Proposed Ala. bill would regulate nonprofit dental clinics

New legislation that would give the Alabama dental board oversight of nonprofit dental clinics -- including Sarrell Dental, the largest provider of Medicaid services in the state -- is being discussed by state legislators in a public hearing today.

The bill, HB 451, would exempt nonprofit clinics from the Dental Practice Act but would require these clinics to register with the Alabama Board of Dental Examiners. It also would require clinic employees to comply with dental licensing laws.

While the measure is supported by Sarrell, it is opposed by the dental board, which wants Sarrell to be subject to the rules and regulations of the Dental Practice Act like every other Alabama dentist.

Nonprofits are already exempt from the act, which states that only licensed dentists can own dental clinics or operate dental equipment, according to Sarrell CEO Jeffrey Parker. In addition, the dentists and hygienists who work at Sarrell's clinics are already subject to the act's requirements and the oversight of the dental board, he said.

Thomas T. Willis, DMD, president of the dental board, said the board has offered an alternative bill that would require Sarrell to register with the board, pay annual fees, and be subject to the rules and regulations of the Dental Practice Act. The group also wants Sarrell to have a chief of staff who is in charge of all the clinics and wants the clinic to provide annual financial statements, Dr. Willis said.

The latest fight seems to be a question of oversight: Sarrell doesn't want to be subject to a dental board that it views as trying to drive the flourishing company out of business, while the dental board says all dental clinics should be subject to the act, which includes oversight by the board.

"We should not be required to do anything more than any other private practice," Parker told DrBicuspid.com. "Sarrell Dental is open to being treated the same as every other dentist in Alabama. We are subject to the Dental Practice Act, and we are subject to inspections just like every other dental practice."

But Dr. Willis disagrees. "They can do whatever they want to. I would love to practice and not have to abide by the Dental Practice Act. They don't want to be subject to the board of examiners," he told DrBicuspid.com. "We're not trying to restrict Sarrell, we're only trying to make them a legal entity. We agreed to the exemption in the act, saying they could practice and run the clinic, if they conformed to regulations."

Too successful?

Parker claims Sarrell's success is to blame for ongoing antagonism between the company and the dental board. Sarrell, which serves mainly poor children and is the largest single provider of Medicaid dental services in Alabama, has grown considerably since it opened in 2005. It now has 11 clinics, staffed by 44 dentists and 27 hygienists. Revenue has increased from $2.3 million in 2006 to $6.75 million in 2009.

"We have seen over 250,000 patient visits with zero consumer complaints to the dental board," he said. "We have reduced the cost of patient care from $328 per patient visit in 2005 to an industry low of $125 per patient visit in 2010."

Sarrell has become such a high-paying employer that he is being "deluged" with dentists applying for jobs, Parker added. It has also become the largest employer of dentists in Alabama, outside of the University of Alabama at Birmingham (UAB).

Frank Catalanotto, DMD, a professor in the department of community dentistry and behavioral science at the University of Florida College of Dentistry, will speak on behalf of Sarrell at today's hearing before the Children and Senior Advocacy Committee, which will decide the matter.

"I'm coming because I believe in the Sarrell Dental clinics. I have visited them and I believe they are doing good things," he told DrBicuspid.com. He criticized the dental board's action as "just a mechanism to harass Sarrell."

Dr. Catalanotto said all healthcare facilities are subject to the same inspections. "So why do they need extra provisions [for Sarrell]?" he asked.

He acknowledged that Sarrell is reimbursing his travel expenses but noted, "I believe so strongly in this that I'm taking a vacation day to testify."

Josh Jones, Sarrell's director of public policy, said, "It's a clear case of the dental board trying to restrict the trade."

In April 2010 the UAB School of Dentistry decided to remove students from the Sarrell clinics, where they had been getting hands-on clinical training -- a move Parker said was due to a turf battle with private practitioners and pressure from alumni dentists. But the university said a lack of proper faculty supervision was the reason students were taken out of training rotation at the Sarrell clinics.

The U.S. Federal Trade Commission subsequently launched an investigation into whether the Alabama Dental Association (ALDA) engaged in unfair competition or deceptive acts by allegedly refusing to deal with Sarrell.

Sarrell then filed a lawsuit against ALDA, claiming the organization had launched an "illegal conspiracy" to drive the clinic out of business.

In March of this year, the UAB School of Dentistry Alumni Association issued a report detailing deficiencies in dental students' hands-on training at the school, citing instances in which clinic rotations allegedly involved playing video games with seniors, brushing their teeth, or being told to go to the beach.

"We're trying to legalize all 501(c)(3) [nonprofit] dental operations," Dr. Willis explained. "We're asking for simple registration, pay the fee, and be subject to inspection and regulation. You can't regulate something that the Dental Practice Act doesn't acknowledge as existing. We're trying to make them legal, but they fight us left and right."