A performance audit of the Arizona State Board of Dental Examiners

              STATE OF ARIZONA
OFFICE OF THE
AUDITOR GENERAL
A PERFORMANCE AUDIT
I) 0 f
THE ARIZONA STATE BOARD OF DENTAL EXAMINERS
SEPTEMBER 1979
THERE IS A NEED IN ARIZONA FOR A STATE
AGENCY TO OVERSEE THE ACTIVITIES OF THE
DENTAL PROFESSION. THE STATE BOARD OF
DENTAL EXAMINERS CAN MORE EFFECTIVELY
FULFILL THAT NEED BY IMPROVING ITS
HANDLING OF CONSUMER COMPLAINTS TO
ENSURE COMPLIANCE WITH STATUTORY
REQUIREMENTS.
A REPORT TO THE
ARIZONA STATE LEGISLATURE
REPORT 79- 1 1
DOUGLAS R. NORTON, CPA
AUDITOR GENERAL
SUITE 600
112 NORTH CENTRAL AVENUE
PHOENIX, ARIZONA 85004
255- 4385
STATE OF ARIZONA
OFFICE OF THE
AUDITOR GENERAL SUITE 820
33 NORTH STONE AVENUE
TUCSON, ARIZONA 85701
882- 5465
September 25, 1979
The Honorable Bruce B a b b i t t , Governor
Members of the Arizona L e g i s l a t u r e
Members o f t h e S t a t e Board of Dental Examiners
Transmitted herewith is a r e p o r t of the Auditor General, A Performance Audit of
the Arizona S t a t e Board of Dental Examiners. This r e p o r t is i n response t o a
September 19, 1978 r e s o l u t i o n of t h e J o i n t L e g i s l a t i v e Budget Committee and a
January 18, 1979 r e s o l u t i o n of the J o i n t L e g i s l a t i v e Oversight Committee.
A summary of t h i s r e p o r t is found on the blue pages a t the f r o n t of t h e r e p o r t .
A response t o t h i s r e p o r t from the members of t h e S t a t e Board of Dental
Examiners is found on the yellow pages preceding the appendices of the r e p o r t .
My s t a f f and I w i l l be happy t o meet with t h e a p p r o p r i a t e l e g i s l a t i v e
committees, i n d i v i d u a l l e g i s l a t o r s o r other s t a t e o f f i c i a l s t o discuss or
c l a r i f y any items i n t h i s r e p o r t or t o f a c i l i t a t e the implementation of the
recommendations.
Respectfully submitted,
u
Douglas R . Norton
Auditor General
S t a f f : Gerald A. S i l v a
Steve A. Wallace
3 r i a n C. Dalton
Brent L. Nelson
OFFICE OF THE AUDITOR GENERAL
A PERFORMANCE AUDIT OF
THE ARIZONA STATE BOARD OF DENTAL EXAMINERS
A REPORT TO THE
ARIZONA STATE LEGISLATURE
REPORT 79- 1 1
TABLE OF CONTENTS
SUMMARY
INTRODUCTION AND BACKGROUND
SUNSET FACTORS
FINDINGS
FINDING I
The S t a t e Board of Dental Examiners has not completely
f u l f i l l e d its s t a t u t o r y r e s p o n s i b i l i t y t o p r o t e c t the
c i t i z e n s of Arizona from incompetent d e n t a l p r a c t i t i o n e r s .
CONCLUSION
RECOMMENDATION
FINDING I1
The Board has not maintained an appearance of
independence o r o b j e c t i v i t y i n its d e a l i n g s w i t h
the Arizona S t a t e Dental Association.
CONCLUSION
RECOMMENDATION
FINDING I11
Changes are needed t o improve t h e e f f i c i e n c y of t h e S t a t e
Board of Dental Examiners.
CONCLUSION
RECOMMENDATION
FINDING I V
The S t a t e Board of Dental Examiners has been substandard
i n its encouragement and use of p u b l i c i n p u t i n its
operations. Information regarding meeting n o t i c e s ,
proposed r u l e s and r e g u l a t i o n s , and Board a c t i o n s has not
been adequately provided t o l i c e n s e e s of the Board or the
consumers of the l i c e n s e e s 1 s e r v i c e s .
Page
1
4
7
CONCLUSION
RECOMMENDATION
FINDING V
Page
7 5
~ d d i t i o n a lc hanges a r e needed t o enhance the S t a t e
Board of Dental Examinerst complaint review process.
CONCLUSION
RECOMMENDATION
OTHER PERTINENT INFORMATION
Entrance i n t o t h e profession
Supervision requirements
P r a c t i c e requirements
General a n e s t h e s i a p e e r review
WRITTEN RESPONSE TO THE AUDITOR GENERAL'S REPORT
APPENDICES
APPENDIX I - L e g i s l a t i v e Council memorandums
APPENDIX I1 - Arizona Revised S t a t u t e 32- 1201( 10)
APPENDIX I11 - L e t t e r from the p r e s i d e n t of the Arizona S t a t e
Dental Association
APPENDIX I V - Correspondence from the Associated Detective
Agency
APPENDIX V - Summary of the r e s u l t s of an Auditor General
survey of l i c e n s e e s of the S t a t e Board of
Dental Examiners
APPENDIX V I - Attorney General Opinion r e g a r d i n g t h e Open
Meeting Law
APPENDIX V I I - Attorney General memorandum regarding public
i n t e r e s t
APPENDIX V I I I - Arizona Revised S t a t u t e 32- 852.02
APPENDIX I X - Statement prepared by the Board's Executive
Secretary r e g a r d i n g p r o g r e s s of t h e complaint
review process
SUMMARY
The f i r s t c i v i l code f o r the S t a t e of Arizona, enacted i n 1913, contained
s t a t u t e s governing the l i c e n s i n g and r e g u l a t i o n of d e n t i s t s through a Board of
Examiners. Dental h y g i e n i s t s were placed under l i c e n s u r e and r e g u l a t o r y powers
of t h e Board i n 1947 and d e n t u r i s t s became c e r t i f i e d and regulated i n 1978.
During the 1973 s e s s i o n , the L e g i s l a t u r e changed the name from the S t a t e Dental
Board t o the S t a t e Board of Dental Examiners.
The Board was composed of f i v e licensed d e n t i s t s u n t i l 1977 when a l a y member
was added. I n 1978 a s t a t u t o r y amendment added a d e n t a l h y g i e n i s t , g i v i n g t h e
Board its present membership of f i v e licensed d e n t i s t s , one d e n t a l h y g i e n i s t
and one lay person. A l l members a r e appointed by the Governor, serve f o r a
period of s i x years and may not serve more than two consecutive terms.
The support s t a f f of the Board is composed of an Executive Secretary and one
full- time t y p i s t with a part- time p o s i t i o n being added i n f i s c a l year 1979- 80.
The s t a f f ' s d u t i e s include: 1) administering examinations, 2) processing
renewals, 3) processing complaints, 4) expending funds, and 5) handling
other routine a d m i n i s t r a t i v e functions. The Board and s t a f f are a l s o
r e s p o n s i b l e f o r enforcing ARS 32- 1201 through 32- 1297, the s t a t u t e s r e l a t i n g t o
d e n t i s t r y .
Our review of the S t a t e Board of Dental Examiners has shown t h a t t h e r e is a need
f o r a s t a t e agency t o oversee the a c t i v i t i e s of d e n t a l p r o f e s s i o n a l s . The
Board can more e f f e c t i v e l y f u l f i l l t h a t need by improving its handling of
consumer complaints t o ensure compliance with s t a t u t o r y requirements.
( page 12)
Our review a l s o revealed t h a t the Board's appearance of o b j e c t i v i t y becomes
questionable when the Arizona S t a t e Dental Association ( ASDA) becomes involved
with Board a f f a i r s . The Board has not maintained an appearance of independence
and o b j e c t i v i t y i n its dealings with the ASDA. ( page 57)
Further we have identified changes needed to improve the efficiency of the
State Board of Dental Examiners. ( page 64)
In addition, our review revealed that the State Board of Dental Examiners has
been substandard in its encouragement and use of- public input in its
operations. Information regarding meeting notices, proposed rules and
regulations, and Board actions has not been adequately provided to licensees of 0
the Board or the consumers of the licensees' services. ( page 67)
Finally, our review has identified additional changes which are needed to
enhance the State Board of Dental Examiners' complaint review process.
( page 76)
It is recommended that:
1) The State Board of Dental Examiners investigate and resolve consumer #
complaints in compliance with ARS 32- 1263( A) through ARS 32- 1263( E).
( page 56)
2) The State Board of Dental Examiners impose discipline as prescribed
in ARS 32- 1263( D) and ARS 32- 1263( E) on those dentists found to have @
provided substandard care. ( page 56
3) The Legislature and Governor consider establishing a Health
Occupations Council as outlined by The Council of State Governments.
This alternative could apply to all health regulatory entities and is ( I
also included in the recommendations of the Board of Optometry
performance audit. ( page 56)
4) The public representation on the State Board of Dental Examiners be
increased to three members. ( page 6 3 ) 9
5) The Arizona State Dental Association not be designated specifically
in ARS 32- 1203 to supply a list from which the Governor may choose
Board members; and the Board maintain a degree of independence and
objectivity when working in conjuction with the Arizona State Dental m
Association. This will help to ensure that the Board's appearance of
objectivity is maintained. ( page 63)
Arizona Revised Statutes be amended to require members of the State
Board of Dental Examiners to terminate active participation as
delegates or officers in professional associations. ( page 6 3 )
Arizona Revised Statutes 32- 1236, 32- 1287 and 32- 1287.06 be amended
to allow for implementation of a triennial renewal system on a
staggered basis. ( page 65)
The Board adopt methods to encourage public input and participation
in the promulgation of rules and regulations and development of
legislative proposals. ( page 75)
The Board actively pursue the ASDA President's offer to
"... cooperate in any proper way with the Board." This cooperation
could best be achieved by having the local societies of the ASDA
forward copies of all consumer complaints to the Board. ( page 81)
ARS 32- 1201 et. seq. be amended to:
- Include a provision similar to ARS 32- 852.02 requiring
insurance companies to forward all dental malpractice claims to
the Board, and
- Require Arizona Superior Courts to forward dental malpractice
suits to the Board. ( page 8 1 )
The public be better informed regarding the Board's complaint review
responsibilities. ( page 82)
The Board improve its documentation of disciplinary actions.
( page 82)
The statutory requirement that consumer complaints must be filed
under oath be eliminated. ( page 82)
The Board increase its utilization of the Office of the Attorney
General as regarding complaint review. ( page 82)
INTRODUCTION AND BACKGROUND
In response t o a September 19, 1978 r e s o l u t i o n of t h e J o i n t L e g i s l a t i v e Budget
Committee and a January 18, 1979 r e s o l u t i o n of the J o i n t L e g i s l a t i v e Oversight
Committee, t h e O f f i c e of the Auditor General has conducted a performance a u d i t
a s p a r t o f t h e s u n s e t review of t h e S t a t e Board of Dental Examiners ( Board), i n
accordance with ARS 43- 2351 through 43- 2374.
The f i r s t c i v i l code for the S t a t e of Arizona, enacted i n 1913, contained
s t a t u t e s governing t h e l i c e n s i n g and r e g u l a t i o n of d e n t i s t s through a Board of
Examiners. Dental h y g i e n i s t s were placed under l i c e n s u r e and r e g u l a t o r y powers
of the Board i n 1947 and d e n t u r i s t s became c e r t i f i e d and regulated i n 1978.
During the 1973 s e s s i o n , the L e g i s l a t u r e changed the name from the S t a t e Dental
Board to the S t a t e Board of Dental Examiners.
The Board was composed of f i v e l i c e n s e d d e n t i s t s u n t i l 1977 when a l a y member
was added. The L e g i s l a t u r e added a d e n t a l h y g i e n i s t i n 1978 giving t h e Board
its present membership of f i v e licensed d e n t i s t s , one d e n t a l h y g i e n i s t and one
l a y person. A l l members a r e appointed by the Governor, serve f o r a period of
s i x years and may not serve more than two consecutive terms.
The support s t a f f of the Board is composed of an Executive Secretary and one
full- time t y p i s t with a part- time p o s i t i o n being added i n f i s c a l year 1979- 80.
The s t a f f ' s d u t i e s include: 1) administering examinations, 2) processing
renewals, 3 ) processing complaints, 4) expending funds, and 5) handling
r o u t i n e a d m i n i s t r a t i v e functions. The Board and s t a f f a r e a l s o r e s p o n s i b l e f o r
enforcing ARS 32- 1201 through 32- 1297, the s t a t u t e s regarding d e n t i s t r y .
The S t a t e Board of Dental Examiners and its o f f i c e are funded through f e e s
charged f o r examination and l i c e n s u r e . Ninety percent of the f e e s c o l l e c t e d
a r e r e t a i n e d f o r the Board's use while ten percent a r e remitted t o the S t a t e
General Fund. Since the Board's budget exceeds $ 50,000 the L e g i s l a t u r e makes a
lump sum a p p r o p r i a t i o n for the Board's operations each year. Expenditures and
revenues f o r t h e Board for f i s c a l years 1975- 76 through 1977- 78 a r e shown i n
the following t a b l e :
Beginning fund balance
Expenditure C l a s s i f i c a t i o n
Personal s e r v i c e s
Employee r e l a t e d
P r o f e s s i o n a l and outside s e r v i c e s
Travel - i n s t a t e
Travel - out of s t a t e
Other operating
Equipment
Other
Total expenditures
Revenue C l a s s i f i c a t i o n
R e g i s t r a t i o n f e e s
Examination f e e s
Penalty f e e s
Other
Total
Less 10%
90% Available
Ending fund balance
a
Amounts
1975- 76 1976- 77 1977- 78
* The Board was granted an i n c r e a s e in annual l i c e n s e renewal f e e s from $ 15 •
t o $ 35 f o r d e n t i s t s and $ 5 t o $ 15 f o r h y g i e n i s t s i n June 1978. These
i n c r e a s e s were necessary t o ensure t h a t expenditures would not exceed the
fund balance i n f i s c a l year 1978- 79.
The Office of the Auditor General expresses its gratitude to the members of the
State Board of Dental Examiners and the Board's administrative staff for their
cooperation, assistance and consideration during the course of our audit.
SUNSET FACTORS
THE OBJECTIVE AND PURPOSE I N
ESTABLISHING THE BOARD
There is no e x p l i c i t statement of o b j e c t i v e or purpose i n t h e d e n t i s t r y
s t a t u t e s under which t h e Board was e s t a b l i s h e d . The Arizona Supreme Court
commented :
" The purpose and the only j u s t i f i c a t i o n o f t h e v a r i o u s
s t a t u t e s r e g u l a t i n g t h e p r a c t i c e o f medicine i n its
d i f f e r e n t branches is to p r o t e c t the public a g a i n s t those
who a r e not properly q u a l i f i e d t o engage i n the healing
art.. . ." ( Batty v. Arizona S t a t e Dental Board, 57 Ariz.
