There exists great variability between states in efficacy of dental board regulatory oversight and discipline. Numbers of professional regulatory boards assume their charge to protect the public welfare with earnest efforts. Others are seemingly overwhelmed by internal corruption and/or gross incompetence.
Ultimately, responsibility for a healthy functioning dental board rests upon state governors who appoint members (and can demand resignations) and state attorneys general who assign a board’s staffing of legal counsel.
Governors and attorneys general are elected officials, who generally disfavor public embarrassment. Watchdog media has been instrumental in promoting dental board transparency for numbers of states.
GEORGIA
On January 11, 2018, The Atlanta Journal-Constitution reported a story on a Medicaid-focused dental service organization (DSO) headquartered in Georgia, which had agreed to a $23.9 million settlement with the US Department of Justice (USDOJ).
The USDOJ alleged “that between January 2009 and December 2011, Benevis and Kool Smiles clinics located throughout 17 states knowingly submitted false claims to state Medicaid programs for medically unnecessary pulpotomies (baby root canals), tooth extractions, and stainless steel crowns, in addition to seeking payment for pulpotomies that were never performed. The United States alleges that Kool Smiles clinics routinely pressured and incentivized dentists to meet production goals through a system that disciplined “unproductive” dentists and awarded “productive” dentists with substantial cash bonuses based on the revenue generated by the procedures they performed.”
“According to the government’s allegations, Kool Smiles clinics ignored complaints from their own dentists regarding over-utilization. In addition, the United States further alleged that Kool Smiles clinics located in Texas knowingly submitted false claims to the Texas Medicaid Program for First Dental Home (FDH), a program intended to provide a comprehensive package of dental services aimed at improving the oral health of children under three years of age. These clinics are alleged to have submitted false claims for FDH services that were not fully provided.”
The chief dental officer for the accused DSO, Dr. Dale Mayfield, had been appointed to serve on the Georgia Board of Dentistry two years prior, during a time of the USDOJ’s investigation. The Atlanta Journal-Constitution publicly asked the Governor’s office immediately following the settlement, why Mayfield remained on the dental board. The following week, former Governor Nathan Deal asked for and got Mayfield’s resignation.
ARIZONA
Investigative journalist and dental consumer advocate, Dave Biscobing, has been instrumental in exposing longstanding malfeasance at the Arizona Board of Dental Examiners (AzBDE). In one particular case in 2018, Biscobing uncovered evidence of dental board officials concealing a doctor’s falsified and forged anesthesiology credentialing. Officials silenced staff to allow a dentist/anesthesiologist to continue to practice upon the public, with a residency degree fabricated off a Microsoft Word template.
One week after Biscobing’s report, former Arizona Governor Doug Ducey accepted the retirement/resignation of AzBDE executive director Elaine Hugunin after her nine years of tenure. Subsequent to three criminal felony convictions, Pankaj R. Goyal, DDS, voluntarily surrendered his Arizona dental license on July 18, 2019, as part of his consent agreement.
A cynic might contend such abuses were ongoing for years and dental regulatory boards either knew of the abuses to the public, or reasonably should have known. Changes favoring the public interest only seemed to occur when the media could potentiate embarrassment to high-level elected officials.
DR. THOMAS J. TEICH
Perhaps one of the most notorious situations of a dental board’s betrayal to the public interest involved Thomas John Teich, DDS, who surrendered his California dental license effective March 31, 2014.
California cited 52 accusations against Teich as cause for discipline. Alleged violations spanned numerous patients and dangerous practices involving sedation of patients at his implant center. At no time was Teich licensed for delivery of sedation services. One alleged action resulted in a patient’s death.
Disciplinary investigation against Teich’s California dental license was initiated in 2008. Unfortunately for patients harmed, he did not surrender his dental license until six years later.
It gets worse—in 2012, CBS News in Los Angeles reported “A dental board representative said Dr. Teich should never have been licensed in California. In 1994, the dentist’s license was revoked in Arizona and Illinois. He was sentenced to 15 months in prison for mail fraud and admitted to a history of cocaine dependence.”
