NDA JOURNAL Summer 24 Volume 26, Issue 2 Official Magazine of the Nevada Dental Association and Component Societies A Peer Reviewed Journal
SUMMER 24 NDA JOURNAL Editor’s Message Daniel L. Orr II, DDS, MS (anesth), PhD, JD, MD 2 Featured Articles Federal Trade Commission Bans Noncompete Agreements 8 AAPS Files Amicus Curiae Brief Against Biden Administration Experimental Formulation Critical Analysis Censorship 10 Reports NDA President Joseph Wineman, DMD 14 NDA Executive Director Nicollette Schmeichel 16 NDF President David Mahon, DDS 19 SNDS President Christine Lemon, DDS 22 SNDS Executive Director Esther Johnson 23 Sections Event Calendars 24 Administrative Offices & NDA Committees 25 On the Cover Capt. Richard Hamilton, OMS, USN DSC Nevada Dental Association 600 E. William Street, Ste 202 Carson City, NV 89701 PH 775-558-9404 FAX 702-255-3302 EMAIL info@nvda.org WEB www.nvda.org NDA Journal is published four times each year by the Nevada Dental Association and state component societies. All views expressed herein are published on the authority of the writer under whose name they appear and are not to be regarded as views of the publishers. We reserve the right to reduce, revise, or reject any manuscript submitted for publication. Materials: All articles, letters to the editor, photos, etc. should be sent to Daniel L. Orr II, DDS, via email to EditorNDA@nvda.org. All chapter and committee reports and business communications should be sent to Jodi Metzgar, Executive Director, Nevada Dental Association, 600 E. William Street, #202, Carson City, NV 89701. Ph: 775-558-9404. Materials may be reproduced with written permission. Subscription: Members receive each publication as a membership benefit paid by membership dues. Non-members may subscribe to the Nevada Dental Association Journal for $50 annually. Advertising Policy: All advertising appearing in the NDA Journal and other Nevada dental publications must comply with the advertising standards of the Nevada Dental Association and its component societies. The publication of an advertisement is not to be construed as an endorsement or approval by the publishers of the product or service being offered in the advertisement unless the advertisement specifically includes an authorized statement that such approval or endorsement has been granted. The publishers further reserve the right to cancel any and all contractual advertising agreements should an advertiser be engaged in litigation concerning their product or service, or should the product or service be in conflict with the standards of the NDA or its component societies. Advertising rates and specifications are available upon request. Contact John Constantino, LLM Publications, at 503-445-2230 or email john@llmpubs.com. Mailing: Send address changes to: 600 E. William Street, #202, Carson City, NV 89701. © 2024 Nevada Dental Association Editor Daniel L. Orr II, DDS, MS (anesth), PhD, JD, MD EditorNDA@nvda.org Publisher LLM Publications 503-445-2220 www.llmpubs.com Design: Shelby Bigelow NDA JOURNAL
NDA Journal 2 Dr. Orr practices Anesthesiology and OMS in Las Vegas, is an Adjunct Professor (Surgery) at UNLV SM and Touro University SM (Jurisprudence), Professor Emeritus at UNLV SDM, and a member of the CA Bar and Ninth Circuit Court of Appeals. Editor’s Message Daniel L. Orr II, DDS, MS (anesth), PhD, JD, MD EditorNDA@nvda.org NDAJ Exclusive A Very Grateful Happy Memorial Day 2024 I had already penned an Editorial for this issue of the NDAJ, but as my dog Kanè took me on our walk around the block at 06:00, I noticed how many homes on our street had done something special with their flags today. Almost every house on the cul-de-sac had a flag flying, and one had over fifty little U.S. Flags lining their lawn. For years peripheral to Memorial Day, we have hung an Old Glory, a Bennington, a Betsy Ross, and a Navy Jack under my eave out front. Those banners stay up until Labor Day. Recently, I had an old, like me, Veteran, not like me, come in for a surgical procedure his caregiver was having trouble finding someone to tackle. He had no larynx, recent radiotherapy, a neck full of vascular clips, and multiple comorbidities. He had a Vietnam Veteran’s cap on and when we met I said thank you and pointed to his chapeau. He couldn’t converse, but wrote: “TY for seeing me.” We figured out that when he was serving in 1969 I was basking under the protective umbrella of my #226 Selective Service draft lottery number, playing soccer and studying hard to try to get into dental school. I was able to do that in part because of his service, so our tasks then turned out to be, if I may be so bold, mutually beneficial to a degree. I’ve known many humble veterans and am so grateful all for their sacrifices. I’ve been privileged to know some more famous ones too, like Jimmy Doolittle1,2, Carlos Hathcock3,4,5, and Monte Irvin6,7. Jimmy Doolittle received the Medal Of Honor for leading the Tokyo bombing mission in April 1942, just four months after Pearl Harbor. Carlos Hathcock demonstrated hand eye coordination, as a Marine Corps Sniper-Scout, that would make any dentist envious. Monte Irvin was scheduled to be the first black player Figure 1. Luke Daniel Orr. Stars and Stripes, Old Glory, Bennington, Betsy Ross, Navy Jack, Memorial Day, 2024 Figure 2. Carlos Hathcock
