Dental Board's Review Process Gets Makeover

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Ahead of the 83^rd legislative session, the Texas House Public Health Committee heard pointed criticism of the Texas State Board of Dental Examiners, with some critics accusing the board of ineptitude and not acting swiftly to address Medicaid fraud cases.

Lawmakers have responded by approving new regulations, and they are optimistic that the board will have the tools to add staffing and become more efficient in handling complaints.

“I felt like we had a weak board,” said state Rep. Lois Kolkhorst, R-Brenham, chairwoman of the Public Health Committee and author of House Bill 3201, which outlines the changes. “This is a big deal, not to be taken lightly. It should lead to great reforms within the dental board.”

The new legislation, which takes effect Sept. 1, sets up a process to investigate complaints against dentists that mirrors the more rigorous process used by the Texas Medical Board to investigate complaints against physicians. It also creates a $55 surcharge added to the cost for dentists who are obtaining or renewing their licenses, allowing the dental board to hire new staff members and an expert panel of dentists to review certain complaints. Dentists will also be required to submit more information when they apply for a license.

In the past, the seven-member dental board reviewed each case individually with the help of volunteer experts, said Julie Hildebrand, acting executive director of the board. With more formal guidelines in place and increased funding, “it is going to make it a more efficient process,” she said.

Under the new process, staff members including dentists, lawyers, investigators, licensing specialists and support staff will review complaints and conduct preliminary investigations to determine if violations occurred. Such a review must be completed within 60 days of when the complaint was filed, said Hildebrand.

In cases where an investigation is pursued, complaints involving standard of care are referred to a new expert panel comprising dentists and dental hygienists. All others investigations will be heard by the dental board, she said.

The board will make final decisions on all cases involving alleged violations and will review the staff's dismissal of other complaints, Hildebrand added.

A timeline for completion has yet to be established for adjudicating cases beyond the preliminary investigation, Hildebrand added.

Kolkhorst said that the board had been taking an average of more than 400 days to resolve complaints.

“Can you imagine having a case where you are accused of mishandling a patient and it taking over 400 days to resolve?” she said. “That is simply not acceptable.”

The board’s failures have to do with its inability to keep up with the state’s rising population and corresponding increase in dentists, said Rick Black, legislative representative for the Texas Dental Association and a practicing El Paso dentist.

“They were certainly struggling to keep up with the increase in the number of dentists,” Black said. “This is going to relieve state board members of literally having to look through these charts themselves and concentrate on policy.”

Texas is ranked 44^th in the nation in dentists per residents and 50^th in the U.S. in the number of dentists needed, according to the Henry J. Kaiser Family Foundation.

When the board did follow up on filed complaints, it often lacked the basic information about the dentist and their practice vital to investigating the complaint in a timely manner, Black said.

When completing their yearly registration before, dentists were only required to list the name of the dental practice, its physical address, hours worked there per week, number of weeks worked per year, the type of practice and the number of hygienists and assistants, Vicki Shoesmith, director of licensing for the board, said in an email.

Under the new law, registration applicants must include more information on the license holder, whether the dentist is a provider under Medicare and whether the licensee is affiliated with a dental service organization — an outside company that owns a portion of a dental practice and provides administrative services for the dentist. In total it will amount to approximately 10 more questions on the application process, Hildebrand said.

“I don’t think this is going to be some onerous process for a dentist,” Black said. “It will be a few more questions for people.”

Now, Kolkhorst said, the main objective is to ensure that the dental board is staffed properly and properly implements the reforms. 

“I think this is a very positive step forward,” Kolkhorst said. “[It is important that] we get a dental board that has the strength that if someone is committing Medicaid fraud or rendering poor services to their patients that there is swift and proper action taken.”

This story was produced in partnership with Kaiser Health News, an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communication organization not affiliated with Kaiser Permanente. 

Breaking Down the Changes:

Here's a quick glance at the changes to the State Board of Dental Examiners' complaint resolution process: