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SB382 – Proposed Rule Changes
Many have reached out and asked about current pending changes to the mental evaluation changes that are present before our current legislative session. In an effort to make sure that everyone understands potential changes to our governing statutes, NCDHA reached out to the NC Dental Board of Examiners for clarification for what these changes would mean for dental providers in NC.
Current laws in North Carolina are:
NCGS 90-41(a)(2) which requires dentist not to be impaired by intoxicants, drugs, or narcotics:
NCGS 90-41(a)(7) which requires dentists to be mentally, emotionally, and physically fit to practice dentistry:
90-41. Disciplinary action.
(a) The North Carolina State Board of Dental Examiners shall have the power and authority to (i) Refuse to issue a license to practice dentistry; (ii) Refuse to issue a certificate of renewal of a license to practice dentistry; (iii) Revoke or suspend a license to practice dentistry; and (iv) Invoke such other disciplinary measures, censure, or probative terms against a licensee as it deems fit and proper; in any instance or instances in which the Board is satisfied that such applicant or licensee:
(1) Has engaged in any act or acts of fraud, deceit or misrepresentation in obtaining or attempting to obtain a license or the renewal thereof;
(2) Is a chronic or persistent user of intoxicants, drugs or narcotics to the extent that the same impairs his ability to practice dentistry;
(3) Has been convicted of any of the criminal provisions of this Article or has entered a plea of guilty or nolo contendere to any charge or charges arising therefrom;
(4) Has been convicted of or entered a plea of guilty or nolo contendere to any felony charge or to any misdemeanor charge involving moral turpitude;
(5) Has been convicted of or entered a plea of guilty or nolo contendere to any charge of violation of any state or federal narcotic or barbiturate law;
(6) Has engaged in any act or practice violative of any of the provisions of this Article or violative of any of the rules and regulations promulgated and adopted by the Board, or has aided, abetted or assisted any other person or entity in the violation of the same;
(7) Is mentally, emotionally, or physically unfit to practice dentistry or is afflicted with such a physical or mental disability as to be deemed dangerous to the health and welfare of his patients. An adjudication of mental incompetency in a court of competent jurisdiction or a determination thereof by other lawful means shall be conclusive proof of unfitness to practice dentistry unless or until such person shall have been subsequently lawfully declared to be mentally competent;
Note that this statute mentions “adjudication of mental incompetency in a court of competent jurisdiction.” Currently, that is the only way the Board can require a dentist to be evaluated. We have to go to court…a very public proceeding…and get a judge to order a dentist to get an evaluation unless the dentist consents. We would also have to report the adjudication of the court to the National Practitioners Date Bank which could have an impact on the dentist’s practice.
The addition of (7a) would allow the Board to order an evaluation when sufficient evidence or probable cause exists to believe that a dentists may be mentally, emotionally, or physically unfit to practice. Such an order would come only after an investigation confirmed sufficient evidence and would be non-public, i.e., it would not have the potential disruptive personal and practice effects of appearing before a judge. (Note: This mirrors a the statutory authority of the Medical Board that already allows non-public evaluations of MD’s to occur.) If an evaluation comes back negative (no concerns with mental, emotional, or physical unfitness) the case would be closed and not subject to disclosure to the public.
Understanding who makes a complaint and how the board reviews and acts upon those complaints?
Anyone can file a complaint with the Board – colleague, staff member, family, patient, insurance company, etc. Most complaints filed with the Board have to be in writing and notarized. However, there are a few types of complaints where the complainant may be anonymous. We accept anonymous complaints only in those instances where the facts/evidence can be independently verified. (Example: a complaint of unsanitary office conditions can be verified by inspecting the office.) However, it is important to note that the evaluation considered in (7a) would never be based solely on a complaint. A (7a) evaluation would be ordered only after an investigation revealed sufficient evidence or probable cause to believe that the dentist was mentally, emotionally, or physically unfit to practice. The investigation would be directed by a dentist on the Board and, before an evaluation could be ordered, a redacted version of the facts (eliminating all personally identifiable information of the dentist) would have to be approved by the entire Board. (Staff has no vote in these matters.)
Is the ability to practice dependent on mental status?
The (7a) evaluation changes nothing in the statute. The ability to practice dentistry is currently dependent on mental, emotional, and physical fitness. (7a) merely gives the Board an opportunity to order an evaluation “quietly” without having to appear before a judge to seek such an order. If the Board received an evaluation report from an expert that stated a dentist is unfit to practice it would not result in an “automatic” disciplinary action. The report would simply be one piece of evidence that could be used in a hearing before the Board. The Dentist who was the subject of the evaluation report could challenge the report, present evidence to the contrary, cross-examine witnesses, provide alternative testimony and take any other steps allowed in a hearing – either him/herself or through legal counsel – to overcome the Board’s (7a) evaluation report and any other evidence.