239, 254, 112 P. 2d 870 ( 1941) 1.
The Board i n i t s b u d g e t request f o r 1979- 80 s t a t e d :
" The Board p r o t e c t s t h e i n t e r e s t s and the h e a l t h and
s a f e t y o f c i t i z e n s of Arizona by adoption and enforcement
o f S t a t e d e n t a l s t a t u t e s and by resolving p a t i e n t
grievances through review, i n v e s t i g a t i o n , r e d r e s s and
d i s c i p l i n a r y a c t i o n . l1
THE DEGREE TO WHICH THE BOARD HAS
BEEN ABLE TO RESPOND TO THE NEEDS
OF THE PUBLIC AND THE EFFICIENCY
WITH WHICH IT HAS OPERATED
The Board has not adequately responded t o the needs of the public through the
complaint review process. Almost - 6 0 pe
Auditor General q---- u e s t i o n n a i r e s- e n--- t - - t o- - - c -- o m- plainants ind- - .-
not adequately protected t h e public from i n
p r a_ c t i t i o n e r s . The average - time t o process a
The operations of the Board have been conducted e f f i c i e n t l y under the
framework of t h e p r e s e n t s t a t u t e s . However, with minor s t a t u t e changes the
Board s renewal process could be performed more e f f i c i e n t l y . ( page 64)
THE EXTENT TO WHICH THE BOARD
HAS OPERATED WITHIN THE PUBLIC
INTEREST
The S t a t e Board of Dental Examiners h a s n o t completely f u l f i l l e d its s t a t u t o r y
r e s p o n s i b i l i t y t o p r o t e c t t h e c i t i z e n s of Arizona from incompetent d e n t a l
p r a c t i t i o n e r s . ( page 12)
e
The Board has not maintained an appearance of independence and o b j e c t i v i t y i n
its dealings with t h e Arizona S t a t e Dental Association. Such a r e l a t i o n s h i p
gives the appearance of not being i n the i n t e r e s t of t h e g e n e r a l public.
( page 57)
According t o a statement prepared by the Executive Secretary o f t h e S t a t e Board
of Dental Zxaminers* the Board h a s o p e r a t e d i n the i n t e r e s t of t h e public i n
t h a t the Board has: ( I
- Made improvements i n its complaint review process;
- C e r t i f i e d approximately 1,200 Dental A s s i s t a n t s t o use X- ray
equipment;
- Developed a program t o evaluate those persons a d m i n i s t e r i n g g e n e r a l •
a n e s t h e s i a ;
- Developed, but not yet adopted, a continuing education program f o r
r e l i c e n s u r e ; and
- Developed a s p e c i a l examination f o r graduates of f o r e i g n d e n t a l
schools.
In a d d i t i o n , i n d i v i d u a l board members:
- Spent ten t o 21 days i n 1978 administering examinations; q
- P a r t i c i p a t e d i n 11 Board meetings plus conference c a l l s ;
- P a r t i c i p a t e d i n nine days of Western Conference of Dental Examiners
and Dental School Deans and American Association of Dental Examiners
meetings ; a
- Assisted the Office of the Attorney General and functioned as
i n f o r m a l h e a r i n g o f f i c e r s ;
- Appeared before l e g i s l a t i v e committees.
* Appendix I X is a complete t e x t of t h i s statement.
8
Overall it is estimated t h a t Board members spend 20 t o 45 days per year
involved i n Board business.
THE EXTENT TO WHICH RULES AND
REGULATIONS PROMULGATED BY THE
BOARD ARE CONSISTENT WITH
LEGISLATIVE MANDATE
The r u l e s and r e g u l a t i o n s promulgated by the Board appear t o be c o n s i s t e n t with
l e g i s l a t i v e mandate with one p o s s i b l e exception. The L e g i s l a t u r e amended the
d e n t a l s t a t u t e s i n 1974 and removed r e s t r i c t i o n s on the number of h y g i e n i s t s
t h a t can p r a c t i c e under a d e n t i s t ' s supervision. However, t h e Board
r e i n s t i t u t e d a r e s t r i c t i o n on the number of h y g i e n i s t s t h a t can p r a c t i c e under
a d e n t i s t ' s supervision by r e g u l a t i o n i n 1976. ( page 37) F u r t h e r , the Board 1
may not have promulgated r u l e s and r e g u l a t i o n s as intended by the L e g i s l a t u r e
i n t h a t ARS 32- 1235 gives t h e Board t h e a u t h o r i t y t o i s s u e l i c e n s e s by
c r e d e n t i a l s , a policy which the Board has chosen not to follow.
THE EXTENT TO WHICH THE BOARD HAS
ENCOURAGED INPUT FROM THE PUBLIC
BEFORE PROMULGATING ITS RULES AND
REGULATIONS AND THE EXTENT TO WHICH
IT HAS INFORMED THE PUBLIC AS TO ITS
ACTIONS AND THEIR EXPECTED IMPACT
ON THE PUBLIC
The Board has been remiss i n its duty t o encourage public input and t o inform
the public of its a c t i o n s . Our a u d i t i n d i c a t e s t h a t a l a r g e p o r t i o n of t h e
public is not aware t h a t the Board e x i s t s . A m a j o r i t y o f the r e g i s t r a n t s a r e
not aware of proposed a c t i o n s or scheduled Board meetings. ( page 67)
I)
THE EXTENT TO WHICH THE BOARD HAS
BEEN ABLE TO INVESTIGATE AND RESOLVE
COMPLAINTS THAT ARE WITHIN ITS
JURISDICTION
The Board has proven its ability to investigate and resolve complaints that are
within its jurisdiction, however, the Board has shown an inclination not to
resolve complaints in the best interest of the public. The Board attempts to
arbitrate complaints rather than initiating appropriate disciplinary
procedures. ( page 12)
THE EXTENT TO WHICH THE ATTORNEY GENERAL
OR ANY OTHER APPLICABLE AGENCY OF STATE
GOVERNMENT HAS THE AUTHORITY TO
PROSECUTE ACTIONS UNDER THE ENABLING
LEGISLATION
The Attorney General's Office has the authority to prosecute actions under the
enabling legislation. However, the Board has failed to bring to the attention ( I
of its Attorney General representative many cases which might warrant
disciplinary action. ( page 81)
THE EXTENT TO WHICH THE BOARD HAS
ADDRESSED DEFICIENCIES IN THE
ENABLING STATUTES WHICH PREVENT
THEM FROM FULFILLING THEIR
STATUTORY MANDATE
The Board has expressed a dissatisfaction with ARS 32- 1263, subsection C which
, requires the Board to request an informal interview if information alleging
unprofessional conduct is or may be true. The Board has ignored or has
attempted to circumvent this provision rather than requesting that the
, provision be amended.
THE EXTENT TO W H I C ~ CH ANGES ARE
NECESSARY I N THE LAWS OF THE
BOARD TO ADEQUATELY COMPLY WITH
FACTORS LISTED I N THIS SUBSECTION
For a discussion of this issue see pages 55, 63, 6 6 , 81 and 82.
FINDING I
THE STATE BOARD OF DENTAL EXAMINERS HAS NOT COMPLETELY FULFILLED ITS STATUTORY
RESPONSIBILITY TO PROTECT THE CITIZENS OF ARIZONA FROM INCOMPETENT DENTAL
PRACTITIONERS.
The State Board of Dental Examiners is responsible for investigating charges of
misconduct on the part of persons licensed with the Board and imposing
discipline upon any licensee who is guilty of unprofessional conduct,
conviction of a felony or misdemeanor involving moral turpitude, or physical or
mental incompetence to practice dentistry. Our review of the State Board of
Dental Examiners revealed that the Board is not completely fulfilling its
statutory responsibility to protect the citizens of Arizona from incompetent
dental practitioners.
According to the Arizona Supreme Court:
" The purpose and the only justification of the various
statutes regulating the practice of medicine in its
different branches is to protect the public against those
who are not properly qualified to engage in the healing
art.. .. " ( Batty v. Arizona State Dental ~ oard,) 5 7 Ariz.
239, 254, 112 P. 2d 870 ( 1941).
In addition, ARS 32- 1207( A)( 8) requires the State Board of Dental Examiners to
investigate consumer complaints against persons licensed with the Board and
states:
" The board shall:. ... Investigate charges of nisconduct on
the part of- l~ censees and persons to whom restricted
permits have been issued...."
F i n a l l y , the Board i n its budget request f o r f i s c a l year 1979- 80
s t a t e d :
" The Board p r o t e c t s t h e i n t e r e s t and the h e a l t h and s a f e t y
o f t h e c i t i z e n s of Arizona by adoption and enforcement of
S t a t e d e n t a l s t a t u t e s and by resolving p a t i e n t grievances
through review, i n v e s t i g a t i o n , r e d r e s s and d i s c i p l i n a r y
action." ( Emphasis added)
According to the Board's Executive Secretary the Board has made a number of #
improvements i n its complaint review process. P r i o r t o 1974 the Board had no
complaint review process.
The Executive Secretary s t a t e d t h a t the following improvements have been made •
over t h e p a s t few years:"
1) I n 1974 the Board began using the C h i r o p r a c t i c Board's complaint
form.
2) From 1974 through 1977 the Board, during its meetings, t r i e d t o a
resolve complaints t h a t were f i l e d and i n v e s t i g a t e d by the Board
o f f i c e .
3) I n 1978 r e g i o n a l complaint committees were formed to i n v e s t i g a t e
consumer complaints, examine p a t i e n t s and r e p o r t t h e i r f i n d i n g s t o ( I
the Board.
4) The Board is i n the p r o c e s s o f :
- Adopting g u i d e l i n e s f o r complaint review from a well
e s t a b l i s h e d C a l i f o r n i a peer review program.
- Adding a lay person t o each complaint review committee.
However, our review of the Arizona S t a t e Board of Dental Examiners1 handling of
consumer complaints revealed t h a t the Board is not completely f u l f i l l i n g its a
s t a t u t o r y r e s p o n s i b i l i t y t o p r o t e c t t h e c i t i z e n s of Arizona a g a i n s t
incompetent d e n t a l p r a c t i t i o n e r s . The Board has c o n s i s t e n t l y f a i l e d t o
---- _ __
ons of substan ompetent
p r o f e s s i o n a l c a r e or unprofessional conduct on the p a r t o f d e n t i s t s licensed by 4
of substandard or
duct have been
s u b s t a n t i a t e d .
See Appendix I X f o r t h e complete t e x t of t h i s statement.
Failure To Adequately Investigate
Alleaations Of Substandard O r Incompetent
Professional Care. Or Unprofessional Conduct
On The Part Of Dentists Licensed By The Board
The S t a t e Board of Dental Examiners has established a process f o r i n v e s t i g a t i n g
and resolving consumer complaints t h a t is not in compliance with s t a t u t o r y
requirements.
ARS 32- 1263( A) d e f i n e s t h e causes for which the Board may censure, prescribe
probation, suspend or revoke t h e l i c e n s e of a person licensed by the Board and
s t a t e s :
" A. The board may censure, prescribe probation or suspend
or revoke the license issued t o any person under t h i s
chapter for any of the following causes:
1. Unprofessional conduct.
2. Conviction of a felo? y or of a misdemeanor involving
moral turpitude, i n which case the record of
conviction or a c e r t i f i e d copy thereof c e r t i f i e d by
the clerk of the court or by the judge i n whose court
the conviction is had s h a l l be conclusive evidence.
3. Physical or mental incompetence t o practice h i s
profession.
According to ARS 32- 1201( 10)* " Unprofessional conduct" includes:
- Use of drugs or alcohol t o the extent t h a t it a f f e c t s
the a b i l i t y of the d e n t i s t or dental hygienist t o
practice h i s profession
- Gross malpractice or repeated a c t s c o n s t i t u t i n g
malpractice
- Any conduct or p r a c t i c e contrary t o recognized
standards of e t h i c s of the dental profession or any
conduct or practice which does or would c o n s t i t u t e a
danger t o t h e h e a l t h , welfare o r s a f e t y of the-?
p a t i e n t or the public. ( Emphasis added)
- Willfully causing or permitting a dental hygienist or
dental a u x i l i a r y personnel operating under h i s
supervision to commit i l l e g a l a c t s or perform an a c t
or operation other than t h a t permitted under the
provisions of a r t i c l e 4 of t h i s chapter and by the
r u l e s and regulations adopted by the board pursuant
to section 32- 1282.
* Appendix I1 is a f u l l t e x t of ARS 32- 1201( 10).
Arizona Revised Statutes 32- 1263( B) through 32- 1263( E) further define the
Board's responsibilities in conducting investigations and imposing discipline
upon those persons licensed by the Board as follows: a
32- 1263( B) " The board on its motion may investigate any
evidence which appears to show the existence of any of the
causes set forth in subsection A of this section, as
grounds for censure, probation, suspension or revocation
of a license. The board shall investigate the report under
oath of any doctor of dentistry, the Arizona state dental
association, any component society, or any other person,
which appears to show the existence of any of the causes
set forth in subsection A of this section as grounds for
censure, probation, suspension or revocation of a
license." ( Emphasis added)
32- 1263( C) " If, in the opinion of the board, it appears
such information is or may be true, the board shall request - -- - -
- an informal interview with the dentist or dental hygienist
concerned." ( Emphasis added)
32- 1263( D) " Following the investigation, including such a
informal interview, if requested, and together with such
mental, physical, or professional competence examination
as the board deems necessary, the board may proceed in the
manner hereinafter provided:.. .
2. If the board finds that the evidence obtained under
subsections B and C of this section does not warrant
suspension or revocation of a license but does
warrant censure or probation, it may either:
( a) Issue a decree of censure.
( b) Fix such period and terms of probation best
adapted to protect the public health and safety and
rehabilitate and educate the dentist or dental
hygienist concerned. Failure to comply with any such
probation shall be cause for filing a complaint and
holding a formal hearing as hereinafter provided in
paragraph 3 of this subsection. ( Emphasis added)
3. If the board finds that the evidence obtained under
subsections issued under this chapter,... then a
complaint shall be issued and formal proceedings for
the revocation or suspension of such license shall be
initiated." ( Emphasis added)
32- 1263( E) " If, after a hearing as provided in this
section any of the causes for censure, probation,
suspension or revocation shall be found to exist, the.
dentist or dental hygienist shall be subject to censure,
probation, suspension of license or revocation of license
or any combination of these and for such period of time or
permanently and under such conditions as the board deems
appropriate for the protection of the public health and
safety and just in the circumstance."
The Board has established a process for investigating and resolving consumer
complaints that provides for:
- Review Of consumer complaints by " complaint committeesf1 which were
formed to assist the Board in processing and investigating
complaints. These complaint committees are comprised of four
practicing dentists. It should be noted that according to the
a lay member
r - should be appointed to each complaint committee. As of August 31,
1979, no lay members had been appointed to the complaint committees. --
- Dismissal of consumer complaints by complaint committees if the
dentist who is the subject of the complaint agrees to make a refund
/ or provide other restitution to the complainant but without holding
an informal interview.
