What's the Impact on a Dentist's License if an Unauthorized Person Prescribes on Your Behalf?

      

IMPORTANT Notice To Dentists:

 

       While reading a Tampa Bay Times article this morning about a doctor who left his prescription pad unsecured which allowed someone to forge the Dr.'s signature on the unsecured RX pad, I was so shocked to see that it caused a death to occur to the recipient of the forged, stolen RX pad. Here is the link to ABC Action News' FB Page, which reported this story this morning on the impact of a stolen doctor's prescription Pad. This is a very disturbing situation with a very disturbing outcome. 

       

       While this situation happened here in the Tampa Bay area with a doctor's family member stealing and forging the dr's signature on a prescription pad, it can EASILY occur in dental offices anywhere. I am reminded of how many times I visit dentist's offices and see the dentist's prescription pads in an unlocked cabinet, and sometimes at the front desk; both unsecured. I have also seen COUNTLESS staff members go into patients' digital charts and print out prescriptions for patients that the DENTIST should be doing. 

       

       I'll go one step further to state that I've seen dental practice staff members have full, unrestricted capabilities to type in and print out prescriptions anytime of any day because the dentist(s) have not restricted this capability through tight administrative controls of their dental software. Audit trails are rarely run to ensure the security of these important systems are in place. In fact, like the story above, doctors and dentists usually find out about these forged signatures, or digital prescriptions with a "signature on file" stamp automatically placed on them, when something awful happens and it is exposed. It is too late when that happens, and the negative outcome is something that impacts the doctor and dentist, for many years to come, sometimes. 

   

       So what happens to a dentist's license, or doctor's license when that happens? A number of negative actions can unfold and cause a series of penalties and potential sanctions from a few different agencies. Because the dentist or doctor could be considered to have been "negligent" in securing their prescription pads, which is a legal requirement for dentists and doctors, they may incur an investigation and potential charges by their governing Board (of Dentistry, for instance). Additionally, they may be subjected to an investigative action or sanctions (restriction or revocation) by the Federal government, HIPAA, and/or the DEA (Drug Enforcement Agency). Here is a short 6-page summary on Prescribing in Florida that provides specific statutes where the rulings can be found, and is a GREAT reference for dentists in Florida! I generally keep this document handy, but then again, I'm a well-known "Landfill of Useless Dental Information" as my sons call me. I prefer to say that I am a walking, talking "Plethora of Useful Dental Information" instead. It has a much better ring to it, don't you think? :)

 

Anywhoooo, I digressed here.....back to the sactions discussion!

 

       Doctors and dentists who have had sanctions from their Board, and/or the DEA, with restrictions or revocations for prescribing schedule and legend drugs, can be found on the website Florida Controlled Substance Prescriber Registration. This is where you can look up a "Practitioner Profile", or look up "A License" and of course where doctors and dentists in Florida must "Register".  I always recommend that dentists look up their own profile and license to check that all is accurate and correct, but also to check on the licenses and profiles of other dentists within their office or immediate area. Why, you ask? Because many times dentists who are sactioned by their Board and the DEA have restrictions on their licenses that don't allow them to prescribe medications, and it is important for all to know, for the sake of safety (first and foremost) and secuirty. The situation below is the perfect example of this.

 

       Recently, I spoke to an associate dentist who was very upset about how the dentists and directors of the "practice management"- owned (which violates the Dental Practice Act, but that's a WHOLE other story) office he/she worked in were not complying with different laws, rules, and statutes. This dentist was wondering what the impact might be to his/her license by being associated with such a dangerous, non-compliant office. After speaking to the Chairman of the Board of Dentistry here in Florida, I was able to pass on important information on who to contact, and how the situation needed to be handled by the associate dentist. In addition, we reviewed all of the licenses of the dentists that own and/or work within the same dental practice and we were FLOORED by what we found. What we found (sit down, this is a mind-boggling result) is that NOT ONE of the OTHER dentists who owned, nor were currently practicing dentistry on patients with complicated treatment plans, had a DEA prescribing license!!! 

 

       This associate dentist that had the "bad gut feeling" about the dental practice they contracted with after graduation to work for, was the ONLY dentist in the practice with a current, active, and unrestricted DEA license for prescribing schedule and legend drugs, and treating "chronic nonmalignant pain" as defined by the Florida Controlled Substance Prescriber Registration!!! How can that be? Well, we discussed that (drug abuse, prescription negligence, frequent violations that lead to revocation, suspension, etc.) and it suddenly dawned on this dentist that they CAN'T possibly be the only person to prescribe schedule and legend drugs since the OTHER dentists in the office were SEEN and KNOWN to be prescribing schedule and legend drugs in the practice during the short timespan this poor associate dentist was working there!??!! This naturally led us to wonder who's name and/or prescribing license number were being used by those other dentists who had NO DEA license to prescribe them. Did this associate dentist leave his/her prescription pads in an unsecured location or with the capability of anyone accessing them, stamping "signature on file" and printing/digitally delivering them to whomever? We don't know as of this date, but the possibility exists.  "Things that make you go Hmmmmmmmmmmm......."

 

       The moral of this story is still unfolding as this situation continues to proceed on and follows the correct channels to legally follow by this associate dentist.  Dentists who are working for larger, or corporate practices should absolutely, positively review DAILY what prescriptions have been written and issued and by whom. If a large group practice or a corporate practice tells a dentist that they should just "worry about their clinical skills and not worry about tracking reports in the dental software" (such as a daily report on prescription activity within the practice), then my recommendation to that associate dentist is: RUN FOR THE HILLS AND DON'T LOOK BACK!!!!!  This is YOUR license, and YOUR legal responsibility, and NO ONE else is accountable for following the laws on Prescribing in Florida, except YOU, the dentist.

REMINDER TO ALL DENTISTS: 

       Secure your prescription pads in a locked cabinet for which only you have the key to! For digital prescribers: Do not allow ANY staff members except you, the dentist, to create prescriptions in your dental software. ALWAYS run a daily report on Prescriptions Written in the practice and by whom, at the end of EVERY day, as a basic accountability tool, and SAVE those reports in a secured, locked file cabinet or in a password protected desktop computer file. Ultimately, the dentist, and the dentist's LICENSE is at stake here ALWAYS and it is a LEGAL responsibility for ALL dentists and doctors to keep them secured. 

 

So, The Bottom Line Here is: DON'T let this happen to you!

 

       Well, that's it for me for today. Thanks for stopping by, and remember; you only have to brush and floss the teeth that you ABSOLUTELY, POSITIVELY want to keep. That's it; nothing more. 

 

Dr. Driscoll

The Tulsa, OK Dental Debacle: How Could This Happen???

       So, before I say another word, let me start out here by giving you the link to the actual Case Documents filed by the Oklahoma Board of Dentistry against W. Scott Harrington, who has surrendered all of his dental licenses. Here is the Link: Ok Board of Dentistry versus W. Scott Harrington. Ok, now that I've gotten that off my chest let's take a deep, dark and UGLY look at this absolute dental debacle of a magnitude that has been unsurpassed in my 30+ years in the field. And when I say this is UGLY, I mean it is UGLY. The laws of common sense did not exist in this destructive dental office, which has been labeled as a 'menace to public health'. There are many, many lessons that can be learned from this dental debacle, which is why I'm going to write about it, but I warn you...it is UGLY and may warrant a big, fat glass of Merlot, or a half a xanax to get through this whole blog entry calmly, due to its overwhelmingly disturbing nature. So, go get yourself a stiff drink, while I wait for you...no, no...go ahead; I'll wait. Believe you and me, you're going to NEED it.
       Ready? Alright. Where to start. I'm still shaking my head in utter disbelief. This makes that last Board of Dentistry meeting that I blogged about look like a walk in the park.......since I can't put this off any further...here goes. For the sake of reality, the former dentist (who is no longer a dentist) will be referred to as WSH (for W. Scott Harrington) in this blog posting.

