Sunday, May 20, 2012

Dental boards: their mission is clear, but the execution—not so much title

One of my least favorite organizations, but still good points made.

Submitted by Editor at DOCS Education on May 16, 2012 - 4:05pm-Dental boards: their mission is clear, but the execution—not so much

Protect the public. That’s the deceptively simple mission of any American dental board. But while the mandate may be uncomplicated, its execution is anything but. Critics of board actions say they range from misguided and contradictory to baldly self-interested. Controversial decisions are increasingly putting boards under fire. Among the more common sources of complaint are
unfair and unequal treatment of dentists; failure to quickly address malpractice and the unlawful restraint of competition.

Perhaps nowhere is the board under greater fire than in Texas, where the executive director recently resigned. Sherri Meek’s abrupt exit followed a rocky stint punctuated by frequent dispute. In particular Meek was assailed for allowing board members to act as paid expert witnesses in lawsuits against Texas dentists; the practice posed a clear conflict of interest. Long-time opponent Dr. Mark
Stankewitz, a prosthodonist, used YouTube to decry the Texas board as “a good- ole-boys’ network…some dentists receive slaps on the wrists for serious matters and others serious consequences for much less significant offenses.”

Dentist-turned-attorney Frank Recker used the same language—a good-ole-boy’s network—to describe his own experience on the Ohio State Dental Board in the early 1980s.

When he had the opportunity to study board activities nationally Recker quickly discovered a widespread pattern of arbitrary and capricious behavior. He also noted differences in the practices of individual boards. “Some put licenses in jeopardy for mere clerical errors. Others deliberated carefully and considered a variety of factors.”

“I saw lives ruined.”

The typical board’s reliance on secrecy, Recker adds, stands in stark contrast to judicial trends overall. “The courts have steadily been moving toward full disclosure.”

Transparency aside, dental boards too frequently develop regulations that are either bewildering or self-contradictory, explains John Bitting. Along with Recker, the DOCS Education regulatory counsel is among only a handful of such legal specialists in the United States.

Regardless of a board’s intent, confusion may pose terrible consequences for the individual dentist, Bitting says. “A Midwestern general practitioner recently received a very intimidating letter from her state’s board. It ordered her to remove the word ‘sedation’ from her advertising and use ‘anxiolysis’ instead. The board further threatened the dentist with fines and penalties if she didn’t comply immediately,” Bitting adds.

Upon review of the actual statute and regulations, Bitting uncovered disparities in the language. When he pointed this out to the dental board attorney, the group rescinded its order. The dentist is now permitted to use the word “sedation” in describing her services.

“Naturally I’m pleased they backed down, but the fact is the experience was not only unpleasant but frightening for the doctor. Dentists shouldn’t need a lawyer’s help simply to interpret state regulations. And state regulations shouldn’t be written in such a convoluted fashion that they are impossible to understand.”

Unfortunately, the provision of inaccurate information is not uncommon behavior among dental boards, according to Bitting. “In a Southwestern state a dentist was told by board staff that he was not allowed to perform sublingual oral sedation. Yet the board’s own definition of ‘enteral’ specifically lists sublingual as a valid route.” In this instance as well, Bitting’s intervention allowed
the dentist to continue providing services.

Bitting doesn’t want to impugn motive to the board’s actions in these cases. But he says it’s not unfair to associate real consequences. “Certainly this failure of the board to competently provide information holds the potential for harm to patients, the one group they were created to protect.”

Some boards do an excellent job with their responsibilities, Bitting hastens to point out. “What we’d like to see is more consistent enforcement throughout the country.”