- Dismissal of consumer complaints by individual Board members without
the approval of a quorum of the Board and without holding an informal
interview.
- Dismissal of consumer complaints by the Executive Secretary of the
Board without the approval of a quorum of the Board and without
holding an informal interview.
- Refusal of the Board to hold an informal interview even though
allegations of unprofessional conduct or incompetent work have been
substantiated by the complaint committees.
According to the Legislative Council, i n opinions dated June 14, 1979 and June
20, 1979, the above practices are not in compliance with the requirements of
ARS 32- 1263. A through 32- 1263. E i n t h a t : 4
"... The dental board is not acting i n accordance with
Arizona Revised S t a t u t e s section 32- 1263, sybsection C if
a representative of the board finds evidence of
substandard care pursuant to a report f i l e d ' w i t h t h e board
under oath by any doctor of d e n t i s t r y , the Arizona s t a t e
d e n t a l a s s o c i a t i o n , any component society, or any other
person and the board does not conduct an informal
interview...
The dental board is not acting i n accordance with Arizona
Revised S t a t u t e s section 32- 1263, subsection D, paragraph
1 if one board member terminates the board's investigation
of a complaint. Action by a majority of the board members
is required.. . .
The Dental Board must conduct an informal interview in
response t o a formal outside complaint involving possible
substandard professional care....
It is inappropriate f o r t h e Dental Board to recommend fee
refunds or r e s t i t u t i o n prior t o holding a t l e a s t an
informal interview.. . . "*
It should be noted t h a t in 1978 the Board received 98 consumer complaints. A s
of July 31, 1979, 70 of these complaints had been resolved. However, the Board
did not i n v e s t i g a t e and dispose of any of these 70 complaints in accordance
with ARS 32- 1263( A) through 32- 1263( E). a
Table 1 summarizes t h e d i s p o s i t i o n o f those consumer complaints f i l e d with the
Board during 1978 and resolved as of July 31, 1979.
* Appendix I contains a f u l l t e x t of these Legislative Council opinions.
TABLE 1
SUMMARY OF THE DISPOSITION OF THOSE CONSUMER COMPLAINTS
FILED WITH THE BOARD AND RESOLVED AS OF JULY 31, 1979
Inappropriate Actions Taken
To Dispose Of Complaints
Complaint dismissed without 1) an i n v e s t i g a t i o n
being performed, 2) an informal interview being
held, or 3) a vote by a quorum of the Board.
Complaint dismissed without 1) a f u l l *
i n v e s t i g a t i o n being performed, 2) an informal
interview being held, or 3) a vote by a quorum
--.
o f t h e Board.
03
Complaint dismissed ( even though an i n v e s t i g a t i o n
indicated t h a t substandard or inadequate dental
care had occurred), without 1) an informal
interview being held, or 2) a vote by a quorum
of the Board.
Complaint dismissed without a vote by a quorum
of the Board.
Totals
Complaint Allegations
Incompetent Refusal
or substandard Insurance Fee t o Release
Other Treatment Fraud Dispute X- Rays , Total
* I n v e s t i g a t i o n s were i n i t i a t e d , however, when
t h e d e n t i s t agreed t o make a refund or provide
r e s t i t u t i o n the i n v e s t i g a t i o n was terminated.
The following cases i l l u s t r a t e the manner i n which the consumer complaints
summarized i n Table 1 were resolved.
Case 1 - Dental Complaints 57- 78, 61- 78
S i t u a t i o n - Two complaints were f i l e d a g a i n s t the same d e n t i s t within
two weeks of each other i n September 1978. Both complaints
involved p a t i e n t s whose t e e t h had been e x t r a c t e d and whose
subsequent dentures were uncomfortable and ill f i t t i n g . The
complaint committee r e p o r t s i n d i c a t e d t h e r e were numerous
d e f i c i e n c i e s i n both s e t s of d e n t u r e s , which caused them t o
be n e i t h e r adequate nor f u n c t i o n a l . I n both cases the
complaint committee's opinion was t h a t f u l l denture s e r v i c e
had not been necessary.
Board Action - The Board took no formal a c t i o n i n e i t h e r case. The
complaints were resolved by l e t t e r s signed by t h e Board's
Executive Secretary t o the d e n t i s t i n January 1979. The
first l e t t e r recommended,
"... that the necessary c o r r e c t i o n s be made which
appear t o be an alveolectomy ( removal o f r o o t
fragments) and a f u l l upper denture remake or a
refund of f e e s be made. The Board f e e l s t h a t i f
the recommendations a r e not f u l f i l l e d they w i l l
f i n d it necessary t o i n i t i a t e an informal
i n t e r v i e w , which is the first s t e p i n the
d i s c i p l i n a r y process."
The second l e t t e r recommended,
" . . . t h a t you ... e i t h e r remake the denture or o f f e r
a f u l l refund of fees."
Case 2 - Dental Complaint 69- 78
S i t u a t i o n - A p a t i e n t f i l e d a complaint i n October 1978 claiming t h a t a
d e n t i s t had overcharged him and was negligent i n the
e x t r a c t i o n of a tooth. The complaint committee r e p o r t
i n d i c a t e s t h a t the d e n t i s t removed the wrong tooth and l e f t
r o o t fragments " with no apparent j u s t i f i c a t i o n o f s u r g i c a l
judgment." The r e p o r t a l s o s t a t e s ,
" We f i n d t r e a t m e n t . . . t o not i n any way meet
standards o f q u a l i t y d e n t i s t r y , the charges seem
excessive and the treatment g r o s s l y wrong."
Board Action - The Board took no formal action. A letter signed by
the Board's Executive Secretary was sent to the
dentist in March 1979 recommending that the dentist
contact the complainant to resolve the matter and the
complaint was closed.
Case 3 - Dental Complaint 22- 78
Situation - The Board received a complaint in April 1978 charging a
dentist with poor surgery procedures, improper
diagnosis and substandard dental care. The complaint
committee report indicates the dentist pulled teeth and
placed crowns on teeth unnecessarily. As a result, the
complainant required subsequent root canal treatment.
Board Action - The Board President wrote a letter to the dentist
which outlined the following areas concerning
professional judgement and treatment planning:
" 1. Some key posterior teeth with good
periodontal health have been extracted,
apparently without consideration for
endodontic or other tooth saving treatment.
2. Arbitrary vertical dimension change on a
patient with ( the patient's) medical and
dental history without benefit of trial
splinting or other reversible procedure for
diagnosis.
3. One appointment nearly full mouth tooth
preparation under the circumstances of ( the
patient's) symptoms, signs and medical and
dental history.
4. Need for full coverage on all teeth.
5. Fixed partial dentures with cantilevered
pontics extended distally further than the
mesial distal diameter of one bicuspid.
6. Crowning endodontically questionable teeth
in a rehabilitative treatment procedure."
- The letter also stated,
" Additionally, the Board is not in a position to
intervene in the area of a professional's
relations with patients. By statute definition,
we may only adjudicate the professional's
conduct, patient management or treatment.''
It should be noted that the dentist under investigation agreed to cooperate a
with the complainant's subsequent dentist to resolve the problems in October
1978. However, the complainant responded to an Auditor General survey in April
1979 that:
"... to this date nothing has been resolved."
Case 4 - Dental Complaint 9- 78
Situation - In January 1978, a complaint was filed against one of the
Board members concerning dentures that were ill fitting and 4
not functional. The complaint file indicates that the
complaint committee never contacted the complainant or
examined the dental work to determine whether or not it was
substandard. The complaint committee report ended with this 4
statement, " We don't feel it is our position to evaluate the
work performed."
Board Action - The Board took no formal action. The complaint was
resolved in May 1979, over 16 months after the complaint 4
was filed, with a letter to the complainant stating that
the dental care provided was adequate.
Case 5 - Dental Complaint 47- 78
Situation - A complaint was filed with the Board claiming a dentist
pulled teeth without waiting for the anesthesia to take
effect and left massive bone spurs protruding from the gums
causing the complainant physical and emotional trauma. The 4
dentist made a refund of $ 250 for a bill of $ 195 and the
complaint committee terminated its review. There was no
indication that the committee had examined the patient or
any subsequent x- rays to determine the extent to which the 4
dental care provided was substandard.
Board Action - The Board took no formal action. The complaint was
resolved with a letter to the complainant stating that
- since the dentist had issued a compensatory check the
complaint would be considered closed.
The complainant responded to an Auditor General survey as follows:
" They ( the Board) seem to try to placate the person who
files the complaint with a refund of their money instead of
attempting to remove the incompetent and unethical from
practice. The quality of dental and medical care in this
state is well below that of other places I have lived and
tougher laws and greater effort to remove quacks from
practice is needed.
As demonstrated in the above cases, the Board has not complied with ARS 32-
1263( A) through 32- 1263( E) in its investigation and ultimate resolution of
consumer complaints. Further, the policy of dismissing- complaints_ if a dentist
/-
tution to the complainant avoids the
cy of the dentist. According to the Legislative
Council in an opinion dated June 20, 1979:
" If the evidence found by the board indicates that a
possibility of substandard care exists, the issuance of a
letter by the board requesting a fee refund does not
satisfy the statutory requirements. In this situation the
statutory mandate is clear. The board is obligated to make
a written request for an informal interview.. . . ll *
Failure To Adequately Discipline Dentists
When Allegations Of Substandard Or Incompetent
Professional Care Or Unprofessional Conduct
Have Been Substantiated
The State Board of Dental Examiners has consistently failed to discipline
dentists in spite of statutory requirements to do so. This policy has allowed
dentists with numerous substantiated consumer complaints of incompetence or
substandard care to continue affording dental services to the public.
* Appendix I contains a full text of this Legislative Council opinion.
Arizona Revised S t a t u t e s 32- 1263( D) and 32- 1263( E) p r e s c r i b e the d i s c i p l i n a r y
options a v a i l a b l e t o the Board and s t a t e t h a t the Board may:
1 ) i s s u e a decree of censure,,
2) f i x such period and terms o f p r o b a t i o n b e s t adapted to p r o t e c t t h e
public h e a l t h and s a f e t y and r e h a b i l i t a t e and educate the d e n t i s t ,
3) suspend a l i c e n s e , o r
4) revoke a l i c e n s e .
D i s c i p l i n a r y a c t i o n s should be based upon the evidence obtained and as the
Board deems a p p r o p r i a t e f o r the public h e a l t h and s a f e t y and j u s t i n the
circumstance.
Our review of the Board h a s r e v e a l e d t h a t the Board has exercised those
prescribed d i s c i p l i n a r y options very i n f r e q u e n t l y . For example, from
January 1 , 1964 t o December 31, 1978, the Board: 4
- Revoked only t h r e e l i c e n s e s , none of which was the r e s u l t of a
d e n t i s t providing substandard care.
- Suspended only two l i c e n s e s , f o r 60 days and 90 days, n e i t h e r of
which was the r e s u l t of a d e n t i s t providing substandard care. a
- Placed ten d e n t i s t s on probation only one of which was the r e s u l t of
a d e n t i s t providing substandard care.
- Issued t h r e e decrees of censure none of which was the r e s u l t of a
d e n t i s t providing substandard care.
F u r t h e r , n o t one o f t h e 70 consumer complaints t h a t were f i l e d with the Board
during 1978 and resolved a s of July 31, 1979, r e s u l t e d i n the Board imposing
any d i s c i p l i n e on a d e n t i s t . ( See Table 1 , page 1 8 ) 4
Our review of consumer complaints f i l e d with t h e Board revealed s e v e r a l
i n s t a n c e s of the Board not imposing any d i s c i p l i n e on a d e n t i s t even i n cases
of s u b s t a n t i a t e d a l l e g a t i o n s of substandard c a r e . The following cases a r e 4
i l l u s t r a t i o n s of t h a t policy.
Case 1 - Review of a 1977 Complaint , iP
Situation - A complaint was filed in May 1977 charging a dentist with
using improper procedures while performing a root canal
which resulted in the loss of a tooth and considerable pain
to the complainant. In June 1977, the Board determined that
the dentist had acted properly. ' The Board reopened the
complaint in March 1979 and, at the request of the
complainant, a dentist representing the complainant was
placed on the complaint committee. The complaint committee
presented their findings at the July 14, 1979 Board meeting.
The chairman of the complaint committee stated,
"... ultimately it boiled down to the removal of the bridge
being an error in judgment on the part of ( the dentist). The
committee found that the bridge should not have been removed
and that access to the decay and the root canal could have
been obtained through the crown."
Board Action - At its July 14, 1979 meeting, a Board member stated,
"... the Board is being asked to be a malpractice panel and
the Board should not act in that capacity." However, the
Board's legal representative from the Attorney General's
Office responded, "... the Board is in fact a panel that
determines or sits in review of malpractice and if in
review of this case there appears to be malpractice the
Board should hold an informal interview in the matter." In
spite of the advice of the Board's Attorney General
representative, the Board voted not to hold an informal
interview or initiate any type of formal disciplinary
action. It should be noted that the Board's only public
member was absent from this meeting.
Case 2 - Dental Complaint 21- 78
S i t u a t i o n - A complaint was f i l e d i n April 1978 charging a d e n t i s t with
improperly capping t e e t h , leaving t h e complainant i n a
continual pain and discomfort. A complaint committee report
s t a t e d ,
" The p r e p a r a t i o n , f i t ( and) cementation of the
cappings was inadequate, e s p e c i a l l y considering
t h a t only 16- 18 months have elapsed s i n c e
treatment."
The d e n t i s t agreed t o make a refund and the complaint review
was terminated i n July 1978.
Board Action - The Board has taken no formal a c t i o n .
It should be noted t h a t the d e n t i s t did not make a refund and i n January 1979 a
l e t t e r was s e n t by the Board t o the d e n t i s t s t a t i n g the only a l t e r n a t i v e t o a 4
refund would be an informal interview. However, as of July 31, 1979, the
refund had not been made and the Board had not voted t o hold an informal
interview. The Executive Secretary s t a t e d the reason f o r the lack of action
was t h a t the complainant had f i l e d a c i v i l s u i t and t h e Board was awaiting the 4
decision of the court. This appears t o be i n a p p r o p r i a t e i n t h a t the decision
of the court should have no bearing on any decision made by the Board. Further,
the Board voted on February 27, 1979, t o hold an informal interview with the
same d e n t i s t regarding a subsequent complaint. However, the Board has not 4
scheduled t h a t informal interview as of July 31, 1979.
