Oversight of dentists lacks strength (just like oversight of builders)

Here’s what happens if industry is allowed to regulate itself

[HOT: Dentists are regulated by a state board run by dentists, and these 3 articles describe the result. At least dentists are licensed professionals with education and credentials to prove their qualifications. Builders aren’t licensed at all. We expect builders to push for a similar agency that they can control, now that we successfully abolished their TRCC (Texas Residential Construction Commission) and showed the need for licensing. We include these articles as a warning against making a sham of licensing and regulatory oversight. Highlights and [bracketed comments] are added.]

Texas State Board of Dental Examiners is less likely to discipline, slower to act and far less likely to impose harshest penalties than other boards, review finds

When Becky Murphy of Baytown found out that someone had been using her name and health insurance ID number to buy the painkiller hydrocodone for a year, she called the police.

She was shocked to discover that the guilty party was her boss at the time, Dr. Russell Boone, whose dental office she had managed in nearby Friendswood for seven years.

Murphy called the Texas State Board of Dental Examiners, which regulates the state’s dental profession, and in June 2008, a board investigator took her report. Thirteen months later, Murphy is still waiting for disciplinary action from the board.

Boone, who pleaded guilty in April to possession of a controlled substance by fraud, was placed on a form of probation called deferred adjudication, according to court records.

“He just continued to practice,” Murphy said. “He didn’t miss a beat.”

Board officials declined to discuss his case. His attorney, Louis Leichter of Austin, said Boone, 52, has undergone addiction treatment and is negotiating a settlement with the board.

“There shouldn’t be any negotiating,” Murphy said. “The man committed a felony.”

An American-Statesman review of disciplinary records found that despite years of critical audits and complaints of lax oversight, the dental board — which regulates 15,950 dentists, more than 33,000 hygienists and registered assistants, and 1,083 laboratories — is less likely to take disciplinary action, slower to act and far less likely to impose the most severe sanction, loss of a license, than the state medical board.

The dental board — which is awaiting the results of a state auditor’s review this month — also routinely suspends dentists’ licenses, then probates those suspensions in full, blunting the penalty’s severity. Of the board’s 158 disciplinary actions since January 2007, 51, or nearly a third, were fully probated suspensions, and 65 were warnings. Rarely is a suspended dentist ordered away from the workplace.

The 15-member board, for example, gave probated suspensions to Dr. Stephen Durbin of Ennis, who videotaped his female employees getting undressed, and Dr. Lon Jude Latiolais of Georgetown, who misprescribed narcotics, abused drugs and treated patients while he was “physically and mentally incapable” of practicing safely for two months in 2006, according to the board’s disciplinary order.

Since January 2007, probated suspensions have been meted out to dentists who have a license revoked in another state or who plead guilty to crimes such as Medicaid fraud or assault.

“There is a lack of transparency, and there is no deterrence for behavior that is unethical or unprofessional,” said Dr. Susana Paoloski, a Houston periodontist who was president of the Greater Houston Dental Society from 1990 to 1991.

By comparison, the Texas Medical Board, which oversees about 62,000 doctors and 7,000 other medical workers,has suspended 56 doctors since January 2007, and all but three were ordered to stop practicing for a period of time, spokeswoman Jill Wiggins said. During that period, the board disciplined 1,007 license holders, Wiggins said.

[HOT: Licensing elevates the stature, respect and earning potential of a trade or profession, and the loss of a license (and ability to work in the field) is a strong deterrent of bad behavior. We want similar regulatory oversight of residential construction.]

Texas Medical Board suspensions are much more likely to require monitoring by another physician, visits to a psychiatrist and a proof of fitness to return to practice. The dental board more often orders fines, classes and adherence to court requirements, and it makes treatment referrals in drug cases. Treatment professionals monitor dentists who have been disciplined and may order inpatient care, said Sherri Sanders Meek, the dental board’s executive director.

Sanders declined to discuss specific cases and would only answer questions in writing.

“Each case is decided based on factors contained in the individual complaint and subsequent investigation,” she wrote in an e-mail.

Two dental board members said Sanders was best able to speak on behalf of the governor-appointed board.

“Right now I’m trusting the people who are working hard to scrutinize the complaints,” said new board member William Birdwell of Bryan. “The person in charge and the board … are very capable policemen. At this point, I’m feeling very good about the staff people who are there.”