“He should not have been licensed back in 2002. He was licensed by mistake,” said Russ Heimerich, a spokesperson for the California Dental Board.
The board admitted Teich did not conceal his past record when he applied for licensure in California.
Teich was founder, CFO, and clinical director of today’s permanently-closed Smile Implant Center in Newport Beach, California.
Numerous patients paid for dental implant surgery and restorative treatment in advance and were left with nothing. Others were damaged by substandard care.
CALIFORNIA
California presents numbers of dentists in active clinical practice, who have been formally charged and disciplined in other states. Teich is far from an isolated example.
Yet, in many of these situations, there exists no public record available from the DBC that these doctors have a problematic history outside of California. Due to the DBC’s lack of transparency, dental consumers are often left in the dark.
The application for a California dental license includes the following verbiage:
“YOU MUST REPORT TO THE BOARD THE RESULTS OF ANY ACTIONS WHICH HAVE BEEN FILED OR WERE PENDING AGAINST ANY DENTAL LICENSE YOU HOLD AT THE FILING OF THIS APPLICATION. FAILURE TO REPORT THIS INFORMATION MAY RESULT IN THE DENIAL OF YOUR APPLICATION OR SUBJECT YOUR LICENSE TO DISCIPLINE PURSUANT TO SECTION 480(c) OF THE BUSINESS & PROFESSIONS CODE.”
Falsifications or omissions on professional licensure applications or renewals have serious potential consequences under California Business and Professional Code Section 480.
Questions on the application include: “HAVE YOU EVER BEEN ISSUED A DENTAL LICENSE IN ANY STATE OR COUNTRY? IF YES, LIST ALL STATES/COUNTRIES WHERE A LICENSE HAS BEEN ISSUED. CERTIFICATION OF LICENSE(S) MUST BE SUBMITTED FOR EACH STATE/COUNTRY.”
“DO YOU HAVE ANY PENDING OR HAVE YOU EVER HAD ANY DISCIPLINARY ACTION TAKEN OR CHARGES FILED AGAINST A DENTAL LICENSE OR OTHER HEALING ARTS LICENSE? INCLUDE ANY DISCIPLINARY ACTIONS TAKEN BY THE U.S. MILITARY, U.S. PUBLIC HEALTH SERVICE, OR OTHER U.S. FEDERAL GOVERNMENT ENTITY. IF YES, PROVIDE A DETAILED EXPLANATION AND A COPY OF ALL DOCUMENTS RELATING TO THE DISCIPLINARY ACTION. DISCIPLINARY ACTION INCLUDES, BUT IS NOT LIMITED TO, SUSPENSION, REVOCATION, PROBATION, CONFIDENTIAL DISCIPLINE, CONSENT ORDER, LETTER OF REPRIMAND OR WARNING, OR ANY OTHER RESTRICTION OF ACTION TAKEN AGAINST A LICENSE.”
In the section for signature declaration, it reads:
“MY SIGNATURE ON THIS APPLICATION, OR COPY THEREOF, AUTHORIZES THE NATIONAL PRACTITIONER DATA BANK AND THE FEDERAL DRUG ENFORCEMENT AGENCY TO RELEASE ANY AND ALL INFORMATION REQUIRED BY THE DENTAL BOARD OF CALIFORNIA. I CERTIFY UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF CALIFORNIA AND AUTOMATIC FORFEITURE OF MY CALIFORNIA DENTAL LICENSE, IF ONE IS ISSUED, THAT THE INFORMATION I PROVIDED TO THE BOARD IN THIS APPLICATION IS TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE AND BELIEF.”
Falsification on an application for dental licensure application or renewal may result in legal perjury charges, as well as automatic forfeiture of a dental license. Such language is standard on most state dental license applications and renewals. All too often, such warnings are apparently not given seriously by California authorities.
