State Board of Dentistry Report Meeting Summary May 17, 2019

Roll was called, and a quorum was achieved. The board welcomed Dr. LaJuan Mountain as a dentist member. She is a Temple graduate and the dental director at an FQHC in York.

The minutes from the previous meeting were amended for typos and approved.

Prosecution

  • An oral surgeon employed someone who was not approved to take radiographs but had done so for six years. This violation was reported while investigating another case. The respondent received a $2,000 civil penalty and a public reprimand, and paid cost of prosecution. A board member asked about the financial gain received as a result of the radiographs. Prosecutors did not know but indicated that it would not change the suggested penalty.
  • A dentist employed someone who was on a lapsed license as an EFDA, hygienist, and local anesthesia provider for eleven months. The dentist received a $3,000 civil penalty and public reprimand.
  • A dentist with a reciprocal license in North Carolina was prosecuted there for MA fraud and providing unnecessary services. They have since relocated to Pennsylvania. They received a $10,000 civil penalty.
  • A dentist was cited for writing Xanax prescriptions for a relative. The violation was reported by the pharmacy. Prosecution indicated that they weren’t eligible for the voluntary recovery program (VRP). They received a $5,000 civil penalty and cost of prosecution. They also received a 24-month probation with oversight.
  • A licensee had entered the voluntary recovery program for depression. There was no substance abuse evident and the licensee was not accused of working impaired.
  • A dentist had previously been disciplined and received a one-year suspension for providing substandard care. The licensee appealed the result in court and continued to practice under the mistaken thought that the suspension was stayed. The dentist agreed to the surrender of their license.
  • A dentist was disciplined in North Carolina in 2018 for practicing impaired. They relapsed and were disciplined in New Jersey later that year for practicing impaired. They received an involuntary temporary suspension in Pennsylvania. They were put in the VRP for mental and behavioral health issues to be monitored for three years.

Report of Board Counsel

Board Counsel Ariel O’Malley reported on the public comments received regarding the expansion of PHDHP independent practice sites. Ms. O’Malley indicated that the proponents all had similar themes of opening access to care for the poor and indigent. The opponents were a combination, with many under the mistaken impression that the scope of hygiene practice had changed in the regulations. PAGD was identified as a separate category of respondent, offering recommendations for systemic improvement rather than opposition.

Below are some of the considerations for regulatory revision:

  • Collaborative Agreements: Board Counsel defined collaborative practice agreements, which were employed in other states. They are written agreements between a dentist and PHDHP filed with the board which would define what an independently-practicing PHDHP could and could not do in specified settings.
  • Certificate of Need: Many board members indicated an interest in requiring certificates of need before allowing independent hygiene practice locations to ensure that community demonstrated a dental shortage area. Other board members objected, indicating that a certificate of need codifies a two-tiered system of care.
  • Liability Issues: Many board members noted the comments from the Pennsylvania Medical Society which addressed the supervisory expectations and liability concerns of the physician. It was mentioned by several board members that the financial model for physicians’ offices does not lend itself to independent hygiene practice, as the space demands and requirements to turn those offices over would necessitate subletting.
  • Safety: Board members indicated that although the scope of practice does not change with these regulations, the expanded practice to hospice and in-home senior care would introduce a vulnerable population that provide challenging environments.
  • Patient Confusion: Some board members expressed reservations with the possibility that a patient would be confused about the type of care that they received from a PHDHP. Other board members indicated that this could be addressed with a consistent referral form that delineated the hygiene care received does not replace a dental exam and gives the patient options for an exam.
  • The board will further consider the draft regulations at its July meeting after receiving the questions from the Independent Regulatory Review Commission, which are due at the end of May. Other board members pressed for an immediate revision and vote, but the board opted to hold until all comments were received. The regulation subcommittee may meet in the interim to consider the comments in their entirety.

Report of the Chair

Dr. Erhard recommended all board members to serve at the MOM-n-PA event. The free dental clinic is scheduled for June 7–8 in Wilkes-Barre.

Correspondence

The board considered a letter received from Dr. Charles Incalcaterra, DMD concerning practice ownership by non-dentists. Board members noted that the dental law passed in 1937 indicated that practices must be owned by Pennsylvania dentists, but there is not provision stating that it must be majority ownership. Several board members noted that this can be troublesome, as a non-licensed executive can direct the standard of care, but the licensed dentist performing the care is responsible and can be punished by the board for providing substandard care. In past meetings, a committee to pursue change was formed on the subject and summarily disbanded because it would require statutory change.

The board also received correspondence from Temple University, who is advocating for deemed licensure of foreign-trained faculty. The board is not inclined at this time to give a university program the freedom to deem foreign faculty as licensees in Pennsylvania.

Adjournment

The next meeting is scheduled for July 19, 2019. The board adjourned to Executive Session.

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