Summer 24 www.nvda.org 3 Editor’s Message integrated into Major League Baseball, but was called to service in the Army during WWII, paving the way for Jackie Robinson’s debut in 1947. Both made the Hall of Fame. My Dad was an honored veteran, the lead navigator for a B-26 squadron in the Korean War. Back then his missions flew from Iwakuni, Japan to North Korea, across an expanse of the East China Sea. The squadron was designated LNA (Light Night Attack), so seventy-eight times the Black Panther, Dad’s plane, flew over a thousand miles, never with a GPS and at times without even stars on cloud covered, moonless nights. Somehow, they always made it back to Iwakuni, once on one engine after flack took out the other.8 My son Dan III is a veteran via the U.S. Army Medical Service Corps (MSC). He was stationed at Ft. Sam Houston and I was able to visit him during a trip to San Antonio, home of the Alamo by the way. During his training he was able to utilize his marksmanship skills. At the range, he wasn’t shooting silhouettes at center mass, but between the eyes. His Line Seargeant demanded: “Orr, what are you doing?” III replied: “Head shots sir.” The range master simply replied: “Carry on.” It was on this trip to Ft. Sam in December 2009, that I met with Col. Robert Hale, who was in charge of the Army’s, and thus the nation’s, face-transplant program.9 Ultimately, Col. Hale asked if I would consider serving on his team and, if so, offered I would enter the Army as a full Colonel. If I had not had over half of my nine kids still at home, I like to think I would have served. Not participating in the military is definitely a bucket item not fulfilled for me. I’ve been blessed with a lot of great adventures during my life, but that void always gives me pause. In dental school at USC, Dr. Clifton O. Dummett was the first one ever, rather optimistically in my opinion, to address me as “doctor.” Dr. Dummett was a singular man in civil rights, in civil rights in dentistry,10 and in service to his country as an Air Force veteran and Chief of the Veterans’ Research Hospital in Chicago. While I was at UNLV SDM Directing Anesthesiology and OMS, I had the privilege of working closely with several dentist veterans such as Christine Ancajas, Director of Admissions, Air Force and Army veterans George McAlpine and John Gallob, both from the UNLV GPR, our own OMS half-timers Richard Hamilton and Lawrence Hundley Jr. in addition to once a week veterans Joe Hansen, Frank Drongowski, and Gary Geracci. Navy Capt. Hamilton coordinated a special graduation ceremony for all the ROTC dental students every year. He also was the lead OMS for the UNLV SDM Army Sgt. Ferrin Memorial Veterans’ Dental Clinic every month. Before my tenure at UNLV SDM, Dr. Hamilton was my principal community OMS mentor in Las Vegas and taught me much about what it meant to be of service. » Figure 3. Recent Veteran Patient Figure 4. The Editor and Monte Irvin
NDA Journal 4 Editor’s Message Our other half-time OMS at UNLV SDM was Lawrence Hundley Jr. Lawrence was a tall, elegant, Black OMS and law school graduate. He was born in 1931 and raised in Alabama, and served in the U.S. Army. Lawrence passed away in 2019 and his son, Pastor Lawrence Hundley III, invited me to speak at his dad’s service. That experience was surreal in many ways as hundreds, including a military honor guard, bid adieu to Dr. Hundley. After the service, Pastor Hundley asked me if I knew why the family wanted me to address the congregation. Many in 95% Black gathering were probably wondering about that themselves as I made my way to the podium. Pastor Hundley then shared that it was because I had defended his dad from unwarranted allegations. While he was alive, Lawrence was absolutely capable of defending not only his nation but himself, as he did when we discussed politics in animated fashion. But, it was an honor for me to cut the legs out of this particular group of naysayers before Lawrence even knew about the professional assault. » Figure 5. Lt. Orr USC USAF ROTC Scholarship Figure 6. D.L. Orr III, U.S. Army MSC Figure 7. U.S. Army OMS Col. Robert Hale Figure 8. The Editor and Dr. Clifton O. Dummett
Summer 24 www.nvda.org 5 I have to mention my contemporary OMS work mate, Ted Twesme. We arrived in Las Vegas within a couple of months of each other in 1979 and were room partners in Chicago for our ABOMS exams, both passing in 1981. We worked together for all our major cases for years. Ted was the longterm Commander of the LV Naval Reserve Unit, fulfilling his monthly weekend obligation with his unit, prepared and literally ready to deploy prn. Amazing. There have been three Dental Service Corps Medal of Honor recipients, Lt. Weeden Osborn, Vice Adm. Alexander G. Lyle, and Capt. Benjamin Solomon. Their citations are unbelievably inspiring.11 UNLV SDM was fortunate to have had a stream of students, many in military training, who coordinated the Dentistry Merit Badge Clinic twice a year at the school for the Las Vegas Area Council of Scouting America during my 12-year tenure. Long ago, I purchased 100 U.S. flags via Congresswoman Barbara Vucanovich to present at Eagle Scout Courts of Honor. Eagle Scouts that enter the military receive an automatic rank advancement. I had the opportunity to work with another dentist, who had served as a U.S. Marine Lt. Platoon Leader in Vietnam. One day he had some serious professional challenges, and I was feeling kind of overwhelmed for him. He opined the current issues were not that bad. I asked: “If that is the case, how exactly do you define bad?” He shared that a bad day was holding his Seargeant’s gunshot-wounded head out of the dirty water at the bottom of a Vietnamese crater during a firefight, and being helpless to save his friend’s life. Thank you Dr. Guess. I’d like to give several non-veteran honorable mentions. My first is to another MLB baseball player and current announcer Rick Monday. At a home game in Los Angeles in 1976 two protestors ran into the outfield and proceeded to attempt to burn an American flag. Rick Monday ran into the scene and rescued the flag to the cheers of tens of thousands.12 Who would have believed that nearly fifty years later the Dodgers would honor an anti-Catholic hate group, just a year after Dodger Hall of Fame broadcaster, Vin Scully, a Catholic himself, retired?13,14 My second non-veteran is Las Vegas resident Ben Lesser.15 Ben is one of the last Nazi concentration camp survivors. His story is compelling.16 I presented an American flag to him last year and opined that he was one of the very finest Americans I know. The third is Frank Chuman, J.D. Mr. Chuman, sat on my own Los Angeles Area Council Eagle Scholarship Board in 1968. Even as a former ROTC » Figure 9. Drs. McAlpine, Orr, and Ochiai, USC Sports Dentistry Figure 10. Dr. Hundley and Friends, UNLV SDM 2018 Editor’s Message
