"YOU HAVE THE RIGHT -- NOT -- TO REMAIN SILENT:"

Securing Dental Patient Rights/Preventing Complaints

A. INTRODUCTION: I am a former U.S. Senate staffer who, in service to country, does only PRO BONO
work for the purpose of "issue advancing," with no pride of authorship. My Senate Oral History interviews
are on the Senate website:
http://www.senate.gov/artandhistory/history/oral_history/Dennis_Brezina.htm

For the past 15 years, my pro bono efforts at the state and federal levels have spanned:
(1) Health care reform -- senior issues, prevention, patient advocacy/navigating; (2) National
security/military affairs;
(3) Fiscal responsibility; and
(4) Legislative oversight strategies -- with traction up to the highest elected levels, for example, directly
relevant measures passed by one-third of the state legislatures, data from national surveys,
Congressionally directed reports, and extensive state and national media coverage.

AND, like most people, I go to a DENTIST regularly. BUT, in my case, I have had bad experiences with
the last two - with the former, DO NO HARM often ignored; and the latter, INFORMED CONSENT all to
rare.

B. SUMMARY: Instead of registering formal complaints, I put on my public policy hat for a:
-- State-wide DENTAL OFFICE Survey(C).
-- STATE DENTAL BOARDS: Website research(D).
-- STATE DENTAL BOARD members/staff: Interviews(E).
-- STATE LEGISLATURES/LEGISLATORS/staff: Research/interaction(F).
-- CONGRESSIONAL ROLE in National Dental Policy/Affairs (in progress)(G).
-- MAJOR QUESTIONS/ISSUES(H):

1. What is the OPTIMAL balance in the dentist-patient relationship (technical/social issue mix) between
ensuring professional integrity and protecting the public interest/welfare? Win-win? Complaint prevention?
- Role of the dental profession -- more fully monitor consumer concern/constructive commentary?
- Role of the dental board -- proactive/interactive/increased public membership?
- Role of the legislature -- oversight/legislation/Resolution-directed study?

2. What is or might be the impact of rapid advances in social networking/mobile communication with
internet access on the dentist-patient relationship and regulatory process? Blogs? Facebook? Mobile
phone with "apps" to guide the patient ("distance guidance"), step-by-step, interactively, through the
dental care process? Rights/responsibility issues? New communications paradigm?

3. Other -- Politics of the mouth? Where do seniors stand/sit?

There follows a "DENSE," but brief summary -- local, state and federal -- from the public record and
interviews on DENTISTRY AND PUBLIC POLICY IN AMERICA.

Click below to read the entire report on Dentistry in America -

C. STATE-WIDE DENTAL OFFICE SURVEY (Could be conducted in any state.)

In looking for another dentist, I called almost 100 dental offices across my home state of Maryland. I
asked a single question, in a matter-of-fact tone, not wanting to lead to the "right answer," introducing
myself correctly as a Marylander looking for a new dentist, who pays his bills and who has good dental
insurance:
"If the dentist offers a consultation, which I'm willing to pay for, does that include a discussion of the
doctor/patient relationship, and, if so, what does the doctor cover in such a discussion?"
Fewer than one in ten offices (10%) indicated the doctor would likely be "enthusiastic" about discussing
the doctor-patient relationship. Of the 30 offices surveyed with individual websites (of the nearly 100
total), one featured a Patient's Bill of Rights.

D. STATE DENTAL BOARDS: WEBSITE RESEARCH

All 50 State Dental Board websites were carefully examined before interviewing Board members/staff,
and interacting with state legislators/staff. (See following Sections.)

The total Board membership for all 50 states of 536 includes 84 Public Member positions, with 13
vacancies at present. The number of Public Members varies from zero allowed -- AL, LA, MS, WY -- to
five -- TX.
NOTE: The Dental Hygienists Committee of California is composed of 4 hygienists, one dentist and four
public members, and is "the first of its kind in the United States."

The information below is "ONLINE" on Board websites, unless otherwise noted. Much of this information
is worked into the "Questions/Issues" Section below. (For state links, see American Association of Dental
Board, www.dentalboards.org/ )

GENERAL: Minutes of meetings -- AL, AK, AR, AZ, CT, DE, FL, GA, IL, IN, IA, KS, ME, MN, MT, NH,
NM, OH, OR, SC, SD, TN, TX, UT, VT, VA, WA, WV, WI;

Disciplinary actions -- AK, AZ, CA, CO, CT, FL, KS, KY, ME, NJ, NY, NC, OH, PA, RI, SC, TN, UT(fee),
VA, WV, WI; Recent newsletter -- AR, CO, GA, ID, KS, KY, MD, MN, NE, NV, ND, OK, OR, SC, VA;

Public Members -- CT, IA, MI, MO, NJ, NM(2), NY(2), RI(3), SC;

Mission broadly stated in terms of protection of the public or consumer interest/public

health/safety/welfare -- AL, CA, GA, ID, IA, KS, KY, ME, MD, MO, NE, NH, NJ, NM, NC, OK, OR, SD,
TN, TX, WA;

Board members with direct contact information online -- AL(7 of 7), KS(9 of 9), LA(14 of 14), MS(8 of
8), NE(10 of 10), PA(1), SD(7 of 7).

