Miner Family Dentistry, pa

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Miner Family Dentistry, PA

Melinda K. Miner DDS

Daniel I. Miner DDS


1010 Downing Ave #10 (785)625-2200

Hays, KS 67601 (785)625-0079 fax

March 8, 2011

Madame Chair and Committee Members,

I would like to introduce myself; my name is Dr. Melinda Miner and I am a general dentist who loves working with children. My husband, Dan Miner DDS and I own a private dental practice in Hays Kansas that serves a clientele which includes a lot of children covered by the state Medicaid and Healthwave programs. Dan grew up in Western Kansas and had always wanted to come back home after graduation. We needed a town that could handle two new dentists. Although Hays had quite a few full time dentists in 2000, not one accepted children on state funded dental insurance programs. There had not been a local provider for about 3 years. Children were not getting routine dental care and their dental disease put them at risk for serious illness. Hays needed at least two dentists to fill that need; we fell in love with Hays and decided to make it our home. We have accepted Medicaid and Healthwave children since we opened our doors in August of 2000. Ten and a half years later we are still the only private practice in Hays that accepts Medicaid and Healthwave. Our little patients frequently come from over 60 miles away to receive care. There are few dentists that enjoy treating children and even fewer that will accept Medicaid and Healthwave. Other dentists frequently refer us the most heartbreaking dental disease cases due to our excellent reputation and ability to help young children in dental need. It is sad that in 2011 there are still children coming to us with terrible dental disease; often at the age of 3 years old. For financial reasons we had to start a waiting list about 3 years ago; although we do still take these new Medicaid and Healthwave patients in at a rate of about 10-15 new children per week, we cannot keep up with the need by ourselves. A couple of years ago a FQHC opened in Hays but even with that we currently have a waiting list of over 150 children with Medicaid and Healthwave that need a dental appointment. As a practice that is approximately 50% Medicaid and Healthwave clientele, we are the people in the trenches.

I am here today in support of senate bill 192, providing for a Registered Dental Practitioner (RDP) or a mid-level provider. This model is ideal for a practice like ours. Properly training a RDP in Kansas, utilizing one of the current RDH schools, and working with the RDP in a team environment would be beneficial to Kansans. In our practice adding just one RDP would help to open up appointments for those children on our waiting list; allowing us to see about 30-40 additional kids per week. It would also open an opportunity of preventive outreach to those towns we currently serve who do not have a dentist; WaKeeney and Ness City.

The main argument I keep hearing against the RDP seems to be a question of public safety due to the training aspect in the proposal. I keep hearing that a dentist has 8 years of dental training. Saying 8 years of dental training is misleading; we are talking about 4 years of an undergraduate degree in any discipline and then 4 years of dental school being the traditional and most often taken path toward becoming a dentist. 8 years of postsecondary education is not always the case. I stand before you a licensed dentist; yet I did not have 8 years of dental training. I was a 6-year student at UMKC. I am a 1993 high school graduate; I graduated from UMKC with both a Bachelor of Arts in Biology and a Doctorate of Dental Surgery in May of 1999 at the young age of 23. I was not alone; I and my classmates were allowed the privilege of completing our undergraduate degrees in conjunction with our Doctorate in Dental Surgery. I do not feel that I or my fellow 6-years (as they called us) are any less prepared for our careers than the traditional dental students we walked the stage with. My husband also did not have 8 years of dental training. He entered the DDS program with a Bachleors degree from K-State University, but he only attended 3 years of undergraduate school to achieve his degree before entering the 4 year dental program. We are not unique; we are dentists who did not require 8 years postsecondary education to complete our dental training.

The proposal before you provides for 18 months of intense dental training. This is the equivalent of 2 years in a typical 9 month school year curriculum. A pre-requisite for admission is a Registered Dental Hygiene (RDH) degree, typically a 2 year program. In essence the graduate of this program will have 4 years of dental related training to receive the Registered Dental Practitioner degree. They will not be a dentist; they will not have a doctorate in dentistry (DDS or DMD). The RDP will work with a dentist providing basic care in a team approach. To be licensed in Kansas the bill requires the RDP pass a clinical board examination demonstrating their skills which is administered independent of the teaching institution. To work under general supervision the RDP must complete at least 500 hours of direct supervision with the supervising dentist and a written contract must specifically state the allowed scope of practice and outline when the supervising dentist must be called in to help out.

