Agency cites funding and old systems, says it's addressing flaws

10:47 AM CDT on Wednesday, August 24, 2005

By ROBERT T. GARRETT / The Dallas Morning News

AUSTIN – The health and safety of dental patients in Texas may have been jeopardized because of lax enforcement and spotty background checks at the State Board of Dental Examiners, the state auditor has found.

"These gaps could put patients at risk," said the audit released Tuesday, which found the agency failed in up to a third of about 60 cases studied to ensure that dentists and dental hygienists complied with sanctions after they had been disciplined for violating professional standards.

One dentist who violated sanitation rules was allowed to reopen his office even though inspections ordered by the board apparently weren't carried out, the audit said.

Another dentist with a history of drug abuse failed to comply with a treatment plan, the audit said.

One day after the agency's contractor for mental health and addiction treatment reported the dentist's noncompliance, the agency renewed his license.

Auditors also found that of 1,137 people licensed by the board from September 2003 to February 2005, six had criminal convictions that should have been investigated and considered during the licensing process. At least one of the convictions was for felony drug possession; the other convictions were not detailed.

The dental examiners' board responded with a news release saying deficiencies found by the auditor "are primarily related to aged computerized information systems and a lack of sufficient funding."

The agency said it "was aware of many of the problems identified in this audit and had already taken steps to correct the deficiencies."

The report was compiled by an eight-person team from the office of State Auditor John Keel, who reports to the Legislature.

Legislative budget writers use performance measures when they decide how much money to give state agencies, and the dental examiners' board said it met 93 percent of its goals last year – a higher score than all but three other state regulatory boards.

The goals include such items as the number of licenses issued, number of complaints resolved and average time for complaint resolution, but they do not touch on the areas criticized by the auditor.

During this year's regular session, however, some lawmakers sharply criticized the dental board for not obtaining competitive bids in 2002 when it hired a New Jersey company to conduct online tests of dental assistants before they can X-ray people's teeth.

The administrator who approved the contract left the agency more than two years ago and her successor, who renewed the deal, quit in April.

The 28-employee agency, with an annual budget of about $1.6 million, pleaded for more staff and higher salaries, citing turnover of more than 40 percent last year. The Legislature approved about $50,000 more per year, according to the state budget.

The Texas Dental Association, which represents about 7,500 of the 10,000 actively practicing dentists in the state, said it "supports the audit process as an ongoing mechanism to ensure patient safety."

The group said it hopes there will be "prompt resolution" of deficiencies raised.

The auditor looked at 62 requirements the dental board placed on 39 dentists and hygienists whom it disciplined.

While the agency's computer database showed all of the licensees to have complied, the auditor found "inadequate enforcement" because its check of files found "evidence of noncompliance" for six of the requirements. For 14 others, the files "were silent as to whether the licensee had complied," the audit said. In one case, there was no record that a $3,000 fine had been paid, though it was due last spring.

The agency said it "fulfills its obligations regarding compliance," though it acknowledged its computer system has "limitations" that don't make it easy to track deadlines for licensees to comply with board orders.

The agency said state law doesn't let it deny renewal to a scofflaw licensee. It said the law allows it only to deny renewal if the licensee has defaulted on a government-backed student loan.

The auditor said if a law needs to be changed to allow the agency to deny renewal for disobeying a board order, "the agency should seek that change."

The agency said it would fix glitches in its review of criminal histories. For example, the auditor discovered the agency "incorrectly believed" it was getting full criminal histories of license applicants from the Department of Public Safety. It actually received only quarterly updates of any new convictions, but it never reviewed an applicant's previous life, the audit said.

E-mail rtgarrett@dallasnews.com

State Auditor John Keel says the State Board of Dental Examiners:

Hasn't enforced sanctions against licensees who violated professional standards.

Used "incomplete information" to determine whether applicants had been convicted of crimes that might force denial or revocation of licenses.

Didn't seek competitive bids and make sure the state received "fair value" on two contracts – for testing and background testing services.

SOURCE: State auditor