
Tim Smith, greenvilleonlineStaff writer

COLUMBIA — Routine state inspections now protect people more from bad food at restaurants than from possible unsafe conditions in dental offices, says the chairman of the Senate Medical Affairs Committee, who said he wants the state to begin routine dental inspections.

And the chairman of the Senate Judiciary Committee told that he thinks the Legislature should look at the idea of routine inspections and broaden them to medical offices.

Sen. Harvey Peeler of Gaffney, who heads the Medical Affairs Committee and is the Senate’s majority leader, said he previously wasn’t aware that dental inspections weren’t conducted by the state.

The Greenville News and revealed this month there were no inspections — unlike at least 15 other states — though the state does regularly inspect barber shops and hair salons and looks into complaints about dentists or dental offices.

“If need be, I’ll sponsor the legislation,” he said. “If you inspect a restaurant that you are putting food in your mouth, it seems like you would inspect a dentist office where you put a hand and instruments in your mouth.”

Sen. Larry Martin of Pickens, chairman of the Senate Judiciary Committee, said lawmakers should at least study the idea of routine inspections.

“I think that’s something we ought to look at since that issue has been raised,” he said.

Martin said one reason the state may not have developed a system for inspecting dental offices is that three agencies have some part in regulating them — the Department of Health and Environmental Control, the Department of Labor, Licensing and Regulation, which houses the state dental board, and the state Occupational Safety and Health Administration.

“That may be why there’s no systematic inspection, no more so than there would be of a doctor’s office,” he said.

Martin said other than responding to certain complaints, state agencies might not regularly look at dental and doctors’ offices, even though the labor agency does systematic inspections of manufacturers or other businesses under OSHA responsibility.

“Maybe there should be,” he said. “I don’t know why they wouldn’t ensure that those various requirements are being met on a spot-check basis.”

Asked how Gov. Nikki Haley felt about requiring routine inspections, Rob Godfrey, her spokesman, said the idea has been discussed by the state Dental Board.

“LLR licenses the professional, not the facility, as is authorized by statute, and LLR does undertake inspections when it receives complaints about licensees — the Dental Board by comparison to other boards receives a relatively low volume of complaints,” he said. “The Dental Board has discussed legislation to mandate inspections but thus far none has been introduced.”

“It doesn’t matter a whole lot to me one way or the other,” said Sen. Ray Cleary, the only dentist on Peeler’s committee. “If they think they need more of them (inspections), my feeling is we need to give government the tools they need to govern. So I don’t have a problem increasing the budget for that.”

Cleary, who said he has been in practice since 1975, says he has a “fairly upscale practice.”

“So my patients expect that,” he said. “I haven’t been in some offices that are not upscale, so it’s hard for me to relate to it.”

At least 15 states, according to the American Association of Dental Boards, conduct routine inspections. Nine more — including South Carolina — conduct inspections only if a consumer complaint is lodged.

Other states’ inspections have found violations.

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.

The routine inspections in Ohio, said Lili Reitz, executive director of that state’s dental board, 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.”

Recently, her inspectors visited a Veterans 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?”

The South Carolina 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. But it doesn’t conduct routine inspections. Nor does the state Department of Health and Environmental Control, which treats dental offices differently than some other medical providers, such as hospitals or nursing homes.

Under the South Carolina Occupational Safety and Health Administration, dentist offices are subject to federal safety standards like 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.

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.