The Board's policy of not imposing d i s c i p l i n e a p p l i e s not only t o those
d e n t i s t s t h a t have one or two consumer complaints f i l e d a g a i n s t them but t o 4
d e n t i s t s with numerous consumer complaints f i l e d against them as well. The
following t h r e e cases a r e c l e a r examples of the Board's c o n s i s t e n t reluctance
t o impose d i s c i p l i n e on a d e n t i s t i n s p i t e of numerous a l l e g a t i o n s of
incompetence, substandard treatment or unprofessional conduct. 4
Case 1
From May 13, 1978 t o August 14, 1979, t h e Board received 47 consumer complaints
a g a i n s t t h e same d e n t i s t . After t h e e i g h t h consumer complaint t h e Board voted
t o hold an informal interview. After t h e 24th consumer complaint, t h e Board
placed the d e n t i s t on probation. After t h e 42nd consumer complaint, t h e Board
voted t o hold a formal hearing, however, as of August 31, 1979, no d a t e has been
U
e s t a b l i s h e d f o r t h a t hearing. @ ~ ~ r ~ ' 3 - pa L CJLcG
The following is a synopsis of t h e s e 47 consumer complaints and t h e r e s u l t a n t
Board a c t i o n or i n a c t i o n .
May 13, 1978
Complaint Number 1 - The complaint a l l e g e d t h a t dentures prepared by t h e
d e n t i s t were inadequate and t h e d e n t i s t ' s behavior was abusive. The
complaint s t a t e d , ' ' ( t h e d e n t i s t ) grabbed my arm, t r i e d t o f o r c e me
i n t o t h e c h a i r , and when I didnl t sit, he grabbed my jaw - as he had a
few times before - t o t r y t o f o r c e me t o put t h e t h i n g s i n my mouth
again.'' It should be noted t h a t t h e d e n t i s t responded t o a complaint
committee i n q u i r y s t a t i n g '' No ... we do not grab them by t h e arm
a n ( s i c ) f o r c e them t o t a k e t h e t e e t h . Not yet anyway.''
Board Action - None
May 23, 1978
Complaint Number 2 - The complaint a l l e g e d t h a t dentures prepared by t h e
d e n t i s t caused s o r e s on t h e complainant's gums, d e s p i t e seven o f f i c e
c a l l s f o r adjustments. The complaint s t a t e d , " What I have is a very
s o r e mouth ( and) a tongue t h a t is so s o r e from a b i t e t h a t I have a
problem t a l k i n g , e a t i n g o r even drinking. The dentures I have do not
f i t a s w e l l a s t h e ones t h e y r e p l a c e d . I c a n ' t a f f o r d t o j u s t throw
t h e p r i c e I paid away."
Board Action - None
June 30, 1978
Complaint Number 3 - The complaint a l l e g e d t h a t dentures prepared by the
d e n t i s t were not f u n c t i o n a l , causing the complainant pain, and .
preventing him from e a t i n g . Another d e n t i s t examined the dentures
and advised the complainant t o take them back- and ask f o r a refund.
The d e n t i s t became abusive when t h e complainant returned f o r a
refund. The complaint s t a t e d , " But f o r God's sake please s t o p him ( I
from taking advantage of some poor person who doesn't know when they
have been taken t o t h e cleaners."
Board Action - None '
J u l y 19, 1978
Complaint Number 4 - The complaint alleged t h a t t h e d e n t i s t ' s behavior was
abusive and t h e dentures prepared by the d e n t i s t were inadequate.
The complaint s t a t e d , !' He put t h e top ones i n my mouth and I j u s t
moaned with p a i n . I t o l d him they did not f i t . He put them back i n
my mouth and I moaned again." The complainant returned t o pick up
t h e f i n i s h e d dentures and the complaint s t a t e d , "... when ( t h e
d e n t i s t ) put t h e top one i n my mouth it f e l t l i k e my gums were being
t o r n a p a r t . . . . Then he put the bottom ones i n , they f e l t l i k e they
were coming out i n my jaw, the t e e t h were away from my gums. I could
f e e l a breeze coming i n between my gums and t e e t h . . . . He t o l d me I
would have t o get used t o them. I s a i d I could never get used t o
them. He j u s t took the d e n t u r e s o u t of my mouth, threw them i n the
waste basket. Handed me my t e e t h and t o l d ( t h e r e c e p t i o n i s t ) t o get
r i d of her."
Board Action - None
August 3, 1978
Complaint Number 5 - The complaint alleged t h a t dentures prepared by the
d e n t i s t were p a i n f u l t o wear and did not fit c o r r e c t l y . The
complaint s t a t e d , " I went t h e r e expecting t o g e t a s e t of custom made
dentures, i n s t e a d they gave me a s e t of pre- made horse t e e t h . "
Board Action - None
September 25, 1978 '
Complaint Number 6 - The complainant is 83 years old, r e t i r e d and on a
reduced income. The complaint alleged t h a t dentures prepared by the
d e n t i s t were much l a r g e r than the complainant's previous s e t and
i r r i t a t e d the gums " so t h a t open sores developed." The complainant
also s t a t e d , "( I) could not enjoy a meal a s they were so loose they
danced around i n my mouth and food gathered underneath so t h a t I was
i n misery trying t o chew."
Board Action - None
September 29, 1978
Complaint Number 7 - The complaint alleged t h a t t h e d e n t i s t made a lower
p a r t i a l which was very loose and caused the complainant's mouth t o
become sore. When the complainant returned for the second adjustment
t h e d e n t i s t became rude. The complaint s t a t e d , " I said t h a t we could
c a l l the B. B. B. and he ( the d e n t i s t ) s a i d he did not give ( a )
( d e l e t e d e x p l e t i v e ) i f we called P r e s i d e n t C a r t e r and walk( ed) out.
Came back. I t r i e d t o t e l l him about my discomfort and sores. He
t o l d me t o open my ( d e l e t e d e x p l e t i v e ) mouth and said he would make
them s o t i g h t I would not be able t o take them out.. . . I told him t h a t
we were on low income and could not afford t o lose $ 185 and not ( be)
able t o wear the p a r t i a l , but he t o l d me t o go to somebody else." The
complaint a l s o s t a t e d , " I w i l l not go back t o ( the d e n t i s t ) again. I
am a f r a i d of him. If nothing comes out of t h i s complain( t) I do hope
no one e l s e w i l l have t o go through with ( t h e d e n t i s t ) what I went
through.
Board Action - None
September 21, 1978
Complaint Number 8 - The complaint alleged t h a t the dentures prepared by
the d e n t i s t were of poor workmanship, impossible t o f i t and painful
even when talking. The complaint s t a t e d , "( the d e n t i s t ) got mad when
he had f i l e d them down and I told him they hurt and looked t e r r i b l e . "
The complaint a l s o s t a t e d , " He is a detriment t o the dental society
i n general." It should be noted t h a t the complainant received a
s a t i s f a c t o r y s e t of dentures from another d e n t i s t .
Board Action - None
September 30, 1978
Board Action - The Board voted t o hold an informal interview based on the
previous e i g h t complaints.
October 3, 1978
Complaint Number 9 - The complaint alleged t h a t dentures prepared by the
d e n t i s t did not f i t . The complaint s t a t e d , " They a r e s o much smaller
than my old set of dentures t h a t when I t r y t o wear them my nose and
chin almost meet and my mouth puckered."
Board Action - None
October 20, 1978
Complaint Number 10 - The complaint alleged t h a t dentures prepared by the
d e n t i s t d i d n o t f i t and t h a t the d e n t i s t r e l i n e d t h e dentures i n a
sloppy manner.
Board Action - None
December 13, 1978
Complaint Number 11 - The complaint alleged t h a t the d e n t i s t became rude
when the complainant t o l d him t h a t the dentures hurt. The complaint
s t a t e d , " The new t e e t h a r e s o d u l l t h a t I cannot even b i t e off a
piece of bread, l e t alone meat."
Board Action - None
December 13, 1978
Complaint Number 12 - The complaint alleged t h a t dentures prepared by the
d e n t i s t were n o t f u n c t i o n a l . The complaint s t a t e d , " I am 78 years
old, on S o c i a l S e c u r i t y , and t o pay $ 255 f o r t e e t h I c a n ' t even use
seems very unfair."
Board Action - None
December 13, 1978
Complaint Number 13 - The complainant was d i s s a t i s f i e d with the
a e s t h e t i c s of a lower p l a t e . Complainant cancelled the check written
as a deposit on the plate and did not r e t u r n t o the d e n t i s t 1 s o f f i c e .
Board Action - None
December 14, 1978 .
Complaint Number 14 - The complaint alleged t h a t dentures prepared by the
d e n t i s t were causing pain and were not functional. The complaint
s t a t e d , " After weeks and then months of pain and misery trying t o use
them I had t o give up, due t o pain, plus the f a c t I didn't e a t one
s i n g l e meal with comfort, and lived mainly on soup and s o f t boiled
eggs. l1 It should be noted t h a t the complainant now has dentures made
by a d e n t u r i s t " and they f i t perfect."
Board Action - None
B December 19, 1978
Complaint Number 15 - The complaint alleged t h a t dentures prepared by the
d e n t i s t were not centered properly and could not be worn. The
complaint s t a t e d , " I've been wearing f a l s e t e e t h since World War I1
and have had several pair made during t h a t time. These a r e t h e most
crudely made, the most i l l - f i t t i n g and the poorest craftsmanship of
any I ' v e had or seen."
Board Action - None
December 19, 1978
Complaint Number 16 - The complaint alleged t h a t dentures prepared by the
d e n t i s t were not f i t t e d properly and the d e n t i s t ' s behavior was
unprofessional. The complaint s t a t e d , '' 1 t o l d him what I thought was
wrong and he t o l d me ' You seem t o know more than me1 and every v i s i t
he was very s a r c a s t i c and even told me t o f i x them myself. Keeps
t e l l i n g me the dentures a r e perfect - upon l a s t v i s i t I was t e l l i n g
him I can't stand t o wear them any longer - t h a t I can not chew food
and have sores a l l over, I ' v e l o s t 6 pounds trying for 5 weeks t o get
used t o them."
Board Action - None
January 12, 1979 .
Complaint Number 17 - The complaint a l l e g e d t h a t dentures prepared by t h e
d e n t i s t did not f i t . The complaint s t a t e d , " 1 think t h i s d e n t i s t
should be made ( t o ) pay the poor peoples money back t o them a r e at
l e a s t what is r i g h t because he did a very poor job. I am on S o c i a l
S e c u r i t y and do not have money t o give away. N The complainant took
the dentures t o another d e n t i s t and, "... he looked at them and s a i d
he had seen Bad Jobs b u t t h i s was t h e worst one he had ever
witnessed."
Board Action - None
January 17, 1979
Complaint Number 18 - The complaint a l l e g e d t h a t the d e n t i s t ' s behavior
was abusive and the dentures prepared by t h e d e n t i s t caused " nothing
but pain.'' The complaint s t a t e d , " 1 went back f o r f i v e adjustments.
The f o u r t h time he reduced me t o t e a r s by h i s manner. The f i f t h and
l a s t time h i s manner had not improved and h i s r e p e a t i n g a g a i n and I
quote ' I don't know what t o do except send you f o r surgery. Your
mouth is beat t o hell!" It should be noted t h a t another d e n t i s t made
a s e t of dentures which f i t t h e complainant without r e q u i r i n g any
surgery.
Board Action - None
January 26, 1979
Complaint Number 19 - The complaint a l l e g e d t h a t dentures prepared by the
d e n t i s t were causing s o r e s p o t s and were n o t f u n c t i o n a l .
Board Action - None
January 26, 1979
Complaint Number 20 - The complaint a l l e g e d t h a t dentures prepared by the
d e n t i s t were i l l - f i t t i n g . The complaint s t a t e d , " I am on Social
S e c u r i t y and a widow, and c a n ' t a f f o r d t h i s kind of l o s s . . . I f e e l
t h a t t h e r e a r e a l o t of other people l i k e myself, ' being taken' but
f e e l ashamed t o admit it." The complaint a l s o s t a t e d , " I have had
another d e n t i s t look a t the t e e t h and the f i t , and they were
astonished t h a t anyone would put t h a t kind of work out at ' any
p r i c e ' ."
Board Action - None
3 1
January 29, 1979 .
Complaint Number 21 - The complaint alleged t h a t dentures prepared by the
d e n t i s t were inadequate and the d e n t i s t ' s behavior was abusive. The
complaint s t a t e d , " When it became evident t o me t h a t the s i t u a t i o n
was hopeless I told him t h a t I would not be able t o accept them, he
appeared t o become very angry and threw them- in the garbage can and
t o l d me there was no one coming i n t o his place and t e l l i n g him how t o
run his business... The r e c e p t i o n i s t r e t r i e v e d them from the garbage
can, rinsed them o f f , and was explaining t h e i r appearance t o us when
the d e n t i s t came i n and found us there. He began cussing and
swearing a t us and t o l d the r e c e p t i o n i s t t h a t I had used up my
appointment and i f I wanted anything more I would have t o make
another appointment.''
Board Action - None
February 5, 1979
Complaint Number 22 - The complaint alleged t h a t dentures prepared by
t h e d e n t i s t were not functional. The complaint s t a t e d , '' they f l i p
and allow food t o get between the lower p l a t e and gums. A week l a t e r
I made an appointment t o have t h i s corrected. The denture was never
taken out o f my mouth and ( the d e n t i s t ) t o l d me ' t h a t was the best
they would ever f i t 1 and he walked out of the room i n a f i t of
temper. . . . l1
Board Action - None
February 5, 1979
Complaint Number 23 - The complaint alleged t h a t dentures prepared by the
d e n t i s t were i l l - f i t t i n g and the d e n t i s t ' s behavior was rude. The
complaint s t a t e d , '' 1 called him again on January 25, 1979 and
explained again the upper t e e t h were too long, and I couldn't e a t or
even drink l i q u i d s without choking.. . . He left the phone when I was
still trying t o t e l l him how they were a f f e c t i n g my health.''
Board Action - None
February 9, 1979
Complaint Number 24 - The complaint alleged t h a t dentures prepared by the
d e n t i s t were not functional, were too l a r g e , and caused pain " a l l the
time."
Board Action - None
February 27, 1979
Board Action - An informal interview was held on . February 9, 1979, and
based on the interviewing o f f i c e r ' s report the Board voted t o place
the d e n t i s t on probation. It should be noted t h a t one of the terms
of probation s t a t e d , " That every e f f o r t be made t o manage complaints
i n the o f f i c e i n order t h a t the inordinate amount of complaints
cease. "
February 28, 1979
Complaint Number 25 - The complaint alleged t h a t the lower p l a t e did not
f i t properly. The complainant took the p l a t e t o a dental l a b and was
t o l d " it was j u s t a p i e c e o f junk."
Board Action - None
April 4, 1979
Complaint Number 26 - The complaint alleged t h a t dentures prepared by the
d e n t i s t caused h i s whole mouth and tongue t o s w e l l . Also, when he
returned t o t h e d e n t i s t ' s o f f i c e he was t o l d t h a t the dentures were a
perfect f i t .
Board Action - None
April 3, 1979
Complaint Number 27 - The complaint alleged t h a t the d e n t i s t ' s behavior
was abusive and the dentures prepared by the d e n t i s t would not f i t .
