Tuesday, April 17, 2012

Texas State Board of Dental Examiners General Counsel Admitted–“If you own a clinic you are practicing dentistry in the state”



There is such a HUGE GI-NORMOUS difference in the way North Carolina’s Dental Board understands the responsibilities given to them and the way the Texas State Board of Dental Examiners understand theirs. It’s truly mind blogging, yes I mean “blogging”.

North Carolina’s dental board hopped all over one dentist trying to skirt the laws and has now taken it to the legislature to make sure the laws against corporations coming between the dentist and the patient are clear.

After 5 years of work and 3 years of jumping through hoops, some Texas citizens finally got a hearing with the state legislature. Three years, now! Three years! Expect at least another 3 or more to clean up the damn mess down there. One good thing, Sherri Meeks, the former Executive Director, resigned just days “We do regulate dentistry. If you own a clinic you are practicing dentistry in the state."- Joy Sparks, TSBDE General Counsel before the hearing, and on more than one occasion it was highly suggested to the board that they now have the opportunity to hire someone who can and will do the job they are paid to do. I guess Texans will just have to wait and see.

At the hearing held on Wednesday, April 11, 2012 by the Texas Legislature Public Health Committee I heard some of the most outrageous statements I think I have ever heard come from members of any governing body, well, other than Nancy Pelosi saying they would have to pass a the Affordable Healthcare Act to see what was in it. That was huge.

Dr. Tammy Gough, the presiding officer of the Texas State Board of Dental Examiners, told the committee they were researching corporate dentistry laws and wanted to “act as advisors to stakeholders and elected officials on the topic because we feel it will probably be addressed in the future with legislation.”
Joy Sparks, general counsel, said this was a “relatively new” issue. And all they do with people who are suspected of the corporate practice of dentistry is turn them over to the local or state prosecutors. She also, indicated they don’t even follow-up on that useless action.

I bet if someone asked the local and state prosecutors how many cases the dental board has ever turned over to them, I could count them on one hand. If I remember, someone on the committee did ask that question. The dental board was also asked they had ever asked for guidance as to what they laws said hat their duties were. Want to guess what that answer was?

Glenn Parker, acting Executive Director, who has been Director of Administration and Licensing since September 1, 2011 said: “I think everybody knows The Board of Dental Examiners is the agency that regulates the practice of dentistry in Texas.”

“We do that by regulating individual practitioners. We have no authority to regulate clinics or clinic owners.”
“We strictly license individual people”

“We report fraud to the HHSC, OIG the AG and recently we’ve been reporting it to the FBI.
When Glenn Parker was asked about why there was a big jump in Medicaid Fraud, Joy Sparks answered for him by saying, “My guess, Representative is that the reimbursement rates increased by Medicaid.”
Representative Carol Alvarado asked if the clinics committing most of the fraud were Corporate owned clinics , franchises or clinics owned by individual dentists or independent.

Joy Sparks stammered, “Representative, I’m not comfortable saying that. We are seeing both. We are seeing individual and we are seeing individual practitioners who are, we have dealt with and we are seeing…uh uh….clinics, who have done it also. I’m not sure what the % would be.”

Rep. Charles Schwertner asked Lisa Jones – TSBDE Director of Enforcement-if there were the same safeguard against the corporate practice of dentistry as there were corporate practice medicine.

Her answered, “Honestly, I don’t know if I can answer that question, we don’t regulate the clinics in any way. We have no jurisdiction over them whatsoever. We don’t keep statistics on how many clinics there are in Texas or how they operate.”

She stumbled and stammered several times trying to not say “corporate” and just use the word, “clinic”. That part was fun.

Glenn Parker then added, “The Dental Practice Act requires the dentist to make all the decisions regarding the treatment of a patient. The dentist who is in charge of…stutter…according to the law …stutter…stutter… of the dentistry decisions”

He then tells what the dental board has “heard” about what is happening. He says they have heard some corporations are requiring their dentists to bill $1000 if the child in 10 or younger, if they are 10 or older, or bill them $1,500 worth of work.

Could possibly the dental board have “heard” these in a Complaint!!!!!???
He then went on to say, “To the degree on which that happens we don’t really Representative Carol Alvarado – “If you guys have been concerned about this, what have you all done?”know.”
To the amazement of the legislative committee he added, “Can we prove that yet, no, we can’t. But I think that is what’s happening to a degree. We do not know how many clinics there are in Texas, dental clinics. We don’t know where they are. We don’t know who the legal own of them is, cause none of that is in the Dental Practice Act to require it.”

Dr. Tammy Gough, the presiding officer followed with, ”we regulate the licensed dentist who is performing the care in these clinics” .Their not running “willy nilly” as far as the actual patient care.” The license dentist is held responsible for maintaining records..and there can be no patient abandonment…”
Representative Carol Alvarado asked, “If you guys have been concerned about this, what have you all done?”  