NDA Journal 6 student at UCLA, he couldn’t serve in the military in WWII because of the prejudice foisted against Japanese Americans at that time. He was forced to leave his USC law school studies and was imprisoned at Manzanar, as thousands of other Japanese were at camps around the nation. Later, as an attorney, he argued against these discriminatory cases, previously sanctioned by the Supreme Court, to the Supreme Court itself, and prevailed. His history is compelling.17 My fourth mention goes to another Japanese internee, my former neighbor Pat Morita. When my son, karate student Andrew used to walk with me where Kanè and I do now, occasionally we would see Mr. Morita. Andrew recognized him and told me Mr. Miyagi was up ahead. I shared with Roo it was really Mr. Morita, but offered to introduce him and let them work things out. Pat and Andrew-San became pretty good acquaintances. We saw Pat sing the National Anthem at a UNLV Basketball game once.18 As with the rest of the individuals listed in this work, Pat was always humble, » Figure 11. Drs. Twesme and Orr, UMC Figure 12. Lt. J.G. Weedon Osborn, DSC MOH Figure 13. Dr. Donald Guess Figure 14. Rick Monday’s U.S. Flag rescue at Dodger Stadium took place on April 25, 1976 Editor’s Message
Summer 24 www.nvda.org 7 Figure 16. Frank Chuman, JD, at 104 Figure 17. Pat Morita kind, and welcoming without any evidence of pride or arrogance. My fifth will remain anonymous at this time. We’ll call him BE. He was a contemporary of my two oldest sons in Scouting America (SA) back in the 1990s, and a great scout by any measure as he exemplified the Scout Oath, Law, Motto, and Slogan. As BE was preparing for his Eagle Scout Board of Review (BOR), the Board Chair called to ask him if he was homosexual; BE replied he thought so. BE had never conducted himself inappropriately, defined as any sexual conduct at all, during scout activities. But, BE was told he was not eligible to sit for his BOR. I learned 25-some years later that his father had petitioned the LVAC and the National offices of SA to revisit the decision. I was asked to Chair the renewed BOR for BE in 2021. Our BOR unanimously approved BE as an Eagle Scout. To me, BE is an exceptional individual in part because he understands that any organization or entity, such as the USA, will have difficulty living up to idealistic goals. The USA however, has never stopped striving to perfect the aspirations iterated in our Founding Documents. BE now lists Eagle Scout prominently on his CV. The USA’s singular strengths are the ideals formalized in the Constitution and Bill of Rights. America has never been perfect, and likely never will be. But, we have gone further on the path to the ideal than any other man-made government in history. In my opinion, that is worth honoring those who fight to continue implementing those ideals. The NDAJ welcomes contrary views. Fight On! 0 Figure 15. Holocaust Survivor Ben Lesser References 1. Personal Communication, Los Angeles Area Council 21st Annual Eagle Scout Banquet, Hollywood Palladium, 1965. 2. Lawson, TW, 30 Seconds Over Tokyo, Random House, 1943. 3. Personal Communication, Las Vegas, 1997. 4. Henderson, CW, Marine Sniper: 93 Confirmed Kills, Stein and Day, 1986. 5. Chandler, RF, White Feather, Carlos Hathcock UMMC, Iron Brigade Armory Publishing, 1997. 6. Irvin, M, Monte Irvin: Nice Guys Finish First, Avalon Publishing, 1996. 7. Nowlin, B: When Baseball Went to War, Triumph Books, 2008. 8. Haarmeyer, AL, Into the Land of Darkness, Trade Paperback, 2013. 9. Hale, RG, Challenges in Craniofacial reconstruction Following Trauma. Conference: American Association for the Advancement of Science, Annual Meeting, 2013. 10. Dummett, CO, The Hillenbrand Era: Organized Dentistry’s Glanzperiode, American College of Dentists, 1986. 11. Lass, K, 3 Dentists Who Received the Medal of Honor, Congressional Medal of Honor Society, https://www.cmohs.org/news-events/medalof-honor-recipient-profile/3-dentists-who-received-the-medal-of-honor/, accessed 27 MAY 2024. 12. Rick Monday saves the American flag from protestors, YouTube, https:// www.youtube.com/results?search_query=rick+monday+saves+ american+flag+from+protesters+in+1976, accessed 27 MAY 2024. 13. Valentine, D, What I Saw At Dodger Stadium-Ordinary Catholics Standing Up For Their Faith, https://www.dailywire.com/news/what- i-saw-at-dodger-stadium-ordinary-catholics-standing-up-for-their-faith, accessed 27 MAY 2024. 14. Meads, T, Dodgers Pitcher Issues Powerful Statement Against His Own Team for Inviting Anti-Catholic Group, https://www.dailywire.com/news/ read-it-dodgers-pitcher-issues-powerful-statement-against-his- own-team-for-inviting-anti-catholic-group, accessed 27 MAY 2024. 15. Zachor Foundation, Ben Lesser, https://www.zachorfoundation.org/, accessed 29 MAY 2024. 16. Lesser B, Living a Life that Matters: from Nazi Nightmare to American Dream, AbbottPress, 2012. 17. Chuman, F, The Bamboo People, Pubs, 1976. 18. Morita, P, The National Anthem, Lambeau Field, 2001, https://www. youtube.com/watch?v=VpEGrq_LXqI, accessed 27 May 2024. Editor’s Message
NDA Journal 8 Federal Trade Commission Bans Noncompete Agreements by: Steph Weber, Medscape; April 24, 2024 The Federal Trade Commission (FTC) voted Tuesday to ban noncompete agreements, possibly making it easier for doctors to switch employers without having to leave their communities and patients behind. But business groups have vowed to challenge the decision in court. The proposed final rule passed on a 3–2 vote, with the dissenting commissioners disputing the FTC’s authority to broadly ban noncompetes. Tensions around noncompetes have been building for years. In 2021, President Biden issued an executive order supporting measures to improve economic competition, in which he urged the FTC to consider its rulemaking authority to address noncompete clauses that unfairly limit workers’ mobility. In January 2023, per that directive, the agency proposed ending the restrictive covenants. While the FTC estimates that the final rule will reduce healthcare costs by up to $194 billion over the next decade and increase worker earnings by $300 million annually, the ruling faces legal hurdles. U.S. Chamber of Commerce president and CEO Suzanne P. Clark said in a statement that the move is a “blatant power grab” that will undermine competitive business