SPECIAL FEATURES:

Transparency in government-- CO, MS; Hardest to find list of Board Members-- NY;
Customer Satisfaction Survey-- FL, OR, SC; Customer feedback-- DE(couldn't access);
Background checks-- TN, TX; License suspended for non-payment of child support-- TN;
Sparking website--OH, UT;
Attractive website-- WV;
Tips for avoiding complaints-- RI("Communicate, communicate, communicate!"), VT, WV(newsletter);
Common complaints-- CA;
Regulatory Town Hall-- VA;
State Bureau of Oral Health-- KS;
Informative message while on hold-- DE;
Bare bones website-- MO;
Very efficient website-- MT;
Very thorough website--OR;
Ask the Board a question-- OR;
Performance measures (assessing effectiveness)-- OR;
Twitter service-- OH;
Board fees increased because of more complaints-- CO;
Grassroot Webinar, November, 2010-- WA(to discuss upcoming legislative session);
Dental Action Day, 2011-- WA(Dental professionals join to lobby state legislators, January 28, 2011);
No telephone number listed-- IL.
Legislative proposals directed to State Dental Boards (from state legislature websites)-- GA, IL,
ME, MA, MD, MO, NV, ND, OK, WA, WI.

Bill of Rights (from various sources)

Patient Rights/Responsibilities(http://ada.org/ );
CA( www.cda.org/ -- Dental profession wanted consumers to know that service excellence was taken
seriously);
FL( http://www.doh.state.fl.us/mqa/Profiling/billofrights.htm );
PA( www.padental.org/ );
NY( www.op.nysed.gov/rght4ver.htm -- from Dental Board link);
VA( http://www.dhp.state.va.us/dentistry/dentistry_guidelines.htm -- See Standards of Professional Conduct).
E. STATE DENTAL BOARD MEMBERS/STAFF: INTERVIEWS
Hoping to turn my negative experiences with local dentists into a positive (explaining my call in that way),
I interviewed Dental Board Members and staff in nearly ONE HALF of the states, asking a cluster of
questions, when possible:
How important are communications skills for the dentist/hygienist?
Do you have a sense of the degree of professional emphasis on the doctor-hygienist/patient relationship
in your state?
Are there new ideas percolating about preventing complaints?
Any such discussion by the Board?
Can the Board tap into constructive, win-win comments by patients?
How is the social networking revolution impacting on dental practice?
Do senior citizens deserve special consideration?
And, in general, what is the major issue before the Board?

SAMPLING OF RESPONSES:
"Fine idea! I'll put that article on 'complaint prevention' on the Board website;"
"Not set up for constructive consumer feedback;"
"Biggest problem is lack of communications between doctor and patient;"
"WOW! You mean being proactive!"
"Complaint process needs straightening out;"
OIG Report noted "inconsistencies in imposing disciplinary sanctions;"
"You're performing a great service;"
"The statutes are clear about what is right and wrong;"
"We speak at graduate schools about how not to have to talk to us again;"
"I'll bring your concerns to the next Board meeting;"
"Board has discussed preventing complaints;"
"Tapping into constructive comments from patients can be suggested through Continuing Education;"
"There will always be complainers;"
"Individual dentists can have a Customer Satisfaction Survey on his/her website;"
"'Attaboy!' letters go out to dentists deserving praise;"
"Helpful, constructive comments by consumers are rare;"
"I can't talk with you about this;" "Not aware of any preventative strategies;"
"So, Vermont has a 'Tips to Avoid Complaints' on its website?"
"Our Board tries to provide a forum for new ideas;"
"No, nothing like that;" "Please hold, no agents are currently available;"
"Our State Licensing Board produced a complaint avoidance pamphlet. You can e-mail Lanette 'A' for
more info;"
"Board issues are technical;"
"Basically -- communication;"
"A risk-management course in CE is in the works;"
"Dentists can use the Board as an informal resource for preventing a breakdown in communications with
a patient, and for a patient, as well, to help structure thinking with regard to options;"
"Newletter had a section on avoiding complaints;"
"Blogs are coming for dental professionals, maybe some day for consumers;"
"The biggest issue is communication between the dentist and patient;"
"Dentist needs to secure informed consent;"
"Consumer can go to the Board for info on the dentist;"
"There's mediation with the state dental association;"
"Idea of increasing number of public members in our state was to make the Board more of a public
advocate;"
"Blog is a good idea."

An extensive search of Board minutes showed a smattering of references to the "public/consumer"

dimension of dentistry -- Public Advocacy Committee, public comment statement, verbal abuse of
patients, "Public member always provided the consumer side of issues."

