Duties and Responsibilities of the Ohio State Dental Board

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Duties and Responsibilities of the Ohio State
Dental Board

• Lili C. Reitz, Esq.
• Executive Director

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Overview of State Licensing and Regulatory Boards
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Purpose ofLicensure and Regulation--

• Protect the Public

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Boards have limited
jurisdiction.
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Professional Organizations
versus
Regulatory Boards
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Professional Organizations
Regulatory Boards
Governmental Mandatory fees to practice
Non-Governmental Voluntary membership dues
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Professional Organizations
Regulatory Boards
Standards Practices Codes of
Ethics Privately created enforced Peer
Review
ORC Standards Practices Credential
individuals to practice Severe
Penalties
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Ohio State Dental Board

• How we work

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Our Authority comes from the Ohio Legislature

• The Legislature passes the laws and rules that we
  are required to maintain and enforce.

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Mission of the Dental Board

• Licensure
• Regulation
• Enforcement

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Board CompositionSet forth in Ohio Revised Code
4715.02 2, four year terms maximum
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Board Meetings

• We are required by law to meet a minimum of 8
  times per year.
• Meetings start at 100 PM. We meet in our
  building in a meeting room on the 19th floor.
• Committees meet prior to the meeting.
• Meetings are generally open to the public.
• A preliminary agenda is prepared and emailed to
  our mailing list a week in advance.

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Typical Agenda

• Meeting the AAG on cases in litigation
• Approval of minutes from last meeting
• Discipline/Enforcement matters
• Personal Appearances
• Licensure Approval
• Committee Reports
• Office Expense Report
• Executive Directors Report
• Anything for the Good of the Board

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Executive Session

• Although most of the meeting is open to the
  public, there are a few reasons the Board may
  move for Executive Session.
• Reasons are set forth in the law, the Open
  Meetings Act.
• The three main reasons the Board goes into
  executive session
• To confer with our AAG on matters that are the
  subject of pending or imminent court action
• To deliberate discipline of a licensee
• To discuss matters involving personnel
• The Board must state in its motion the purpose
  for the Executive Session

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Board Staff

• Executive Director
• Enforcement Supervisor
• Six Investigators
• QUIP Coordinator
• Five Administrative Staff
• Executive Secretary to the Director
• Administrative Assistant for Enforcement
• Licensure Coordinator
• Fiscal Officer
• Receptionist/Secretary

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Budget

• The Boards budget is made solely of fees
  obtained through licensure and renewal.
• No GRF Monies
• Revenue is deposited into the 4K9 Fund, which is
  comprised of the majority of the health care
  licensure boards.
• Legislature sets forth agency budget based on
  review of revenue and spending, and the Boards
  budget request.
• Any increase in spending authority, whether it be
  for larger space, additional staff, new programs,
  etc., requires a fee increase to cover the
  expenses necessary.

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Licensure

• Through Application process, we ensure minimum
  competence
• Formal education requirement
• Examination requirement
• Good moral character

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Formal Education Requirement

• Graduation from a dental school accredited by the
  Commission on Dental Accreditation.
• The Regulatory Boards and the Public rely on the
  dental schools to teach adequate skills in all
  areas of practice
• Clinical skills
• Business skills
• Ethics and Professional skills
• The Regulatory Boards and the Public rely on the
  dental schools to graduate only those who can
  demonstrate competence in all areas of dentistry
• The Regulatory Boards rely on the dental schools
  to provide on going education throughout the
  licensees careers.

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Examination Requirements

• Passage of National Board Examination
• Tests theory of dentistry
• Required to graduate from dental school
• Successful Passage of Independent Third Party
  Clinical Assessment
• Tests clinical skills
• Required for licensure in 99 of jurisdictions in
  the United States
• NERB, SRTA, CRDTS, WREB

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Why is a Clinical Independent Third Party
Assessment Necessary?

• Independent Evaluation
• Conducted by an independent party with the sole
  interest of public protection which is separate
  from the training institution.
• Protects the public in that initial licensure is
  given only after successful demonstration of
  clinical skills.
• Psychometrically evaluated and validated.
• Legally validated.
• Clinically reliable.

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Good Moral Character

• Goal to ensure that candidates for licensure
  meet minimum professional and ethical standards.
• Boards expect that if a dental school has a
  concern regarding these issues involving a
  particular candidate, it will notify the board of
  the concern so that it can review the matter in
  full.
• Review Process Many states perform background
  checks.
• The criminal background check is the least
  expensive, most efficient way Boards can
  determine whether an applicant is of good moral
  character as is required by law.