The complaint s t a t e d , !' I t r i e d t o t e l l him they hurt my gums, and one
tooth t h a t wasn't r i g h t and d i d n o t f i t r i g h t and every time I would
s t a r t t o t e l l him about it he would y e l l a t me t h a t I wasn't giving
them a chance. So I t o l d him I couldn't wear them and he would y e l l
a t me, and grab h i s head and say Jesus, and walk o u t o f the room,
saying, I can't t a l k t o t h a t woman, then he would come back i n , and
when I t r i e d t o t a l k he would do the same thing, grab h i s head and
walk out. I thought he was going t o slap me."
Board Action - None
April 21, 1979
Complaint Number 28 - The complaint alleged t h a t dentures prepared by the
d e n t i s t were inadequate and not f i t t e d properly. It should be noted
t h a t the complainant took the dentures t o another d e n t i s t and was
t o l d , " 1 don't know what you paid f o r them but whatever it was it was
way too much."
Board Action - None
April 21, 1979
Complaint Number 29 - The complaint alleged t h a t dentures prepared by the
d e n t i s t were very uncomfortable. The complaint s t a t e d , " 1
complained t h a t my mouth was g e t t i n g worse from pain. He asked me t o
come i n f o r ( an) adjustment which I did... he made a minor adjustment
which was no help." The complaint a l s o s t a t e d , " 1 have now reached
the conclusion t h a t it is useless t o t r y t o obtain s a t i s f a c t o r y
service from ( the d e n t i s t ) and i n making t h i s complaint it w i l l spare
someone e l s e a similar treatment."
Board Action - None
April 23, 1979
Complaint Number 30 - The complaint a l l e g e d t h a t : 1) dentures prepared by
the d e n t i s t were received approximately October 20, 1978, 2) the
complainant returned numerous times f o r adjustments, 3) the
dentures never f i t properly, and 4) the complainant returned f o r a
r e l i n e i n e a r l y Arpil 1979. The complaint. s t a t e d t h a t a f t e r the
r e l i n e , ltPieces were breaking o f f them before I got home. They still
have my mouth s o r e so I am not s a t i s f i e d with h i s work a t all."
Board Action - None
April 24, 1979
Complaint Number 31 - The complaint a l l e g e d t h a t dentures prepared by the
d e n t i s t were not properly f i t t e d and t h a t the d e n t i s t had l e f t a
c i r c u l a r cut i n a p l a t e while grinding which i r r i t a t e s h i s mouth.
Board Action - None
May 9, 1979
Complaint Number 32 - The complaint a l l e g e d t h a t t h e upper p l a t e made by
the d e n t i s t d i d n o t f i t . The complaint s t a t e d , " 1 t o l d him ( t h e
dentures) were too wide and did not match up with my bottom p a r t i a l
bridge. He i n t u r n ground my lower bridge and t r i e d t o bend it t o f i t
and on four occasions made it worse each t i m e , u n t i l my mouth was so
s o r e I could no longer wear the t e e t h . "
Board Action - None
May 4, 1979
Complaint Number 33 - The complaint a l l e g e d t h a t dentures prepared by the
d e n t i s t were inadequate and the d e n t i s t ' s behavior was very rude and
uncalled f o r . The complaint s t a t e d , " I s a i d I c a n ' t chew and choke
on my food - had a locked jaw and earache - he s a i d ( d e l e t e d
e x p l e t i v e ) He acted l i k e a madman waving h i s arms i n t h e air and
shouting." The complaint a l s o s t a t e d , " I hope t h i s may help some
o t h e r s e n i o r c i t i z e n on a l i m i t e d income as we are."
Board Action - None
May 28, 1979
Complaint Number 34 - The complaint a l l e g e d t h a t dentures prepared by the
d e n t i s t a r e i l l - f i t t i n g and not f u n c t i o n a l . The following s t a t e -
ments were excerpted from the complaint:
1. " When food is taken, the lowers f l o a t o f f i n t o t h e food, with
the exception o f mashed p o t a t o e s . T h i s is h o r r i b l e i n public
and a l s o h u r t s whenever it touches t h e gums. ll
2. " The shape o f t h e t e e t h a l s o was so jagged you had t o hold your
tongue motionless t o keep from scraping it."
3. " As a r e t i r e d person on S o c i a l S e c u r i t y I cannot a f f o r d t o pay
f o r dentures I cannot use, and a l l I got was a s o r e mouth. ll
4. " ( t h e dentist)'^ way of doing business reminds me very much of
Bugs Bunny."
It should be noted t h a t the complainant received a s e t of dentures
from another d e n t i s t t h a t " f i t fine."
Board Action - None
June 1, 1979
Complaint Number 35 - The complaint a l l e g e d t h a t the dentures prepared by
t h e d e n t i s t i n September 1978 were i l l - f i t t i n g and inadequate. The
complaint s t a t e d , " Now t h e t e e t h i n t h e p a r t i a l a r e worn down and I
am chewing on the s i l v e r . I don't think it's r i g h t . "
Board Action - None
June 19, 1979
Complaint Number 36 - The complaint a l l e g e d t h a t the dentures were not
f i t t e d c o r r e c t l y d e s p i t e f i v e o f f i c e v i s i t s f o r adjustments. The
complaint s t a t e d , " 1 am on S o c i a l S e c u r i t y , I c a n ' t j u s t throw my
money away on something l i k e t h i s . The complaint a l s o contained a
newspaper a r t i c l e which s t a t e d i n p a r t :
!* The i r r i t a t i o n t o mouth t i s s u e s , including the tongue
and l i p s , t h a t can r e s u l t from wearing i l l f i t t i n g
dentures can s e t the stage f o r o r a l cancer, they
( d e n t i s t s ) caution.
In addition, dentures t h a t f i t poorly do not permit
the proper chewing of food. A s a - r e s u l t , food is
swallowed when only p a r t l y masticated, leading t o
d i g e s t i v e u p s e t s and sometimes even' choking, d e n t i s t s
say.
The i n a b i l i t y t o chew food properly can lead t o the
avoidance of s o l i d food, r e s u l t i n g i n malnutrition,
d e n t i s t s a l s o say."*
Board Action - None
June 25, 1979
Complaint Number 37 - The complaint alleged t h a t the dentures prepared by
t h e d e n t i s t did not f i t and were t o t a l l y unacceptable. The
complainant had another d e n t i s t evaluate the dentures.
The second d e n t i s t s t a t e d , " My opinion is t h a t the dentures a r e of a
poor quality and t h a t t h e service should be dramatically improved."
The complaint a l s o s t a t e d , " 1 hope you can prevent t h i s happening t o
others, "
Board Action - None
June 17, 1979
Complaint Number 38 - The complaint alleged t h a t the dentures prepared by
4
the d e n t i s t were inadequate and i l l - f i t t i n g and the d e n t i s t ' s
behavior was rude. The complaint contained the following
statements:
1. " He kept h i t t i n g my top l i p and t e l l i n g me t o relax. I
couldn't because it f e l t l i k e the piece of skin t h a t
connects my l i p t o my gum was being cut off."
2. " I had gotten so mad and upset t h a t it brought on a c o l i t i s
a t t a c k which l a s t e d q u i t e a few days."
* DeVries, Julian. " National Dental Association Warns Against
Prefabricated False Teeth," The Arizona Republic, April 12, 1979.
3. " When he was s a t i s f i e d with the f i t , I told him they were
still too long and cut i n t o the back of my mouth. He said
my old ones were too short and I ' d get used t o these."
4. " 1 haven't been back and I don't intend t o see him again.
I would still l i k e t o have my $ 50.00 back and I don't f e e l
he should be a licensed Dentist." ~
June 23, 1979
Complaint Number 39 - The complaint alleged that: 1) the complainant put
down a $ 50 deposit f o r a s e t of dentures a f t e r a b r i e f examination,
2) checked i n t o the d e n t i s t ' s background by c a l l i n g the Better
Business Bureau and the Dental Association, 3) stopped payment on
the check and cancelled h i s appointment for the following day, and
4) the d e n t i s t threatened t o i n s t i t u t e proceedings to c o l l e c t t h e $ 50
deposit .
Board Action - None
June 25, 1979
Complaint Number 40 - The complaint alleged t h a t t h e d e n t i s t was very rude
and t h a t the dentures did not f i t . The complaint s t a t e d , " 1 don't
want a l o t of trouble over t h i s but I do want my money refund( ed)
because I have save( d) for a long time so I could get these teeth."
Board Action - None
July 5, 1979
Complaint Number 41 - The complaint alleged t h a t p a r t i a l dentures prepared
by t h e d e n t i s t would not f i t and were causing sores despite f i v e
return v i s i t s for adjustments. The complaint s t a t e d , " He t o l d me I
would have t o learn t o chew d i f f e r e n t l y and t h a t I may be one of
those people who would never be able t o get used t o wearing dentures.
I told him I have worn dentures f o r t h i r t e e n year^.^
Board Action - None
July 7, 1979
Complaint Number 42 - The complaint alleged t h a t dentures prepared by the
d e n t i s t were i l l - f i t t i n g and caused her gums t o swell and hurt.
Board Action - None
July 11, 1979
Complaint Number 43 - The complaint alleged t h a t t h e d e n t i s t ' s behavior
was unprofessional and the dentures prepared by t h e d e n t i s t did not
f i t . The complaint s t a t e d , " He came out of h i s o f f i c e l i k e a mad
man. He never l i s t e n e d t o me. I t r i e d t o t e l l - h i m t h a t he could keep
the $ 50 deposit and give me back the r e s t . He'never l i s t e n e d t o me or
heard a word I s a i d . A t f i r s t he claimed I ' d never been i n t h e r e -
d i d n ' t know me. He was j u s t r a n t i n g and raving."
Board Action - None
J u l y 14, 1979
Board Action - The Board voted t o hold a formal hearing.
August 13, 1979
Complaint Number 44 - The complaint alleged t h a t t h e occlusion o f t h e
dentures was not proper, the dentures were i l l - f i t t i n g and the
d e n t i s t ' s behavior was rude. The complaint s t a t e d , " When he repaired
the crack i n the uppers he took my lower p a r t i a l and ground the four
f r o n t f a l s e t e e t h s o t h a t cosmetically, they were much s h o r t e r than
the adjacent t e e t h giving a wolfish fang- like look. The uppers a r e
a l s o s l a n t e d way up t o the l e f t and abnormally too low on the r i g h t . "
Board Action - None
August 14, 1979
Complaint Number 45 - The complaint a l l e g e d t h a t dentures prepared by the
d e n t i s t were i l l - f i t t i n g and n o t f u n c t i o n a l . The complaint s t a t e d ,
" 1 haven't eaten a s o l i d piece of food since g e t t i n g these dentures.
I have l o s t weight r a p i d l y and is g e t t i n g weak and unsteady. ll
Board Action - None
August 14, 1979 .
Complaint Number 46 - The complaint a l l e g e d t h a t dentures prepared by t h e
d e n t i s t lacked proper occlusion and were i l l - f i t t i n g . The complaint
s t a t e d , " In t h e t h i r t y - f i v e ( 35) years of wearing dentures I have
never had t h e problems t h a t ( t h e dentist)'^ dentures were giving me."
Board Action - None
August 14, 1979
Complaint Number 47 - The complaint a l l e g e d t h a t dentures prepared by t h e
d e n t i s t were i l l - f i t t i n g and caused " great painf1 d e s p i t e f i v e o r s i x
v i s i t s f o r adjustments.
Board Action - None
Case 2
From October 15, 1975 t o January 8, 1979, the Board received 15 consumer
complaints a g a i n s t d e n t a l c l i n i c s owned and operated by the same dental
corporation. The consumer complaints alleged t h a t t h e l e v e l of professional
care was substandard and/ or t h a t dental a u x i l i a r i e s * were performing unautho-rized
duties. The Board held an informal hearing on' the 8th, 9th and 10th
consumer complaints which dealt only with the use of dental a u x i l i a r i e s . An
informal hearing was not held by the Board t o i n v e s t i g a t e any of the allega-tions
of substandard care. The Board did not impose any d i s c i p l i n e on the
d e n t i s t named i n the consumer complaints. The following is a synopsis of these
15 consumer complaints and t h e r e s u l t a n t Board action or inaction.
October 15, 1975
Complaint Number 1 - The complaint alleged t h a t the dentures were very
painful and did not f i t properly. The complaint s t a t e d , " I ' m very
nervous, and have l o s t weight, as I can not eat anything y e t , except
s o f t foods."
Board Action - A l e t t e r from the Board's Executive Secretary to the
complainant s t a t e d , '' 1 r e g r e t t h a t from the material presented i n the
l e t t e r we can take no action. l1 It a l s o s t a t e d , " Generally the things
you mention a r e matters for c i v i l courts t o determine and I might
suggest you obtain the advice of an attorney t o determine your legal
standing i n respect t o the implied contract you have with the
doctor ."
* Dental a u x i l i a r i e s , as used i n t h i s report, r e f e r s t o dental a s s i s t a n t s ,
d e n t a l h y g i e n i s t s , dental technicians and d e n t u r i s t s .
February 1, 1976 .
Complaint Number 2 - The complaint alleged t h a t the dentures received
were i l l - f i t t i n g and caused the complainantls face and gums t o become
swollen.
Board Action - No d i s c i p l i n a r y a c t i o n was taken, A l e t t e r from the
Board's Executive Secretary to the complainant s t a t e d , " I wish t o
assure you t h a t t h i s agency t h a t was created t o serve t h e p u b l i c ' s
i n t e r e s t is not i n d i f f e r e n t t o your plight." The same l e t t e r s t a t e d ,
" I am a f r a i d there is no agency t h a t can help you unless you went t o
the Legal Aid Society or Lawyers1 Referral. Both agencies are
designed t o aid persons i n legal matters.''
August 9, 1976
Complaint Number 3 - The complainant alleged t h a t a dental p l a t e received
from the d e n t i s t cracked a f t e r l e s s than two months use and t h a t the
d e n t i s t refused t o have it remade.
Board Action - No d i s c i p l i n a r y a c t i o n was taken. A l e t t e r from the
Board's Executive Secretary t o the complainant s t a t e d , '' As I
indicated on the telephone, it takes more than one or two complaints
about a d e n t i s t i n order t o have a hearing on incompetency and we
w i l l keep your complaint on f i l e pending r e c e i p t of others of l i k e
nature. l1
September 22, 1976
Complaint Number 4 - The complaint alleged t h a t a p a r t i a l plate repaired
by the d e n t i s t was not repaired c o r r e c t l y , kept f a l l i n g out and was
not s a t i s f a c t o r y .
Board Action - No d i s c i p l i n a r y a c t i o n was taken. A l e t t e r from the
Board's Executive Secretary t o the complainant s t a t e d , " charges of
incompetency against a professional requires more than one complaint
i n order to conduct a hearing i n the matter. We w i l l r e t a i n your
complaint i n the f i l e s pending receipt of others.''
November 23, 1976 .