State audits dating to 1997 have found flawed enforcement and weak oversight of dental professionals. The most recent audit, in 2005, said the staff lacked a system to determine whether orders were being followed.

The state medical board makes detailed information about doctors’ disciplinary records available on its Web site. But the dental board requires members of the public to file an open records request to see a dentist’s disciplinary record. Its Web site shows whether a dentist has been disciplined but gives no other details. Sanders said the board is considering posting the text of its disciplinary orders online.

[HOT: Complaints against builders and the list of homes built is blocked from public view, even with an open records request, thanks to the efforts of a strong builders’ lobby and the TRCC they put in place to regulate themselves. With the TRCC going away, there won’t be any records to hide or seek.]

Unequal resources

The dntal board has 37 employees and an annual budget of $1.8 million. The board is supported largely by fees related to licensing, credentialing and examinations, but its budget is set by the state Legislature. The budget will increase to $2.8 million next fiscal year, Sanders said, including money for two more staff members, a new computer system and salary increases.

By comparison, the medical board, which oversees a total of 36 percent more medical workers and entities than the dental board but nearly four times as many doctors, has 142 employees and a $9.2 million budget.

Sanders declined to say whether the agency has sufficient resources, calling that a matter of opinion.

Dr. Donald Patrick, a former executive director of the medical board, said resources make a big difference.

“You can be sure those state employees are doing their best to protect the public,” he said. “But I can imagine they don’t have enough experienced lawyers to prosecute cases. We were outlawyered for the longest time.” With more money from the Legislature, “we did get some really good lawyers.”

Leichter, who represents other dentists besides Boone and doctors who have been accused of drug violations, said the board does “a reasonably good job” with the resources it has. But, he said, he has seen “some serious abuse” not get prosecuted “because they didn’t have the manpower and resources to handle the case.” He added that he was not referring to his clients.

[HOT: Rather than establish and fund a separate agency to regulate residential construction, as we expect builders to favor, we prefer (as we proposed in the 2009 legislative session) contractor licensing by the Texas Department of Licensing and Regulation. TDLR has over 100 years of unbiased experience regulating professions like electricians.]

Leichter said it would be unfair to conclude that the dental board is not acting in Boone’s case.

In January, Boone was charged with fraud for using Murphy’s insurance information to buy 48 fraudulent prescriptions for hydrocodone and antibiotics (Murphy said she thinks the antibiotics were bought to mask the hydrocodone purchases), according to an arrest warrant that Murphy provided. Boone pleaded guilty to the felony drug charge on April 3 in Galveston County, two weeks before a regularly scheduled dental board meeting.

Boone was well into treatment by the time Friendswood police arrested him in January, Leichter said, adding that it is not uncommon for dentists to be in treatment by the time the board acts, thus resulting in a suspended probation.

Murphy says she is angry. With the three-year court probation, Boone could end up with a clean record, she said. From law enforcement to the dental board, the system is skewed to shield doctors, she asserted.

The Friendswood Police Department refused to provide Boone’s arrest records in response to an open records request from the Statesman. The Friendswood city attorney appealed to the state attorney general’s office to withhold the documents, saying that their release might be “highly intimate or may be embarrassing.”

[HOT: Texas builders blocked open records access to homeowner information after a 2006 Texas Comptroller’s Report embarrased the TRCC.]

Second chances

Leichter, who says he is himself a recovering addict, said Boone has been sober for more than a year, and Boone’s dental practice continues to thrive. Dental board members “believe addicted people deserve a second chance,” Leichter said.

In June 2008, the board suspended Durbin, who is under a Ellis County Court-at-Law No. 2 probation order after videotaping his female employees changing clothes in August 2007, according to the board’s order. The board ordered him to be suspended for five years and then probated that in its entirety, fined him $5,000 and required him to follow the terms of his court-ordered community supervision and sex offender counseling. Durbin declined to comment.

In the case of Latiolais, the Georgetown dentist accused of abusing drugs and practicing while impaired, the board in January 2007 ordered his license be suspended for 10 years — and then probated the entire suspension, according to the order. He also was ordered to undergo drug treatment for at least five years and had to surrender certain drug-prescribing permits for at least a year. Latiolais did not return phone calls seeking comment.