Additionally, all licensees are required to present the DBC with mandatory reporting requirements under California Business and Professions Code § 1680. This includes: “(r) Suspension or revocation of a license issued, or discipline imposed, by another state or territory on grounds that would be the basis of discipline in this state.”
CALIFORNIA DENTISTS PRACTICING WITHOUT PUBLIC DISCLOSURE BY DBC OF DISCIPLINES IN OTHER STATES-
The recent fiasco revolving around the bankruptcy of Borrego Community Health Foundation (Borrego Health), formerly the largest federally qualified health center (FQHC) in the USA, has led to many interesting discoveries.
One of the litigants involved with a lawsuit and countersuit with Borrego Health is Husam Aldairi, DDS.
Aldairi and his dental clinics with multiple providers formerly served as outsourced contract dental Medicaid providers for Borrego Health.
Aldairi has a disciplinary consent agreement with the DBC. His June 4, 2021, disciplinary order related to alleged causes of unprofessional conduct which were specific to repeated acts of negligence, record keeping violations, and gross negligence. No actions by the DBC have been rendered on Aldairi’s dental license related to his dealings with Borrego Health.
Language specific to the stipulated settlement and disciplinary order reads “If Respondent is subject to any other disciplinary order from any other health-care related board or any professional licensing or certification regulatory agency in California or elsewhere and violates any of the orders or conditions imposed by other agencies, this shall be deemed a violation of probation and may result in the filing of an accusation or petition to revoke probation or both.”
In fact, Aldairi has a history of disciplinary action in Illinois, which is totally absent from records with the DBC. Initially, the Illinois Board of Dentistry alleged Aldairi abandoned patients in a 2011 complaint (No. 201104261). The Department alleged Aldairi “engaged in dishonorable, unethical, or unprofessional conduct of a character likely to deceive, or harm the public; or has engaged in billing irregularities involving dental procedures.”
Aldairi received a formal reprimand and was to financially reimburse a collection of over 20 patients. Aldairi and his attorney signed the Consent Order, which was effective September 19, 2014.
Aldairi’s Illinois unrenewed dental license was held in a “suspended” status. Then on February 14, 2018, the director of the Illinois Department of Financial and Professional Regulation (IDFPR) issued an order to indefinitely suspend Aldairi’s dental license for a minimum of six months for failure to comply with the 2014 Consent Order.
Eventually, Aldairi did satisfy the agreement with the out-of-state IDFPR. However, none of this information is available for public access from the DBC. Yet, the DBC was very willing to report Aldairi’s alleged drunk and disorderly conduct at a local Native American gambling casino.
Questions arise. Was the DBC ever informed of Aldairi’s disciplinary actions in Illinois? If not, why did Aldairi not receive further action once the CDB learned of deception and code violation? If the DBC was advised as required under state code, why was that history not a consideration in Aldairi’s most recent consent agreement in California and made public?
Another former contracted dental provider for the bankrupt FQHC Borrego Health was Douglas G. Ness, DDS. Ness has an active and current California dental license, permit for oral maxillofacial surgery, and certificate for oral conscience sedation. The DBC cites no record of Ness involving discipline.
On August 4, 2010, the Alaska Board of Dental Examiners (ABDE) ordered a suspension of Ness’ dental license for four months. Suspension initiated on February 8, 2011.
The ABDE’s decision on professional reprimand stated, “… Dr. Ness, his professional judgement unaffected by substance abuse or personal stressors, inexcusably failed to appreciate the limits of his own knowledge and training, and deliberately undertook to perform complex oral surgery that he was only minimally, if at all, qualified to accomplish.”
“He failed to perform oral surgery in accordance with minimal professional standards, and failed to refer his patient to an appropriate specialist when complications arose. He inflicted a serious injury on his patient that required significant remedial care. He did not, prior to initial imposition of a sanction, unequivocally demonstrate an awareness of the limits of his professional training and knowledge. The Board finds Dr. Ness’s conduct a violation of professional standards of such a scope and severity that a four-month suspension of his dental license is amply warranted…”
Again, the DBC maintains no record for public access of this action by the ABDE. California citizens and dental consumers are kept in ignorance.