Complaint Number 5 - The complaint a l l e g e d t h a t t h e dentures were not
f i t t e d properly. The complaint s t a t e d , " Hence I a l s o l o s t consider-a
b l e weight as I was not a b l e t o chew with them." It should be noted
t h a t the complainant was subsequently f i t t e d ncomfortablyll and
l l s a t i s f a c t o r i l y w with dentures by a p r i v a t e d e n t a l l a b o r a t o r y
t e c h n i c i a n .
Board Action - No i n d i c a t i o n of any a c t i o n .
January 22, 1977
Complaint Number 6 - The complaint a l l e g e d t h a t the dentures were ill-f
i t t i n g and caused p a i n w h i l e e a t i n g d e s p i t e approximately 12 r e t u r n
v i s i t s f o r adjustments .
Board Action - There was no i n d i c a t i o n t h a t the Board ever responded t o
t h e complaint. However, a l e t t e r from the Board's Executive
Secretary t o the d e n t i s t s t a t e d , '' The Board has asked me t o w r i t e t o
you t o advise you t h a t perhaps you might r e - e s t a b l i s h communication
with ( t h e p a t i e n t ) t o t r y and r e s o l v e the s i t u a t i o n . We a l l r e a l i z e
p a r t i c u l a r l y a t t h i s time t h a t d e n t i s t r y does not need vocal c r i t i c s
e s p e c i a l l y i n t h e a r e a of dentures." ( Emphasis, added)
March 27, 1977
Complaint Number 7 - The complaint a l l e g e d t h a t proper treatment was not
received from the d e n t i s t when a " dry socketv occurred a f t e r a tooth
was e x t r a c t e d . The complainant made an appointment with another
d e n t i s t t o have the pain a l l e v i a t e d .
Board Action - No d i s c i p l i n a r y a c t i o n was taken. A l e t t e r from the , a
Board's Executive Secretary t o the complainant s t a t e d , " Perhaps i n
view of t h i s complaint, the d e n t i s t s i n ( t h e dentist)'^ o f f i c e w i l l
go t o g r e a t e r lengths t o explain t h e i r treatment plans and e s p e c i a l l y
when t h e s e s p e c i a l problems occur."
March 28, 1977
Complaint Number 8 - The complaint alleged t h a t the dentures caused
" excruciating paintt d e s p i t e a s e r i e s of o f f i c e v i s i t s f o r
adjustments. The complaint a l s o alleged t h a t dental a u x i l i a r i e s ,
not d e n t i s t s , were a d j u s t i n g the dentures.
Board Action - See Complaint Number 10
July 9, 1977
Complaint Number 9 - The complaint alleged t h a t the dentures did not f i t
properly. The complaint a l s o a l l e g e d t h a t dental a u x i l i a r i e s , not
d e n t i s t s , were a d j u s t i n g the dentures.
Board Action - See Complaint Number 10
August 8, 1977
Complaint Number 10 - The complaint a l l e g e d t h a t the dentures did not f i t
and were n o t f u n c t i o n a l . The complaint a l s o alleged t h a t d e n t a l
a u x i l i a r i e s , not d e n t i s t s , were a d j u s t i n g the dentures. It should be
noted t h a t the complainant a l s o requested a s s i s t a n c e from the
Maricopa County Legal Aid Society. This agency s e n t a letter t o t h e
Board of Dental Examiners which s t a t e d , " Where s e v e r a l such persons
come t o our o f f i c e with e s s e n t i a l l y similar claims a g a i n s t a s i n g l e
person, f o r a time period covering l e s s than two years o f p r a c t i c e ,
it would appear t h a t the problem would be one t o which the Board
might give more weight than an i s o l a t e d denture complaint."
Board Action on Complaint Numbers 8, 9 and 10 - An informal interview was
held f o r complaints 8, 9 and 10. The Board d i d n o t r e t a i n a copy of
the t r a n s c r i p t o f t h e interview. However, t h e interviewing o f f i c e r
did prepare a one- page summary of t h e interview. The i s s u e of
substandard d e n t a l c a r e does not appear t o have been addressed i n the
interview based on the o f f i c e r ' s summary. The main i s s u e addressed
was l a c k of proper supervision over a u x i l i a r i e s . One other i s s u e was
discussed as evidenced by t h i s statement i n t h e i n t e r v i e w e r ' s
r e p o r t , " The f a c t t h a t ( t h e d e n t i s t ) has had more complaints than
anyone i n t h e s t a t e r e g i s t e r e d with t h e Dental Board was discussed
and ( t h e d e n t i s t ) s t a t e d t h a t he was proud of h i s s e r v i c e and t h a t he
simply had a very l a r g e p r a c t i c e . " The Board voted t o censure the
d e n t i s t based on the interviewing o f f i c e r ' s r e p o r t .
November 17, 1977
Complaint Number 11 - The complaint alleged t h a t the upper p a r t i a l p l a t e
did not f i t and was never p r o p e r l y a d j u s t e d . The complaint a l s o
a l l e g e d t h a t the d e n t i s t ' s c l i n i c was " engaged i n u n e t h i c a l and
f r a u d u l e n t conduct which is dangerous t o the people of Arizona."
Board Action - The complaint committee could not determine t h e v a l i d i t y
of the p a t i e n t ' s complaint. There is no i n d i c a t i o n i n t h e complaint
f i l e t h a t the complainant was n o t i f i e d of t h e r e s o l u t i o n of the
complaint.
May 8, 1978
Complaint Number 12 - The complaint alleged t h a t the dentures caused the
complainant's mouth t o become sore and were i l l - f i t t i n g . It should
be noted t h a t the complainant received a s e t o f d e n t u r e s which " f i t
perfectly1' from a d e n t u r i s t .
Board Action - The complaint committee found numerous inadequacies i n the
dentures and determined t h a t the biggest problem was t h a t the
complainant and d e n t i s t could or would not work together. No
d i s c i p l i n a r y a c t i o n was taken.
May 5, 1978
Complaint Number 13 - The complaint a l l e g e d t h a t the d e n t a l p l a t e was
inadequate and caused the complainant's mouth t o become sore and
swollen. It should be noted t h a t the complainant received a p l a t e
from a d e n t u r i s t which '! fit perfect.''
Board Action - The complaint committee found numerous d e f i c i e n c i e s i n the
p l a t e and s t a t e d , " The denture was not i n our opinion s a t i s f a c t o r y
and t h e p a t i e n t has a l e g i t i m a t e ~ o m p l a i n t . ' ~ I t should be noted t h a t
no d i s c i p l i n a r y a c t i o n was even i n i t i a t e d .
July 6, 1978
Complaint Number 14 - The complaint a l l e g e d t h a t the dentures did not f i t
properly and t h a t the d e n t i s t was rude.
Board Action - The complaint committee determined t h a t the treatment was
proper.
January 8, 1979 .
Complaint NGmber 15 - The complaint a l l e g e d t h a t the d e n t a l c a r e performed
was inadequate and t h a t a p a r t i a l was n o t p r o p e r l y f i t t e d .
Board Action - The complaint committee determined t h a t the d e n t a l c a r e
provided was l e s s than adequate and the p a r t i a l was unacceptable. It
should be noted t h a t no d i s c i p l i n a r y a c t i b n was i n i t i a t e d .
Case 3
From July 15, 1976 to August 23, 1979, the Board received 15 consumer
complaints a g a i n s t s e v e r a l dental c l i n i c s owned and operated by the same dental
corporation. Not only has the Board not imposed any d i s c i p l i n e on t h i s d e n t i s t
but it has f a i l e d to hold an informal interview to determine what action i f any
it should take. The following is a synopsis of these 15 consumer complaints
and the r e s u l t a n t Board action or inaction.
July 15, 1976
Complaint Number 1 - The complaint alleged that: 1) the dentures provided
were i l l - f i t t i n g , 2) despite 18 o f f i c e v i s i t s the dentures were
never properly adjusted, and 3) the complainant l o s t 20 pounds
during t h i s time. It should be noted t h a t the complainant did
receive dentures which f i t properly from another d e n t i s t .
Board Action - The Board i n i t i a t e d no i n v e s t i g a t i o n or d i s c i p l i n a r y
action.
August 9, 1976
Complaint Number 2 - The complaint alleged t h a t the d e n t i s t ' s diagnosis
involved overtreatment. The complaint also alleged t h a t a second
d e n t i s t was consulted using the f i r s t d e n t i s t ' s x- rays and the second
d e n t i s t diagnosed nine fewer c a v i t i e s .
Board Action - There is no indication t h a t any action was taken by the
Board.
November 16, 1976
Complaint Number 3 - The complaint alleged t h a t the dentures provided were
i l l - f i t t i n g despite two v i s i t s for adjustments. It should be noted
t h a t the complainant did receive a s a t i s f a c t o r y set of dentures from
one of the " new denture s p e c i a l i s t s " ( a d e n t u r i s t ) .
Board Action - The Board i n i t i a t e d no investigation or d i s c i p l i n a r y
action. It appears t h a t the complaint was closed when two members of
the d e n t i s t ' s s t a f f agreed to t r y to s a t i s f y the complainant.
December 14, 1976 -
Complaint Number 4 - The complaint alleged t h a t the dental p l a t e s provided
were nothing more than temporary plates. •
Board Action - The Board i n i t i a t e d no i n v e s t i g a t i o n or d i s c i p l i n a r y
action. The Board did send a l e t t e r t o the d e n t i s t ' s o f f i c e which
s t a t e d , " We have received additional complaints concerning each of
( t h e d e n t i s t ' s ) offices.'? The l e t t e r a l s o indicated t h a t no action ( I
would be taken u n t i l the d e n t i s t ' s o f f i c e " had an opportunity to t r y
and come to some mutual understanding with the p a t i e n t s . "
July 9, 1977 d
Complaint Number 5 - The complaint alleged t h a t the dentures provided did
not f i t despite s i x return v i s i t s f o r adjustments and t h a t the
d e n t i s t was very rude.
Board Action - The Board did not i n i t i a t e any d i s c i p l i n a r y proceedings. ( I
There is no indication t h a t the Board informed the complainant of the
resolution of the complaint.
March 25, 1978 a
Complaint Number 6 - The complaint alleged t h a t the dentures provided were
very unsatisfactory and were never properly f i t t e d despite numerous
v i s i t s for adjustments. It should be noted t h a t the complainant
received a s e t o f dentures from another d e n t i s t which f i t correctly a
and are of much b e t t e r quality.
Board Action - The Board had not resolved the complaint a s of August 23,
1979
May 25, 1978
Complaint Number 7 - The complaint alleged t h a t the dentures provided were
inadequate and did not f i t despite numerous v i s i t s for adjustments.
Board Action - The Board did not take any d i s c i p l i n a r y action. A l e t t e r @
from the Board's Executive Secretary t o the complainant revealed
that the complaint was closed a f t e r the d e n t i s t made a f u l l refund.
August 18, 1978 .
Complaint Number 8 - The complaint alleged that a p a r t i a l was i l l - f i t t i n g
and t h a t the d e n t i s t f a i l e d t o diagnose periodental disease. The
complaint also alleged t h a t surgery was required and a new plate was
necessary.
Board Action - The Board took no action a f t e r the complaint was
withdrawn. There is no indication of the reason t h a t the complaint
was withdrawn.
December 4, 1978
Complaint Nunber 9 - The complaint alleged t h a t the treatment plan was
improper and t h e m a t e r i a l s and workmanship were o f questionable
quality. The complainant had another dental office re- do much of the
work.
Board Action - The Board did not take any d i s c i p l i n a r y action.
December 13, 1978
Complaint Number 10 - The complaint alleged t h a t the dentures a r e ill-f
i t t i n g and are causing s o r e s p o t s on the complainant's jaw.
Board Action - The Board did not take any d i s c i p l i n a r y action. A l e t t e r
from the Board's Executive Secretary to the complainant indicated
t h a t the complaint was closed because " an appointment was made for
you on... with ( t h e d e n t i s t against whom the complaint was f i l e d ) i n
an e f f o r t to resolve the issue and t h a t you chose not t o pursue the
matter. l1
January 15, 1979
Complaint Number 11 - The complaint alleged t h a t an immediate p a r t i a l
prepared by the d e n t i s t was i l l - f i t t i n g , inadequate and not properly
adjusted. The complaint also alleged t h a t the discomfort caused the
patient t o not wear the p a r t i a l . The report also indicated t h a t
a f t e r the complaint was f i l e d the d e n t i s t made a new p a r t i a l p l a t e
s a t i s f a c t o r y to the p a t i e n t .
Board Action - None
March 19, 1979 .
Complaint Number 12 - The complaint alleged t h a t the dentures caused the
complainant's mouth t o hurt and gums to bleed despite numerous return
v i s i t s for adjustments. The complaint committee determined that the
dentures were not acceptable in t h e i r present condition.
Board Action - A l e t t e r from the president of t h e Board t o the d e n t i s t
recommended t h a t the p a t i e n t be contacted a s soon a s possible to
resolve t h i s matter. No d i s c i p l i n a r y a c t i o n was i n i t i a t e d .
May 1, 1979
Complaint Number 13 - The complaint alleged t h a t the dentures prepared by a
the d e n t i s t were t o t a l l y useless.
Board Action - The Board has not taken any d i s c i p l i n a r y action. A l e t t e r
from a Board member t o the complainant advised, "... that ( t h e
d e n t i s t ' s ) o f f i c e should have an opportunity to correct any problem II
t h a t was created i n the process of making the denture prior t o
carrying the complaint any further."
July 1 , 1979 a
Complaint Number 14 - The complaint alleged t h a t the dentures prepared by
the d e n t i s t did not f i t i n s p i t e of several o f f i c e v i s i t s for
adjustments.
Board Action - The complaint is being reviewed by the complaint a
committee.
Complainant D i s s a t i s f a c t i o n With
The Board's Complaint Process
The Office of the Auditor General surveyed 130 people who had f i l e d complaints
with the Board from January 1978 t o March 1979 t o assess t h e i r s a t i s f a c t i o n
with the Board's handling of t h e i r complaint. The - r e s u l t s of t h i s survey
revealed a widespread d i s s a t i s f a c t i o n with the Board's complaint process.
Nearly 60 percent of those persons responding to the survey f e l t t h a t the Board
had not adequately protected the public from incompetent or unscrupulous dental
p r a c t i t i o n e r s . Those complainants t h a t were d i s s a t i s f i e d with the Board's
complaint process generally expressed reservations about the Board's a b i l i t y
t o a r b i t r a t e consumer complaints objectively. Complainant comments included
the following :
" Very few complainants can receive a fair and impartial
hearing before a Board t h a t has a b u i l t - i n c o n f l i c t of
i n t e r e s t , whose dental members know most of the defendants
named i n the complaints, and i n ( an) arena where it is
d i f f i c u l t to get one d e n t i s t t o t e s t i f y against another."
" It should be handled by somebody or group who are
impartial from the Dental A ~ s o c i a t i o n . ~ ~
" A request for an examination should be given. Poor work
c e r t a i n l y cannot be determined by l e t t e r . Both p a r t i e s
should be afforded the same c o u r t e s i e ~ . ~ ~
" 1 believe if you want a s a t i s f a c t o r y decision made as to
the experience the public a r e having with the dental
p r a c t i t i o n e r s you should have a board of NON- DENTISTS to
handle the complaints. l1
" There are many other victims i n my position who do not
have the means t o f i g h t back therefore a r e left t o have t o
s u f f e r the consequences with no r e l i e f or help."