 By Mary Ann Roser (maroser@statesman.com; 512-445-3619), Austin American-Statesman, 7/20/2009
Source: http://www.statesman.com/search/content/news/stories/local/2009/07/20/0720dental.html

READER COMMENTS: [ most recent first, followed by two related articles ]

reggiesright wrote:

This frankly paints too glowing of a picture of the Texas Medical Board. I suppose what you could take from this story is, “you think the Medical Board is bad, then go look at the Dental Board.” [HOT: and if you think the Dental Board is bad, then go look at the TRCC] It has been my personal experience through a more than year-long complaint and investigation process that eventually resulted in a “case closed, no action taken” response that the Medical Board does nothing more than protect their own. Was the physical harm and poor medical action and anesthesiologists’ ill judgment worthy of a revoked or suspended license–perhaps not, but the fact that this man walked away with a clean record is breathtaking to me.

faceit wrote:

LUMP: there’s many small agencies just like the TBDE, many! The governor appoints the board, remember that. These small agencies provide a lot of revenue for the state by the fees they collect. So the state could care less if they are doing their jobs as long as they collect more revenue than their expenditures. I had several bad experiences myself. Dr. McDonald in North Austin replaced a filling with a crown. The crown was too tight and therefore caused the crown next to it to become loose and fall out within a few weeks. I went back to get him to fix it but then his office said I would have to pay for the office visit for him to look at it. I didn’t file a complaint because I knew it wouldn’t do any good. This is what our country has come to, more and more and MORE AND MORE AND MORE AND MORE TAXES AND FEES WITH NO REPRESENTATION.

Ohana wrote:

The dental field in Texas has alot of bad apples. Yes there are some great dentists. The real problem is that the Board of Dental Examiners and the Peer review gang is focused on keeping law suits down and the public in the dark. Years ago I watched a dentist take out a very sore and infected tooth. The root canal was out of apex by a couple of millimeters. All three roots. When the dentist was not looking I wrapped up the tooth and gave it to the patient along with a copy of the Xray. I told him to take it to a lawyer. The dentist should have given the advise to the patient himself. The botched root canal was not his fault. The guy had spent a fortune on that tooth and he lost it anyway. I have been a temporary assistant and a hygenist for 35 years. Now retired, I have caught dentists fooling around with the help and also with the patients. One guy has a weakness for his receptionist. He married several of them. Three divorces and several children with various receptionists, and he has a lovely new office and receptionist. I am pretty old and have out lived several of my old bosses. Some will burn in hell for the lying and the crappy and lazy work. Some will have a special place in heaven for all of the people they worked on for free.

Here is a tip to all of you potential patient out there. It is so hard to tell if you are getting good work. If you can go home and cut a piece of floss with your new filling. You probably need a new dentist, his work is sloppy.

dr78753 wrote:

Unfortunately, there are always a few bad apples among the good ones. People should do more research before trusting someone with their health. Sometime it’s a matter of economics–dental care can be very expensive. With care you can find an equally good dentist in Mexico to perform the same procedures for much less. Again that requires research also.

TXstreet wrote:

maybe ya’ll should try brushing your teeth once in a while

toothdoc wrote:

Lump, I’m sorry you had a rough experience with a dentist or two, but that doesn’t make us all bad. Most dentists spend thousands and thousands of dollars, of their own money, every year, to learn how to better treat their patients. The commitment of most dentists far outreaches the level of commitment and care from many professionals.

pioneergrrrk wrote:

Wow, the infection sounds serious. I never looked forward going to a dentist. But I never had to deal with anything like that. And I would not let McLeroy or clone anywhere near drugs and/or sharp objects. They’re the flat-earth folks!

Lump wrote:

About 8-10 years ago I had a major infection after receiving a filling by Dr. JOHN BAPTISTE LITTERER in Burnet Texas. I remember when he was done drilling, the dental assistant asked him if he wanted a disinfect before he put in the filling and he told her it would, “be OK”. Dr. LITTERER saved a few cents and seconds but….a few days later my face was blown up and I was in extreme pain. When I called his office (Dr. LITTERER in Burent) to see if he would help me at a reduced cost, he said things like this happen. I ended up missing 2 days at work and spent $800+ on a root canal and crown. I was basically told by that State Board of Denial (not a typo) Examiners that there was nothing I could do. They didn’t even bother taking a report. They said something to the effect that I would have to find a dentist to back up my claim in court and dentists don’t go again each other. Note: Dr. Hulse (can’t recall first name), an Austin Dentist performed the root canal and crown. However, he seemed to be incompetent also b/c his work had to be redone (my crown looked like I had a piece of popcorn for a tooth) at no cost by a different/seasoned dentist in the same office. How can I get a job at State Board of Denial Examaniers, sounds like a good job, you can catch up on your on-line shopping!! Or better yet, I’ll just go back to school to be a dentist, seems to be a relatively easy way get paid WELL and not care about your patients.