Moreover, as both Aldairi and Ness were formerly contract dental providers for Borrego Health, it would be essential for them to have passed California’s dental Medicaid/Medi-Cal credentialing process.
Were their complete histories disclosed? If so, were oversight safeguards in place?
Under California’s Department of Health Care Services, Medi-Cal providers may be suspended or ineligible if a person or entity “lost or surrendered a license, certificate, or approval to provide health care.”
Yet, Medi-Cal credentialing has not been suspended for either Aldairi or Ness.
On March 2, 2022, Florida dentist Bonnie Rae, DMD, voluntarily surrendered her dental license in response to an active disciplinary action conducted by the Florida Board of Dentistry.
Rae immediately and subsequently practices dentistry in California under her California dental license.
The Florida order in part reads:
“1. Respondent’s purpose in executing this Voluntary Relinquishment is to avoid further administrative action with respect to this cause. Respondent understands that acceptance by the Board of Dentistry (“Board”) of this Voluntary Relinquishment shall be construed as disciplinary action against Respondent’s license pursuant to section 456.072(1)(f), Florida Statutes. As with any disciplinary action, this relinquishment will be reported to the National Practitioner Data Bank as a disciplinary action, Licensing authorities in other states may impose discipline in their jurisdiction based on discipline taken in Florida.”
“2. Respondent agrees to never reapply for Iicensure as a dentist in the state of Florida.”
“4. In order to expedite consideration and resolution of this action by the Board in a public meeting, Respondent, being fully advised of the consequences of so doing, hereby waives the statutory privilege of confidentiality of section 456.073(10), Florida Statutes, regarding the complaint, the investigative report of the Department of Health, and all other information obtained pursuant to the Department’s investigation in the above-styled action. By signing this waiver, Respondent understands that the record and complaint become public record and remain public record and that information is immediately accessible by the public. Respondent understands that this waiver of confidentiality is a permanent, non-revocable waiver.”
In the formal complaint, Florida alleged Rae practiced outside the scope of her license, delegated clinical duties to an uncertified auxiliary, failed to maintain adequate records, failed to document a treatment plan, and proffered misleading advertising.
SCOPE OF THE PROBLEM IN CALIFORNIA
The breadth of troubling matters associated with the DBC far surpass seemingly acting as a sanctuary state for dentists disciplined in other states.
Michael Mashni, DDS, is a dental anesthesiologist practicing in Whittier, California. He is a past president of the American Society of Dentist Anesthesiologists, served in executive capacities with the American Dental Society of Anesthesiology, and functioned in leadership at the American Dental Board of Anesthesiology.
His comments in the groundbreaking seven-part report by Brooks Egerton for The Dallas Morning News in 2015 continue as a disturbing admonition today.
In 2011, Mashni saw a news report, in which the DBC attributed 55 dental patient deaths in a 4-year period related to dental care. Mashni requested all information of those cases from state authorities, with redactions for the identity of dentists involved.
After Mashni paid data compilation costs to the state, the DBC changed their story. They revised the number of deaths down to 24 for the timeframe, and only released specifics on three cases. As a conscientious leader in the specialty of dental anesthesiology, Mashni pushed back.
Mashni cited that the foundational purpose of the DBC is to protect the public. “Hiding this important information is contrary to this very purpose,” he wrote in one letter to the state.
“If we cannot identify where the problems or system breakdowns are occurring, how can we as both a profession and consumer agency prevent them?” Mashni asked.
“To put this bluntly, how many children have to die unnecessarily before any action is taken or trends identified?” added Mashni.
Mashni also reported a DBC employee advised him that dental patient death reports could be destroyed after a single review.
“If Dentist A has an issue and Dentist B says everything was done within the standard of care despite a poor outcome, then there is no discipline and the record is destroyed,” Mashni said. “The question to me becomes, ‘Is the standard of care high enough?’”