" I f e e l the d e n t i s t s do not honestly monitor t h e i r own
society. "
" A s f a r as I ' m concerned the Dental Board is nothing but a
farce f i l l e d with Dentists looking out f o r other
Dentists. l1
" I believe the examiners are not tough enough. They should
be an independent body. I think they a r e a f r a i d t o do
anything against one of t h e i r own kind."
" The ~ o a r dsh ould be composed of a t l e a s t half lay people. -
Since it is impossible to take l e g a l a c t i o n a g a i n s t
d e n t i s t s due t o the reluctance of d e n t i s t s to t e s t i f y
against each other."
"... I know I would never c a l l them again."
I1A Dentist i n v e s t i g a t i n g a Dentist? ( Birds of a feather
flock together)"
Public Membership On
Professional Boards
D r . Benjamin Shimberg, a recognized authority on occupational regulation, 4
addressed the issue of public p a r t i c i p a t i o n i n the regulatory process i n a
recent Council of S t a t e Governments publication*. The following section of the
booklet discusses public representation on regulatory boards as one method of
enhancing t h e e f f e c t i v e n e s s of d i s c i p l i n a r y procedures. ( I
" For many years, trade and professional groups fostered
the idea t h a t only members of t h e i r own occupational group
were qualified to make judgments about entrance standards,
examination content, or d i s c i p l i n a r y matters. This
professional mystique argued t h a t the public had no role
t o play i n the regulatory process.
In recent years t h i s view has been challenged. Consumers
now argue t h a t since regulation a f f e c t s t h e i r v i t a l
i n t e r e s t s , they have a r i g h t t o share i n the decision-making
process. They point out t h a t every day laymen
l e g i s l a t o r s and jurors must make decisions i n highly
t e c h n i c a l a r e a s . They are able to do so by u t i l i z i n g the
testimony of experts to s e t f o r t h the f a c t s and c l a r i f y the
issues.
There has been a growing movement to place public members
on regulatory boards to ensure that there w i l l be input
from groups other than those representing the regulated
occupation. Those who favor the idea believe t h a t the
presence of public members w i l l help to break up the in-group
psychology t h a t o f t e n p r e v a i l s when a l l board
members are p r a c t i t i o n e r s . Ideally, public members w i l l
provide a point o f view otherwise absent on a board
composed solely of license holders.
Shimberg, Benjamin, and Roederer, Doug, Occupational Licensing:
Questions a Legislator Should Ask. Lexington, Kentuchky:
Council of S t a t e Governments, 1978.
I n i t i a l - experience with p u b l i c members o f t e n was not
favorable because those appointed lacked the-q
u a l i f i c a t i o n s f o r e f f e c t i v e s e r v i c e on a board. Recent
experience suggests t h a t public members can make
s i g n i f i c a n t c o n t r i b u t i o n s when they have backgrounds
equipping them t o deal with problems and i s s u e s l i k e l y t o
come before t h e board, a s t r o n g i n t e r e s t i n s e r v i n g ,
s u f f i c i e n t time t o devote t o board a c t i v i t i e s , and p r i o r
experience i n community a f f a i r s s o t h a t they know how t o
g e t things done i n the public arena."
" While public members may not know much about the
t e c h n i c a l a s p e c t s of an occupation, they may n e v e r t h e l e s s
c o n t r i b u t e t o board d e l i b e r a t i o n s by r a i s i n g questions
about such t o p i c s as the a p p r o p r i a t e n e s s of entrance
requirements, board r u l e s , t e s t s , f e e s , and d i s c i p l i n a r y
How many public members should be on a board? There is no
simple answer, but i f impact is the major c r i t e r i o n , one
p u b l i c member is probably too few, two would be t h e
minimum, and t h r e e o r four would i n c r e a s e t h e l i k e l i h o o d
t h a t the impact of public members would be f e l t ,
p a r t i c u l a r l y i f the board had from seven t o 10 members. In
C a l i f o r n i a , the l e g i s l a t u r e has decreed t h a t f o r c e r t a i n
boards a majority s h a l l be public membersu ( Emphasis
added)
The p u b l i c a t i o n went on t o p o i n t o u t another problem t h a t may r e s u l t from
p r o f e s s i o n a l l y dominated boards, by s t a t i n g :
" Many r e g u l a t o r y agencies a r e perceived as overly
p r o t e c t i v e of those whom they r e g u l a t e . T h i s h a s led
consumers t o question whether p r o f e s s i o n a l l y dominated
boards are w i l l i n g t o deal f o r c e f u l l y with t h e i r peers
when complaints a r e received from the public. Consumers
a l s o express doubts t h a t they w i l l r e c e i v e a f a i r hearing
before boards composed s o l e l y o f l i c e n s e d p r a c t i t i o n e r s . "
Health Occupations Council Is
Alternative To Individual
Regulatory Bodies
A Council of S t a t e Governments* publication e n t i t l e d , S t a t e Regulatory
Policies - Dentistry and the Health Professions, contains a description of a
model law creating a S t a t e Health Occupations Council. Composed of one
representative from each health area subject to regulation through the law and
a t l e a s t one- third membership representing the general public, the Council is
authorized to review and coordinate licensing boards regulations, e s t a b l i s h
d i s c i p l i n e and enforcement procedures, and resolve scope o f p r a c t i c e
questions. Such a Council would also coordinate c e r t a i n functions currently 0
performed by individual licensing boards by c e n t r a l i z i n g budgeting, s t a f f i n g ,
i n v e s t i g a t i o n s and professional d i s c i p l i n e .
The major purpose of such a Council is, according t o the Council of State a
Governments, t o maintain the perspective of public i n t e r e s t in the regulation
of professions and occupations :
" Historically, once licensed, the groups tended to be
regulated by autonomous boards composed primarily of
representatives from the profession. any have f e l t - t h a t - such a system dominated by p r a c t i t i o n e r s w i l l primarily
p r o t e c t the i n t e r e s t s of t h e i n d i v i d u a l p r o f e s s i o n a l
groups r a t h e r than those of the consumer. S t a t e policy-makers
often have been f r u s t r a t e d i n t h e i r attempts t o
ensure t h a t the licensure and regulatory process takes
i n t o consideration broad public policy issues such a s
c o s t s , a v a i l a b i l i t y of s e r v i c e s , and fragmentation of
h e a l t h c a r e delivery." ( Emphasis added)
* The Council of S t a t e Governments is a joint agency of a l l the s t a t e
governments - created, supported and directed by them. It conducts
research on s t a t e programs and problems; maintains an information service
available t o s t a t e agencies, o f f i c i a l s , and l e g i s l a t o r s ; issues a variety
o f publications; a s s i s t s i n s t a t e - f e d e r a l l i a i s o n ; promotes regional and
s t a t e - l o c a l cooperation; and provides s t a f f for a f f i l i a t e d organizations.
CONCLUSION
The State Board of Dental Examiners has not completely fulfilled its statutory
responsibility to protect the citizens of Arizona against incompetent dental
practitioners. The Board has consistently failed to adequately investigate
allegations of substandard care or discipline dentists when allegations of
substandard care have been substantiated. As a result, dentists with numerous
substantiated consumer complaints of incompetence or substandard care continue
to offer dental service to the public.
RECOMMENDATION
It is recommended that:
1. The State Dental Board investigate and resolve consumer complaints in
compliance with ARS 32- 1263( A) through 32- 1263( E).
2. The State Dental Board impose discipline as prescribed in ARS 32-
1263( D) and on those dentists found to have provided substandard care.
3. The number of public members on the State Dental Board be increased. ( See
page 58)
4. The Legislature and Governor consider establishing a Health Occupations
Council as outlined by the State Council of Governments. This alternative
would apply to all health regulatory entities and is also included in the
recommendations of the Board of Optometry performance audit.
FINDING I1
THE BOARD HAS NOT MAINTAINED AN APPEARANCE OF INDEPENDENCE OR OBJECTIVITY I N
ITS DEALINGS WITH THE ARIZONA STATE DENTAL ASSOCIATION.
Jonathan Rose, an A. S. U. l a w professor and an authority on a n t i t r u s t a s it
applies t o occupational licensing, s t a t e d i n a report t o the Attorney General's
o f f i c e :
" The S t a t e Dental Board does not provide for adequate
p u b l i c r e p r e s e n t a t i o n nor provide adequate policing
against undue influence by the profession and its p r i v a t e
society. l1
Professor Rose is not alone i n holding the above opinion. Office o f the
Auditor General surveys indicate t h a t complainants and even some d e n t i s t s f e e l
t h a t the Board is too heavily influenced by the dental profession i n general
and the Arizona S t a t e Dental Association ( ASDA) i n p a r t i c u l a r . The Council of
S t a t e Governments has addressed several f a c t o r s r e l a t i n g t o occupational
licensing boards*, two of which appear t o be major problems with the Arizona
S t a t e Board of Dental Examiners.
1. " Trade and professional associations frequently are
vested with the power t o nominate board candidates.
This practice contributes t o the notion t h a t the
board is an extension of the association r a t h e r than
an arm of s t a t e government.*' l
2. " How many public members should be on a board? There
is no simple answer, but i f impact is the major
c r i t e r i o n , one public member is probably too few, two
would be the minimum, and three or four would
increase the likelihood t h a t the impact of public
members would be f e l t , p a r t i c u l a r l y if the board had
from seven t o ten members.*"
Board Membership
Prior t o June 2, 1978, ARS section 32- 1203 provided for the s e l e c t i o n of new
board members as follows:
* Shimberg, Benjamin, and Roderer, Doug. Occupational Licensing: Questions
a Legislator Should Ask. Lexington, Kentucky: Council of S t a t e
Governments, 1978.
" B. A vacancy on the board for a position for a licensed
dentist shall be filled by the governor from a list of
ethical practitioners recommended for appointment bx -
the Arizona state dental society* over the signatures
of its president and secretary. The governor may --
request such additional lists as he deems necessary.
Layperson board members appointed pursuant to this
section may participate in all board proceedings and
determinations, except in the giving or' grading of
examinations for licensure." ( Emphasis'added)
During 1978, the Arizona Legislature amended the preceding section to state:
" B. A vacancy on the board for a position for a licensed
dentist may be filled by the governor from a list of
ethical practitioners recommended for appointment by
the Arizona state dental association over the
signatures of its president and secretary. "
( Emphasis added)
A letter received from Arthur Dalpiaz, D. D. S., current president of the Arizona
State Dental Association states:
" The ASDA recommends qualified nominees for the Dental
Board to the Governor. When a Board Member takes his oath
of office, he becomes a representative of the State and not
the profession." ( Emphasis added)**
Four of the five dentists serving on the State Board of Dental Examiners during
fiscal year 1978- 79 have continued their active participation in the State
Dental Association. In fact, one Board member served as president of the
Southern Arizona Dental Society while serving on the Board. This may affect the
appearance of objectivity of the Board in the eyes of the public.
Table 3 summarizes the extent of the Dental Board membersf involvement in the
Arizona State Dental Association, Central Arizona Dental Society and Southern
Arizona Dental Society.
* The Arizona State Dental Association. ** Appendixm contains the full text of this letter.
Name of
- B-- o- ard Member
Dr. James ' dong
Dr. Jim Yount
Dr. Donald Beall
Dr. John Misenheimer
Dr. William Polson*
cn Dr. Wilfred Alter
\ D
Dr. J. Allan H2mblin
Dr. Dale E. Shirley
Dr. Ralph Koerner
Board
Term
EXTENT OF BOARD MEMBER INVOLVEMENT IN THE ARIZONA STATE
DENTAL ASSOCIATION ( ASDA), CENTRAL ARIZONA DENTAL SOCIETY ( CADS)
AND SOUTHERN ARIZONA DENTAL SOCIETY ( SADS)
DESCRIPTION OF INVOLVEMENT -
1978- 79 - 19- 77-- 7 8 - 1- 9 76- 77 - 19- 7 5- 76 1974- 75
SADS Delegate
CADS Delegate CADS Delegate CADS Delegate CADS Delegate
CADS Delegate CADS Delegate CADS Delegate CADS Delegate CADS Delegate
SADS President SADS Pres- elect. SADS Vice President SADS Secretary SADS Treasurer
SADS Delegate SADS Delegate SADS Delegate SADS Delegate
CADS Delegate CADS Delegate CADS Delegate CADS Delegate CADS Delegate
SADS Delegate SADS Alternate Delegate SADS Alternate Delegate SADS Delegate
CADS Delegate CADS Delegate CADS Delegate CADS Delegate Past President ASDA
On June 11, 1979, Dr. Polson was reappointed by the Governor for a six- year term.
As shown in Table 3, eight of the nine current and most recent Board members
have been delegates to the ASDA1s annual meeting while serving on the Board.
The ASDA has provided assistance to and communicated with the Board in areas
where it appears the primary concern is protecting the- interests of Arizona's
dentists. For example, the ASDA has worked with the Board on a lawsuit
challenging the licensure examination. The ASDA also provided a substantial
amount of the funding for investigations of the denturists* and a dentist
involved in the denturism movement.
In August 1973, the Board was involved in a lawsuit filed by a dentist who
challenged the manner in which the licensing examination was being averaged.
( page 83) The legal counsel for the ASDA defended this case at the request of
the Board and the ASDA paid the associated legal fees.
The ASDA has stated that:
" The ASDA1s interest in the case was to insure that the
State's position was adequately represented so that the
legal standards for dental licensure in Arizona would not
be circumvented by someone not found qualified by the
licensure Board. It**
* A denturist is statutorily defined as a person who:
1. Takes impressions and bite registrations for the purpose
of or with a view to the making, producing, reproducing,
construction, finishing, supplying, altering or repairing
of complete upper or lower prosthetic dentures or both, or
removable partial dentures for the replacement of missing
teeth.
2. Fits any complete upper or lower prosthetic denture or
both, or adjusts or alters the fit of any full prosthetic
denture, or fits or adjusts or alters the fit of removable
partial dentures for the replacement of missing teeth. ** Appendix I11 contains a full text of this letter.
In a similar matter, the ASDA provided assistance to the Board when, in 1976,
the denturists in Arizona began to make inroads into the dental profession.
This movement culminated in 1978 when the " Denturism Billn was passed by the
Arizona Legislature. During the period from 1976 to 1978, the ASDA appeared to
be using the Board as a tool against the denturist and a dentist who supported
the denturists.