Astounding Fact #1: WSH got his dental license in 1974 (OK dental license #3666). That's almost 40 years ago. He must be in his 70's and still "practicing" (ahem) when this all came to light and his Oral Surgery specialty license was granted in 1977. That license number is 59. 59!!! That's the same as having a social security number that's only 2 digits long! Due to limited record keeping (they couldn't find the stone tablets of his original dental patients?), the complaints only date back to the last 3 years. HOWEVER, over 7000 patients were notified that they may be at risk of contracting HIV, Hepatitis B and Hepatitis C, and should get tested immediately. Over 7000 patients in a 3 year time period? Was this an assembly line or a dental practice?? Original CNN Article About 'A Perfect Storm' for HIV

Astounding Fact #2: On March 15, 2013 ("beware the Ides of March", said Brutus to Caesar) investigators conducted an in-office investigation based on a complaint by a patient who contracted both HIV and Hepatitis C (both potentially fatal individually but together- a total powder keg) who had no other risk factors besides getting dental treatment done. The investigators found "multiple sterilization issues, multiple cross-contamination issues, the drug cabinet was unlocked and unattended during the day and dental assistants were routinely providing the IV sedation for the procedures". WHAT??? Did you just say that DENTAL ASSISTANTS were providing the IV SEDATION for the PROCEDURES??? HOW is this even POSSIBLE?? It's 2013 and we are in the United States of America here, for heaven's sakes!!! That defies basic LOGIC and COMMON SENSE!?!?! Dental assistants can't provide IV sedation and yet in this situation they not only PROVIDED it, they DETERMINED which drugs and time frames for each sedated patient they IV sedated!??!! My 5 year old grandson knows that can't happen! How and when did the dentist EVER think this was acceptable or allowed, and a better question to ask here: how the heck did the DENTAL ASSISTANTS think this was a 'delegatable' duty???? This one defies all sense of rationale. There is no way that either that 'dentist' or those 'dental assistants' could have thought this was acceptable. There are no courses for dental assistants to become certified to administer IV sedation. None.  It is clearly stated in the Oklahoma Dental Practice Act Here. 

       WSH's one dental assistant was with him for over 27 years, and the other for over 6 yrs. Both of them could read and write. Neither of them were blind, nor developmentally disabled. Therefore, they could have CLEARLY seen the Oklahoma Dental Practice Act and unless these ladies lived under a ROCK, there is no way they would have ever SEEN anything stating that they could perform such medical procedures when they didn't even have formal dental assisting training or permitting as assistants! This is just criminal, in my opinion. Ignorance is not a defense. It is impossible for these ladies to have NOT known they couldn't perform this service. Impossible.  However, WILLFUL violations not only get licenses/permits revoked, but can cause a dentist and dental assistants to face criminal charges for this type of heinous disregard towards over 7000 patients. It's not often that I advocate criminal charges, but in THIS case, I believe they are warranted AND that the dental assistants should be charged as aiding and abetting, willful accomplices. I believe the phrase Charlatans comes to mind, like the circus 'scammers' pawning their elixirs to fix what ails you. These are life threatening illnesses that patients were at risk of getting, with one already contracting two of them. It really should be attempted murder, but hey, that's just my opinion, and it's the first time I've felt this way in over 30+ years of my career. This is unimaginable, inexcusable, and intolerable.

Astounding Fact #3: The Oklahoma Health Department held a free screening for patients of WSH on 3/30/13, to test them for HIV, Hepatitis B and Hepatitis C, plus established and are manning a phone hot line. 420 prior patients were tested. This, of course, is at the expense of the taxpayers of Oklahoma, which is, in my opinion, a double jeopardy for patients and citizens. It was a fantastic and quick response (by the OK Health Department) for testing the panicked 7000 prior patients of WSH, but HIV can lay dormant for years (as established by significant prior available research), which means regular and routine testing over the next 7-10 years will need to be conducted on all of those patients. At who's expense, is still undetermined. Personally, I would urge the Oklahoma Board of Dentistry to estimate out the cost of that present and future expense, and add it to the Case against WSH for him, or his estate if need be, to reimburse the state of Oklahoma for that resulting consequence of being a "menace to public health". But, again, that's just my humble opinion....And by the way, the PUBLIC hearing for ex-dentist WSH to face the OK Board of Dentistry (the public is invited to attend ALL Board of Dentistry meetings and I WISH I could attend this one!) is slated for April 19, 2013 at the State Board of Dentistry headquarters at 201 N.E. 38th Terrace, Suite 2, Oklahoma City, Oklahoma, and begins at 10:00am, should any of you decide you wish to attend this hearing where WSH will be sanctioned....I'm just saying.....

Astounding Fact #4: When asked to see where the dentist, dental hygienist, and dental assistants' licenses and permits were located (they should be clearly placed where all patients can see them as current), the office manager found some in a file folder in a cabinet and others were missing. That's right; they were missing. That would be the same thing as not having them, or never having gotten licensed/permitted, as required by the state of OK. The one dental assistant had NO radiography permit, nor ANY formal dental assisting training AT ALL, EVER, the ex-dentist only had licenses for ONE of his TWO office locations, and the ex-dentist did not have an IV sedation certificate/education/training/license/permit; let alone his assistants who performed the actual IV procedures. In fact, they weren't fully trained even in dental assisting! How's THAT for a slap in the face reality-check! This prompted the office manager to state to the investigators (who advised her they should be active, current, and placed in a conspicuous place), "we need YOU (the investigators) to educate us on that". I don't even know how the investigators could've kept calm on this site visit! Honest to God! I would have stood there stupefied, with an open mouth, and a seriously twitching left eyebrow, in SHOCK from hearing that absurd statement leave the office manager's mouth!! Oklahoma has a clear, comprehensible website with their rules and statutes easily seen and listed on the website, as does OSHA, HIPAA, Dept. of Labor, CDC, DEA, Board of Dentistry, ADA, AND, on top of THAT, Continuing Education required of WSH would have provided him and his staff with that information on a regular biannual basis!! In other words, there are NO excuses for this level of ignorance, which only leaves readers and investigators with the conclusion that this was blatant and willful, which should be prosecuted to the fullest extent of the law.  "Additional counts may be added as the investigation continues...", states the Case document by the Oklahoma Board of Dentistry. Wow.This is a no brainer, folks. My guess, is that these 17 counts of serious violations, are the tip of the iceberg, and other agencies will be notified (such as OSHA, HIPAA, HHS, DEA, CDC, OK Attorney General's Office, etc, etc,) to jump in the ring here and conduct their own investigations of what other violations occurred. Stay tuned for more violations and charges to likely become known when these other agencies conduct their own investigations; which I believe will happen.