Pure silence!

Of course there was a lot of testimony on horror stories that would curl your toes. After all the hearing did last for 4 hours, 21 minutes and 21 seconds.

The big admission on the part of the dental board came with Joy Sparks, their general counsel admitted, “We do regulate dentistry.” “If you own a clinic you are practicing dentistry in the state. The problem is ..our remedy is we sanction a license. So if someone is practicing dentistry under a corporate clinic or private equity they are not licensed so we refer those cases, if we think, their … ya know what I’m saying.. we refer those cases to the Attorney General’s office…cause we don’t regulate…….when we asked if they own the clinic they say “I do”.

Then there was this, “They are practicing dentistry without a license. We don’t do anything with people who are practicing dentistry without a license.”
Well, there ya go.

You can continue reading or stop here.

More on Texas Laws:
The expected conduct of dentists practicing in Texas are written into the Texas Administrative Code, I guess to make sure the dental board knows what yardstick should be used to measure dentists behavior. But according to the Texas State Board of Dental Examiners it’s not in their job description, I beg to differ.
Chapter 108-Dentist Professional Conduct
Subchapter A-Professional Responsibilities
Rule 108.1 - A licensed dentist shall conduct his practice on the highest plane of honesty, integrity, and fair dealing. In order to safeguard the dental health and welfare of the public and the dentist-patient relationship and fix professional responsibility for dental services, no dentist or any other licensee or certificate holder of the Board shall:
  (1) circumvent or attempt to circumvent any provision of the Texas Dental Practice Act or any rule, regulation, or order of the Board;
i.e. Gloria King, Tu Tran, Richard Malouf
  (2) participate, directly or indirectly in any plan, scheme, or arrangement attempting or having as its purpose or result the evasion of any provision of the Texas Dental Practice Act or any rule, regulation, or order of the Board;
i.e. Gloria King, Tu Tran, Richard Malouf
  (3) fail to exercise reasonable diligence to prevent partners, associates, and employees from engaging in conduct which would violate any provisions of the Texas Dental Practice Act or any rule, regulation, or order of the Board;
i.e. Gloria King, Tu Tran, Richard Malouf
  (4) permit or allow himself, his practice of dentistry, his professional identification, or his services to be used or made use of, directly or indirectly, or in any manner whatsoever, so as to create or tend to create the opportunity for the unauthorized or unlawful practice of dentistry by any person, firm, or corporation or for the practice of dentistry in violation of any provision of the Texas Dental Practice Act or any rule, regulation, or order of the Board;
i.e. Gloria King, Tu Tran, Richard Malouf
  (5) associate with or permit or allow the use of a dentist's name, professional identification, office, or practice in any business, commercial, or mercantile venture, project, or enterprise which the dentist or licensee knows or by the exercise of reasonable diligence should have known is engaged in acts, practices, or omissions which violate any provision of the Texas Dental Practice Act or any rule, regulation, or order of the Board;
i.e. Gloria King, Tu Tran, Richard Malouf
  (6) divide, share, split, or allocate, either directly or indirectly, any fee for dental services, appliances, or materials with another dentist or with a physician, except upon a division of services or responsibility and with the prior knowledge and approval of the patient; provided, however, this section shall not be construed to prohibit partnerships for the practice of dentistry.
i.e. Gloria King, Tu Tran, Richard Malouf
If any of the above takes place, the Texas State Board of Dental Examiners have the duty to sanction, suspend and/or revoke a dental practitioners licenses. Maybe they don’t know what the word, “ensure” means.
verb (used with object), en·sured, en·sur·ing.
1.to secure or guarantee.
2.to make sure or certain: measures to ensure the success of an undertaking.
3.to make secure or safe, as from harm.
 
In Chapter 100 of Title 22, Part 5 it lays out the general provisions and duties of the board. It reads as follows:
What part does the Texas State Board of Dental Examiners, it’s Presiding Officer and its Executive Director not understand? Besides the meaning of “ensure”, “investigate”, “prohibit” “enforce” “shall” and “discipline” and “regulate”?

Rule 100.1:

(d) The board shall be composed of those persons appointed by the Governor with advice and consent of the senate.
Rule 100.2 – Purpose and Function
(a) Purpose. The purpose of the board is to safeguard the health and safety of Texans by developing and maintaining programs to:
  (1) Ensure that only qualified persons are licensed to provide dental care; and
  (2) Ensure that violators of law and rules regulating dentistry are appropriately sanctioned.
(b) Functions. The board shall perform the following functions, as outlined in Occupations Code, Chapter 254:
  (1) Establish standards of dental practice and regulate the practice of dentistry;
  (2) Interpret and enforce the Dental Practice Act and other statutes relating to the practice of dentistry, and implement the Act's intent through the promulgation and enforcement of rules, as necessary to protect the public health and safety;
  (3) Receive complaints and investigate possible violations of the Dental Practice Act, other statutes relating to the practice of dentistry, and board rules;
  (4) Discipline licensees for violations of the Dental Practice Act, other statutes relating to the practice of dentistry, and board rules through appropriate legal action;
  (5) Investigate infection control in the dental profession and adopt and enforce rules to control the spread of infection in the practice of dentistry as necessary to protect the public health and safety;
  (6) Adopt and enforce rules placing reasonable restrictions on advertising relating to the practice of dentistry;