practices, adding that the Chamber will sue to block the measure. The FTC received more than 26,000 comments on noncompetes during the public feedback period, with about 25,000 supporting the measure, said Benjamin Cady, JD, an FTC attorney. Cady called the feedback “compelling,” citing instances of workers who were forced to commute long distances, uproot their families, or risk expensive litigation for wanting to pursue job opportunities. For example, a comment from a physician working in Appalachia highlights the potential real-life implications of the agreements. “With hospital systems merging, providers with aggressive noncompetes must abandon the community that they serve if they [choose] to leave their employer. Healthcare providers feel trapped in their current employment situation, leading to significant burnout that can shorten their [career] longevity.” Commissioner Alvaro Bedoya said physicians have had their lives upended by cumbersome noncompetes, often having to move out of state to practice. “A pandemic killed a million people in this country, and there are doctors who cannot work because of a noncompete,” he said. It’s unclear whether physicians and others who work for nonprofit healthcare groups or hospitals will be covered by the new ban. FTC Commissioner Rebecca Slaughter acknowledged that the agency’s jurisdictional limitations mean that employees of “certain nonprofit organizations” may not benefit from the rule. “We want to be transparent about the limitation and recognize there are workers, especially healthcare workers, who are bound by anticompetitive and unfair noncompete Featured Article
Summer 24 www.nvda.org 9 Section Header Featured Article clauses, that our rule will struggle to reach,” she said. To cover nonprofit healthcare employees, Slaughter urged Congress to pass legislation banning noncompetes, such as the Workforce Mobility Act of 2021 and the Freedom to Compete Act of 2023. The FTC final rule will take effect 120 days after it is published in the federal register, and new noncompete agreements will be banned as of this date. However, existing contracts for senior executives will remain in effect because these individuals are less likely to experience “acute harm” due to their ability to negotiate accordingly, said Cady. Before the federal ban, several states had already passed legislation limiting the reach of noncompetes. According to a recent article in the Journal of the American College of Cardiology, twelve states prohibit noncompete clauses for physicians: Alabama, California, Colorado, Delaware, Massachusetts, Montana, New Hampshire, New Mexico, North Dakota, Oklahoma, Rhode Island, and South Dakota. The remaining states allow noncompetes in some form, often excluding them for employees earning below a certain threshold. For example, in Oregon, noncompete agreements may apply to employees earning more than $113,241. Most states have provisions to adjust the threshold annually. The District of Columbia permits 2-year noncompetes for “medical specialists” earning over $250,000 annually. Indiana employers can no longer enter into noncompete agreements with primary care providers. Other specialties may be subject to the clauses, except when the physician terminates the contract for cause or when an employer terminates the contract without cause. Although the AMA does not support a total ban, its House of Delegates adopted policies last year to support the prohibition of noncompete contracts for physicians employed by forprofit or nonprofit hospitals, hospital systems, or staffing companies. The American Hospital Association, which opposed the proposed rule, called it “bad policy.” The decision “will likely be short-lived, with courts almost certain to stop it before it can do damage to hospitals’ ability to care for their patients and communities,” the association said in a statement. To ease the transition to the new rule, the FTC also released model language for employers to use when discussing the changes with their employees. 0
NDA Journal 10 AAPS Files Amicus Curiae Brief Against Biden Administration Experimental Formulation Critical Analysis Censorship 08 February 2024 Physicians who misuse the “copyand-paste” feature in patients’ electronic health records (EHRs) can face serious consequences, including lost hospital privileges, fines, and malpractice lawsuits. In California, a locum tenens physician lost her hospital privileges after repeatedly violating the copyand-paste policy developed at Santa Rosa Memorial Hospital, Santa Rosa, California. “Her use of copy and paste impaired continuity of care,” said Alvin Gore, MD, who was involved in the case as the hospital’s director of utilization management. Gore said the hospital warned the doctor, but she did not change her behavior. He did not identify the physician, citing confidentiality. The case occurred more than five years ago. Since then, several physicians have been called onto the carpet for violations of the policy, but no one else has lost privileges, Gore said. Copy-paste practices can save doctors’ time when dealing with cumbersome EHR systems, but they also can lead to redundant, outdated, or inconsistent information that can compromise patient care, experts said. “EHRs are imperfect, time consuming, and somewhat rigid,” said Robert A. Dowling, MD, a practice management consultant for large medical groups. “If physicians can’t easily figure out a complex system, they’re likely to use a workaround like copy and paste.” Copy-and-paste abuse has also led to fines. A six-member cardiology group in Somerville, New Jersey, paid a $422,000 fine to the federal government to settle copy-and-paste charges, following an investigation by the Office of the Inspector General of the Department of Health and Human Services, according to the Report on Medicare Compliance. This big settlement, announced in 2016, is a rare case in which physicians were charged with copy-andpaste fraud—intentionally using it to enhance reimbursement. More commonly, Medicare contractors identify physicians who unintentionally received overpayments through sloppy copy-and-paste practices, according to a coding and documentation auditor who worked for 10 years at a Medicare contractor in Pennsylvania. Such cases are frequent and are handled confidentially, said the auditor, who asked not to be identified. Practices must return the overpayment, and the physicians involved are “contacted and educated,” she said. Copy and paste can also show up in malpractice lawsuits. In a 2012 survey, 53% of professional liability carriers said they had handled an EHR-related malpractice claim, and 71% of those claims included copyand-paste use. One such case, described by CRICO, a malpractice carrier based in Massachusetts, took place in 2012–2013. “A patient developed amiodarone toxicity because the patient’s history and medications were copied from a previous note that did not document that the patient was already on the medication,” CRICO stated.