Astounding Fact #5: Drugs and anesthetics in WSH's office were scattered willy-nilly all over the place (including inside of blood stained boxes that were carried to the OTHER unlicensed location by these dental assistants), were not inventoried nor logs kept of their daily usages on patients, were reused on other patients, were NOT kept in a secured, locked cabinet (all of these are requirements; hint, hint), and were EXPIRED with some dating back to an expiration date of 1993! That's TWENTY years ago!! How in the HECK did NO ONE who worked in this office have the common DECENCY to say, 'Hey Doc, we really need to think about going through our scattered drugs in this office and trash the ones that are EXPIRED from TWENTY years ago' (!). Not ONE single employee. Not a one. It doesn't appear that they were bullied, or harassed, or threatened by this ex-dentist so what the HECK, ladies??!!?? These were your neighbors, your fellow community members, the single moms, the poorest and sickest people living in your towns and not ONE of you had the GUTS to stand up and say this isn't RIGHT?? THIS, to me, is the worst of the worst of these offenses. In other words, and in my HUMBLE opinion, these other employees were JUST as guilty as the ex-dentist. They should face criminal negligence charges (IMHO). I have NO idea how these ladies, who were named in the complaints (Shout out to this country's most notoriously insensitive, dangerous, additional  "menaces to their communities", Terry (Waugh) Valega and Lisa Young) could even SLEEP at night over this. I just have NO IDEA how they can LIVE with themselves over this willful disregard and danger they put their neighbors in, who now has/may have, life-threatening diseases. I'm so disturbed by this lack of humanitarian action. How no one could say anything about how wrong this all was is just beyond comprehension. It's unfathomable.......(still shaking my head in total disbelief).....

       So, here we are. A dental debacle of significant proportions that will live on in the minds of our potential and future patients for many years to come. We, in dentistry, are stuck looking at each other with a deer-in-the-headlights look of "How could this have happened for so long??". There just are no answers at this time. Hopefully, as the case evolves, some answers will come to light that we can really evaluate and create solutions from. In the meantime, the damage continues....

       These mind-boggling factual details of this Case No: 13-005 will grow as the investigations, case, and sanctions grow and evolve. They say that 'something good comes out of something bad eventually' (author unknown). I'm not sure if the trusting patient who now has HIV and Hepatitis C can embrace that inspiring quote, nor should they be able to right about now, but these are actionable and criminal offenses, in my eyes. In the long run, when the shock and outrage and sadness wears off (theoretically and in a perfect world), we will dissect this case, beef up our training schedules and requirements for dentists and their staff ALL over the country, and learn enough to NOT have history repeat itself with a similar dental debacle (hopefully).

       For now, though, this is an incredibly sad day for dentistry, as a whole, and an even sadder day for 7000 patients who trusted their ex-dentist. We have damage control to take care of immediately, to restore the faith lost in our field of dentistry. I will be posting additional blogs very soon on damage control, restoring faith in dentistry, and ensuring our offices, teams, and patients feel confident with our safety, compliance, and infection control protocols and procedures. We simply MUST learn from this. We simply must. And learn from it we will, because dentistry is too important and society needs dentistry and dentists whom they can trust. Unfortunately, we have a lot of work ahead of us but I'm confident that we can do it. I'm tired just thinking about all of the work that we have ahead of us to correct this...I just wish that ex-dentists like this, and complicit staff would stop making it so hard for the dentists and teams who are honorable, trust-worthy, and put their patients' needs and safety FIRST, who will now have to work harder to overcome these negative dental stereotypes that this OK dental debacle just created. In the end, the reality is that the vast majority of dentists and dental teams are inherently good, and that will outshine the darkness of this bad situation, any day.

       Well, that's enough from me today. Thanks for stopping by and remember; you only have to brush and floss the teeth that you ABSOLUTELY, POSITIVELY want to keep. That's it. Nothing more.

Dr. Driscoll

Reality Slap 101: Dental Disciplinary Meetings...Not for Amateurs...

       So, as I sit here after a whirlwind day of disciplinary hearings, I'm exhausted, yet more passionate than ever about the fate, and the future of our field of dentistry. But I have to just say it because I'm STILL shaking my head....Holy Hot Dental Messes, Batman! When will dentists learn that they can run but they can't hide when it comes to complaints filed, violations piling up, disciplinary sanctions issued, fines, penalties and costs multiplying like rabbits? And, might I just add that showing up to face these unattractive situations completely unprepared is NOT a good STRATEGY!!??!! You know, it takes a lot to shock me...really...but today, I'm still rather stunned and definitely shaken...as I patiently await the appropriate time for the commencement of Merlot-Thirty to smooth out the jagged edges created by 23 disciplinary actions, and 3 (count them THREE) dentists who 'Voluntarily Relinquished their Licenses'. Yowza! How the heck does it even GET to this stage? This is a sad day for Florida dentists, my friends, but as soon as I'm done mentally processing this catastrophic situation, I will get up, dust myself off, and trudge on with renewed purpose to save dentistry....one dentist at a time. Unfortunately, I feel like I will need to be working OVERTIME on that monumental task. Ugh....

       So, let's back up here for a second. When I received the agenda from the Board of Dentistry for today's meeting I was extremely disheartened to see ALL THOSE DENTISTS' NAMES on the docket to address complaints issued against them, plus 3 dentists who have to literally give up their license...as in, you will NEVER practice dentistry again because you did NOT learn your lesson the first, third, or twelfth time you were sanctioned (in more states than just Florida, for some) so we are left with no choice but to have you VOLUNTARILY relinquish your dental license. Period. The End. Buh Bye, Dental Career and Future Dental Income! It sure was nice knowing you, and you DEFINITELY will be missed!

        That really hit me and I began researching these situations to find out how this could happen to not one but THREE dentists in this FIRST Board meeting of the year. We still have 3 more meetings to go this year and the docket is overwhelmingly full! In fact, many of these cases go back to 2009 so this is one heck of a pile of complaints and actionable violations here yet to be resolved. Where's my massive shovel and flashlight when I need them most? This pile literally needs some strong TOOLS to get through here!

       Well,  like a combination of a good archeologist and Sherlock Holmes, I can pretty much dig up anything on anybody so researching these situations unearthed a dentist with many relinquished dental licenses in many other states BESIDES Florida.....! What the heck??? Ok, this sounds like we have a 'Serial Dental Violator' on the loose in Florida that has finally been caught but I still ask myself...what in the heck are these dentists thinking? I can imagine a trail of lousy dental work and dissatisfied patients across many states who have pursued on, followed these dentists' trails, and filed complaints to each state's Board of Dentistry (exposing the sins committed in prior locations), with tenacity and newly-scorned determination, until one by one, the licenses were revoked; state by state. How awful. How truly, really, awful. Everyone loses in a situation like this; patients, communities at risk, colleagues fooled, and the field of dentistry with additional burdens trying to minimize the damage and continual repairs needed to FIX this bad situation ("reputation management", we now call it). How ridiculously sad......Merlot-Thirty can't come quick enough today it seems.

