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March 30, 2013

Oklahoma: Dental clinic inspections not necessary

TULSA, Okla. — The Oklahoma agency that accused a Tulsa oral surgeon of unsanitary practices, putting thousands of people at risk for hepatitis and HIV, says it’s never needed to inspect medical offices regularly.

“This doesn’t happen,” Susan Rogers, the executive director of the Oklahoma Board of Dentistry, said Friday. “There’s not been a need for these inspections because we’ve never had a complaint like this.”

That’s not unusual. Some other states don’t routinely inspect clinics, either, noting they don’t have the money and such incidents are so rare that the need just isn’t there.

In Oklahoma, the Board of Dentistry’s small staff does inspections only if the agency receives a complaint. That’s what happened in the case of Dr. W. Scott Harrington, whose practice was inspected after officials determined a patient may have contracted hepatitis C while having dental surgery.

State epidemiologist Kristy Bradley and Tulsa Health Department Director Bruce Dart sent letters Friday to all 7,000 patients they found in Harrington’s 6-year-old records, urging them to be screened for hepatitis B, hepatitis C and the virus that causes AIDS because of unsafe practices at his two clinics. More patients may be at risk, but Harrington’s files go back only to 2007.

“Although we do not know whether you were personally exposed to blood-borne viruses, there is a possibility that you may have been exposed to infectious material,” they wrote, acknowledging their discovery could be “alarming and frightening” for the patients.

Rogers’ office filed a 17-count complaint against Harrington, saying officials found rusty instruments, potentially contaminated drug vials and improper use of a machine designed to sterilize tools.

According to guidelines from the American Dental Association, of which Harrington was listed as a member Friday, to keep their licenses dentists must stay up to date on the latest scientific and clinical developments.

Rogers noted that dentists know they could close their licenses if they violate health codes, so they are motivated to “do the right thing” — clean their instruments, inspect drug cabinets for outdated or expired medicines and require staff to be trained.

Rogers said the Oklahoma board will consider changes in its practices but that it was too early to provide specifics.

In Colorado, where an oral surgeon was accused of reusing needles and syringes, the state doesn’t routinely inspect dental offices. No changes were made to that policy after the 2012 incident.  

“We respond if there is a complaint,” spokesman Mark Salley said in a telephone interview Friday. “I don’t know of any agency in this department that has the resources to conduct routine inspections of private practices.”

California, too, responds only if a problem is reported.

“We are complaint-driven. Inspections are not routine. We’re looking at 30,000-plus dentists in California alone,” said Kim Trefry, the enforcement chief at the Dental Board of California.

Dr. Douglas Dieterich, a professor of medicine at the Icahn School of Medicine at Mount Sinai in New York, called the Oklahoma case “an anomaly.”

“There’s all sorts of codes. The employees are watching. The patients are watching. With all the news reports of mini-epidemics caused by unsafe practices, I think everybody is” more careful, Dieterich said.

Harrington had been a dentist for 36 years before giving up his license March 20. He faces an April 19 hearing at which he could have his certification revoked.

Lydia Miller, director of communications for the Oklahoma Dental Association, said Harrington was a member of the organization until Thursday, when health officials branded him a “menace to the public health.” Oklahoma has between 2,000 and 2,200 dentists; 1,600 belong to the ODA.

Until Thursday, the state Dentistry Board had had no problem with Harrington. Rogers said the agency, which is funded from license fees that range from $25 for a dental assistant’s annual certificate renewal to $500 for an initial license testing fee, has only a $1 million budget and five employees to monitor dentists serving 3.8 million residents. She said the board concentrates primarily on complaints involving missing drugs and possible sexual misconduct.

Harrington could not be reached for comment Friday. His malpractice lawyer, Jim Secrest II, did not respond to phone messages left Thursday or Friday. A message at Harrington’s Tulsa office said it was closed and an answering service referred callers to the Tulsa Health Department.

According to the Centers for Disease Control and Prevention in Atlanta, there have been only three documents cases of a dental patient contracting either HIV or hepatitis B from a dental procedure: HIV in Florida in 1991 and hepatitis B in New Mexico in 2001 and West Virginia in 2009.

The CDC in 2003 established infection control guidelines for dental offices, including rules about hand hygiene and sterilization of dental instruments, but inspections are left to the states.

According to the Oklahoma Dentistry Board’s complaint, Harrington’s practice had varying cleaning procedures for its equipment, needles were re-inserted in drug vials after their initial use, drug vials were used on multiple patients and the office had no written infection-protection procedure. Also, dental assistants performed some tasks reserved to a licensed dentist, such as administering IV sedation. A device used to sterilize equipment hadn’t undergone required monthly tests in at least six years.

Hepatitis B, hepatitis C and HIV are typically spread through intravenous drug use or unprotected sex.

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