“If you do face a malpractice claim, copying and pasting the same note repeatedly makes you look clinically inattentive, even if the copy/ pasted material is unrelated to the adverse event,” CRICO officials noted in a report. Copy and paste is a great time-saver. One study linked its use to lower burnout rates. However, it can easily introduce errors into the medical record. “This can be a huge problem,” Dowling said. “If, for example, you copy forward a previous note that said the patient had blood in their urine ‘six days ago’, it is immediately inaccurate.” Practices can control use of copy and paste through coding clerks who read the medical records and then educate doctors when problems crop up. The Pennsylvania auditor, who now works for a large group practice, said the group has very few copy-andpaste problems because of her role. “Not charting responsibly rarely happens because I work very closely with the doctors,” she said. Featured Article »
NDA Journal 12 Featured Article Dowling, however, reports that many physicians continue to overuse copy and paste. He points to a 2022 study which found that, on average, half the clinical notes at one health system had been copied and pasted. One solution might be to sanction physicians for overusing copy and paste, just as they’re sometimes penalized for not completing their notes on time with a reduction in income or possible termination. Practices could periodically audit medical records for excessive copy-paste use. EHR systems like Epic’s can indicate how much of a doctor’s note has been copied. But Dowling doesn’t know of any practices that do this. “There is little appetite to introduce a new enforcement activity for physicians,” he said. “Physicians would see it just as a way to make their lives more difficult than they already are.” Some hospitals and health systems have gone as far as disabling copyand-paste function in their EHR systems. However, enterprising physicians have found ways around these blocks. Some institutions have also introduced formal policies, directing doctors on how they can copy and paste, including Banner Health in Arizona, Northwell Health in New York, UConn Health in Connecticut, University of Maryland Medical System, and University of Toledo in Ohio. Definitions of what is not acceptable vary, but most of these policies oppose copying someone else’s notes and direct physicians to indicate the origin of pasted material. Santa Rosa Memorial’s policy is quite specific. It still allows some copy and paste but stipulates that it cannot be used for the chief complaint, the review of systems, the physical examination, and the assessment and plan in the medical record, except when the information can’t be obtained directly from the patient. Also, physicians must summarize test results and provide references to other providers’ notes. Gore said he and a physician educator who works with physicians on clinical documentation proposed the policy about a decade ago. When physicians on staff were asked to comment, some said they would be opposed to a complete ban, but they generally agreed that copy and paste was a serious problem that needed to be addressed, he said. “The hospital could have simply adopted guidelines, as opposed to rules with consequences, but ‘we wanted our policy to have teeth,’” Gore said. When violators are identified, Gore says he meets with them confidentially and educates them on proper use of copy and paste. Sometimes, the department head is brought in. Some physicians go on to violate the policy again and have to attend another meeting, he said, but aside from the one case, no one else has been disciplined. It’s unclear how many physicians have faced consequences for misusing copy-paste features—such data aren’t tracked, and sanctions are likely to be handled confidentially, as a personnel matter. Geisinger Health in Pennsylvania regularly monitors copy-and-paste usage and makes it part of physicians’ professional evaluations, according to a 2022 presentation by a Geisinger official. Meanwhile, even when systems don’t have specific policies, they may still discipline physicians when copy-and-paste leads to errors. Scott MacDonald, MD, chief medical information officer at UC Davis Health in Sacramento, California, told Medscape Medical News that copyand-paste abuse has come up a few times over the years in investigations of clinical errors. Physicians can be held accountable for copy and paste by Medicare contractors and in malpractice lawsuits, but the most obvious way is at their place of work: A practice, hospital, or health system. One physician has lost staff privileges, but more typically, coding clerks or colleagues talk to offending physicians and try to educate them on proper use of copy-and-paste. Educational outreach, however, is often ineffective, said Robert Hirschtick, MD, a retired teaching physician at Northwestern University Feinberg School of Medicine, Chicago, Illinois. “The physician may be directed to take an online course,” he said. “When they take the course, the goal is to get it done with, rather than to learn something new.” Hirschtick’s articles on copy and paste, including one titled, “Sloppy and Paste,” have put him at the front lines of the debate. “This is an ethical issue,” he told Medscape Medical News. He agrees that some forms of copy and paste are permissible, but in many cases, “it is intellectually dishonest and potentially even plagiarism,” he said. Hirschtick argues that copy-and-paste policies need more teeth. “Tying violations to compensation would be quite effective,” he said. “Even if physicians were rarely penalized, just knowing that it could happen to you might be enough. But I haven’t heard of anyone doing this.” 0 »