       On good side of this, however, and yes, there really IS a (small) good side hiding underneath this pile of disdainful disciplinary damage, which can be taken away from today's injurious events, and that is this: there are some VERY important lessons that can and should be learned from this hot mess of a situation. If a dentist ends up being summoned by the Board of Dentistry for a Disciplinary Hearing, I STRONGLY recommend the following actions be undertaken by the dentist (pay attention here; this is where I get direct):

1. SHOW UP ON TIME!
For the love of GOD, make this a priority and DON'T go into other areas to talk on the phone, text whomever, or check on your emails while waiting to be called!! This SHOULD be common sense but it was not for some dentists. The Board members had to go OUT into the HALLWAY and call out the dentists' NAMES, for heaven's sakes, and it would appear to me that there was DEFINITELY a correlation with less patience on behalf of the Board (and rightly so) and more cases being settled in record, speedy, time with little opportunity for negotiating or commenting (again, and rightly so after wasting the Board's time HUNTING for dentists). In fact, one No-Show dentist received the highest fine of the day of $20,000.00 (not including court costs, restitution, or other fees assessed) which was hitherto stated as Moved, Seconded, and So Accepted by Board members in 'likitty-split' fashion! Poof! Just like that! You win the big penalty prize of the day! Done! 20 Grand Now Due! Please Remit Immediately!Thanks so much and Have a Great Day!

2. BE PREPARED!
Bring every and all documents related to this and other situations similar to this violation, like CE records, Payment or Refund Information, Letters of Apology to whomever, Witnesses or Witness Statements that are Notarized for the events that took place, and if guilty of the violation, ADMIT IT, show attempts at restitution, and illustrate how this violation can be AVOIDED in the future by the new PROTOCOLS that have been put in place to correct the error and/or deficiency that caused the violation! I was literally flabbergasted at how unprepared these dentists were and how their inability to prove anything stated impacted their accountability. I sat there and listened to dentists state that they have learned their lesson but when asked by a Board member (and rightly so!) what changes have been made in their practices to avoid this happening again,.... NOTHING CONCRETE was even explained! No new protocols, no new training, no new safety precautions, no new continuing education completed, no new checklists designed, NOTHING...other than, (and I'm paraphrasing here) 'Well, I know not to do that again". Huh??? That's IT???? If I wasn't so stunned at the lack of preparedness for a vast number of these cases, I would have likely seen the equally stunned look on the faces of the Board members who (I'm told) were as incredulous as I was!

3. ACCEPT ACCOUNTABILITY!
Since no one is perfect, and people of all professions and walks of life make mistakes everyday, it is how these mistakes are CORRECTED that can make a powerful and more positive impact on the end result. In fact, here's the research from the National Institute of Health to substantiate this approach: Communication Gaffes: A Root Cause of Malpractice Claims. Therefore, I STRONGLY suggest (as do the researchers on this topic) that an attitude of humility and honesty be taken, that dentists not argue out the details of a bad situation in an attempt to make it all SOUND better than it is, and APOLOGIZE for the mistakes made. I recognize that if dentists were able to do this to begin with then 98% of the complaints submitted to the Board of Dentistry would likely not be submitted at all, but I know what I know about this topic and here's what I know. Dentist's don't like confrontation, nor do they like admitting they are wrong on something regardless of the fact that doctors in all disciplines make mistakes from time to time as well. I don't know how dentistry compares to doctors, since I'm in dentistry, but I do know that dentist's generally don't like confrontation. Ask any staff members of dentists and they will likely confirm this (in my humble opinion). Being arrogant, argumentative, defending the actions, or worse yet CRITICIZING the complainant and/or patient will get dentists an UBER-UGLY result! In FACT, if a dentist DID make a mistake, and actually DID apologize for it to the patient and whomever was impacted by the mistake, there is a VERY real likelihood that the complainant would not even REPORT it to the Board of Dentistry, ESPECIALLY if a dentist attempted to CORRECT it to the patient's satisfaction level! But no...that does not happen as much as it should based on the 26 names and cases on the Disciplinary Agenda for this meeting alone. We still have three more to go for this year. I'm pooped just thinking about it.

       So, here we are at the corner of What The Hell Just Happened Street and You Just Lost Your License Boulevard, and it's an ugly crossroad to be standing at, and an even uglier place to spend the rest of your life living in; I can assure you. I'm hoping that the severity of this sobering meeting will make a difference in the way mistakes are handled by dentists. I'm hoping that this lesson in Reality Slap 101 is an effective "redirect" for dentistry as a whole. If you are a dentist, and you're reading this, and you're angry at my words, chances are that you may have a negative attitude that will not get you far in the field of dentistry (in my HUMBLE opinion). It just won't. If you're a dentist and you read this and you're saddened, shocked, or embarrassed by my words, then there's hope for you going forward because you realize the seriousness of this situation. I call 'em as I see 'em and this one was ugly on all levels. Let's face it; they don't call me the Scariest Woman in Dentistry for nothing. And, if you're a dentist, and you're having a hard time believing the severity of this meeting, or the facts and opinions stated here in this blog posting, then I invite you to visit the website for the Board of Dentistry's Meetings and download the Meeting Minutes from past meetings, as well as this meeting which will be posted soon.

       Additionally, I encourage you to attend a Board of Dentistry meeting, and there are 3 others this year in Jacksonville, Orlando, and Gainesville. In fact, here is the link: Florida Board of Dentistry Meetings and Minutes. It will be an eye-opener for sure, and hopefully, it will impact your own practicing of dentistry in a more positive way. That's my hope and I'm going to keep hoping that it will. In the meantime, there's a 'crap-ton' of more work to do to save dentistry and dentists themselves, so I'm going to get off this blog and continue my massive amount of work on that next!

       Thanks for stopping by, and remember, you only have to brush and floss the teeth that you ABSOLUTELY, POSITIVELY, want to keep. That's it. Nothing more.

Dr. Driscoll

 

I've officially read the Dental Xray Study! Round two (ding, ding!)

FINALLY, my final comments on the controversial study on dental x-rays and brain tumors.........ugh.

       First, below is the link to the study documents. Well, actually it is the 8 page condensed version that was published by the peer-reviewed journal, Cancer. At the top of the page you can click on the "Full Article (html) and that leads you to view the full article (a whopping 8 pages!?!?) or download the PDF version. Personally, I'm rather surprised that an article attempting to tie dental x-rays with brain tumors is only 8 pages (including references, no less). That's pretty short in publication terms, especially for an article of this suggested "profound correlation" to the "Big C". Most journal articles with a thought-provoking topic like this are normally 15-30 pages long. I know, because I review them for a number of respected peer-reviewed journals, such as The Journal of the American Dental Association, The Journal of Public Health Dentistry, The Journal of Sexually Transmitted Disease, and a journal called Vaccine. Believe you and me, 8 pages is a walk in the park compared to most comprehensive studies accepted for publishing! (Hint, hint)..

  I have read the study documents numerous times by now. I've also been developing and teaching an executive-level business program specific only to dentists, which is why I'm just now getting back to this blog. Going forward, I'll be blogging regularly again since there's apparently NO END to the controversies we have in dentistry! So much controversy....so little blogging time...but I digress...

Link to Study: http://onlinelibrary.wiley.com/doi/10.1002/cncr.26625/pdf

Dental Xrays and Risk of Meningioma Study

       Ok, here we go...
I officially stand by my prior rant of a post regarding this study. It is beyond flawed. The fact that it was conducted by researchers from Yale probably had a lot to do with it being published as Yale is a (normally) prestigious ivy-league university, of (hopefully) prestigious ivy-league researchers (ahem). HOWEVER, it is so flawed in so many ways, that I am FLOORED it was approved for publishing. Floored, I tell you!

