KDA Today

KDA Today

For Immediate Release

Date: Oct 19th, 2012
Contact: Dr. John Thompson
Phone: 800-292-1855
Email: info@kyda.org

Self-Regulation

“Professions tend to be autonomous, which means they have a high degree of control of their own affairs: "professionals are autonomous insofar as they can make independent judgments about their work".[1] This usually means "the freedom to exercise their professional judgement."[2]

However, it has other meanings. "Professional autonomy is often described as a claim of professionals that has to serve primarily their own interests...this professional autonomy can only be maintained if members of the profession subject their activities and decisions to a critical evaluation by other members of the profession "[3] “The concept of autonomy can therefore be seen to embrace not only judgment, but also self-interest and a continuous process of critical evaluation of ethics and procedures from within the profession itself”. 

(Wikipedia)

1. Bayles, Michael D. Professional Ethics. Belmont, California: Wadsworth, 1981

2. "The World Medical Association Declaration of Madrid on Professional Autonomy and Self-Regulation", 1987. Revised in France in 2005, rescinded and archived in India in 2009, and rewritten and adopted in India in 2009 as "WMA Declaration of Madrid on Professionally-led Regulation"

3. "Hoogland J. & Jochemsen H., ''Professional Autonomy and the Normative Structure of Medical Practice,'' Theoretical Medicine, 21.5, September 2000, pp.457-475". Ingentaconnect.com. 2006-06-16. Retrieved 2009-11-07

Self Regulation

It is apparent that the full impact of HB1 and its implication for the practice of dentistry has hit the fan. This is one of those new regulations that make me glad that when my DEA license expires in two months, I don’t need to renew it. How we prescribe controlled substance pain relief for our patients in treatment and as emergencies has now changed dramatically by our Kentucky Board of Dentistry and emergency regulations (E-regs) that went into effect June 20th.

Before we demonize the Board of Dentistry for onerous over regulation of the practice of dentistry we need to look at where these restrictions originate. No one practicing dentistry in this commonwealth has not seen firsthand the ravages wrought by the abuse of legal prescription medications. In many counties abuse has reached epidemic proportions. For many years, local news reports cannot be made without reporting crime associated with drug abuse and dependency and how common has it been to hear the term pill-mill referenced as a contributing or primary factor.

If I were a legislator from a county whose citizens were being devastated by dependency on readily available prescription controlled substances I would be seeking an immediate solution. It would seem that one solution would be to look to the boards that control licensure of those who are allowed to write prescriptions.  History says that the Kentucky Board of Dentistry has done its part in policing the prescribing practices of our colleagues who have ventured outside the lines of appropriate dispensing practices. The ready availability of KASPER has been a tremendous resource in tracking prescribing patterns inconsistent with the practice of dentistry. History also says that medicine has failed dismally in both, control of medical licensure of those expelled from other jurisdictions and those who choose to dispense drugs for sheer profit. The very presence of a pill-mill in a community can be devastating and the number of easily identified “legal” drug sources in Kentucky has been an embarrassment.

I personally have no knowledge of how these prescription dispensaries can be so mobile and ongoing in spite of repeated “busts” by law enforcement. It has appeared that these operations just move to a new location under a new name and continue prescribing as before. I have often wondered why the medical licensing board was so absent in control of physicians who were writing these prescriptions. What I never considered was the fact that this would eventually have a dramatic impact on dentistry.

That same legislator, having failed to see any resolution of the pill mill plague in his community must now seek to solve the problem with the resources with which he is most familiar. That would be legislation. I followed the progression of House Bill 1 throughout the recent legislative session. I saw it die in committee and I saw it resurrected at the last moment and passed. All the while, I knew that our KDA Executive Director and lobbyists, as well as KDA officers and Board of Dentistry members had monitored the progress of this bill during the session. The bill that was passed during the dying minutes of this legislative session was not the same bill that dentistry had seen previously. Language had been reinserted that would have unintended consequences for our profession.

When regulations were written, the medical board was largely silent in opposing provisions that impact both medicine and dentistry in providing prescription pain relief in the treatment of patients in acute situations. A demand was made for the Kentucky Board of Dentistry to accept the regulations that the Board of Medicine had approved or acquiesced to accept. I have asked the Board of Dentistry to address both, the politics and the consequences of these regulations in our lead story this month _________________________ on page ____ of this issue of KDA Today.

I prefaced this commentary with a partial definition of a profession. Part of that definition is that we, for the most part, are expected to police ourselves. Our license to practice is granted by government and government appoints a board made up of all but one member from the profession represented. I am clearly identifying hygiene board members as an integral part of the profession of dentistry as I make this point. The profession licensed and regulated by government is therefore largely self-regulating within the scope of professional practice, be it dentistry or medicine. I will contend that dentistry has been meeting its obligation to self-regulate and I am being specific as to how the Kentucky Board of Dentistry has interacted with DEA, KASPER and all issues regarding prescriptive abuse. I will also contend that The Kentucky Board of Medicine failed miserably in its process of self-regulation and that HB1 and the new regulations we face are the direct result of that failure.

It is easy to be critical of a vital and active board of dentistry when we find regulation that is counter to something we want to do. That is human nature and the American way to chafe at anything that restricts our “freedoms”.  The consequences of an ineffective means of self-regulation are that others will fill that void and provide regulation that does not have the benefit of professional expertise. I am not faulting the legislative process that decided to solve the “pill mill problem” and passed into law HB1, flaws and all. The professions simply failed to self-regulate a major societal problem and legislators did the best they could to fill that void and now we get to deal with the unintended consequences of having failed our duty to society.

I use the word “our duty” collectively, because I feel this problem was easily identified by all professions that have prescriptive license and when medicine was failing its responsibility, all professions should have offered council. I have said it before and this is simply another demonstration of how dentistry is being swept into the web of medicine and the whole of health care reform. The best we can hope for is that we continue to have members of this profession who are willing to serve on the Kentucky Board of Dentistry and who are as dedicated as those serving now.

Over the past several years we have been going through what I will call a “rediscover y process” in the relationship between our KDA and the Board of Dentistry. While it is largely KDA members who do serve on the BOD it is not an extension of the Kentucky Dental Association.  The BOD is an extension of government and this board must work from a perspective of public protection as well as professional integrity. I am grateful to those that have willingly agreed to serve on a very necessary and largely unappreciated board that fulfills one of the tenants of a true profession. The absence of effective self-regulation is the invitation for a cascade of unintended consequence by well-intended legislators and bureaucrats.   

 

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