Texas hearing exposes ongoing dental board issues

The Texas State Board of Dental Examiners should address patient complaints faster and dentists' disciplinary actions should be more accessible, according to testimony from patients, dentists, and lawyers during a legislative hearing in Austin this week.

Legislators were also urged to increase oversight of corporate dental clinics, citing concerns that businessmen are exerting too much influence on patient care.

The complaints came during a hearing April 11 by the Public Health Committee, in which the dental board responded to recurring concerns about the difficulty of checking dentists' disciplinary actions.

A 2009 report by the Texas State Auditor's Office chided the board for failing to adequately regulate dental licenses and for not including the names of all dentists who had been disciplined in its database.

Continuing staff turnover has been part of the problem, according to the board's acting executive director, Glenn Parker, a chiropractor and former director of the state's Board of Chiropractic Examiners.

Parker took over as executive director of the dental board last month after Sherri Meek resigned in advance of the public hearing. Meek who cited "personal reasons" for her departure, is one of several dental board directors who have left in recent years.

Parker told committee members that the board doesn't have enough money to oversee nearly 60,000 licensees, including 15,000 dentists, 11,350 hygienists, 32,000 dental assistants, and 900 dental labs. In 2011 the board received almost $9 million in licensing fees but by state law was only allowed to spend $2.6 million to cover costs.

The board receives about 1,000 complaints annually, which must be reviewed by two dentists, Parker noted. Currently there are 1,270 open cases, half involving standard-of-care issues, which are being handled by nine investigators.

"Should these cases be resolved faster? Absolutely," Parker told the Public Health Committee. "Sometimes people do what's easiest to do instead of what should be done."

Rise of corporate dentistry

The growing number of corporate dental chains in Texas also need to be regulated, but the board lacks jurisdiction to provide oversight, Parker testified. The U.S. Centers for Medicare and Medicaid Services is looking into allegations of Medicaid fraud involving some cases, he said.

In 2008, All Smiles Dental Centers -- a chain of 51 dental clinics in Texas -- collected $5.4 million from Medicaid for orthodontic treatments performed there, according to a news report by WFAA-TV in Dallas/Ft. Worth. Since then, All Smiles' Medicaid orthodontics billings nearly doubled to $10.2 million.

The 2007 Texas Legislature approved a 50% rate increase for dentists to help expand access to dental services for children on Medicaid. Spending on orthodontic care in Texas has increased from $102 million in 2008 to $185 million in 2010.

As in most states, Texas dental practices must be owned by dentists, but various state dental boards have become increasingly concerned about companies trying to overstep the bounds of practice management contracts to illegally take control of dental practices.

Dental chain teams go into poor neighborhoods and stand outside Medicaid offices to sign up patients, Houston lawyer James Moriarty told the panel.

Attorney Charlie Gustin, also of Houston, told the committee about a medical negligence lawsuit he filed against the Smile Center in San Antonio involving a 5-year-old boy who received 20 pulpotomies and 20 steel crowns during a 48-minute procedure in August 2010 by Song Hun Hong, DDS. The lawsuit, filed in November 2011 in Bexar County District Court, also names several Smile Center dentists in addition to Dr. Hong.

Gustin said he and other dentists filed complaints about Dr. Hong with the board in November 2010, but the matter has yet to be resolved.

"It's a glaring example of somebody who multiple patients and dentists have filed complaints about, who's been the subject of several TV news exposés," he told DrBicuspid.com. "His license was suspended in New York, but you can't find any of that on the Texas website."

Dr. Hong agreed to the New York suspension in July 2010 following charges that he failed to treat periodontal disease in three patients, according to the New York Office of Professions website.

El Paso orthodontist Rich Black, DDS, told the committee that dental chain owners are interfering with dentists by dictating treatment plans and setting quotas. In addition, there are conflicts of interest between patient care and corporate profitability, he asserted.

Committee members said they will make it a legislative priority to bring the chains under the dental board's purview.

Inconsistent treatment

Mark Stankewitz, DDS, a Houston dentist who is a member of a group called Texans for Dental Reform, told DrBicuspid.com there seems to be a "good 'ol boy" atmosphere in which the outcome of cases appears to be decided before cases are heard.

"There is inconsistent treatment of dentists and the public where multiple offenders are given preferential treatment while dentists with minor infractions are castigated and public complaints are brushed aside," he said.

The board spent $600,000 to update its database in 2010, but it still contains conflicting information about disciplinary actions. For instance, Isaiah Harris, DDS, whose license was revoked in 2007 for having sex with a female inmate at a jail where he worked, has two listings in the database, only one of which includes this information.

Parker explained that once a dentist's license is revoked, they must apply for a new license, which has a different number. So only Dr. Harris's old license includes the revocation while his new license number does not.

"It's very confusing," board attorney Joy Sparks acknowledged to DrBicuspid.com.

Critics also complained about board members acting as expert witnesses in civil lawsuits against dentists, but Sparks noted this occurred once several years ago and the ethics policy no longer allows it.

"Some of their complaints are legitimate, some are misunderstandings," Parker told the committee, referring to the grievances aired by several disgruntled patients during the hearing. "We are committed to doing our job to protect the public."