        I read through this 8 page document in no time flat, while my blood pressure rose alarmingly high due to my growing outrage over its contents and assumptions. Honest to God, my blood pressure was off the charts by the time I was done reading it and looked at who in their RIGHT MIND had funded this study. Then I calmed down.....and I started to smile...and actually laugh a little. Why, you ask? Well, because this study was funded by the National Institutes of Health by 5 R01 grants (FIVE!!!) PLUS funding from the Brain Science Foundation, and also by (get ready for this one, folks, because it will have you in stitches momentarily) the Meningioma Mammas. That's right. You read this correctly. In fact, the total wording from this document states: the following:

"This work was supported by National Institutes of Health R01 grants CA109468, CA109461, CA109745, CA108473, and CA109475 and by the Brain Science Foundation and the Meningioma Mommas."

       Huh? What? Who in the world are the Meningioma Mammas and why are they sponsoring/funding this study? Well, I now know who the Meningioma Mammas are from their website (thank you, Google!) and I'm still thoroughly confused as to how this group is even associated with, or attempting to fund an ivy-league research effort. Granted, they are looking for answers in the form of correlations so they can find out why people are getting these common tumors, but for Yale to have to take that funding from this group, after using 6 other forms of grant funding from respected sources, is unbelievable, really.

        To get the FULL SCOPE of this, these Yale researchers (who are NOT dentists, by the way) had to secure funding from THREE sources, and FIVE different NIH grants, and the best they can produce is an 8 page document based on childhood memories of dental visits from 70 year olds??????? Wow. What in the heck did they do with all of that money (more than half a million dollars just from one grant alone) and no other means of gathering data than to ask people in 5 locations to remember and recount what type and how many x-rays they received throughout their childhood and adulthood with NO factual verification of these self-reported memories? Yowza.....unbelievable....

       Apparently, I'm not the only PhD in the pack to really object to this study, its flawed methodologies, and its attempted tie-in of dental x-rays and brain tumors. An NYU College of Dentistry dental researcher (Dr. Arthur Goren) called the results of the study "based on supposition", and was further outraged by the fact that the study was not "reviewed by a dental radiologist (prior to publication)" and called it "ludicrous". Many other members of the American Academy of Oral and Maxillofacial Radiology (AAOMR) disputed the (ahem) results of this study at their November 2012 annual meeting held in Savannah, Ga. AAOMR Statement on the dental xray & meningioma study conclusions

     I feel validated! It IS INDEED ludicrous! I remain staunch in my position that this study was SO flawed, and very over-funded (in my HUMBLE opinion), with ludicrous conclusions based on "guestimates" from people of all ages, including senior citizens. To say this is unacceptable is an understatement. It is flat out IRRESPONSIBLE to ATTEMPT to correlate dental x-rays (from antiquated machines back in the 1960's) with brain tumors, based on guesswork as the basis of the data collected to come to this conclusion. Yale, or no Yale, this study should NOT have been published and lacks all evidence-based scientific credibility (in my HUMBLE opinion). Oh, the horror!

       As Karl Pilkington, from An Idiot Abroad, would say; "Its BULLOCKS!"... and I have to say.....I concur. Not only do I agree, but officially feel validated from all of the other responsible researchers disputing the conclusions made in this ghastly study! Finally! Common sense has prevailed!

       Well, that's all for me today! Thanks for stopping by, and remember...you only have to brush and floss the teeth that you absolutely, positively want to keep. Nothing more. That's all.

Dr. Driscoll

Ok, let's talk about this controversial dental x-ray study...

Since I appear to be on a roll with a number of issues these days, including dental xrays, I might as well add the latest (and very controversial) study to come out about the "links" between dental xrays and some form of brain tumor. It simply must be addressed, as I've been asked my opinion on this a lot recently. As usual, I conduct my own research on the research reportings, plus the fine print (of course!), before presenting the facts. THEN, and only THEN, do I give my opinion. So, here goes...here's what I found....and hold on to your hats, 'cuz this is going to be one heck of a bumpy ride...just sayin'..(shaking my head)...

First thing to state here is that there is a significant difference in the way this study was reported by three sources. Significant is an understatement. I have to wonder if I'm looking at the same study results here. I've looked at four articles "reporting" the study results. I have not viewed the actual study itself as it is not yet accessible to me through the journal Cancer, that published it. I can assure you, though, that I WILL read that study and report back on it, as soon as I can access it. So, consider this Round One (ding! ding!) of this controversial study.

Here are the links to those articles:
1. The Washington Post
 http://www.washingtonpost.com/blogs/the-checkup/post/study-links-dental-x-rays-to-brain-tumor-risk/2012/04/09/gIQALz8k6S_blog.html
2. WebMd
 http://www.webmd.com/brain/news/20120410/dental-x-rays-linked-brain-tumors
3. Yahoo Health
http://health.yahoo.net/news/s/nm/dental-x-rays-linked-to-common-brain-tumor
4. Reuters
http://www.reuters.com/article/2012/04/10/us-dental-x-rays-idUSBRE8390GM20120410

After reading all four articles, all I can say is Holy Biased Study Reporting, Batman! Facts, assumptions, and correlations swing wildly between the four articles. Limitations and potential issues with the study, also swing wildly. This is such a classic case of playing "telephone" with a study. However, we, as the readers and consumers of dental services, have a right to know exactly what the deal is here. Having and knowing the facts can GREATLY impact decisions regarding dental care here. Yowza...while the facts from this study are fascinating; how they are written, in what tone, and with what "spin" they include, will fuel consumers and feed their preconceived notions.  Time to put our "pseudo surgeon's gloves" on and dissect this mystery...

Facts stated:
1. Two groups of subjects were studied; one group with meningioma brain tumors (benign, as in not cancerous), and one group without meningioma brain tumors. Good. A comparison group is good to use. I like it so far.

2. Ages of study participants ranged from 20 to 79. That is a significant variation in age and could be considered a study limitation right off the bat. It would be very difficult to "control" or rule out, other potentially influential factors here with this wide span of "adults".

3. The sample size (# of study participants) was similar for both groups and was fairly large: 1,433 people with tumors, and 1,350 people without the tumors. Apparently, the study participants in both groups were of similar age (?) and from similar states/cities (Conn., Ma., NC., Houston and San Francisco areas). I'm not sure why they chose broad states and two cities as study sites, but my guess is that there were numerous researchers involved in the study and they lived in these areas listed above. However, the 3 states and 2 cities are a strange choice overall. Again, it would be hard to rule out other impacting geographical factors arising from these locations alone, and I'm not sure if locations were even taken into consideration, but this is what I have to work with until I can read the actual study itself.

4. The study participants were asked to remember their xray usage, type, and frequency, dating back to the 1960's. (RED FLAG HERE!!!) Huh? How many of us remember what we had for breakfast in 1968 let alone how many xrays we had taken at the dentist 50 years ago??? This is a SELF REPORTED study. It is not based on gathering actual FACTS from physical DATA, from, say, DENTAL OFFICES. They are relying on people's MEMORIES here. They are basing a HUGE conclusion linking xrays to BRAIN TUMORS on people's recollections!?! That's a huge step and conclusion to make with unreliable data, from decades ago.

