Oklahoma’s Dental Act was intended to ensure patient safety, but limited funding for regulators, a small staff and a state prohibition against surprise inspections restrict its effectiveness when there’s trouble.
The state Dentistry Board claims a Tulsa-area oral surgeon ran an unsafe practice and, over the past six years, put at least 7,000 people at risk for contracting hepatitis or the virus that causes AIDS. Last month, it branded Dr. W. Scott Harrington a “menace to the public health” in a 17-count complaint that could lead to a license revocation. It also urged his patients to submit blood for medical tests, and nearly 2,000 have done so.
Harrington operated below the radar because the system depends on dentists and oral surgeons to police themselves – and a law prevents spot checks of their offices.
“Our people have post-graduate degrees and we expect them to do what they’re supposed to, but we all realize there are smaller groups out there who don’t,” Susan Rogers, the Dentistry Board’s executive director, told The Associated Press in an extensive interview. “Ninety-nine percent of the dentists and oral surgeons are doing what they are supposed to be doing, but yes, dentists and oral surgeons operate in Oklahoma on an honor system to some extent.”
Oklahoma, with three inspectors for its 2,200 dentists and oral surgeons, is not alone in expecting its professionals to act professionally. California sends out inspectors only if a problem is reported among its 30,000 dentists, as does Colorado, which made no changes to its procedures after a dentist was accused last year of reusing needles and syringes.
“If you look at what the guidelines and regulations are in health care settings, they are very stringent,” said John Molinari of Ann Arbor, Mich., an infectious control expert for the American Dental Association. “There are standards that the profession has adopted and complied with. You won’t see a practice not routinely wearing gloves, for example.
“It’s not a camaraderie thing, there are regulations. There are standards for infection control. The patients trust that the dentists are providing safe care and it becomes a professional responsibility,” Molinari said. “They don’t have inspectors to go out to every office routinely.”
Inspectors from Oklahoma health agencies intervened to check on a report that one of Harrington’s patients had contracted hepatitis C and HIV, perhaps around the time of recent dental work. While it was later determined the patient had only hepatitis C, the Dentistry Board said it found filthy conditions behind Harrington’s clinic’s tidy facades and scheduled a hearing for April 19. Harrington’s lawyer, Jim Secrest II, issued a statement saying Harrington’s previous record with the dental board was “impeccable” and that the oral surgeon is cooperating with investigators.
The Dentistry Board operates with a budget of less than $1 million – relying on license fees that range from $25 for a dental assistant’s annual certificate renewal to $500 for an initial license testing fee. The Legislature provides no state funding and the chairman of the Senate Appropriations Committee says if the board wants more money it has other means to pursue it.
“We would not be increasing their funding. If they wish to increase fees to increase their funding level, they would have to initiate that change,” Sen. Clark Jolley, R-Edmond and chairman of the Senate panel, said in response to questions submitted by email.
Under the state Dental Act, Rogers’ agency receives about 100 complaints per year, often about missing drugs, alleged sexual misconduct and unlicensed dentists who might set up a shop in a garage and perform work on the poor or uninsured. To watch 2,200 dentists serving 3.8 million Oklahomans, she has three inspectors and one unfilled position – and the state law limits her to only five employees. The board has used secretaries and office assistants to perform undercover work and report back.
And, as a lawyer, Rogers serves as the agency’s general counsel to save money.
“If I had a wish list, it would be more investigators by far,” she said. “Doing regular inspections after this situation probably need to be done. Is that my decision to make? No. Is it something I’m going to recommend? Yes. There’s going to have to be some changes made.”
Jolley said he anticipates the Dentistry Board will seek changes in its operations but warns modifications won’t be approved automatically.
“We need to also make sure that they aren’t overreactions to a very bad situation in Tulsa,” Jolley wrote to the AP.
The transmission of infectious diseases by dentists and oral surgeons is extremely rare, with only three known cases, according to the Centers for Disease Control and Prevention. The Oklahoma and Tulsa health departments recommended that Harrington’s patients be screened for hepatitis and HIV as a precaution, not as a result of any known transmission.
“The overwhelming majority (of dentists), to the point of 98 percent or 99 percent, are doing above and beyond of what’s required by law because they’re afraid of getting sued,” Rogers said. “There are the ones where there is the disconnect. When you think of (Harrington), if you think back, he started practicing in 1977, so in 1977 they weren’t required to wear gloves. There was no hepatitis C. No one’s told him you need to change this because he hasn’t received a complaint.”
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