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WHY LICENSURE IS SIGNIFICANT

• A license issued by the Dental Board guarantees
  to the citizens of that state that the dental
  professionals they are seeing are able to perform
  all minimum competencies the day they are granted
  licensure.

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Licensure Statistics FY 2009

• Dental licensed issued by examination 172
• Dental Hygiene licensed issued by examination 174
• Dental licenses issued by credentials 12
• Dental Hygiene licenses issued by credentials 4
• Dental Assistant Radiographers certificates
  issued 1263
• Coronal Polishing certificates issued 109
• Expanded Function Dental Auxiliaries
  registered 192

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Licensees Registered To Practice as of June 30,
2009

• Dentists 7,042
• Dental Hygienists 7,676
• Dental Assistant Radiographers 10,909
• Limited Residents Licenses 191
• Limited Teaching Licenses 34
• Limited Continuing Education License 18
• Coronal Polishing Certificates 735
• Expanded Function Dental Auxiliary 1142

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Regulation

• Set standards to draw line between safe and
  dangerous practice
• Rules
• Policies
• Position Statements
• Committees

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How?

• Enforce the laws and rules governing the practice
  of dentistry.
• Sets parameters for advertising
• Adopt policies and position statements.
• Monitors scope of practice of dentistry and
  practice by dental auxiliaries.
• May license/recognize specialists
• May issue anesthesia/sedation permits to
  qualified dentists
• May license/certify various levels of auxiliaries

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Committees

• Anesthesia
• Education
• Law and Rules Review
• Policy
• Scope of Practice
• Board Operations

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Enforcement

• Maintain oversight of profession
• Identify those who fall short/violate the
  law/rules

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Focus of Enforcement Activities

• The Dental Board's enforcement activities focus
  on initiating and taking disciplinary action
  against practitioners who have violated the
  Dental Practice Act. The Board must take action
  to stop substandard practice, or practice by
  those without necessary qualifications.
• Investigation of complaints and/or information
  which demonstrate that the Dental Practice Act
  has been violated
• Conducting disciplinary proceedings pursuant to
  Chapters 119 and 4715 of the Ohio Revised Code

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Filing a Complaint and the Subsequent
Investigation
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Initial Complaint

• Verbal or Written numerous sources including
  patients, colleagues, hospitals, insurance
  companies, etc.
• Verify jurisdiction i.e. does the complaint
  allege a violation of the Dental Practice Act??
• Anonymous complaints are investigated, but
  without a contact, it may be difficult to proceed
  depending on the nature of the complaint.
• Mandatory reportingmalpractice settlements,
  prosecutors, etc.

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Investigative Process

• Determine initial allegations
• Identify witnesses to contact
• Identify and obtain relevant documents
• Patient Records
• Billing Documents
• Radiographs/Models, etc.

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Confidentiality of Investigations

• Confidentiality protects both the complainant and
  the licensee
• Promotes full disclosure by complainants.
• Protects dentists from negative repercussions
  based on complaints that do not warrant formal
  action.
• Statistics 7000 dentists. 600-700 complaints
  per year (complaints against 10 of dentists),
  Board takes action in 60-70 cases per year.
  Therefore, only 10 of complaints warrant
  action, which equates to only 1 of the number of
  dentists being formally sanctioned. Imagine if
  all complaints were public information.

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Types of Violations

• Failing to meet Standards of Care
• Criminal Activity / History
• Impairment Issues
• Continuing Education Violations
• Sexual Misconduct
• Fraud
• Improper Prescribing

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Enforcement, FY 2008

• Classification of Cases
• Standard of Care 243
• Infection Control 18
• Unlicensed practice 15
• Misrepresentation 10
• Drugs (selling,
• prescribing, giving away) 10
• Permitting Unlicensed
• Person to Practice 8
• Advertising 22
• Impairment 10
• Immoral Conduct 9
• Adverse Occurrence 6
• Continuing Education 9
• Renewal 2
• Licensing 3

• Charges Filed and Citations Issued
• Administrative Charges Filed 20
• Evidentiary Reviews 0
• Hearings Held 3
• Suspensions 31
• Revocations 0
• Consent Agreements 57
• Hearings Pending 6
• Warning Letters 81
• Infection Control Evaluations 496
• Voluntary Surrender 4

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Enforcement, FY 2009

• Classification of Cases
• Standard of Care 283
• Infection Control 23
• Unlicensed practice 7
• Misrepresentation 36
• Drugs (selling,
• prescribing, giving away) 11
• Permitting Unlicensed
• Person to Practice 2
• Advertising 12
• Impairment 9
• Immoral Conduct 8
• Adverse Occurrence 12
• Continuing Education 2
• Renewal 252
• Licensing 2