NDA Journal 14 “What’s Wrong with Change?” As I near the end of my term as President of the Nevada Dental Association and prepare for the peaceful transfer of leadership to Dr. Patrick Silvaroli, I am struck by the conundrum that continues to exist in the tripartite: shrinking membership numbers and the lack of member engagement. The fate of organized dentistry sits squarely on the shoulders of the young doctors of dentistry. Millennials and Gen Z’ers are the rising tide of dentists across the nation. Baby boomers will soon be retiring in large numbers and with their departure our numbers will get smaller. Why are our membership numbers decreasing? Could it be that the cost of dental education has skyrocketed, and newly graduated dentists think the cost of joining organized dentistry is too great? Could it be that organized dentistry does not offer a terrific value proposition for its annual dues invoice? Why do so many members pay their dues but resist stepping into leadership positions? Are they too busy with their families and professional lives? Leaders of organized dentistry have been scratching their heads for the past decade to solve this dilemma. They have tried almost every conceivable way to attract and retain the newest generation of dentists. They say “We need an app, we need ‘fun’ conventions, and we need a better experience” at the state and local member level. Whatever “it” is—it had better happen fast or the dental profession (ADA) will follow the medical profession (AMA) and lose the prestige of claiming they represent the majority of U.S. dentists. Membership and engagement face severe and intensifying inertia. Throughout each vein of the tripartite, I have come to the conclusion that many of the challenges within our organization are simply caused by inertia. Inertia can be defined as the tendency to do nothing or to remain unchanged. Inertia can be resistance to change, a reluctance to deviate from established routines or ways of doing things which can lead to stagnant leadership. It can be a powerful force which can hold back progress and prevent our organization from adapting to new challenges and taking advantage of new opportunities. While it is a natural tendency to accept the status quo since it provides stability and avoids uncertainty, is inertia inhibiting our progress and growth? Inertia can show up as resistance to innovative ideas, a reluctance to take risks, or a lack of urgency in responding to changing market and professional conditions. It can also be fueled by organizational structures and processes that reinforce the status quo and discourage innovation. Inertia can be problematic since it is so deeply rooted in the organization’s culture and even when organizations recognize the need for change, they often struggle to implement it effectively. To overcome inertia, we need to pursue a fundamental approach to change which means: Joseph Wineman, DMD, ABGD NDA President Article
Summer 24 www.nvda.org 15 NDA President Article 1. Identify the challenges we face (lack of association growth and lack of member engagement) 2. Develop a clear vision for the future (how do we reverse those trends) 3. Implement a realistic plan to change the outcome (embrace diversity of thought, become inclusive in our membership, improve our value proposition to increase our market share). Finally, as the Kittleman report suggested, creating a culture that supports change, rewards innovation and risk-taking, while ensuring the right people are in the right seats on the organizational bus who feel empowered to take ownership of their work and contribute to the organization’s success is essential for the NDA’s future success. The NDA needs leaders who will answer the call to protect our patients and defend our profession. Ultimately, the success of overcoming inertia rests with the challenging task of recognizing change is needed in order to reverse the trends and move forward into the future. After more than two decades of service to Nevada’s organized dentistry, forty- three years in this profession and my own sixty-three years of life, I have witnessed many significant changes. Winston Churchill once said, “To improve is to change; to be perfect is to change often.” So, in my final days serving as the NDA’s President, I ask, “What’s wrong with change? Where will we end up if we continue to resist it?” Thank you for the opportunity to serve as the 2023–2024 Nevada Dental Association President and I am hopeful that we will overcome the persistent inertia that hampers our association’s success. 0
NDA Journal 16 NDA Executive Director’s Summer 2024 Message NDA Executive Director’s Message Nicollette Schmeichel HELLO NDA MEMBERS, It is with great pleasure that I introduce myself as the new Executive Director of the Nevada Dental Association. As I step into this role, I am filled with enthusiasm and determination to uphold our mission and drive positive change within NDA. In March, we kicked things off with the UNLV Student Signing Day. We had a chance to meet and encourage students to join the Tripartite membership, where they got to hear inspirational and motivating speeches by Dr. Nygren and Dr. Tina Brandon. I want to thank Marianna Kacyra, NDA’s Director of Member Services, and all our volunteers for their hard work in making this event such a success! Our Summer House of Delegates meeting is just around the corner! The meeting will be held at the Downtown Grand Hotel and Casino in Las Vegas Friday, June 21 and Saturday, June 22. This gathering presents us with a platform to come together and chart the course for the rest of 2024. This event will include our semi-annual House of Delegates and a variety of guests such as Dr. Cohlmia, ADA’s Executive Director; Dr. Mah, UNLV’s Dean; Dr. Kahl, ADA’s Fourteenth District Trustee, and more. We hope to see you there! The NDA lobby team, TriStrategies, the NDA Council of Government Affairs, and the NDA leadership are fighting hard for our members and organized dentistry in Nevada. Their next BDR session will be held at the end of the HOD meeting on Saturday, June 22, and we are excited to see what they will be working on for the next legislative session. We are very grateful for each and every one of you and what you bring to the Tripartite membership. Together, we can make a difference for our patients and communities. 0