For example, in September 1976 the Board suspended the license of a dentist who
was employing a denturist. However, it should be noted that the Board did not
suspend or revoke the license of a single dentist for reason of substandard
care from fiscal years 1964- 65 through 1978- 79. I
In October 1976, the Board hired a private investigative agency to gather
evidence against denturists, and a dentist who was supportive of the denturism
movement. The ASDA offered to employ the investigator and pay the fees*
allegedly because the Board did not have sufficient funds to pay for the
investigations. However, a review of the Board's financial position reveals
that the Board had ample funds to pay for the investigations. The ASDA paid
approximately $ 6,300 for the investigation of denturists from November 1976
through July 1977 while during that same period the monthly balance of the
Board fund never fell below $ 20,000 and at times was as high as $ 36,000.
Further, the Board did not attempt to request a special budget appropriation or
authorization for a fee increase from the Legislature until fiscal year 1977-
78. According to the Legislative Council in an opinion dated July 12, 1979:
* When our Office contacted the person in charge of the investigations on
July 3, 1979, he stated emphatically that the agency had been employed by
the Executive Secretary of the Board of Dental Examiners and the Board
itself from 1976 through 1978 and not by the Arizona State Dental
Association. Approximately one week later after our Office had discussed
the involvement of the ASDA in the denturism investigations with the
Executive Secretary for the Board, the person in charge of the
investigations called back and retracted his statement. ( See Appendix IV)
" In s p i t e o f t h e f a c t t h a t no s t a t u t o r y provisions
p r o h i b i t ' t h e ASDA from paying f o r i n v e s t i g a t i o n s o f the -
S t a t e Dental Board and even assuming t h a t the Board has
a u t h o r i t y t o accept a g i f t , we believe t h a t c e r t a i n
fundamental e t h i c a l and e q u i t a b l e p r i n c i p l e s compel the
conclusion t h a t such a c t i v i t i e s a r e highly i n a p p r o p r i a t e
f o r an a d m i n i s t r a t i v e agency i n v e s t i g a t i o n . A hearing
before an a d m i n i s t r a t i v e agency exercising j u d i c i a l ,
q u a s i - j u d i c i a l or adjudicatory powers must ' be fair, open
and i m p a r t i a l . The applicable p r i n c i p l e has been
described by one s t a t e court as t h e d o c t r i n e of the
appearance o f f a i r n e s s . If *
The L e g i s l a t i v e Council a l s o s t a t e d :
/ " dWenhteurer isma mporvoefmeesnsti o npaaly s orfgoarn izaanti on' i moppaprotsieadl ' t op ubtlhice
w i n v e s t i g a t i o n of the movement, a d i s i n t e r e s t e d person
could e a s i l y conclude t h a t the appearance of f a i r n e s s
doctrine has been v i o l a t e d . In order t o i n s u r e t h a t
a d m i n i s t r a t i v e agencies a c t i n an i m p a r t i a l manner
a c t i v i t i e s such as those taken by the ASDA should be
discouraged.""
The following statement by the ASDA president during 1977- 78, which was printed
i n the ASDA Dental Notes i n bctober 1977, is a f u r t h e r example of the
r e l a t i o n s h i p between the Board and the ASDA being an apparent v i o l a t i o n of the
appearance of f a i r n e s s doctrine.
"... that the strengthening of the S t a t e Board of Dental
Examiners was of utmost importance, since the defense of
the denturism i n i t i a t i v e proposal must come from t h a t
e n t i t y i n order t o avoid exposure o f t h e p r o f e ~ s i o n . ~ ~
CONCLUSION
The Board's appearance of o b j e c t i v i t y becomes questionable when the ASDA
becomes involved with Board a f f a i r s . The Board's involvement with the ASDA i n
t h e i n v e s t i g a t i o n of d e n t u r i s t s is an apparent v i o l a t i o n o f the f a i r n e s s
doctrine. A s a r e s u l t , the Board has not maintained an appearance of
independence and o b j e c t i v i t y i n its dealings with the ASDA.
* Appendix I contains a f u l l t e x t of t h i s L e g i s l a t i v e Council opinion.
RECOMMENDATION
It is recommended t h a t :
1. The public representation on the Board of Dental Examiners be increased.
The Board should be composed of f i v e d e n t i s t s , t h r e e lay members and one
dental hygienist.
2. The Arizona S t a t e Dental Association not be designated s p e c i f i c a l l y i n ARS
32- 1203 to supply a list from which the Governor'may choose Board members. 7 ,
3. The Board maintain a degree of independence and o b j e c t i v i t y when working
i n conjunction with the Arizona S t a t e Dental Association.
4. Arizona Revised S t a t u t e s be amended to require members of the S t a t e Board
of Dental Examiners t o terminate a c t i v e p a r t i c i p a t i o n a s delegates or
o f f i c e r s i n professional associations i n order to ensure t h a t an
appearance of o b j e c t i v i t y is maintained.
FINDING I11
CHANGES ARE NEEDED TO IMPROVE THE EFFICIENCY OF THE STATE BOARD OF DENTAL
EXAMINERS.
Our review of the S t a t e Board of Dental Examiners has shown t h a t t h e e f f i c i e n c y
of the Board could be improved with the following changes:
1. Implement a t r i e n n i a l renewal system t o reduce the number of renewals
V' processed each year by the Boardls s t a f f ; and
2. Implement a staggered renewal system t o spread the r e g i s t r a t i o n
workload more evenly throughout the year.
These changes could r e s u l t i n a savings of $ 10,970 and 104 s t a f f days over a
four- year period. In a d d i t i o n , i n t e r e s t earnings could be increased by $ 38,900
over the same time period.
The d e n t a l s t a t u t e s r e q u i r e the l i c e n s e e s of the Board t o renew t h e i r l i c e n s e s
p r i o r t o June 30 each year. The applicable s t a t u t e s a r e ARS 32- 1236 f o r
d e n t i s t s , ARS 32- 1287 f o r h y g i e n i s t s and ARS 32- 1297.06 f o r d e n t u r i s t s .
According t o t h e L e g i s l a t i v e Council i n an opinion dated April 20, 1979:
" Therefore, i f it is considered d e s i r a b l e t o stagger the
r e g i s t r a t i o n of d e n t i s t s , it is recommended t h a t Arizona
Revised S t a t u t e s s e c t i o n 32- 1236 be amended. The
amendment could:
1. Provide f o r the annual r e g i s t r a t i o n of d e n t i s t s by
payment of a r e g i s t r a t i o n fee.
2. Provide t h a t t h e board may p r e s c r i b e r u l e s t o
implement a staggered r e g i s t r a t i o n system.
3. Provide f o r f o r f e i t u r e of the l i c e n s e f o r persons who
f a i l t o pay on t h e d a t e s e t by the board and t h e
imposition of p e n a l t i e s f o r d e n t i s t s who wish t o
r e i n s t a t e the l i c e n s e a f t e r t h i s date. The penalty
provision could be s i m i l a r t o t h e p e n a l t i e s t h a t a r e
presently found i n Arizona Revised S t a t u t e s s e c t i o n
32- 1236, subsection B."*
* Appendix I contains a f u l l t e x t of t h i s L e g i s l a t i v e Council opinion.
Each year the Administrative Office of the State Board of Dental Examiners
processes an increasing number of renewals. Based on estimates of the Board's
Executive Secretary, the office staff spent a total of 40 work days during a
fiscal year 1977- 78 processing approximately 2,750 renewals. The renewal
process creates a backlog of work during May, June and July each year and has
caused the Board to hire additional part- time clerical help during fiscal year
1979- 80.
One means of reducing the number of renewals processed each year and the
resultant strain on the operations of the Administrative Office is to implement
a triennial renewal cycle. The strain on the Administrative Office could be a
further reduced by processing the renewals on a staggered basis. A triennial
renewal cycle implemented on a quarterly basis would allow the Administrative
Office to process only one- twelfth as many renewals each quarter as are now
being processed in June each year. This could' result in a savings of $ 10,970 a
over a period of four years.
When questioned by the Office of the Auditor General about the possibilities of
renewing licenses biennially or triennially the Board members expressed one
( I
major objection. The extended renewal cycle would reduce contact with the
licensees, leaving the Board less aware of the many address changes that occur.
This problem could be prevented with an announcement in a newsletter to all
license holders that the Board should be notified of all address changes. a
( See Table 5, page 74)
Interest earnings would also be increased by implementing a triennial renewal
cycle. Revenues collected and deposited in the State Board of Dental Examiners
fund ( 90 percent of the Board's revenue) and the State General Fund ( 10 percent
of the Board's revenue) are invested by the State Treasurer until needed. All
interest earnings from such investments are retained in the General Fund. As a
result of converting to a triennial renewal cycle, additional interest earnings
of $ 38,900 could be generated over a four- year period assuming a nine percent
rate of return on investments."
The increase in interest earnings will result because revenue collected during
the initial year of implementation will exceed the amount needed to finance
that year's operations. The additional amount can be invested until needed,
thus generating the additional interest earnings and leaving a reserve fund for
emergencies.
CONCLUSION
Our review of the State Board of Dental Examiners revealed that by implementing
a triennial renewal system on a staggered basis the operating expenses of the
Board could be reduced by as much as $ 10,970 and the workload of the
administrative staff could be reduced by as much as 104 work days over a four-year
period. In addition, interest earnings could be increased by as much as
$ 38,900 over that same time period.
RECOMMENDATION
Arizona Revised Statutes sections 32- 1236, 32- 1287 and 36- 1297.06 should be
amended to allow for the implementation of a triennial renewal system on a
staggered basis.
* According to the State Treasurer, the annual rate of return on investments
for 1979 is projected to be nine percent.
FINDING IV
THE STATE BOARD OF DENTAL EXAMINERS HAS BEEN SUBSTANDARD IN ITS ENCOURAGEMENT
AND USE OF PUBLIC INPUT IN ITS OPERATIONS. INFORMATION REGARDING MEETING
NOTICES, PROPOSED RULES AND REGULATIONS, AND BOARD ACTION HAS NOT BEEN
ADEQUATELY PROVIDED TO LICENSEES OF THE BOARD OR THE CONSUMERS OF THE
LICENSEES1 SERVICES.
The State Board of Dental Examiners has been substandard in its encouragement
of public input from the consumer of licensees1 services and in notifying
license holders of Board meetings, proposed rules and regulations and Board
actions. The Board needs to expand its efforts to encourage participation by
potential and actual consumers and to notify all licensees of Board meetings,
activities and actions.
Board Actions Regardinq
Public Notice Of Meetings
Arizona Revised Statutes 38- 431.02( A) defines the responsibility of the Board
of Dental Examiners to provide public notice of all meetings:
" Public notice of all meetings of public bodies shall be
given as follows:
1. The public bodies of the state shall file a
statement with the secretary of state stating
where all public notices of their meetings will
be posted and shall give such additional public
notice as is reasonable and practicable as to
meetings."
In addition, the Attorney General in a memorandum to al1, state agencies dated
August 19, 1975, noted that an:
"' open meeting1 is open only in theory if the public has no
knowledge of the time and place at which it is to be held."
( I
The Attorney General stated further that the law on open meetings was not
specific, and outlined guidelines to be followed in complying with the public
meeting law. He also cautioned agencies against the serious consequences for
failure to comply with the law as follows:
( I
" Decisions made at a meeting for which defective notice was
given may likely be declared null and void....''*
The latest statement which the State Board of Dental Examiners has filed with
the Secretary of State indicates that notices of meetings are posted at 2538 E. ( I
University Drive, Suite 235, in Phoenix. However, the Board's Administrative
Office moved from this location in January 1977. According to the Executive
Secretary of the Board, the meeting notices are now posted in the Occupational
Licensing Building at 1645 W. Jefferson and are no longer posted at 2538 E. ( I
University Drive.
In providing guidelines to agencies regarding what would constitute sufficient
" additional" public notice of meetings beyond posting printed notices, the •
Attorney General stated:
' IF. Additional Notice
In deciding what types of notice shall be given in addition to
posting, governing bodies should consider the following:
1. Newspaper Publication
In many cases, notice of meetings can be disseminated
by providing press releases to newspapers published
in the area in which notice is to be given. In
addition, paid legal notices in such newspapers may
be purchased by the governing body.
2. Mailing List
Some bodies may wish to provide a mailing list
whereby persons desiring to obtain notices of
meetings may ask to be placed on a mailing list. All
notices of meetings issued will then be mailed to
those appearing on the current mailing list.
* Appendix VII contains the full text of the Attorney General's memorandum.
( I
3. A r t i c l e s or Notices in Professional or Business
Publications.
In addition, the governing body may obtain
publication of a r t i c l e s or notices i n those
professional and business publications r e l a t i n g to
the agency's f i e l d or regulation.
It is not necessary t h a t a l l of these types of notices be given.
Indeed, merely providing notice through the use of a mailinq
list and by posting should be s u f f i c i e n t in most cases. Neither
should the above l i s t i n g s be considered exclusive and, t o the
e x t e n t o t h e r forms of notice are reasonably available, they
should be used." ( Emphasis added)
The Board has not adopted any o f t h e " a d d i t i o n a l n o t i c e u methods for notifying
the public and its licensees of meetings a s outlined by the Attorney General.
It should be noted t h a t in a survey by the Office o f the Auditor General o f t h e
Board's licensees*, 66 percent ( 214) of the 323 licensees responding s t a t e d
they were not aware of scheduled Board meetings. Thus, by t h e c u r r e n t public
notice methods used by the Board, only one- third of the license holders, and
only those consumers who are n o t i f i e d through the postings in the Occupational
Licensing Building or who c a l l the Board d i r e c t l y , would be aware of meetings.
Board Actions Regarding Public
Notice O f Proposed Rules And
Regulations And Other Board Actions
When proposing changes i n r u l e s and regulations, each agency is required by ARS
41- 1002 ( Administrative Procedures Law) t o f i l e a notice of such changes with
the Secretary of S t a t e a t l e a s t 20 days prior t o the proposed adoption date.
The Secretary of S t a t e publishes the proposed changes monthly i n the Adminis-t
r a t i v e Procedures Digest.
The S t a t e Board of Dental Examiners has complied with t h i s s t a t u t e ; however, a
review of the d i s t r i b u t i o n list f o r t h e Digest a s of May 1, 1979, revealed t h a t
87.4 percent ( 195) of the 223 individuals or organizations reviewing the Digest
were law firms or government agencies. Thus, the publication of proposed r u l e s
i n the Digest does not appear to be an e f f e c t i v e method of n o t i f y i n g t h e
consuming public or Board r e g i s t r a n t s of proposed rule changes.
* Appendix V contains the r e s u l t s of the survey.
Methods Used By Other Arizona
Regulatory ~ g e n c i e s To Encourage
Public Input
A survey of 34 Arizona regulatory agencies was conducted by the Office of the a
Auditor General regarding methods used to encourage public input and p a r t i c i -
pation i n the promulgation of r u l e s and regulations and i n developing l e g i s l a -
t i v e proposals. The survey revealed t h a t 82 percent ( 28) n o t i f i e d r e g i s t r a n t s
of r u l e changes prior to the required public hearing and 35 percent ( 12) a
notified r e g i s t r a n t s of l e g i s l a t i v e proposals. Table 4 summarizes the various
p u b l i c i n p u t methods used by these 34 regula