Ok, as a researcher myself, I have to step back and gain my breath. (Breathe, Annelise, breathe...inhale, exhale, inhale, exhale..). I am now officially skeptical (understatement of the century). Remember here, that many study participants were in their 60's and 70's when this study was conducted. The age ranges of participants were up to 79. 79, for pete's sake!!!!! You mean, these researchers interviewed senior citizens about when, type and number of xrays they had dating back to the 1960's??? Is that what they are basing these IMPORTANT conclusions & results on????? If so, I might as well stop here and tell you in my most humble and professional opinion, that this study is flawed, if this is the methodology used. I don't mean slightly flawed, I mean, "are you people seriously KIDDING ME?" kind of flawed. I believe the british term here is "bullocks", but I'm not positive. There was NO conclusive, confirmed, credible DATA to back those "guestimates" up. None. Ok, granted back in the 60's, 70's and even into the 80's dental offices used paper, not digital charts and computers, but dental charts were not studied at all here. They relied on people's memories alone. It would be near IMPOSSIBLE to verify ANY of these "guestimates" since most of those dental practices are GONE by now. Not to mention, how mentally and cognitively healthy were those senior citizens interviewed for this study??

 But this is too important to simply state the early limitations of this study that I have found. There is more so let's keep going here...

5. The study looked at 3 different types of xrays that people "recalled" having taken on them. Bitewing xrays (4 films of your back/posterior teeth; 2 of the upper back, and 2 of the lower back), a full mouth series of xrays (FMX) which total 18 xrays of all teeth and INCLUDES a set of 4 bitewings in this series of xrays (remember that), and a pano xray that is taken from further away from the face, circles the face, and gets a wider image of all teeth, bone, sinus cavities, etc. Ok, that said, here is what they found. Ready? This is going to blow you away. Honest. You need to sit down for this level of contradictory reporting. The study found that those study participants who had bitewings and a pano were much more likely to develop this benign brain tumor; 40%-90% more likely, is what they are saying. HOWEVER, (here it comes), those that had an FMX series of xrays (which INCLUDES bitewings, you will recall) are NOT more likely to develop meningioma brain tumors. Huh?? What?? Back up a sec. How is it possible that bitewings by themselves are linked to higher likelihood of developing brain tumors but FMX which INCLUDES bitewings, are NOT linked to developing brain tumors? I'm raising a hale and hearty RED FLAG here. Umm. Pardon me, but that makes NO sense whatsoever. None. Zero. Zip. Nada. No Way, Jose. A flat out Oh HELL NO....you just did NOT say that, did you? Ugh...wow. Ok, well, in the best interest of everyone getting all the "facts" straight, let's continue...I did warn you...this is about to get even bumpier...strap yourself in.

6. The study reported, based on the highly scientific "findings" (oye vey..were the surveys filled out with red crayon too, or burnt sienna, by chance?) that those study participants who were more likely to develop these brain tumors  received a more frequent number of xrays back in the 1960's, because the ionizing radiation from the OLD xray systems was HIGHER then, so THOSE people who REMEMBER that they had lots of bitewings every year at the dentist back in the 1960's were 40-90% more likely to develop brain tumors! Yes, you heard me right!! This HIGHLY "scientific study" linking dental xrays with BRAIN TUMOR development, is basing its conclusions on self-reporting, and on xrays that have not been used in 50 years! Guys, this is like saying that not washing your hands back in 1912 led to a kabillion percent increase in risk of infection! Really? No WAY! I'm FLOORED!....I kid you not. I am beyond floored. The more I read, the more doubtful I became.....but THIS??? Dear Lord, save us all.....from this level of skewed, flawed, and flat out DANGEROUSLY overstated reporting...please...I beg of you...because, Lord, if you don't....people will HONESTLY think that getting xrays at the dentist TODAY will give them brain tumors TOMORROW!

Yes, I am continuing...against my better judgement here...but nonetheless...

7. Direct quote from the lead researcher, Dr. Elizabeth Claus "It's likely that the exposure association we're seeing here is past exposure, and past exposure levels were much higher", end quote. I'm very tempted to quote my adorable grandson, Gage, here when I say something silly and he looks at me and says "Double Duh, Grammalise"! But I won't. What I will say is this: you will receive higher levels of radiation walking out your front door than you will from getting a dental xray taken today. In fact, and I will back this up with REAL facts, dental clinical staff do not even have to WEAR xray badges, like hospital staff or medical staff who take xrays do. Why, you ask? Well, because the miniscule levels of radiation from today's wonderful digital xrays are not even a concern to the health department that REGULATES xray radiation exposure levels!! That's right! Anyone else in ANY medical facility that takes xrays MUST wear a radiation badge around their neck and have it tested for exposure levels throughout the year to avoid staff overexposure to radiation, EXCEPT dental staff. This can be found in Florida's Administrative Code 64E-5.314, and here it is:

64E-5.313 Compliance with Dose Limits for Individual Members of the Public.
(1) The licensee or registrant shall make or cause to be made surveys of radiation
levels in unrestricted areas and radioactive materials in effluents released to
unrestricted areas to demonstrate compliance with the dose limits for individual
members of the public in 64E-5.312.
(2) A licensee or registrant shall show compliance with the annual dose limit in
64E-5.312 by:
(a) Demonstrating by measurement or calculation that the total effective dose
equivalent to the individual who is likely to receive the highest dose from
the licensed or registered operation does not exceed the annual dose
limit; or
(b) Demonstrating that:
1. The annual average concentrations of radioactive material released
in gaseous and liquid effluents at the boundary of the unrestricted
area do not exceed the values specified in State of Florida Bureau
of Radiation Control ALIs, DACs and Effluent Concentrations, July
1993, Table II; and
2. The dose from external sources would not exceed 0.002 rem
(0.02 millisievert) in an hour and 0.05 rem (0.5 millisievert) in a year
if an individual were continually present in an unrestricted area.
64E-5 Florida Administrative Code 64E-5.314
III - 12
(3) Upon approval from the department, the licensee can adjust the effluent
concentration values in State of Florida Bureau of Radiation Control ALIs, DACs,
and Effluent Concentrations, July 1993, for members of the public to take into
account the actual physical and chemical characteristics of the effluents, such as
aerosol size distribution, solubility, density, radioactive decay equilibrium, and
chemical form.
(4) Dental and podiatry registrants are exempt from (1), (2), and (3), above.(Here it is)
(5) Each licensee or registrant shall maintain records sufficient to demonstrate
compliance with the dose limit for individual members of the public until the
department terminates each pertinent license or registration requiring the record.

See? I told you so. AND, if you still need further proof that the radiation exposure in dental offices TODAY is SO LOW that dental personnel who take dozens of xrays EVERY DAY, don't even have to wear an exposure capture badge, you should call my buddies at the Department of Health; they are awesome peeps!
Bureau of Radiation Control
Radiation Machine Section
Suite 300
705 Wells Road,
Orange Park, FL 32073
Telephone: (904) 278-5730 Fax: (904) 278-5737

So, getting back to this study. First, if researchers wish to study whether xray exposure is really linked to brain tumors, they should seriously study dental personnel. They're in the xray trenches everyday for years on end. To date, I have known no one in dental clinic settings, to have developed any form of cancer, let alone, brain tumors. That's not to say they haven't; I just have not heard of any, and believe me, I get around (in a professional way only).

