By DARREN BARBEE - Star-Telegram staff writer - Mon, Jun. 11, 2007
Second in a four-part series examining state regulation of health professionals
One dentist was accused of botching root canals, bridges and crowns and writing 100 prescriptions after his controlled-substances permit had expired.
Another dentist was sentenced to 27 months in prison for overbilling a government program to help the poor. Still another, from Euless, was shot in the chest while breaking into his in-laws' home. He received probation after pleading guilty to criminal trespass and assault charges.
The dentists all have at least two things in common: They're currently licensed to practice in Texas, and the Texas State Board of Dental Examiners only shares details about their past if a request is made in writing -- just don't expect a quick answer.
Some say the governor-appointed board has struggled in recent years to fulfill its basic mission: protecting the public.
Board member Tammy Allen, a Hurst dental hygienist, said the board does the best it can with the resources it has. But she is troubled by a sharp decline -- 58 percent over three years -- in the number of dental professionals disciplined. She's also concerned penalties are handed out too subjectively.
"Two dentists can have the same violation and one will get a warning and the other a $1,000 fine," Allen said. "That's not right, it's not fair, and as a board member, that bothers me."
The state has taken the board to task for such problems as failing to enforce its disciplinary actions and not meeting deadlines.
Consumer advocates are concerned that, while the board can give bad dentists and even those who are convicted criminals a second chance, its Web site merely states if a dentist has faced discipline and the type of penalty imposed. It offers little information about the nature of their offenses.
Supporters say the board in recent years has cleared a large backlog of complaints, some stretching back more than six years. During that time, disciplinary actions exceeded state-set benchmarks, although last year they were lagging.
Fread Houston, the board's general counsel, said the agency's penalty system has been overhauled in recent years to make it more evenhanded. More consistent results would come if the small agency with 29 budgeted employees had more funding, he said.
State reports show last fiscal year the board generated $4.5 million more than it spent. But that money, largely from fees related to licensing, credentialing and examinations, went to the state's general fund. The board spent $1.8 million.
Among other needs is an updated computer system.
"It's crazy," Houston said. "Literally, I look at the screen and it's as if you're in 1980."
Houston said the board is making progress.
"Can it be made better? Yes. I think there is room for improvement."
Backlog of complaints
The board's job is big: Each year it must screen the approximately 12,000 dentists and 10,000 hygienists it licenses, on top of investigating hundreds of complaints.
It has fallen short in both areas, according to the most recent state auditor's report on the board.
Houston said he doesn't agree with some conclusions reached in the August 2005 report, including the discovery that six convicted felons weren't investigated during the licensing process.
The board uses the Texas Department of Public Safety to conduct criminal background checks but relied on a report that showed only changes in criminal records during the prior four months, rather than a full criminal history as required by law.
The board responded by saying that it would work with the DPS to ensure it obtained full histories on all new licensees.
"It wasn't that we weren't doing our job," Houston said. "It was that the information we were getting back was just not complete."
The audit also found that sanctions imposed against dentists and hygienists weren't enforced. One dentist, for instance, was required to receive peer assistance for a substance-abuse problem. The day after the board was notified the dentist hadn't done so, its staff renewed his license.
In response, the board noted that it is not authorized to use the license-renewal process as a disciplinary tool.
In a separate report by the Legislative Budget Board, the board took hits for failing to investigate complaints on time. In 2005, for instance, it averaged about a year to resolve problems, about 80 days longer than the state benchmark. Last year, the board again averaged a year response time, but the state upped the deadline to 400 days.
Earlier this spring, the board faced a backlog of about 270 complaints, including a 2001 case.
The slow response to a backlog of complaints resulted from employees leaving for other agencies or the private sector, Houston said.
From June through December 2005, for instance, the executive director, director of enforcement, five investigators, an attorney and two administrative employees left the board. As a result, new employees were constantly being trained and were unfamiliar with the system. In the legislative session that just ended, the board was granted eight new positions it requested.
Thief's license reinstated
Greed got the best of Amarillo dentist Charles T. Carr.
In the late 1990s, he began overbilling a government poverty program for the care he provided. In the end, it cost him two years in prison, but not his profession.
"You know, it was just a case of seeing a way to maybe make a little extra money," Carr said.
He was stripped of his license but in 2003 received a new one from the board. He's at a loss to explain why the board granted his application.
"I haven't got a clue," said Carr, who is barred from billing the state or federal government for patients. "I've prayed about it a lot."
The board considers the nature of the crime, the amount of time passed, recommendations from court personnel and other information when deciding whether to license a dental professional.
Cases such as Carr's aren't detailed on the board's Web site. The site notes if a dental professional has faced disciplinary action in the past. In another part of the Web site, there's a listing of the penalty a dental professional received, but it only goes back about three years.
Dr. Robert Baratz, a Massachusetts physician and dentist who helps run the watchdog Web site dentalwatch.org, said it ought to be easier for the public to know about disciplinary actions. "As the consumer, I would like to know. ... A lot of boards want you to go through hoops to try to get it," Baratz said. "I would just as soon click on it and read it."
New York state's Web site, for instance, gives the day action was taken against a dentist, a summary of the infraction -- such as "admitted to the charge of filing a false report" -- and details about penalties, such as the terms of probation and amounts fined.
Dr. Richard Black, an El Paso dentist and past president of the Texas Dental Association, said the group doesn't support adding more information to the Web site.
"I feel that's a privacy issue between the licensees and the people who are disciplined," he said.
The association supported increasing the board's budget.
Online.
Filling the coffers
Like most regulatory agencies of its kind, the Texas State Board of Dental Examiners is a moneymaker for the state, spending less than a third of its revenues.
A look at fiscal 2006 revenue and expenses:
Net revenue: $6,337,539
Net expenditures: $1,806,608
Excess: (to the state general fund): $4,530,931
Source: State of Texas 2006 Annual Cash Report
About the Consumer Report Card series
Evaluating healthcare professionals
This report is part of the first installment of a periodic series of stories examining how well Texas is fulfilling its consumer protection role. Findings are based on documents and data compiled by the state, and the Consumer Report Card criteria employ some of the measures the state has devised to judge performance. Evaluations were determined by weighing a variety of factors and reflecting the state's overall performance.
Tell us about your problems
What happened when you had a problem with a medical professional? Go to www.star-telegram.com to comment on your experience or to suggest other topics for future consumer report cards.
For information on filing a complaint about a licensed healthcare professional, call the state's toll-free hot line: 800-821-3205
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