More recently in 2022, the media again stepped up to shine light on an allegedly disturbing situation. NBC News 7 in San Diego ran an in-depth investigation on failures of the DBC to protect the public, and in particular, vulnerable Medicaid (Medi-Cal) eligible children. Evidence uncovered by NBC News 7 demonstrated a gross lack of state investigation, as well as a paucity of appropriate disciplinary actions by the DBC.
In fairness to full disclosure, the DBC is far from the only state dental regulatory board to demonstrate problematic issues. Earlier in this report, matters surrounding the dental boards in Georgia and Arizona were cited.
A former president of the Ohio State Dental Board, Dr. Edward R. Hills is today a criminally convicted felon for fraud and serving federal correctional time.
In 2019, three members of the Nevada State Board of Dental Examiners (NSBDE) resigned under accusations of “ethical lapses,” and other board staffers were terminated. Arthur Kane, investigative journalist for the Las Vegas Review-Journal, ran a six-chapter report in 2019, which highlighted outrageous abuses by the NSBDE.
SOLUTIONS
Obviously, an engaged investigative news media has been instrumental in bringing light to problematic state dental boards, inclusive of the DBC. Ultimately, accountability extends to the state governor’s office, as well as the state attorney general’s office. In political one-party controlled states, which lack viable competition of a second-party voter option, exposure and political embarrassment may unfortunately only have minimal consequences for reform.
Charles Schumacher, DDS, president of the New Mexico Board of Dental Health Care (NMBDHC) offered, “We have a couple requirements per our rules about background checks. The applicant must do a self-inquiry from two separate entities, B&B Reporting, which does personal and criminal checks, and the National Practitioner Data Bank, which checks previous licensure activities.”
“We also ask questions on the applications of 1) past history of any discipline action against a dental license, or any other professional license; 2) any legal action involving liability/malpractice; 3) any volunteer surrender of a license or certification; and 4) any lapse in child support responsibilities.” added Schumacher. “These inquiries are important to adequately screen the applicants and if any positive responses, then the application is referred to the full Dental Board for proper review and decision.”
Schumacher said, “Per the Dental Practice Act and the Uniform Licensing Act, if an applicant submits a fraudulent application, they would be subject to referral to the AG’s office for possible disciplinary action.”
He also added that a valuable investigation resource for the NMBDHC is the American Association of Dental Boards’ (AADB’s) Clearinghouse for Board Actions.
From the AABD website:
“The American Association of Dental Boards’ Clearinghouse for Board Actions is intended to restrict the ability of incompetent practitioners to move from state to state making it a valuable tool for initial licensing of dental practitioners. Information indicating whether an individual has been involved in a board action can be obtained by the Clearinghouse Database. The Clearinghouse is fully computerized and has the capability of complete and rapid transfer of information on licensees. Although some of this information is available from the National Practitioners Data Bank, the NPDB cannot publish periodic reports on the information they obtain like the AADB Monthly Reports we send to our member boards.”
“As a State Dental Board Agency Member, you are allowed up to 50 queries per year at no cost. In addition, the information you provide will enable other states to access information on practitioners who have been sanctioned, furthering boards’ efforts to protect the public. By reporting to the AADB’s Clearinghouse you will help us to provide the most complete information available.”
Viable resources are available to the CDB, and every state dental board executing detailed background checks on applicants, as well as current dental licensees.
Dental board failure to generate background checks on licensed dentists, or those seeking a license, and the further failure to take appropriate protective action indicates a disturbing abrogation of their public trust.
ABOUT THE AUTHOR
Dr. Michael W. Davis practices general dentistry in Santa Fe, NM. He also provides attorney clients with legal expert witness work and consultation.
Davis also currently chairs the Santa Fe District Dental Society Peer Review Committee.
He can be reached at MWDavisDDS@Comcast.net.
FEATURED IMAGE CREDIT: Alexander Lukatskiy/Shutterstock.com.