NDA Journal 18 John Constantino 503-445-2230 john@llmpubs.com
Summer 24 www.nvda.org 19 Summer Article David Mahon, DDS The Nevada Dental Foundation (NDF) opened the Tonopah Dental Center (TDC) November 3, 2023, in rural Central Nevada. The practice has been well received by the residents of this underserved, frontier region. Currently, the staff is comprised of volunteer tripartite members, hygienists, dental assistants, and support staff. Our goal is to recruit a qualified fulltime dentist, eligible for one of the available student loan repayment programs. This enterprise has been a rewarding experience for our volunteers, NDF President Article building camaraderie amongst colleagues, while facilitating team building with staff. We value our partnership with the Nevada Dental Association; your support has made the NDA’s Council on Advocacy for Access and Prevention concept of rural dental care a reality, showcasing organized dentistry’s ability to solve access issues in our state. For decades, no progress was made, or dental programs established. Please contact the NDF if you would like to volunteer and improve rural residents’ access to oral health care. NevadaDentalFoundation@gmail.com or call TDC (775) 477-3033. 0 Kalpana Bhatt, Dental Assistant Adaven Children’s Dentistry & Orthodontics, Henderson Phyllis Boucher, RDA Wineman Dental, Henderson Dr. Trina Chau Radiant Smiles, Las Vegas Dr. Grace Chung & Kaylee Chung Smile Shop Dental, Henderson Ronda Farnsworth, Dental Assistant Round Mountain Libby Griego, RDH Siena Dental, Henderson Jennifer Krantz, Dental Assistant Dr. Robin Lobato & Associates, Las Vegas Dr. Robin Lobato Dr. Robin Lobato & Associates, Las Vegas Brea Mahon, RDH Siena Dental, Henderson Dr. Dave Mahon Siena Dental, Henderson Lourdes Mcintire, Dental Assistant Siena Dental, Henderson Dr. Nina Mirzayan Adaven Children’s Dentistry & Orthodontics, Henderson Kiana Oda, Dental Assistant Siena Dental, Henderson Linda Pilster, Sterilization Technician Wineman Dental, Henderson Shawna Rivera Dr. Robin Lobato & Associates, Las Vegas Dr. Mark Rosenberg Captain, United States Public Health Service (retired), Sparks Julie Stage-Rosenberg, RDH, MPH Professor, Truckee Meadows Community College (retired), Sparks Tiffany Schultz, Treatment Coordinator Dr. Robin Lobato & Associates, Las Vegas Dr. Mary Tabrizi Associate Professor, UNLV School of Dental Medicine, Las Vegas Dr. Sean Truong Dr. Robin Lobato & Associates, Las Vegas Dr. Joseph Wineman Wineman Dental, Henderson The NDF would like to thank the following volunteers for their service providing patient care: »
NDA Journal 20 NDF President Article Dr. Mark Rosenberg and assistant Ronda Farnsworth, patient Donald K Dr. Rosenberg, and patients Dr. Trina Chau and Dr. Valeria Romero Dr. Rosenberg, assistant Lisa Gillard, patients Rebeca and Normar Martin »
Summer 24 www.nvda.org 21 Dr. Mark Rosenberg and RDH Julie Stage-Rosenberg Dr. Rosenberg and patient Alex Guzman Assistant Kaylee Chung Dr. Trina Chau and assistant Norma R Dr. Valeria Romero Assistant Kiana Oda and Ronda Farnsworth Dr. Grace Chung and assistant Kaylee Chung Patient Laura N Dr. Robin Lobato and his team, Jennifer K and Tiffany S RDH Elizabeth Griego and patient Terry Owers Dr. David Mahon Assistant Lourdes McInquire and patient Laura N NDF President Article
NDA Journal 22 SNDS President’s Message Christine Lemon, DDS SNDS President’s Message DEAREST COLLEAGUES, It is with great enthusiasm that I take this opportunity to introduce myself to all of you. My name is Christine Lemon, and I am truly honored to be your President for the next year. Home has always meant Nevada to me. I started as a K–12 student in the Clark County School District and fast forward seventeen years later, I am so blessed to have established my mobile practice, Nevada Dental Anesthesia, here in the Silver State. Throughout my educational career, I made my best effort to advocate for and spearhead initiatives to influence positive change. As one of five board certified dentist anesthesiologists in our state, it was important for me to become a tripartite member so there could be a voice prioritizing patient safety in the dental office setting. Organized dentistry plays a crucial role in protecting the interests of dental professionals. We advocate for legislative policies to ensure fair reimbursement, promote access to care, and address issues related to insurance, licensure, and scope of practice. We provide opportunities for continuing education, training, and networking. We offer support and resources such as legal guidance and mentorship programs to help dentists navigate challenges and succeed in their careers. We serve as a unifying force within the profession, and we hope to only grow this coming year. I would like to share some goals that I believe will not only enhance our society but also enrich the experiences of each and every member: *Increase Membership* Our strength lies in our numbers, and by expanding our membership base, we can amplify our impact within the dental community. Let us reach out to colleagues and peers, inviting them to join us in our journey of growth and learning. *Build Community* A sense of belonging is essential for fostering collaboration and camaraderie. Through networking events, workshops, and social gatherings, we will create opportunities for members to connect, share ideas, and support one another. *Embrace Diversity and Inclusion* Our profession is as diverse as the patients we serve, and it is imperative that our society reflects this diversity. By actively promoting inclusivity and celebrating our differences, we can create a welcoming environment where all voices are heard and valued. In the spirit of collaboration and shared purpose, I invite each of you to join me in meeting these goals. Together, we can strengthen our society, elevate our profession, and make a meaningful impact on the world around us. 0 With gratitude, Christine A. Lemon, DDS, DADBA SNDS President 2024–2025
