Claudia Cavallino, DDS

1. Claudia Cavallino, DDS • Louisiana State Board Of Dentistry

2. My History and Background • Lifelong New Orleans resident, Completed DDS and Pediatric Dentistry Residency at LSU School of Dentistry • Private practice in New Orleans and Houma, LA since 2004 • On staff at Children’s Hospital and Ochsner Hospital, serving on the Cleft Palate/Craniofacial Team • Part time faculty at LSUSD, past President of the LSUSD Alumni Association • Since 2004, have served on various committees for the Louisiana Dental Association, including the LDA’s Medicaid Task Force • First AAPD Public Policy Advocate for Louisiana • State Board Member since 2012, serving as Board President in 2017

3. Functions of the LSBD • Mission of all dental boards: Protect the Public • This mission is accomplished through: • Investigation of complaints • Licensing and permitting of dentists and hygienists • Rule making and enforcement of the Dental Practice Act • Participating in clinical licensure examinations

4. Structure and Composition of the LSBD • 14 members: 13 DDS (1 perio, 1 pedo, 2 omfs, 9 GPs), 1 RDH • New legislation just passed this year adds 1 public member • Nominated by licensees in each district at a public meeting • 3 names (top 3 vote getters ) submitted to governor • Governor reviews nominees and makes appointment • Exception: RDH member and 3 At-Large DDS members directly selected and appointed by the Governor • 5 year term, term limited to 2 terms (10 yrs) • Current Executive Director: Dr. Arthur Hickham (DDS & JD)

5. How and Why I became a State Board Member... • In 2010-2011 Louisiana went through a very contentious debate regarding mobile school-based dentistry. • A new mobile school-based dentistry program began to operate throughout the state and at the time the LSBD had no rules or regulations in place. • Complaints began to crop up around the state and the Louisiana Dental Association (LDA) formed a task force to look into the practice. • The LDA took the position that the current operation was not practicing under the comprehensive dental home model (i.e., only providing preventive and diagnostic services with no access to continuing care or emergency care and very little access to restorative/oral surgery care) and therefore did not support the mobile school-based dentistry concept.

6. How and Why I became a State Board Member... • The LDA went to the LA legislature to get the practice banned. • The end result of the legislative debate was that the legislature allowed the practice of mobile school-based dentistry to exist, but tasked the LSBD with promulgating rules to regulate this new model of delivering dentistry. • For an entire year the LSBD held public meetings on the matter during the course of its rule-making. • As a member of the LDA’s Medicaid Task Force I attended each and every one of the legislative hearings and Board meetings.

7. How and Why I became a State Board Member... • What struck me the most at all of the Board meetings was that there was NO pediatric dentist on the LSBD. Also, very few of the dentists on the board treated children and even fewer were medicaid providers. • It became very obvious to me during this 2 year process, that the pediatric medicaid population needed a “voice” on the State Board. Since the mobile school-based dentistry programs primarily affect children on medicaid, it was obvious to me that many of the dentists on the Board did not fully grasp the complex issues involved. • Therefore, when a spot on the board opened up at the end of 2011, my colleagues in New Orleans asked me to consider serving. I agreed, was nominated, then appointed, and began serving in January, 2012.

8. How and Why I became a State Board Member... • I am now on my 6th year serving on the Board. • It is my observation that a significant percentage of complaints that the Board receives involve children and especially children on Medicaid. • These involve: fraud, over-treatment, substandard care, sedation/anesthesia incidents, inappropriate use of restraints, informed consent issues to name a few. • Because of what I have observed, it is now my STRONGLY HELD BELIEF that all states should have a pediatric dentist on the Board at all times!

9. Rule Making • New rules and rule changes DO NOT require legislative approval. • Rule changes are discussed at Rule Making Committee meetings and full Board meetings, all of which are open public meetings and allow for public comment. • Once a rule change is passed the new rule is sent to the House & Senate Health and Welfare Committees, which has oversight over all health regulatory boards. • Notice of Intent is also published which allows for an additional period of public comment. • New law passed this legislative session calls for the creation of a commission that will review all new rules by all health regulatory boards. The intent of this law is to examine rules for any potential anti-trust violations thus hoping to create immunity through active legislative oversight.