Bottom line: Evaluations of mental, emotional, and physical fitness occur now when evidence is sufficient to believe they are necessary. They are ordered through the court if the dentist does not consent to such an evaluation. If (7a) does not become law the Board will have no other choice in its mission to protect the public than to continue current procedures and seek court orders to have dentists evaluated when there is sufficient evidence to believe that a dentist is mentally, emotionally, or physically unfit to practice.
What Is Legislative Advocacy?
Advocacy is the deliberate process of influencing legislators who make decisions on issues that affect you, your family and your profession.
NCDHA members interested in advancing our profession and advocating for our ability to provide oral health care services to underserved, should spend time introducing themselves to their local legislative representatives. The future of oral health equity STARTS with your involvement!
Now is the time to speak up about the benefits and needs of our profession!
CURRENT LEGISLATIVE ACTIONS & RECENT RULES CHANGES
THIS SECTION IS FOCUSED ON KEEPING YOU UP TO DATE ON RECENT CHANGES IN THE DENTAL HYGIENE PRACTICE ACT WHICH DIRECTLY AFFECTS YOU
DENTAL HYGIENE CLINICAL EXAM & SUBSTANCE ABUSE and MENTAL HEALTH CE REQUIREMENT
Two new sets of rules were recently approved by the Rules Review Commission of the NC General Assembly that will widely impact both applicants and current licensees.
- Applicants for a dental or dental hygiene license may now take their clinical examination either on a live patient or a manikin.
Dental: 21 NCAC 16B .0303(d)(1), and
Hygiene: 21 NCAC 16C .0303(d)(1)
- Current dental and dental hygiene licensees must now complete a one-hour continuing education course every two years on the subject of substance abuse and mental health.
Dental: 21 NCAC 16R .0206, and
Hygiene: 21 NCAC 16I .0206
This one-hour course is to be counted among the number of CE hours currently required and DOES NOT add hours to the current requirement. The course may be taken anytime in 2023 or 2024 to meet the requirements of license renewal for 2025 and will follow this once every two-year pattern thereafter.
Public Health Dental Hygienists
The North Carolina State Board of Dental Examiners and the Rules Review Commission (RCC) of the NC General Assembly recently APPROVED all proposed changes related to the direction of public health dental hygienists especially in underserved areas: Rules 21 NCAC 16W, .0101 and 21 NCAC 16W .0104! These changes will allow public health dental hygienists to provide specific preventive care services to individuals without receiving a prior examination by a dentist and without a dentist being present. These changes will be effective February 1, 2020! To comply with the new rule, a dental hygienist would have to complete the Public Health Dental Hygiene training offered through DHHS [NCGS 20-233(a)] and work with a dentist who has signed an agreement, contract, memo of understanding, or a similar legal document with a public health entity, a county health department for example, and provide the services as provided for in 21 NCAC 16W .0104(a). This rule DOES NOT apply to dentists who provide these services while exclusively in private practice.
Please stay tuned for more details in Our Upcoming News &Events Section.
This is one positive step forward in addressing the access to oral health care issue in NC!
Any dental hygienist wishing to practice under this rule must complete the Public Health Dental Hygiene training offered through DHHS [NCGS 20-233(a)] and work with a dentist who has signed an agreement, contract, memo of understanding, or a similar legal document with a public health entity [a county health dept. for example] and provide the services as provided for in Rule 21 NCAC 16W .0104(a) as well as changes made to Rule 21 NCAC 16W .0101
Revisions to Rule the Public Hygiene Rule 21 NCAC 16W .0101 and .0104
What has changed?
Newly adopted changes to 21 NCAC 16W .0101 and the addition of 21 NCAC 16W .0104 allow public health hygienists to work pursuant to a standing order in certain facilities in designated dental access shortage areas.
How do the new rules work?
First: No rules have changed for dentists and dental hygienists in private practice. Supervision of auxiliaries and delegable duties remain unchanged. “A dentist in private practice may not employ more than two dental hygienists at one and the same time who are employed in clinical dental hygiene positions.” [NCGS 90-233(b)] The new rules apply ONLY to dentists employed by a federal, state, county, or local government and are, therefore, not considered to be in private practice.
Second: The key condition is employment. Unless already employed by a local health department, state government dental public health program, or the Dental Health Section of the Department of Health and Human Services, a dentist in private practice must enter into a contract of employment with one of the aforementioned agencies in order to utilize these rules.
The contract must create an employment relationship: full-time, part-time, or temporary. It is also expected that the parties will address other terms to ensure that treatment does not fall below the standard of care and that a “dental home” is created and available for all patients seen pursuant to the standing order. The list of potential contract terms below is not exhaustive and is intended only to provide guidance in addressing potential issues:
- Designate the approved facility in a DHHS defined dental access shortage area where the services are to be performed.
- Delineate what procedures will be allowed to be performed under the standing order.
- Indicate how many hygienists will be performing assessments so that follow-up treatment does not exceed capacity.
- Clearly indicate that the patients seen by the public health hygienist are patients of record for the supervising dentist.