F. STATE LEGISLATURES/LEGISLATORS/STAFF: RESEARCH/INTERACTION

Regarding dental policy, I've conducted research on legislative initiatives/committee structure, while
interacting with state legislators/staff in THREE FOURTHS of the states -- looking for possible interest in
resolving issues raised. An earlier pro bono effort across America on teenage risk-taking -- my
surveys/interviews in a league with "Lewis and Clark," and interactions with officials, elected or otherwise,
a Mt. Everest climb -- resulted in measures passed by ONE THIRD of the state legislatures and media
coverage in TWO THIRDS of the states.

SPECIFIC STATE Standing COMMITTEES on PROFESSIONAL LICENSURE -- AL, CA(H/S), IL(H),

KY(S/H), MA(JT), PA(S), TX(H).

SPECIFIC STATE Standing COMMITTEES on CONSUMER AFFAIRS/PROTECTION -- CA(H),

GA(H/S), IL(H), MA(JT), MN(H/S), MO(S), NH(S), NJ(H), NM(H), NY(H/S), OH(H), OR(H/S), PA(H/S),
TN(H), WA(S), WI(H/S).

SAMPLING OF LEGISLATIVE INITIATIVES:

Amending dental law;
Dental insurance;
More hygienists on Board;
Effective consumer safeguards;
Bill of Rights; patient education;
Expand dental access;
Dental Education Loan Program; sunset recommendations;
"Give Kids a Smile;"
Dental clinic grants;
Amend Dental Practice Act;
Prohibit patient quotas;
Senior Dental Services Grant Program;
Modify laws governing investigations/hearings by the Dental Board;
Children's Dental Health Month;
Dental therapist;
Increasing the number of Public Members on the Board; expanding duties of Hygienists/assistants;
Retired dentist malpractice insurance;
Retired teachers insurance;
Advisory Committee on Dental Education;
Duties of dental hygienists;
Dental Loan Repayment Program;
Protecting rights;
Task Force on Access to Dental Care;
Dental Exam Board; amend code; directing the Board on a variety of other concerns.
G. CONGRESSIONAL ROLE IN NATIONAL DENTAL POLICY/AFFAIRS (in progress)
Congressional initiatives tend to cover broad dental issues:
Medicare/Medicaid reform;
Military/retiree benefits;
New initiatives with national focus; etc.

Over 70 Congressional bills relating to dental affairs were introduced in the 111th Congress (2009-2010).

Senators/Representatives from the following states were most represented:

SENATE -- IA, MD, MT, NM, RI, WA; HOUSE -- AR, CA, MD, NJ, NY, TN, TX.
CONGRESSIONAL COMMITTEES:
SENATE -- Health, Education, Labor and Pensions: Finance;
Appropriations; Armed Services;
Homeland Security and Government Affairs;
Judiciary;

HOUSE -- Energy and Commerce;

Ways and Means;
Education and Labor;
Appropriations;
Oversight and Government Reform; Armed Services;
Judiciary.

LEGISLATIVE SUMMARY --
Health Care Reform (e.g., alternative Dental Health Care providers, dental training, primary care
residency):
Children's Dental Health Month;
National Facial Protection Month;
ADA's 150th Year;
Children's Health Insurance Program Reauthorization;
Medicaid-SCHIP Dental Benefits Improvement Act;
Medicare Medically Necessary Dental Care Act; Dental Emergency Responder Act;
Access to Orthodontic Services Act;
Medicare Oral Health Rehab Enhancement Act;
Meth Mouth Prevention Act;
Sunset of Life Protection Act;
Primary Care Dental Academic Workforce Development Act;
Dental Health Promotion Act;
Essential Oral Health Care Act;
CHOMP Act;
Medicaid Options for Dental Fillings Act;
National Defense Authorization Act;
Military Retirees Health Care Protection Act.

H. QUESTIONS/ISSUES:
- Can an enhanced doctor-patient relationship be a "win-win" situation for both professional and
consumer? Complaint prevention? Genuine marketing tool during the economic downturn?

- Politics of the mouth. What is the impact of the dentist/hygienist dynamic (sorting out
roles/responsibilities) on the consumer?

- More than a plaque or pamphlet! How might a Patient Bill of Rights be brought center stage -- integrated
into dental office procedures; Dental Board mission/activities; consumer awareness?

- Does increased office efficiency impact on patient rights? If so, how?

- What is the OPTIMAL balance in the dentist-patient relationship (technical/social mix) between
preserving professional dental integrity and protecting the public interest and public welfare? How to
achieve such a balance?

- Professional role? Monitor more fully consumer concern and constructive commentary?

- Dental Board role? More proactive, interactive? More public members?

- Legislative role? Oversight/legislation/Resolution-directed study?

- Seniors? Where do they stand/sit? Geriatric dentistry? See ADA Conference, November, 2010.

- Impact of social networking/mobile communication with internet access on the doctor-patient

relationship and regulatory process?

- Facebook, Blogs?

- Mobile phone with "apps" guiding patients ("distance guidance"), interactively, step-by-step?

- Rights/responsibilities issues?

- New communications paradigm?

Again, I'm a former U.S. Senate staffer whose Senate Oral History interviews are featured on the Senate
website . All of my work for the past 15 years has been PRO BONO as a resource person for the
purpose of "issue advancing"

Sincerely,
Dennis W. Brezina