toothdoc wrote:

If I thought it might do some good, I might try to explain some of these things to you. However, after reading some of your comments, it doesn’t sound like some of you deal with a full deck…

tbrown16 wrote:

What have we here? Another do-nothing state agency, drawing big-buck salaries and winking at the offenders. “We only want to get compliance” is the state agency mantra and stock excuse for doing nothing. Thanks be to the political hacks who create these agencies for looking out for our interests. This bunch is worse than the TACB.

Mefungu wrote:

Yeah, somebody needs to pay particular attention to Don McLeroy.

georgiegirl wrote:

I had a dentist tell me I needed a root canal. I had a root canal (on the same tooth) does for a cost a thousand dollars 4 years prior by another dentist. I don’t trust dentists especially when it comes to so much money.

Big Al wrote:

Unfortunately this is just another example of how regulatory boards place priority on protecting the people that they are allegedly regulating rather than protecting the public. Most complaints from the general public are dismissed out of hand because they can’t possibly know enough to be file a valid complaint.

Chavela wrote:

Several years ago, a dentist told me I needed extensive work on several teeth. I was unconvinced, and paid for exams from two other dentists who both told me (a) No, I didn’t need the work she’d recommended, but (b) I had decay in a tooth that needed immeditate attention–a tooth she completely missed. I documented this malpractice, including x-rays, and sent it all in to the board. Two years later, they sent back a note that no action was taken “because of insufficient evidence” (or wrds to that effects). That dentist is still happily practicing.

desk wrote:

The dental profession should be investigated under the RICO Act. The prices they charge!!

Jon7 wrote:

Just another example of how easy it is to buy off useless state employee’s. Sure worked for state rep. Mike Krusee last year for his DWI in WILCO! He “walked” just 5 minutes before his jury trial.

JimM wrote:

Yes, there are many dentists floating around nowadays and some are getting very careless. Watch those in Georgetown.

Newspaper review finds Texas dental board

Press Release, The Associated Press, published in Austin American-Statesman, 7/20/2009
Source: http://www.statesman.com/search/content/gen/ap/TX_Dentist_Oversight.html

AUSTIN, Texas — The Texas State Board of Dental Examiners is less likely than the state medical board to take disciplinary action, slower to act and less likely to impose the most severe sanction — loss of a license, a newspaper review found.

The Austin American-Statesman reported Monday that the dental board is awaiting the results of a state auditor’s review this month. The board, which has been dogged for years by critical audits and complaints of lax oversight, regulates 15,950 dentists, more than 33,000 hygienists and registered assistants, and 1,083 laboratories.

The 15-member board routinely suspends dentists’ licenses, but then probates the suspension, allowing the dentists to serve probation instead of missing work, the newspaper reported. Of the board’s 158 disciplinary actions since January 2007, 51, or nearly a third, were fully probated suspensions, and 65 were warnings. Rarely is a suspended dentist ordered away from the workplace.

Probated suspensions have been given to dentists who have had their licenses revoked in other states or who pleaded guilty to crimes such as Medicaid fraud or assault, according to the newspaper’s review of the board’s actions since January 2007.

“There is no deterrence for behavior that is unethical or unprofessional,” said Dr. Susana Paoloski, a Houston periodontist who was president of the Greater Houston Dental Society from 1990 to 1991.

The Texas Medical Board, which oversees about 62,000 doctors and 7,000 other medical workers, has suspended 56 doctors since January 2007, and all but three were ordered to stop practicing for a period of time, spokeswoman Jill Wiggins said. The board also disciplined more than 1,000 other license holders during that time, she said.

Texas Medical Board suspensions are more likely to require monitoring by another doctor, visits to a psychiatrist and a proof of fitness to return to practice. In contrast, the dental board more often orders fines, participation in classes and adherence to court requirements. The dental board also makes referrals for treatment in drug cases.

The dental board’s executive director, Sherri Sanders Meek, declined to discuss specific cases and would only answer questions from the newspaper in writing.