The four articles were extremely selective in what they reported on this study. One article, from WebMd, no less, omitted the most important limitations of this study. By doing so, they have, unfortunately, and in my HUMBLE opinion, done an injustice and disservice to themselves. Based on this important, and omitted, information, I now have my serious doubts as to the credibility of information presented by WebMd. In fact, it states that "Neurosurgeon Michael Schulder, MD agrees that the published findings make a good case for limiting the frequency of dental xrays whenever possible". Wow. Michael...did you even READ this study? Did you READ the methodology? Did you READ the self-reported instrument used? Did you READ the time frame the "link"s were referring to? And, lastly, Michael, did you READ the age groups that self-reported???? Wow... Wow.... And Wow....How incredible to make such broad statements on such flawed and skewed presentation of information. Wow. Unless I am 100% wrong, and the actual study itself states something very different than the articles reporting on them, I'm floored still.

Here's my last word...and it's strong. The only other studies conducted on ionizing radiation and its effects were conducted on atomic bomb survivors or radiation treatment patients. Studies were inconclusive. This study does NOT show cause and effect. The findings CANNOT prove that radiation from imaging caused tumors. This is clearly stated in the articles. I have been reviewing study manuscripts for many peer-reviewed journals and had I received a manuscript of this study to review, with these limitations & biases, I would have rejected it from being published. It is misleading the public dangerously, into believing that dental xrays CAUSE brain tumors, and they don't, according to the current body of knowledge.

With 66% of our population overweight or obese, one can safely say, that those extra pounds didn't come from overeating on salads. The 50% of children who have their first cavity by age 5 did not get them from eating lettuce. Diabetes, heart disease, high blood pressure, certain cancers, and many other current chronic conditions that the majority of Americans suffer from, can be traced back to poor eating habits. Those poor eating habits include the MOUTH as the receptacle for the poor food choices and the MOUTH as the ENTRANCE to the rest of the body. What do you think the oral health status is of this vast majority of Americans? Is it healthy? Not likely. Is it cavity free? Again, not likely. If you ask any of the 88 million Floridians who went to the Emergency Room in 2009 with severe tooth abscesses (NY Times, 4/9/2012), I'm fairly sure they will agree here. Should we wait to take xrays until someone has a symptom, like INTENSE PAIN? Or do we take a more proactive approach in those people who are at a higher risk of tooth decay by taking needed xrays to avoid  waiting 2 years (thanks for that suggestion, Dr. Neurosurgeon) until that little cavity turns into a full blown abscess with more than $2000.00 in needed treatment to save a tooth that a $20 xray and a $100 filling could have taken care of??? Well, I suppose so, bit it certainly is not optimal, now is it.

Instead of worrying about a questionable study, stating that taking those xrays (taken in 1960) could give you a benign brain tumor in 50 years, why don't we address the xray needed to ensure that the abscess doesn't travel to the brain and kill someone THIS YEAR. Just a thought. That's all I'm saying...

Whew! That was a workout. Hopefully, I burned calories over this one. It certainly was draining, wasn't it? Well, that's it for me today. Thanks for stopping by. And, remember, you only have to brush and floss the teeth that you ABSOLUTELY, POSITIVELY, want to keep. That's it. Nothing more.

Dr. Driscoll

The truth, the whole truth, and nothing BUT the truth: Humana, Round Two (ding! ding!)

So, in my last blog, I dissected Humana's new individual dental insurance plan that "rewards" its enrolled members on year two and three. Well, I didn't dissect the WHOLE plan because I couldn't get past that the colossal fees for enrolling and using preventive services. In all fairness to Humana, and having presented the point of view of the patient and dentist, I will shed light on Humana's point of view. I can only speculate here, but providing all sides is what this blog is about, and since there are usually three sides to every story, I will illuminate the third side as best I can.

Here goes:
Humana: There is no shared risk for individual dental plans. "What the heck does that mean, Annelise??", you ask? Well, it basically means that unlike group dental policies, with many enrolled members, like the plans that employers purchase for their employees, individual plans have no shared risk pool. In a group plan, there is an assumption that while many people will use their benefits to the max because they have them (called Moral Hazard), many will only use some of the benefits, and some will use NONE of the benefits of the plan. If a dental insurance plan is paying out up to $1000.00 in annual benefits, but only charging  $467.00 per year in premiums ($35 enrollment fee + approximately $36 per month premium), they will not be making money off of that policy (called a loss ratio). If EVERYONE in the group plan uses all $1000.00 in benefits and only pays $467 per year for premiums each, then the insurance company has lost a crap-ton of money on that group. Obviously, an insurance company can not survive by losing money on insurance plans, therefore, the risk of no profitability is shared in a group policy, and offset by those who will use only some of their benefits and those who will use none of their benefits. That's what a shared risk pool means.

On individual dental plans, it is highly likely that the insured will be using ALL of their benefits for the first year, since most people purchase individual plans when they are in desperate need of dental work all of a sudden. People are famous for doing this. They don't have any dental work, exams, or even cleanings for years on end, then wake up one day in pain and realize, "Oh Crap! I need dental work! I have no insurance! It's going to be expensive (because I waited so long and didn't have even routine cleanings done)! Let's see if I can find a "cheap" individual dental insurance plan so I can get this work done!" Yes, that's how it happens. Nothing like last minute emergency planning on compromised oral health....but I digress.

So, because dental insurance companies KNOW this, they usually do not pay out very much in the first year, which makes people upset since they are paying premiums for little benefits. USUALLY, however, the difference is that almost ALL preventive services are covered at 100% with zero deductible. THAT I understand AND support fully. That's not what Humana's dental plan is doing, though, as you know. And, while I DO see where collecting $467 in premiums from an enrolled member and paying out $1000 in benefits does NOT make good business sense, nor is it a viable/sustainable business model for insurance companies, I STILL believe that putting a $150 deductible on xrays is flirting with disaster on all ends. It just makes everyone cranky: the patient for having to pay out a whopping amount at the first visit, the dentist who gets an aggravated patient upset at having to pay for expensive/needed/required xrays on the first visit, and the insurance company who will have to deal with that upset patient when they call and complain. Three strikes on this one all the way around.

Humana really, really, really, should have put that deductible on basic and major work and NOT on preventive services that are critical to proper diagnosis. In fact, based on the statutes that relate to the actual duties of a dentist, it is not even possible for a dentist to diagnose what type of cleaning a patient needs, without first viewing the xrays to see if there is bone loss (from periodontal disease), debris under the gums (subgingival calculus/tartar), or infection brewing (like an abscess). Soooooooooooo, technically, and according to the statutes, the dentist must conduct a thorough exam and diagnose the cleaning type needed by using a diagnostic tool (called xrays!) along with other visual and manual methods, BEFORE a patient can get their teeth cleaned.

And, JUST so that you know, that INDEED I speak the truth, here is the actual statute on dental records (along with the link for you seriously Doubting Thomas types). Get ready to be impressed by my massive dental geekiness (I'm just a veritable LANDFILL of useless dental legal knowledge)!

CHAPTER 64B5-17
DENTAL PRACTICE AND PRINCIPLES
64B5-17.002 Written Dental Records; Minimum Content; Retention.
(1) For the purpose of implementing the provisions of subsection 466.028(1)(m), F.S., a dentist shall maintain written records
on each patient which written records shall contain, at a minimum, the following information about the patient:
(a) Appropriate medical history;
(b) Results of clinical examination and tests conducted, including the identification, or lack thereof, of any oral pathology or
diseases;
(c) Any radiographs used for the diagnosis or treatment of the patient;
(d) Treatment plan proposed by the dentist; and
(e) Treatment rendered to the patient.
Link: http://www.doh.state.fl.us/mqa/dentistry/rule_64B5-17Dental_Prac-Princ.pdf

I highlighted the brilliant, supporting parts--you don't have to thank me, I'm happy to help.

