Licensing and Dental Regulations
Discipline of Dentists at the Board of Registration – August 2009
The Board of Registration in Dentistry has the ultimate power to regulate the licensing of dentists in Massachusetts, and the courts have given it wide discretion in enforcing those rules, deferring to the Board unless decisions are arbitrary, capricious or based on legally untenable grounds. There is a range of behavior that can result in differing penalties for disciplining dentists, and those penalties include but are not limited to revocation or suspension of a license, probation, censure, reprimand, restriction of privileges, non-renewal, resignation or termination of participation. All disciplinary actions require a hearing, and the courts have been strict about this to ensure due process rights are maintained.
Violation of the laws of the Commonwealth is the most obvious ground for disciplining dentists, and conviction of a felony can most definitely result in the revocation of a license. This particular ground for discipline is written into the Massachusetts General Laws and the Board has wider discretion if the crime is directly related to the practice of dentistry. Forgery of a prescription and fraud frequently result in revocation of a license, in at least one case, for five years.
Violation of “good and accepted medical practice’ is the second part of what allegations must be based on in order to constitute a valid complaint against a physician or dentist. The violations listed here are numerous, including those having to do with practicing under the influence of alcohol or drugs, breaking rules having to do with licensing and many other actions which the Board may consider to be inappropriate. Several years ago the listed violation of “gross misconduct” was supplemented by a determination of simple “misconduct.” Gross misconduct carries more serious disciplinary consequences, often up to five years suspension or revocation of a license. The distinction between the two types of behavior, when related to dentistry, is illustrated by the case of D’Amour v. Board of Registration in Dentistry when the Supreme Judicial Court upheld a suspension of a dental license for three years for gross misconduct when a dentist admitted to photographing a patient nude who volunteered to do so for research purposes in presenting a seminar on TMJ, even while the patient’s mother was present.
Misconduct requiring lesser penalties is usually based on minor violations of dental laws such as irregular billing practices, not informing the Board of the movement of the location of a dental practice (a stated requirement of the Board), submission of an insurance claim without performing work, performing unwanted services, refusing to respond to a patient’s request for care, refusing to provide patients with copies of medical records, or failure to renew a license. Small probationary periods are often imposed, or such penalties as requiring a dentist to undergo psychotherapy or reimbursing patients for insurance claims submitted without performance of services. The infraction of “habitually being drunk” stated in the rules without necessarily being intoxicated while practicing dentistry is often forestalled by the enrollment in a voluntary program for alcohol addiction that is offered exclusively for health care professionals such as dentists.
There are specific references in the Code for dentists regarding rules related to advertising and anesthesia administration. There is an anesthesia review committee to supervise the administration of various types of sedation and in most cases prohibits a dentist from using a special material, appliance or equipment not available to other dentists.
In sum, dentists should be aware that that the standard of behavior required by the Board of Registration in Dentistry to continue to hold a dental license in good stead is higher than just obedience to the law that the regular everyday citizen must conform to on a daily basis.