“Each case is decided based on factors contained in the individual complaint and subsequent investigation,” she wrote in an e-mail.

State audits since 1997 have found flawed enforcement and weak oversight of dental professionals. The most recent audit, in 2005, said the staff lacked a system to determine whether orders were being followed.

The state medical board makes detailed information about doctors’ disciplinary records available on its Web site. But the dental board requires members of the public to file an open records request to see a dentist’s disciplinary record. Its Web site shows whether a dentist has been disciplined but gives no other details.

The dental board is considering posting the text of its disciplinary orders online, Sanders Meek said.

It’s been 13 months since Becky Murphy called the Texas State Board of Dental Examiners about her then-boss, Dr. Russell Boone. She contacted police after discovering that someone had been using her name and insurance number ID to buy the painkiller hydrocodone for a year. She was shocked to find out the person using her information was Boone, whose Friendswood dental office she managed.

In June 2008, she called the dental board.

“He just continued to practice,” Murphy said. “He didn’t miss a beat.”

Board officials declined to discuss Boone’s case. His attorney, Louis Leichter of Austin, said his client has undergone addiction treatment and is negotiating a settlement with the board.

“There shouldn’t be any negotiating,” Murphy said. “The man committed a felony.”

Leichter said Boone, 52, was well into treatment by the time Friendswood police arrested him in January and has been sober for more than a year. Boone continues to have a thriving dental practice, the attorney said.

In January, Boone was charged with fraud for using Murphy’s insurance information to buy 48 fraudulent prescriptions for hydrocodone and antibiotics, according to an arrest warrant that Murphy provided. Boone pleaded guilty to the felony drug charge on April 3 in Galveston County, two weeks before a regularly scheduled dental board meeting.

He was placed on a form of probation called deferred adjudication, according to court records.

Texas dental board should have bite

By Austin American-Statesman Editorial Board, 7/24/2009
Source: http://www.statesman.com/search/content/editorial/stories/2009/07/24/0724dentists_edit.html

Most of us are lucky enough to find dentists who are efficient, effective and reliable. Those who luck passes by, however, will find a state agency responsible for disciplining errant dentists reluctant to act and too quick to forgive.

The American-Statesman’s Mary Ann Roser reported earlier this week that the Texas State Board of Dental Examiners, which licenses and oversees dentists, dental hygienists and registered dental assistants, is much more forgiving of transgressions than the state medical board, despite past critical audits and public complaints about the low level of oversight.

A state auditor’s report on the dental board is expected this month. Roser reported that even when the dental board sanctions a dentist, it is more likely than not to mitigate its discipline. If, for example, a dentist’s license is suspended, the board is likely to fully probate the action, effectively negating it.

Since January 2007, Roser reported, 51 of the board’s 158 disciplinary actions have been probated and another 65 disciplinary actions were warnings. The dental board oversees 15,950 dentists.

The Texas Medical Board, which oversees 62,000 doctors, has suspended 56 doctors since January 2007 and all but three were ordered to stop practicing.

The contrasts are startling enough to command the attention of the governor who appoints the board and the Legislature that appropriates the money for it and theoretically holds the agency’s leadership accountable.

There should be a full explanation as to why the dental board is so reluctant to move against dentists. Maybe there’s a good one. Maybe the state’s doctors are more prone to bad behavior than dentists are. Maybe a lot of things, but one thing is clear: the dental board is slow to act and quick to give the benefit of the doubt when it does.

Roser documented how Texans who filed complaints with the board are often frustrated by the process as well as by the results. Becky Murphyof Baytown, for example, discovered that Dr. Russell Boone, her dentist and employer, hijacked her name and health insurance identification to buy hydrocodone, a painkiller. The dentist pleaded guilty to a third degree felony charge of possession of a controlled substance by fraud. The dental board has yet to act on Murphy’s complaint.

Dr. Susana Paoloski, a Houston periodontist who was president of the Greater Houston Dental Society from 1990 to 1991 was blunt in her assessment of the dental board’s performance: “There is a lack of transparency, and there is no deterrence for behavior that is unethical or unprofessional.”

The upcoming audit of the dental board should be required reading for the governor and as well as legislative leaders. In an ideal world, a regulatory agency shouldn’t have to be reminded that its first obligation is to the public and not to the industry or group being regulated.

In the real world though, those reminders are necessary, and in the case of the dental board, long overdue.