Anywhoooo, as you can see, those stinking xrays are a thorn in the side of this dental insurance policy that Humana created. While I have presented all three sides now, and you now fully understand the financial loss potential Humana faces with individual dental insurance plans, that does NOT change the fact that, no matter what "loyalty" rewards this policy provides for enrolled members over the first 3 years, it STILL gets a hearty, finger-wagging "tisk, tisk" for subjecting a basic required diagnostic tool to a whopping $150 deductible. Not cool, Humana. It's a disservice to patients and dentists alike, and opens up the door for conflict between the two, which is 100% avoidable and preventable had you placed that deductible on basic and major services only.

Go ahead, Humana. Redo the plan and shift the deductible to basic (fillings) and major (root canals/crowns) services, so there is no fuel for further debate. I can wait. I'm right here. It needs to be done. It's the right thing. Just let me know when it's done so I can reassess this plan and hopefully, recommend it to everyone I know who does not have dental insurance. No pressure or anything, but I'm waiting here. :)

Wow, I'm exhausted! Did I burn calories on this one, or what? Am I thin yet? That was a workout.

That's it for me for today. Thanks for stopping by and remember; you only have to brush and floss the teeth that you ABSOLUTELY, POSITIVELY want to keep.

Dr. Driscoll

Oh Humana....I had such high hopes for you...tisk, tisk.

So, recently I came upon an article in an Orlando business paper announcing that the insurance company Humana was getting ready to offer a dental insurance plan for those who don't have dental insurance, that would "reward its members" for their "loyalty" to the plan. What this means, bottom line, is that they will increase benefit levels in the second and third year of (having) the plan. At first, I thought, hmmm...well that sounds pretty good, especially since there are few, if any, "good" individual dental plans out there. Most cost more then what they provide in limited benefits. In other words, its "slim pickin's" out there for dental insurance if your employer does not provide you with a decent plan. A decent individual plan with little or no co-pays,and increasing coverage after the second and third years? Rewarding my loyalty? Well, alrighty then! Sounds good to me (finally)! I was almost excited! Almost........

Upon further review of this HumanaOne Loyalty Plus Plan, I will let you know what I have found. Before I tell you about their reasonable premiums, let me just say that there is an enrollment fee, and administration fee, and a PBA member monthly association fee ON TOP OF the monthly premium. What is this PBA group that enrollees must subscribe to? Is it something fantastically beneficial to help mankind improve on their dental status? Um. No. It is not. The small writing at the bottom of the page states it is a (and I quote the Humana ad here) "a not-for-profit membership organization that provides health, travel, consumer and business-related discounts to its members". Hmmmm...you mean, I HAVE to join this group to purchase the dental insurance and then I have to PAY money every month to get "travel discounts"? Huh?? Why is this sending off a red flag in my head? Ok, well, as it turns out it is a small fee, which when combined with the other small fees, for other "stuff", you get a monthly premium of $35.74, after an enrollment fee of $35.00. Really. Hmmm...Ok.

Driving on, I realize that they pay 100% for preventive services (exam and healthy mouth cleanings) in all three years, so that's good. That should be a savings right there, no? Oh wait a minute! They don't pay for x-rays at the first appointment or anytime after that until I've met my deductible of $150.00? Holy moly. So, after paying the premiums, and enrollment fees, I have to pay for the x-rays out of pocket, which cost more than $100 for the first visit to a dentist's office. I'm not feeling the "loyalty" being "rewarded here. In fact, if I'm not mistaken, this now will likely become a bigger issue....possibly....

And, here is where we get to the BIG red flag:
Every new patient visit at a dental office requires a full series of xrays to be taken in order for the dentist to view your whole mouth, teeth, roots, bones, etc. Without that full series of xrays, the dentist is not able to see your whole mouth and its total oral health status, nor is he/she able to properly and thoroughly diagnose any conditions that are evident on the xrays, but maybe not by the naked eye's visual exam only. That is a significant issue. But, in all fairness, let's look at this from both sides, shall we?

The Consumer: Having to pay out over $100 for xrays on the first visit, after paying the premiums and other "fees", may seem like a lot. In fact, that consumer may very well say to the dental practice, "Hey, I don't have that kind of money, so can I just get the exam and cleaning at least?" I certainly understand where the consumer is coming from. I really do. I would be annoyed to have to find out that the xrays were subject to a $150 deductible. In most other group dental insurance plans, that is part of the preventive services that are USUALLY covered at 100% by the insurance company. I can see where the consumer might want to just get what is covered. I get it. It feels like the consumer is getting "nickled and dimed to death", as they say, and they will likely be annoyed and request no xrays be taken.

The Dentist: Knowing what their protocols are for a new patient exam, which includes taking a full series of xrays, to "see" everything and assess the true condition of the patient's mouth, this presents a liability issue. The difference between conducting a new patient exam with only the naked eye, and one which includes a full series of xrays, is the difference between looking through a keyhole into a room to see what is in it, and opening the door to get the whole view of what is in that room. They don't compare. It would be a disservice to a patient to not fully view and diagnose the condition of that patient's mouth. In fact, it could very easily lead to a lawsuit if something is "brewing" that was not visible with the naked eye and then did not get addressed. Major Liability Risk: "Danger, Will Robinson, Danger Will Robinson"! Plus, the dentist may very well get cited by the Board of Dentistry for negligence for NOT taking the appropriate and needed/required xrays on a new patient. That dentist's license may now be at risk.

And all because Humana 'rewarded' its enrollees by putting a $150 deductible on xrays.....Oh boy. Hot mess. Not good. Both sides of this equation have merit and can be clearly seen and understood. Both sides have issues that are real and valid. Unfortunately, what I REALLY fear happening here, in this very troubled time, and in this tough economy, is PERHAPS a dentist accepting that patient anyway, because they threatened to see someone else, and waiving the xrays until "next time". Meanwhile, under the gums, 'something wicked this way comes'....like a looming infection, bone loss, resorption, an abscess, a cyst, you name it...I was almost excited about this plan...I really, really was...

But really, Humana, all you have done here, is create a difficult situation for everyone involved; except you. Having a customer pay 3 extra fees plus a premium is enough. It could be overlooked if indeed you rewarded your customers. I see where your benefits for basic and major services increase at year 2 and 3 and I think that's ok; not great, but ok. But do I feel you did the right thing by penalizing both the patient and the dentist by creating the conflict associated with attaching a high deductible to needed/required xrays on the VERY FIRST VISIT??? Nope. I do not. Not only do I NOT think it was the right thing, I fear it will place both parties involved at great risk; both clinically, and ethically/legally.

Sure, there may be many patients who can pay the $70 plus for the enrollment fees and first month's premium, but then another $150 to get an exam, xrays and cleaning after that? Over $200 for the first visit? Unless I'm mistaken, that's pretty comparable to what the patient would have paid without any insurance at all, isn't it? Oh Humana, you were SO CLOSE to being a good policy...SO CLOSE...but not close enough.  Based on all of that (and I couldn't even really get to the rest of the plan "benefits"), I would have to give this policy a big "tisk, tisk"....Buyer beware...and dentists beware too!

That's it for me today. Thanks for stopping by. And, remember, you only have to brush and floss the teeth that you ABSOLUTELY, POSITIVELY want to keep. That's it. Nothing more.

Dr. Driscoll