Two dental colleges from the state have featured prominently in the performance audit of the Dental Council of India (DCI) by the Comptroller and Auditor General (CAG). The CAG has recently tabled the report in the Lok Sabha.

Taking a critical look at the performance of the council and its recommendations for the establishment of the NIMS Dental College under the NIMS University in Jaipur and the Vyas Dental College and Hospital in Jodhpur, amongst 13 new dental colleges that were set up across the country between 2006 and 2011, the CAG has wondered if the council was allowing the same faculty to work in multiple colleges amongst a whole set of other anomalies. The CAG also raps the Union ministry of health and family welfare for allowing some dental colleges to function despite a shortage of faculty and lack of proper infrastructure.

According to the CAG report, the council had given a negative recommendation for setting up of these two colleges. The colleges then approached the Supreme Court which ordered the Centre to give a personal hearing. Later, the ministry despite the negative recommendations gave the green signal for establishment of the colleges in September 2006.

For the establishment of a dental college, the DCI-a statutory recommendatory body to the Union ministry- has to evaluate proposals, conduct physical examinations and send its recommendations to the ministry which may or may not consider them. The ministry, under the Dentists Act 1948, can then send another team, on the lines of a special investigation team (SIT), to gather more information before reaching a final conclusion. However, the final authority over establishment of a college rests solely with the ministry.

In the case of Vyas Dental College and Hospital in Jodhpur, even the special team had given a negative recommendation for its establishment. It’s recommendation in the case of the NIMS Dental College was in contrast to the findings of the council.

According to the CAG report, the council in its visit to Vyas Dental College, Jodhpur, on September 26-27, 2006 found shortage of teaching and para-medical staff, inadequate clinical material and not up-to-the-mark emergency facilities.

On the recommendation of the council, the ministry had disapproved the establishment of the college but the college moved court and was again inspected again by the council on September 15, 2006. This time too council found that the staff quarters were not within the campus and some equipment were uninstalled in addition to the other deficiencies it found earlier.

Later the ministry constituted a SIT that same month which on an inspection to the college noted that nurses were not present during inspection, the staff quarters and girl’s hostel were not complete then and emergency facilities too were absent.

Despite the observations, the ministry gave a go ahead to the college. all this the college was given a go ahead by the ministry.

For the NIMS Dental College, too, the council had pointed inadequacies in dental and medical faculty during its July 2006 visit. A subsequent visit by another team, the CAG report says, disagreed with the council’s findings and the college was established.

A South Carolina lawmaker says the state should consider routine inspections of dental offices, as is done in 15 other states. But another legislator who’s also a dentist questions the need for such inspections, saying several state agencies already oversee the facilities and respond to complaints.
State Sen. Harvey Peeler, who heads the state’s Medical Affairs Committee, recently said the Legislature should consider the idea of routine inspections that could be expanded to medical offices.

Some 15 states conduct regular inspections of dental offices; South Carolina currently only does routine inspections of barbershops and hair salons.

But state Sen. Ray Cleary, DDS, a dentist on Peeler’s committee, noted that three agencies already have some part in regulating dental offices: the state’s Department of Health and Environmental Control (DHEC); the Department of Labor, Licensing and Regulation (which houses the state dental board); and the Occupational Safety and Health Administration.

He also argued that requiring routine inspections should extend to physicians and other medical offices.

"If you have mandatory inspection of dental offices, wouldn’t you have to inspect medical and chiropractic offices since they’re under the same regulations as we are?" Dr. Cleary said
The issue arose after a reporter asked Sen. Peeler if South Carolina should start routine inspections in the wake of an infection-control scandal at the dental clinic at an Ohio Veterans Affairs (VA) medical center last year, Dr. Cleary said.

The VA notified 535 veterans that they may have been exposed to hepatitis B, hepatitis C, and HIV by Dwight Pemberton, DDS, the dentist who allegedly failed to properly sterilize dental instruments between patients between 1992 and 2010. Officials are continuing to determine whether three veterans who tested positive for hepatitis contracted the disease at the clinic.

Step in the right direction

However, Don Marianos, DDS, MPH, chairman of the Organization for Safety, Asepsis and Prevention (OSAP) Foundation and former oral health director at the U.S. Centers for Disease Control and Prevention, finds merit in the proposal.

"This could be a very meaningful component of a comprehensive program to enhance safety," he told DrBicuspid.com. "This is a step in improving dentistry. There’s now a strong global effort to improve the safety of care delivery and lower existing risks. We support the idea and encourage all states to take a look at this situation and do what they can to make dentistry even safer."

OSAP Director Therese Long said her group could provide South Carolina with checklists for dental practices that practitioners could use to self-evaluate whether they were being inspected or not. She also advised that inspectors should be calibrated to understand dental procedures and dental infection control guidelines before doing inspections.

"Anything we can do to make healthcare better is laudable, but you have to consider cost benefits," Dr. Marianos said.

Regulatory agencies are already struggling to do existing inspection requirements in the face of budget cutbacks, Dr. Cleary pointed out.

"My conversations with DHEC indicate there’s not an issue, and they don’t have enough funds to keep up with inspections of residential centers where they know there are problems, so they should focus where they know there’s a problem," he observed.

Dr. Cleary said the issue could be revisited in the future if problems arise.

"If there’re issues out there, the public is pretty intelligent, and I’m sure they’ll complain and DHEC will investigate and things will be taken care of," he said. "But I think it’s a solution in search of a problem, and at what level do we stop?"