Any dentist that would employ a RDP would understand that they are ultimately responsible for the successes and the failures of that employee. Any dentist that would agree to supervise, and then fail that RDP by not ensuring quality, would have to face the dental board when the outcome is not good. Just as any other employee there is a responsibility to assure quality in what they do for us. As long as the RDP is held to the same standard of care, continuing education requirements, and they are supported by their supervising dentist, there is no need to worry about the final product. Requiring the RDP pass a clinical board examination will ensure that they can produce a quality product. I would ensure quality from my RDP; they will be helping to treat my patients.

It is clear that the Kansas Dental Association opposes this particular model. Being a KDA member for the last 11 years I was saddened to discover that this was not discussed with the membership before it was opposed without compromise. Although the KDA does not seem to realize it, they have presented you with their version of a mid-level in their Senate Bill 132. They call their provider an Extended Care Permit (ECP) III. Knowing this, one would assume that there is agreement in the need for a mid-level dental provider. The disagreement seems to be in the training and full scope of practice of this mid-level provider. Both models are based off the 2 year RDH degree; allow offsite practice location (general supervision); normal Hygienist duties (prophylaxis, removal of calculus deposits, education, fluoride application, sealant placement), extraction of deciduous (baby) teeth, removal of decay and placement of temporary fillings, adjustment of a denture or partial denture, and use of local anesthetic. Where do we differ in our plans? (Please see attachment). The first difference is in the extensive schooling, clinical board examination and apprenticeship a RDP must complete. The second is in the scope of practice a RDP will be able to provide that will make a huge difference in preventing dental emergencies.

Many of the dentists that oppose this RDP model are also unwilling to sign up to be Medicaid and/or Healthwave providers. I have heard that only 25% of the dentists in Kansas are providers for the Medicaid program. Even more alarming is that only 10-15% of those provider dentists see more than 100 Medicaid patients per year. The dentist’s arguments for not signing up to provide care are many; they are valid and right for their practice. I am not in favor of the government mandating that they sign up or help out in any way. We all have to do what is right for the patients we choose to serve. The reality is that I and my husband are the providers for a lot of the low income children in our broad area in Kansas. I am one of the dental providers that would utilize this model and children in my area would benefit from it greatly. I would be responsible for the outcomes in my office and I require quality care be provided to all patients. I, my husband and any RDP employed by Miner Family Dentistry will always strive to provide the highest standard of care. I support SB 192. I ask the 75% of Kansas dentists whom are not Medicaid and/or Healthwave providers; why are you opposed to something that would help me to serve my low income patients better when you are not willing or able to help? Why don’t we ask the families on my waiting list; or the people of the 13 counties without any dentist, the 19 counties without a Medicaid provider, or the 27 counties without a Healthwave provider what they think?

Senators, thank you for your time and consideration. I would be happy to answer any questions you may have.

Melinda Miner DDS

Differences in Mid-level provider Models, both are based off the prerequisite of an RDH degree

Mid-level Title

Registered Dental Practitioner

Extended Care Permit III


18 month (2 year) classroom and clinical training

Clinical board examination

500 hour apprenticeship

2000 hours work experience as RDH

18 hours (2 days) classroom training

Offsite Dentist Supervision

General with written contract outlining scope and follow up.

General with signed agreement to monitor the ECP III

Scope of Practice

Make and Read Radiographs (x-rays)

Diagnose a patients dental condition

Formulate a treatment plan

Cavity preparation and restoration (Fillings and stainless steel crowns)

Pulpotemy on deciduous teeth

Placement & Removal of spacemaintainers

Emergency palliative treatment of pain

Extraction of all deciduous(baby) teeth

Extract periodontally involved adult teeth

Writing Prescriptions is not in the scope and is left to the supervising dentist

Place preventive sealant on teeth that are diagnosed as cavity free to protect them.

RDP cannot do treatment that is not in the written contract.

Assessment of the patient's apparent need for further evaluation by a dentist to diagnose the presence of dental caries and other abnormalities

Identification and removal of decay using hand instrumentation, place a temporary filling, including glass ionomer and other palliative materials

Smoothing of a sharp tooth with a slow speed dental handpiece (drilling on a tooth)

Extraction of deciduous (baby) teeth that are partially exfoliated with class 4 mobility

Write prescriptions of fluoride, chlorhexidine, antibiotics and antifungal as directed by a standing order from sponsoring dentist

other duties as may be delegated verbally or in writing by the sponsoring dentist consistent with this act (sealants fall into this category)

*Radiographs allow you to see decay between teeth which is not seen on a visual exam. Not allowing a midlevel to take and read radiographs causes decay to be missed. Assessing without a radiograph that a patient does not need a dentist exam is not standard of care.

** It is impossible to remove decay, place a temporary filling, seal a tooth, or extract a tooth without a diagnosis first being given. To diagnose properly the patient must be examined by the person who does the diagnosis.

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