- Ensure that patients of record will be seen and treated by the employed dentist for those procedures not covered by the standing order.
- Indicate the dates, times, and places of all regularly scheduled return visits throughout the year.
- Ensure that the employed dentist will adhere to all sterilization, infection control, radiation protection, and patient safety requirements.
- Provide clear direction as to how billing, collections, and other administrative functions will be handled and by whom.
- Include other terms and conditions that the parties deem necessary to meet local or individual needs.
Third: Dentists employed by a local health department, state government dental public health program, or the Dental Health Section of the Department of Health and Human Services (DHHS) may allow a public health hygienist “especially trained by the Dental Health Section of the Department of Health and Human Services” to perform procedures described in NCGS 90- 221(a) based on a standing order rather than an in-person examination by the dentist. The public health hygienist in these situations may also supervise a Dental Assistant.
Fourth: Restrictions apply! The public health hygienist may not work independently. He or she may only assess patients pursuant to a standing order from a supervising dentist employed by an approved government agency and the assessments can only occur in public schools, nursing homes, rest homes, long-term care facilities, and rural and community clinics operated by federal, State, county or local governments in areas identified by DHHS as dental access shortage areas.
Fifth: The standing order must describe what procedures the public health hygienist can perform. No standing order may allow the public health hygienist to perform irreversible procedures or exceed delegable functions as defined in NCGS 90-221(a), 21 NCAC 16G .0101 and 21 NCAC 16H .0203.
Stay tuned for more information as it becomes available. Please reach out to us with any questions, etc.
North Carolina Licensure Information
FAQ Regarding Dental Hygiene Licensure
The following provides reference information about requirements and procedures related to obtaining a dental hygiene license in North Carolina.
Application Forms and Information: Application Forms and Information
Fees for License: Fees for License
Under North Carolina Law, § 90-233, A dental hygienist may practice only under the supervision of one or more licensed dentists.
Eligibility to Practice Dental Hygiene Outside Direct Supervision: Eligibility to Practice Dental Hygiene Outside Direct Supervision
Dental hygienists are required to complete 6 hours of continuing education every year. In addition, dental hygienists area required to maintain current CPR certification received from a “hands on” course.
Dental hygienists may obtain any or all of their required hours through correspondence or online courses which have post-tests and issue certificates of completion.
Dental hygienists with a limited supervision license must complete 6 hours of continuing education every year in dental office medical emergencies, in addition to the minimum 6 hours of continuing education as required for license renewal.
Appropriate course subjects: Courses must be related to patient care. Courses stressing practice management or self-improvement, for example, could not count, while courses in sterilization and infection control, pharmacology, dental materials and dental procedures are acceptable. The Board will accept some risk management courses.
Approved Sponsors for CE Hours: providers who are recognized by the American Dental Association’s Continuing Education Recognition Program, courses sponsored the Academy of General Dentistry, the American Dental or American Dental Hygienists’ Association, or components of such organizations, the North Carolina Area Health Education Centers, Federally Qualified Health Centers, educational institutions with dental or dental hygiene schools or departments, and national, state, or local societies or associations. (Study clubs are considered “associations”.)
Reporting CE Hours: The number of hours completed each year is reported on the license renewal form and no documentation of course work should be sent to the Board’s office. Each person is responsible for maintaining his/her own documentation for at least two years of CE courses completed and must show evidence of completing CE when requested by the Board.
The online renewal system is open from November 1 to March 31 each year. A $50 late penalty will be assessed to those renewing after January 31. Licensees may use the online system to update their address and phone information throughout the year.
All licenses that are not renewed by March 31 become void and continuing to practice without a valid renewal certificate is a Class I misdemeanor. Each day’s violation is a separate offense.
Licenses not renewed by March 31 must be reinstated by the Board. Reinstatement involves submitting an application and paying a reinstatement fee ($225 for dentists; $60 for dental hygienists) along with the current year’s renewal fee.
North Carolina State Board of Dental Examiners
The North Carolina State Board of Dental Examiners is responsible for the professions of dental hygienists, dentists and dental assistants. The purpose of the North Carolina State Board of Dental Examiners is to ensure that the dental profession merit and receive the confidence of the public and that only qualified persons be permitted to practice dentistry and dental hygiene in the state of North Carolina. The board members include 6 dentists, 1 dental hygienist and 1 consumer member. The dentists members and the dental hygiene member are voted on by their peers. The consumer member is appointed by the Governor of NC.
North Carolina Caring Dental Professionals
The North Carolina Caring Dental Professionals is available to all licensed dentists and dental hygienists as well as faculty and students associated with or enrolled in NC dental or dental hygiene schools. Established as an outreach for our licensed dental professionals in NC, NCCDP is a nonprofit agency charged with identifying, intervening, and assisting with those who themselves, or may have family or team members struggling with the consequences of alcohol, substance or drug abuse, burn-out or mental illness. If you need help or know of a dental team member who needs help – call 704-284-3039 or the confidential hotline at 980-295-2055.