10. How a Complaint is Handled • Every complaint that is received is investigated. The first step is to notify the licensee and request a response and patient records. Only exception to this is advertising complaints. • Once all documentation is received the complaint is then turned over to a 3 member Disciplinary Oversight Committee (DOC). • The dentists chosen for a DOC are Board members who are outside the district of the licensee who received the complaint. DOC members then independently review the investigative materials and make a recommendation to the Board President.

11. Disciplinary Process • DOC members can choose from the following options: • Take no action and close the matter • Investigate the complaint further • Send a letter of concern to the licensee (not made public and not reported to the National Practitioner Data Bank) • Offer a settlement to the licensee - CONSENT DECREE. This could involve a fine, suspension, public reprimand, remediation, reimbursement to a patient, or surrender of a license. This is made public. • Conduct an informal hearing “dentist to dentist” • Conduct a formal hearing with 3 Board members, similar to a trial • New law also gives licensee the option to have a formal hearing before an administrative law judge instead Board members

12. 2017 Complaint Data • 125 complaints received. By year’s end 111 cases were closed: • Take no action - 85 • Advertising strike 1 - 4 • Letter of Concern - 11 • Consent Decree - 10

13. 2017 Complaint Data • Abandonment - 1 • Advertising - 9 • Billing for services not performed - 1 • Fee dispute - 10 • Fraud - 5 • Habitual indulgence - 3 • Illegal prescribing - 4 • Other - 12 • Anesthesia incident - 4 • Unsanitary conditions - 4 • Rude treatment - 4 • Substandard care - 74 • Violation of board rule - 5 • Allow unlicensed person to practice - 1 • Other: spore testing, inappropriate touching, inappropriate access to PMP

14. Specialty Advertising Rules • The Board has reviewed and approved the “Standards for Advanced Specialty Education Programs” set forth by the Commission on Dental Accreditation of the American Dental Association and approves of the following specialties: • dental public health • endodontics • oral and maxillofacial surgery • oral pathology • orthodontic and facial orthopedics • pediatric dentistry • periodontics • prosthodontics; and • oral and maxillofacial radiology

15. Specialty Advertising Rules • American Academy of Implant Dentistry v. Parker (W.D. Texas, January 21, 2016) • The court held that a Texas Dental Board rule preventing dentists from advertising as a specialist in any area of dentistry not recognized as a specialty by the ADA was an unconstitutional restriction of free speech.

16. Specialty Advertising Rules • The Board approves the following specialties: • dental public health • endodontics • oral and maxillofacial surgery • oral pathology • orthodontic and facial orthopedics • pediatric dentistry • periodontics • prosthodontics; and • oral and maxillofacial radiology • any other area of dentistry for which a dentist has completed a post-doctoral program consisting of at least 2 full time years and which program is accredited by an accreditation agency that is recognized by the US Department of Education.

17. Sedation/Anesthesia Regulations • Prior to 2003, no regulation of oral (enteral) sedations in Louisiana. Permits required for IV (parenteral) or GA only. • Then a pediatric death occurred. • State changed the dental practice act to require personal permit and office permit for all levels of sedation (enteral vs. parenteral and pediatric vs. adult). • Only training required to obtain an enteral permit (pediatric or adult) was a weekend CE course and an office inspection.

18. Sedation/Anesthesia Regulations • In 2013, the Anesthesia Committee began looking into updating the sedation rules and regulations. • Shortly after this process began, another pediatric death occurred. • As part of this process LSBD did an exhaustive search of national best practices and what was required in other states. • We found that educational requirements to obtain a sedation permit was WAY out of line with the rest of the country.

19. Sedation/Anesthesia Regulations • In 2016 new rules went into effect. Louisiana’s rules now in line with current national standards and ADA guidelines. • Any sedation permit beyond just N20 requires either: • PG training (GPR, Pediatric Dentistry, OMFS) • or, approved course which provides 60 hrs of didactic lecture and 20 clinical cases • Only exception to this is if a 3rd party anesthesia provider is administering the sedation (CRNA, MD anesthesiologist), the dentist does not have to have any sedation training. Just PALS or ACLS. Office inspection still required.

20. Sedation/Anesthesia Regulations • Be Proactive not Reactive...otherwise your legislature will make rules for you!!!!!! • My prediction: the single operator model that we have seen for decades in pedo and omfs may be coming to an end

21. Any Questions ???