• Charges Filed and Citations Issued
• Administrative Charges Filed 91
• Evidentiary Reviews 45
• Hearings Held 3
• Suspensions 71
• Revocations 0
• Consent Agreements 64
• Hearings Pending 7
• Warning Letters 52
• Infection Control Evaluations 502
• Voluntary Surrender/Retirement 62

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Role of Board Secretary

• The Board Secretary is to determine whether
  administrative action is warranted based on the
  complaint and the information collected.
• Provides dental professional expert perspective.
• Can ask for additional information/evidence.
• Options for proceeding
• Close
• Close with warning letter
• Refer to QUIP Review Panel
• Charge

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Role of AAG

• If Board Secretary believes administrative action
  is warranted, AAG reviews to ensure the evidence
  is legally sufficient to support any charges that
  are brought
• Provides professional legal perspective.
• Need reliable, probative and substantial
  evidence.
• Can ask for additional evidence.

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Administrative Charges

• If Board Secretary believes that charges are
  warranted and AAG believes the evidence is
  sufficient, a Notice of Opportunity for Hearing
  is drafted and approved by Secy and AAG, and
  referred to the Board for final approval.
• The Board, knowing the process engaged in in
  bringing the draft Notice to the Board, votes
  whether to send the letter based on the content
  contained therein.
• Once approved, the notice is mailed and R.C. 119
  provisions are in effect.
• Notice contains
• Facts and allegations
• Laws/rules allegedly violated
• Right to a hearing
• Right to counsel

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Administrative Hearing

• If the licensee requests an administrative
  hearing, the case is assigned to an attorney
  hearing examiner for handling (Enforcement Rules,
  Ohio Admin. Code 4715-15-01 through 28, govern
  this process).
• The hearing is held, and a Report and
  Recommendation is filed by the Hearing Examiner
  outlining the evidence presented, law/rules
  violated based on facts, and sanction
  recommended.
• Objections to RR filed by licensee.
• Licensee permitted to appear before the Board at
  meeting.
• Board deliberates decides whether to accept,
  reject, modify recommendation of Hearing
  Examiner.
• Adjudication Order issued.

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Appeals

• Appeal to Court of Common Pleas
• Is Board Order supported by reliable, probative
  and substantial evidence?
• Is Board Order in accordance with law?
• Either Affirm, Reverse, Remand
• Court of Appeals
• Did lower court abuse its discretion?
• Supreme Court of Ohio
• Matter of Great Public Interest
• Constitutional Issue

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The Disciplinary Process
Issuing the Citation
Request for Hearing
Administrative Hearing
Board Decision
Appeal
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Consent Agreements

• Parties may agree to settle a matter during the
  investigative stage, or after being charged. The
  terms must be initially approved by the Board
  Secretary.
• The Consent Agreement must be approved by the
  Board
• The Board does not plea bargain cases are
  settled when the public is adequately protected,
  and there is accountability for action/behavior.

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Sanctions

• Reprimand
• Probation, terms
• CE
• Pro-bono work
• Personal appearances
• Definite/Indefinite Suspension with conditions
  for reinstatement
• CE
• Impairment terms very specific
• Permanent Revocation
• Permanent Loss of license to practice

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Quality Intervention Program (QUIP)

• GOAL of the QUIP Program to address certain
  enforcement issues more efficiently and
  effectively, while ensuring public protection.
• The Quality Intervention Program (QUIP) provides
  an alternative to formal adjudication whereby
  education is recommended to dentists who have
  demonstrated that they have engaged in practice
  patterns that fall below the accepted standards
  of the profession.

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Focus of QUIP

• The Quality Intervention Program (QUIP) is
  intended for licensees who have demonstrated
  practice behaviors which are careless and less
  the optimal, but who have thus far caused no
  serious harm to patients.
• QUIP enables the Board to intervene early and
  direct these licensees to appropriate remedial
  education tailored to their specific
  shortcomings. The education must be done at an
  ADA accredited dental college. The dentist, if
  successful, is not subject to formal
  disciplinary action. The licensees is then
  monitored to ensure success in the remediation
  efforts.

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Why Discipline

• Punishment
• Rehabilitation
• Deterrence
• Focus is ultimately protection of the public.

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Current Issues

• Lead in dental work
• Bleaching kiosks in malls
• Use of restalyn and botox by general dentists

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WEBSITE dental.ohio.gov

• Information on Board Members, Staff, Schedule of
  Meetings
• Minutes
• Publications
• Laws, Rules, Policies
• Applications/Forms
• Licensure Verification

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GOAL

• Protection of the Public