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Washington state enacts legislation to protect patient-dentist relationship

May 26, 2017

By David Burger

Safe passage: Gov. Jay Inslee signs Senate Bill 5322 — colloquially called the "King Bill" — into passage as supporters of the law surround him May 16 at the Washington State Capitol in Olympia. Photo courtesy of Washington State Legislative Support Services. 
Olympia, Wash. — A new law in Washington confirms dentists' rights to contract with third parties for business support and reaffirms existing state law that prohibits unlicensed persons and non-professional entities from interfering with a licensed dentist's independent judgment on patient care.

The bill, SB 5322, was supported by both the Washington State Dental Association and the Association of Dental Support Organizations. Both the House of Representatives and the Senate of the Washington legislature passed the bill unanimously and Gov. Jay Inslee signed it into law May 16.

This was "landmark legislation, which we believe provides the strongest prohibitions and enforcement mechanisms in the nation to curb the unlicensed practice of dentistry by non-dentist third parties," according to a statement Washington State Dental Association Executive Director Bracken Killpack sent to member dentists.

SB 5322 defines the unlicensed practice of dentistry as interference with a licensed dentist's independent clinical judgment, including any time nondentists engage in any of the following:

  • Imposing time limits for patient procedures.
  • Limiting or imposing requirements on a dentist's decision regarding a patient's course of treatment.
  • Requiring or limiting the use or choice of a laboratory, materials or equipment in patient treatment.
  • Limiting or imposing requirements on the referrals by dentist to a specialist or any other practitioner,
  • Interfering with a dentist's access to patient records.
  • Interfering with a dentist's decision to refund payments made by a patient for treatment performed by the dentist.
The bill also includes patient protections with procedures for terminating treatment or transfer of care to another dentist. It specifies that a dentist employer or authorized legal entity employer is responsible for the continuing care of a patient should the employee or contractor dentist cease their employment arrangement. It also prohibits a non-licensed person or entity from employing or contracting for the services of licensed dentists, licensed dental hygienists, licensed expanded function dental auxiliaries, certified dental anesthesia assistants and registered dental assistants.
The legislation gives the state department of health and the attorney general authority to investigate and enforce the law, up to and including issuance of cease-and-desist orders to prohibit continued operation by those who violate those conditions.

Violation of this law is a misdemeanor for those that stand between a dentist and a patient to influence clinical decision making, said Dr. Keith Collins, a Vancouver, Washington, dentist involved in advocacy for the alternative bill He added that this can help to prevent an office manager, scheduler, or higher-level manager to avoid mistreating a dentist in a way that compromises patient care.

Mr. Killpack told ADA News that SB 5322 is clearer than the old law in regards to accountability and what is allowed — and what isn't. "For years, we've been adamantly advocating that third parties shouldn't interfere in the patient-dentist relationship."

The Association of Dental Support Organizations also approved of the bill's passage. "Our desire is simply for dentists to have the freedom to choose the practice model that best fits them and their patients, which benefits everyone," said Dennis LaGanza, senior vice president of government affairs for the Association of Dental Support Organizations.

"It is true, that neither side got everything they wanted," Mr. Killpack said. But one thing was important to the Washington State Dental Association, he added. "We want dentists in our state to know what their rights are and to reaffirm the importance and sanctity of the doctor-patient relationship."

"The ASDO applauds the Washington legislature, Gov. Inslee and the Washington State Dental Association for the bipartisan and collaborative work in passing SB 5322, an important step in allowing dentists, hygienists and staff to spend more time serving the people of Washington state and protect their freedom to choose who to contract with to perform non-clinical functions," said ADSO President Michael Bileca in a news release after the bill was signed. "By adopting this bill, the state of Washington clearly recognizes the value dental support organizations provide to dentists, who in turn can focus on delivering quality oral health care to their patients."

ADSO membership includes seven DSOs in Washington state, each of which provides business support to an aggregate of about 100 dental practices, according to the Association of Dental Support Organizations.

Dr. King
SB 5322 was a compromise bill, said Selah, Washington, dentist Dr. Jennifer King, whose father, state Sen. Curtis King, co-sponsored the bill.

The bill was a response to another bill, SB 5158, which would have loosened restrictions on corporate dentistry, Dr. King said.

SB 5158, a separate bill proposed by state Sen. Ann Rivers, contained language that ended up in SB 5322; however it never advanced out of committee as the alternate bill was introduced. "It was give-and-take from both sides," said Dr. King, who lobbied for the alternative bill.

"Washington had an 82-year-old statute that didn't reflect current business realities," said Mr. LaGanza. This language led to confusion on the part of regulators, WSDA members and ADSO member companies alike.

Dr. Collins referred to the bill as the "King Bill," because the team of Dr. King and her father worked determinedly on revising the bill, with the aid of the Washington State Dental Association and the Association of Dental Support Organizations. "She worked so hard on it that I called her 'Tiger,'" Dr. Collins said. "Don't poke the tiger."

Dr. Collins said SB 5322 was "ground-breaking," and that he hoped other states would draft similar legislation. "I think we're creating a movement."

Mr. LaGanza said, "We are pleased to have worked with the WSDA on legislation that ensures all dentists may continue to choose the model they feel is best to provide quality dental care to Washington state."