  (7) Adopt rules to prohibit a dentist from engaging in contracts that allow a person who is not a dentist to influence or interfere with the exercise of the dentist's independent professional judgment;
If I could make this one flash, I would!
What part does the Texas State Board of Dental Examiners, it’s Presiding Officer and its Executive Director not understand? Besides the meaning of “ensure”, “investigate”, “prohibit” “enforce” “shall” and “discipline” and “regulate”?
Rule 100.3 - Organization and Structure
(f) Each member of the board is entitled to receive a per diem set by legislative appropriation of each day the member engages in board business, and may receive reimbursement for travel expenses in accordance with the travel policies of the state of Texas and the Board of Dental Examiners.
There was a lot of whining about how they are “volunteers”. Representative Jodie Laubenberg remarked more than once about this. As if ,since the board in “volunteer” then they should not be held responsible for too much! I’m not kidding!
(a) Presiding officer.
  (1) The governor shall designate a member of the board as the presiding officer of the board to serve in that capacity at the will of the governor.
  (2) The presiding officer must be a dentist.
  (3) The presiding officer shall:
    (A) Preside over all meetings of the board;
    (B) Represent the board in legislative matters and in meetings with related groups;
    (C) Appoint standing, ad hoc, and advisory committees;
    (D) Perform other such duties as pertain to the position of presiding officer; and,
    (E) Designate a member of the board to coordinate the annual performance reviews of the executive director and evaluation of the agency.
(b) Secretary. The board shall elect a secretary from its members to serve for a one-year term.
Rule 100.4 – Officers
(a) Presiding officer.
  (1) The governor shall designate a member of the board as the presiding officer of the board to serve in that capacity at the will of the governor.
  (2) The presiding officer must be a dentist.
  (3) The presiding officer shall:
    (A) Preside over all meetings of the board;
    (B) Represent the board in legislative matters and in meetings with related groups;
    (C) Appoint standing, ad hoc, and advisory committees;
    (D) Perform other such duties as pertain to the position of presiding officer; and,
    (E) Designate a member of the board to coordinate the annual performance reviews of the executive director and evaluation of the agency.
(b) Secretary. The board shall elect a secretary from its members to serve for a one-year term.


Rule 100.10 - Executive Director
(a) The Board may determine qualifications for and retain an Executive Director who shall be the chief executive officer of the agency.
(b) The Executive Director shall have the authority and responsibility for the operations and administration of the agency and such additional powers and duties as prescribed by the Board. As chief executive of the agency, the Executive Director shall manage all aspects of the agency, including personnel, financial and other resources, in support of the Dental Practice Act, Board rules and policies, the Board's mission and strategic plan.
(c) The Executive Director shall attend all meetings of the Board and may offer recommendations to the Board, but shall not vote on matters brought before the Board.
(d) The Executive Director, with the Board's consent, may employ an Assistant Executive Director to perform the Executive Director's duties when the Executive Director is absent or unable to act.
(e) The Executive Director is authorized to accept the voluntary surrender of a license. Board ratification is not required. The Executive Director will report summaries of dispositions to the Board at its regular meetings.
Rule 100.20 - Final Board Decisions in Contested Cases
(a) The board shall render the final decision in a contested case and has the responsibility to assess sanctions against licensees who are found to have violated the Act.
(b) The board welcomes recommendations of administrative law judges as to the sanctions to be imposed, but the board is not bound by such recommendations.
(c) Sanctions should be consistent with sanctions imposed in similar cases and should reflect the board's determination of the seriousness of the violation and the sanction required to deter future violations. A determination of the appropriate sanction is reserved to the board. The appropriate sanction is not a proper finding of fact or conclusion of law.
(d) This section shall be construed and applied so as to preserve board member discretion in the imposition of sanctions and remedial measures pursuant to the Act's provisions related to methods of discipline and administrative penalties. This chapter shall be further construed and applied so as to be consistent with the Act, and shall be limited to the extent as otherwise proscribed by statute and board rule.






























Bottom line, all the members of this board have been around a while. All of them are responsible, to some degree, for the mess in Texas. All of them should be at the least, ashamed. Surely they are when they see what North Carolina’s dental board is doing. If nothing else, they should be ashamed for the blatant disregard for the welfare of the public health.
Acting Executive Director and Director of Administration and Licensing
Glenn Parker
475-1660
Director of Enforcement
Lisa Jones
305-6735
General Counsel
Joy Sparks
475-0987