UPDATE, April 26: TDMR has received a complete recording of the virtual TSBDE board meeting held on April 21. The meeting lasted around 50 minutes, 40 of which were taken up with a wide-ranging discussion about how to best to word their rule to help dental providers comply with the Governor's Executive Order GA 15 and serve the needs of patients.
The controversial excerpt we earlier received was part of that discussion and is not indicative of the board's discussion as a whole. We have added to the short transcript we published to provide more context and added a short transcript of a later discussion with the same board members showing a different side as the discussion progressed.
We have replaced the short audio clip with the recording of the entire meeting and placed the starting time codes on the short transcripted sections so users can go directly to them if they desire. [the transcripts may have some errors, not all words were audible or intelligible on the recording].
UPDATE, April 24: TDMR received a recording of the short controversial discussion at the TSBDE virtual board meeting held on April 21 on whether it was okay under Governor Abbott's GA 15 executive order for a dentist to treat someone who had fallen and broken their tooth and was in pain.
Robert G. McNeill, D.D.S., M.D.: This is Dr. McNeil. From my standpoint, if I fall and I fracture my tooth #8 in the front of my mouth and I am trying to find a dentist to treat me and I am having pain. And they look at me and they say "Well, I'll see ... I am not sure this is a serious medical condition or preserve my life and I've got an exposed pulp and no one's going to treat me and its going to be like that for however long, 3 or 4 weeks. I just think there are some practitioners that wouldn't treat that and there are some practitioners that would treat that.
Casey Nichols, General Counsel: That is correct. Sorry, this is Casey. Our staff, Dr. Bush, Wendy and I are running into questions like that almost daily. And I can tell you that that's exactly right. Some practitioners would treat that and some wouldn't. And would we take action against the practitioner that chose to treat that situation? No. I highly doubt it.
Jorge Quirch, D.D.S: This is Dr. Quirch. Under this order that we have from the Governor, we should not treat that. The way I read this order you cannot treat that patient. He is not in imminent danger of his life or going to the hospital.
David Tillman, D.D.S: By your professional judgment?
Jorge Quirch, D.D.S: By my professional judgment. That's right.
David Tillman, D.D.S.: In your professional judgment, that's fine. This rule allows for professional judgment. The patient can go down the street to another dentist who has perhaps a different professional judgment.
Robert G. McNeill, D.D.S., M.D.: This is Dr. MacNeil. I went with the scenario that I talked about before. I went to see a dentist, he refused to treat me, so I went to the hospital.
David Tillman, D.D.S.: Correct.
Robert G. McNeill, D.D.S., M.D.: I think that is the risk there. I appreciate what you are saying Dr. Quirsh. I appreciate what Ms. Nichols was saying there. Okay, if someone chose to treat me, Board action wouldn't take place... I get to the point of saying what is a dental emergency/urgent dental care? And that's why I like the ADA guideline. That's why I made it as motion previously that wasn't seconded because I think we're going to cause some problems for practitioners and the public.
David Tillman, D.D.S.: This specific instance happened to me. I had a patient, I was here on a Friday, they needed me. I was down in Austin. They ended up in the emergency room. In my opinion, that is a worst-case scenario. Because they entered the emergency room where there were COVID patients, sick patients, they had a toothache. He was seeking care. He received care. But the fact is we as clinicians should keep these patients out of the emergency rooms so they don't have the potential of catching COVID or any other entity or ailment. If the person approaches an emergency room, whether they should or not, they're in pain. That's the only avenue they felt they could do. We should in our judgment prevent that from happening. And so that's why we leave in particularly this portion of the rule ... and as a guide to clinicians.
Jorge Quirch, D.D.S: Dr. Tillman, this is Dr. Quirsh in the queue. You know I totally agree. I think if we change the verbiage, I think we ought to leave the verbiage alone. And as a prudent dentist, I think we all know if a patient has an emergency we're going to see them and not let them go to the ER. If you were at home you would have treated that patient and nobody would blame you for that. And I think as a board we're not going to seek out dentists doing the right thing. If we change the verbiage and open the door, we're going to have the dentists that don't follow the rules... I think a prudent dentist like you, me, all of us on the board and 99 percent of the dentists in Texas are following the rules and if we feel the patient has a true emergency we're going to go in and take care of him whether it is life-threatening or not. But if we change the verbiage we open the door for those who are not following the rules to go ahead and practice dentistry when they shouldn't be. That's my concern.
Full recording of April 21 meeting
TDMR received the following opinion piece from a concerned Texas dentist. We thought it was important enough to publish as patient care is a primary concern of TDMR.
On Tuesday, April 21, the Texas State Board of Dental Examiners held an emergency meeting with the sole purpose of adding language to the Dental Practice Act so they could potentially prosecute dentists that perform dental procedures the Board does not believe to be proper under Governor Abbott’s Executive Order GA15 “Relating to hospital capacity during the COVID-19 disaster”.
Patients should "deal with it"
During the emergency Board meeting, the following scenario was presented to articulate the position of various board members.
The example was of a person that fell down and fractured a front tooth leaving an “exposed nerve”. For those that don’t know, this is an extremely painful and agonizing condition. Left untreated, this condition would eventually lead to severe dental infection and possible tooth loss. It was expressed by at least one board member that this condition was not severe enough to warrant dental treatment and the patient would just have to deal with it. Many observers were left dumbfounded by this position, especially from members of the dental board who have been charged with protecting the public.
Following this bizarre line of discussion, every board member voted in support of the resolution, effectively limiting dental access in the most extreme manner possible.
Should be allowing treatment
Many are wondering how the Board even came to the conclusion "that dental offices must remain closed and were prohibited from doing any treatments other than the treatment of life-threatening conditions," especially as the Governor eased medical restrictions that now allow for even cosmetic surgeries to take place.
The Governor himself is on record explaining that many medical professionals have over-interpreted his Executive Order and that medical treatment has been curtailed more than was intended.
Also, the Texas Dental Association, Texas Academy of Pediatric Dentistry, Texas Association of Orthodontists, and Texas Society of Oral and Maxillofacial Surgeons recently submitted suggestions to the Governor's office on how to safely reopen dental offices. https://www.kxan.com/news/texas-dentists-eager-to-reopen-offices-as-state-loosens-covid-19-medical-restrictions/
So, while everyone else is working to figure out how to ensure good oral health while safely protecting from COVID-19; the TSBDE is talking about patients having to ‘deal with it’ and is set to fine providers for providing treatment that, in their opinion, violates a strict interpretation of the Executive Order.
People of Texas deserve better
It probably goes without saying, but we would hope this is not what Governor Abbott expected from his Dental Board appointees; the people of Texas certainly deserve better. In the face of a pandemic, Governor Abbott should be able to trust his agencies to do the right thing and not have to micromanage their every move, sadly that is not the case with our current Dental Board.
It is situations like these that reveal who we truly are. In this case, it has revealed a Dental Board that is incredibly out of touch and in need of major changes.
*A transcript of the Board meeting has been requested and will be made available once it is received.