Court Stops CSUN Dental Experiment : Health: Dentists win suit to stop a program that allowed licensed hygienists to clean teeth without supervision.

By JOHN JOHNSON

Oct. 25, 1989 12 AM PT

TIMES STAFF WRITER

The 3rd District Court of Appeal in Sacramento has ordered a halt to an experimental program run by Cal State Northridge in which dental hygienists worked independently, without the supervision of a dentist.

The court said state authorities did not follow proper procedures when they approved the pilot program in 1987. Sixteen Southern California dental hygienists are participating in the experiment, which is designed to determine whether hygienists can clean teeth safely and profitably without the supervision of a dentist.

All other dental hygienists are required by state law to work under the supervision of a dentist.

The appeals court ruled Friday that the Office of Statewide Health Planning and Development should have held a public hearing before approving the experiment. Four more hygienists have applied to work in the program, which comes up for review in 1991.

Dentists, who sued state regulators in an attempt to shut down the program, applauded the ruling.

“We’re not opposed to research. We are opposed to experimentation on unsuspecting patients,” said Dr. Dale Redig, executive director of the California Dental Assn. “Programs that have the potential to threaten public health should be put through the most rigorous scrutiny.”

Hygienists, 90% of whom are women, have long labored as employees in dental offices.

“They got us on a technicality,” said Phil Perry, assistant director of external affairs for the Office of Statewide Health Planning and Development. State regulators reviewed the experiment during an open meeting attended by dental association members but failed to keep proper transcripts or meet other criteria required for a proper public hearing.

“We’re not going to take this lying down,” Perry said. Regulators will seek a delay while trying to appeal the court’s ruling, he said, or schedule a public hearing on the dental program, which has operated at offices in Reseda, Van Nuys, La Canada and in Central and Northern California. It is directed by a public health specialist at CSUN.

“It’s a good program. It’s a viable program,” Perry said. “They’re taking X-rays and cleaning teeth. If they find a cavity, they call the doctor they’re working with.”

He said association members were “guarding their turf” and “trying to remove any perceived competition” because unsupervised hygienists might provide some dental care at a lower price than dentists charge.

All the hygienists are licensed, and most have been practicing for 10 years or more.

The court ruling was the latest setback for the experiment, called the Dental Hygiene Independent Practice Prototype. It was created as a result of a 1972 law authorizing experiments in health care that would otherwise be illegal in an effort to find novel ways of treating patients. The hygienist project took six years to get under way, delayed by lack of financing and the opposition of the dental association, which represents more than 14,000 dentists.

The association, saying the project amounted to a declaration of war on dentistry, filed suit against the program in 1987. A Sacramento Superior Court judge refused to halt the project, but the association appealed, leading to Friday’s ruling.

Paul Lombardo, an attorney for the association, said hygienists are not educated or licensed to diagnose dental disease or serve as primary health-care providers. Dentists characterized the patients as guinea pigs.

“We went to court because this is an experimental program that necessarily involves human subjects,” Lombardo said. “It should be scrutinized very carefully and in an open setting.”

But the hygienists have responded that patients of the independent hygienists are no more guinea pigs than patients of dentists are when the dentist is on vacation or takes a day off, leaving an hygienist unsupervised.

The appeals court ordered the Sacramento Superior Court to require the Office of Statewide Health Planning and Development to halt the program.