State Board of Dentistry Report – May 15, 2020

Report of Prosecutorial Division

As many of the prosecutorial cases involved recusals, which difficult to achieve on a web conference, prosecutions were reported at different points in the meeting.

The first case involved a patient treated for periodontal disease from April 2014 to July 2016. Experts cited inadequate record keeping, no chart updates, and an overall poor standard of care that led to several avoidable extractions. The practitioner was assessed $4,500 in civil penalties, $2,000 in costs, and required to fulfill ten extra hours of continuing education. The age of the case and inability to contact witnesses were contributing factors to the penalties.

The second case involved a standard voluntary recovery program (VRP) treatment for an EFDA.

The third case involved two dentists charged with negligently employing a hygienist with an expired license. The first employed the hygienist from 2011–2015 and was assessed a $4,800 penalty and public reprimand. The second employed the hygienist from 2015–2018 and received a $3,900 penalty and public reprimand. The board asked if sanctions were being levied against the hygienist. Prosecutors announced that the matter was being addressed.

The fourth case involved a hygienist who practiced on a lapsed license from 2017–2019. The hygienist was assessed a $1,450 civil penalty and public reprimand.

The fifth case involved a hygienist practicing on a lapsed license for 53 months. The hygienist paid a $2,550 civil penalty.

The sixth case involved recusals. It was a consent agreement for a licensee convicted of a DUI with a highly elevated blood alcohol level and resisting arrest. She received a immediate temporary license suspension on March 9, but hasn’t been able to return to practice due to the requirement to meet with an evaluator, which could not be achieved during lockdowns. The conditions of the consent agreement include civil penalty of $2,000 and cost of investigation. Her license will remain indefinitely suspended until evaluated.

The seventh case involved a hygienist that received a license suspension based on a mental and physical disorder. She was diagnosed with thought and cognitive impairment. Based on her evaluation, she cannot practice with reasonable skill and safety without constant monitoring. Due to the circumstances of the case, the licensee was not assigned a financial penalty, and would enter into three-year monitoring agreement.

Regulations

Board counsel reported on several different regulatory packages that are making their way through the process. Regulations regarding licensure and examination fees increases are expected soon. Regulations in accordance with Act 41, which creates a process for licensure by credential when transferring from another state, will likely be addressed in an upcoming regulations subcommittee meeting. As these regulations are required for all licensing boards, they are proceeding in a similar fashion for all boards.

Dr. Lugo received suggested edits to the preamble of the regulations expanding public health dental hygiene practitioners (PHDHPs). These edits do not affect the changes made in the regulations. The regulations will need to be considered by several other reviewers by its deadline of March 2021. The board recommended completing the preamble revisions by its July meeting with the goal of voting then.

Report of the Chair

Dr. Erhard thanked the employees of the Department of State that have dedicated the time to respond to licensee requirements, especially while working remotely. Dr. Erhard noted that the complications of COVID-19 have resulted in changes made to licensing exams for dentists and hygienists. The board was given the option of waiving licensing exams entirely, postponing, or trying to find a pathway to middle ground. The chair felt that taking the long layoff for dental school graduates into consideration, testing is essential. Dental exams will use a Compedont in place of live patients for certain dentist exam requirements in this examination cycle only. Hygienists will be granted a provisional license until a patient exam can be completed.

DOH Guidance

Dr. Matta asked if anything has been changed since the May 8 Department of Health Revised Guidance. April Hutcheson from the Pennsylvania Department of Health (DOH) reported the May 8 guidance is still controlling and is not subject to the Governor’s county-by-county reopening plan. Although it supersedes CDC prohibitions on non-emergency procedures, it does follow CDC and OSHA guidelines for PPE. According to Ms. Hutcheson, the key message communicated in the revised guidance is that it is not intended to signify a return to routine practice as normal because it is not safe. Pennsylvania is still in very early stages of mitigation, and it is endemic to protect Pennsylvania’s overall public health. The DOH intends for care to be provided for patients that have been putting it off.

If a dental office is following the CDC and OSHA guidelines regarding PPE, licensees can do certain procedures if necessary. Ms. Hutcheson indicated that guidance is designed to allow for clinical judgement when deciding what can be performed, but in terms of public health, going to a dentist is a risk.

The board discussed the confusion that many licensees are reporting due to conflicting interpretations. There was interest expressed on having the SBOD provide communication and work in conjunction with DOH. Commissioner Johnson noted that while the Department of State is distributing the message and DOH is listed as the issuing agency, since it is coming from the Governor’s office, the name on the masthead does not matter and is being produced with a unified voice from all Departments. Board members recommended against membership groups issuing interpretations as there is too much nuance in each interpretation. DOH is working on a fact sheet on the May 8 guidance to clarify further.

Linda Straub-Bruce from the Pennsylvania Dental Hygienists Association (PDHA) was asked to address the board. Ms. Straub-Bruce made note of the work done in coalition with PDA, PAGD, the American Academy of Pediatric Dentistry (AAPD), and the three major dental schools, as well as their independent advocacy. Ms. Straub-Bruce understands that DOH needs to be broad-based and allow for clinical judgement, but PDHA members have demanded clarification. DOH conducted a follow-up to its May 8 revised guidance with a phone conference on May 13, in which the Department of State participated. Recommendations for practice were given and requested to be distributed to membership. PAGD, PDHA, and the Pennsylvania Coalition on Oral Health’s messages were similar. According to Ms. Straub-Bruce, PDA’s message included additional information and interpretation that was not included in the other three. Ms. Straub-Bruce reached out to Dr. Jim Tauberg, President of PDA, and will move forward with a coproduced statement between the two organizations.

Ms. Hutcheson noted it was clearly stated in the May 8 guidance that dentistry will not receive PPE from the Commonwealth. It will be up to the individual provider to secure necessary PPE. Dr. Pete Ross from AAPD replied that his organization is not looking for PPE from Commonwealth but have been told by suppliers that they are being directed to sell only to state government. Ms. Hutcheson reported that there is no prohibition for a dental office to purchase PPE and will follow up with suppliers to determine where they are getting that information. Dr. Linda Himmelberger, ADA Trustee, has reported that this used to be the case, but was reversed by FEMA. She suggested that PEMA reach out to regional FEMA to clarify that dental offices can be purchasers.

Committee Reports

Dr. Matta asked if the Standard of Practice Committee can hear proposals to expand the standard to allow for COVID-19 testing in dental offices. Mr. Johnson indicated that expanding the standard in this matter is not in the authority of the committee, it would have to be escalated to governor’s policy office.

 

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