Summer 24 www.nvda.org 23 SNDS Executive Director’s Message by: Esther Johnson, SNDS Director
NDA Journal 24 Northern Nevada DENTAL SOCIETY NDA Calendar of Events Check our website for the latest updates to calendar at www.nndental.org. 2024 June 6/21–22 NDA Annual Summer Meeting & House of Delegates Las Vegas—www.nvda.org July 7/9 NNDS Executive Committee Meeting 5605 Riggins Court, #101A, Reno 5:30pm August 8/13 NNDS Executive Committee Meeting 5605 Riggins Court, #101A, Reno 5:30pm 8/15 NNDS Open House Picnic Bartley Ranch Park, Reno 5:30pm September 9/10 NNDS Executive Committee Meeting 5605 Riggins Court, #101A, Reno 5:30pm 9/20 NNDHP/Joel F. Glover 22nd Annual Charity Golf Tournament Red Hawk Golf Club, Hills course 7:30am 9/27 NNDS Mystery Bus Trip Location: it’s a secret!! 5:00pm
Summer 24 www.nvda.org 25 NDA Executive Offices Nicollette Schmeichel, Executive Director 600 E William St, Ste 202 Carson City, NV 89701 702-255-4211 • FAX 702-255-3302 nschmeichel@nvda.org • www.nvda.org PRESIDENT Joseph Wineman, DMD PRESIDENT-ELECT Patrick Silvaroli, DMD VICE PRESIDENT Sheronda Strider- Barraza, DMD SECRETARY Aimee Abittan, DMD TREASURER Perry Francis, DMD PAST PRESIDENT Jason Doucette, DDS Nevada State Board of Dental Examiners Christopher Bateman, MBA, Executive Director Chelsea Lucas and Parker Arecchi, Licensing & Credentialing 2651 N Green Valley Pkwy, Ste 104 Henderson, NV 89014 702-486-7044 • 800-DDS-EXAM FAX 702-486-7046 nsbde@nsbde.nv.gov www.nvdentalboard.nv.gov Northern Nevada Dental Society Lori Benvin, Executive Director 5605 Riggins Ct, Ste 101A Reno, NV 89502 775-337-0296 • FAX 775-337-0298 nnds@nndental.org • www.nndental.org PRESIDENT K.C. Gilbert, DDS, MS VICE PRESIDENT Garrett Swanson, DMD SEC./TREASURER Whitney Bryant, DDS PAST PRESIDENT Christopher Galea, DDS, MD MEMBERS AT LARGE Debra Peterson, DMD Megan Utter, DDS Trisha Hansen, DMD ADA Business Resources affliated We are pleased to announce that the NDA and ADA have combined the purchasing power of dentists to gain discounts on a large variety of products and services. Call the company or the NDA to learn more. CareCredit Patient Financing 800-300-3046 x4519 www.carecredit.com InTouch Practice Communications 877-493-9003 www.intouchdental.com/ada NDA-Affiliated Products These companies and their products have been evaluated by the NDA and are recommended for use in running your practice. Let us know if you have any feedback or would like to recommend a product or service for affiliation. For a weblink to each company, go to www.nvda.org/ affiliatedproducts.shtml. Best Card, LLC Credit card processing 877-739-3952 www.bestcardteam.com The Dental Record Digital record keeping 800-243-4675 www.dentalrecord.com TDIC The Dentists Insurance Company 800-733-0633 www.tdicinsurance.com TDSC Supplies The Dentists Supply Company dentalsupplies.tdsc.com/nevada IC System Collection service 800-279-3511 www.icsystem.com/nda.htm Lands’ End Business Outfitters Uniforms 800-490-6402 www.ada.landsend.com Lenovo 800-426-7235 ext. 4886 www.adabusinessresources.com/en/ endorsed-programs/computers Mercedes-Benz Mercedes-Benz leasing 866-628-7232 http://ebusiness.ada.org/ adabei/luxury-vehicles.aspx Office Max Office supplies 702-647-8662 www.officemax.com SurePayroll Payroll processing 866-535-3592 www.surepayroll.com/ada Compliancy Group One stop shop for all things HIPAA www.compliancy-group.com UPS Shipping services 800-636-2377 www.adabusinessresources.com/en/ endorsed-programs/shipping Council on Communications Dr. Tina Brandon Abbatangelo, Chair Dr. Erin Anderson Dr. Ed DeAndrade Dr. Daniel Orr Dr. Garrett Swanson Ms. Nicollette Schmeichel (NDA Staff) Council on Ethics, Bylaws and Judicial Affairs Dr. Tina Brandon-Abbatangelo, Chair Dr. Brady Neugebauer Dr. Michael Banks Dr. Todd Wilkin Ms. Nicollette Schmeichel (NDA Staff) Administrative Offices NDA Committees Northeastern Nevada Dental Society Lori Benvin, Executive Director 600 E William St, Ste 202 Carson City, NV 89701 702-337-0296 • 800-962-6710 FAX 702-255-3302 www.nends.org PRESIDENT Jeremy Keener, DDS VICE PRESIDENT Todd Thompson, DMD SEC./TREASURER Scott Forvilly, DDS PAST PRESIDENT Jamie Marvel, DDS Southern Nevada Dental Society Esther Johnson, Executive Director 9205 W Russell Rd, Ste 240 Las Vegas, NV 89148 702-793-4455 • FAX 702-733-6062 www.sndsonline.org PRESIDENT Christine Lemon, DDS PRES-ELECT Sonal Shah, DDS PAST PRESIDENT Richard Shoen, DDS SECRETARY Maryam Tabrizi, DMD TREASURER Moni Ahmadian, DMD American Dental Association 211 E Chicago Ave Chicago, IL 60611-2678 312-440-2500 • 800-621-8099 www.ada.org ADA DELEGATES TBD Tina B. Abbatangelo, DDS David M. White, DDS Council on Government Affairs Dr. David White, Chair Dr. Whitney Bryant, Vice Chair Dr. John Griffiths Dr. Steve Saxe Dr. Christian Peralta Dr. Rick Dragon Dr. Daniel Orr Dr. John Nerwinski Dr. Michael Britting Dr. Marc Cirelli Ms. Nicollette Schmeichel (NDA Staff) Council on Membership Dr. Scott Sutter, Chair Dr. Deaudre LeCato Dr. Christine Lemon Dr. Steve Saxe Mr. Spencer Coleman Ms. Autumn Wolfer (ADA Staff) Ms. Lori Benvin (NNDS Staff) Ms. Esther Johnson (SNDS Staff) Ms. Marianna Kacyra (NDA Staff) Ms. Nicollette Schmeichel (NDA Staff)
Free Online CDE www.adaceonline.org www.septodontlearning.com www.dentalcare.com www.kerrlearningsource.com henryschein.com/us-en/dental/events- education/about-events-education.aspx www.wileyhealthlearning.com CLASSIFIEDS INTRAORAL X-RAY SENSOR REPAIR/SALES We repair broken sensors. Save thousands in replacement costs. Specializing in Kodak/Carestream, major brands. We buy/sell sensors. American SensorTech 919-229-0483 www.repairsensor.com. DOCTOR/LAWYER You wouldn’t want a coach who hadn’t been a player, so why would you want a lawyer who hasn’t practiced dentistry? Contact Tom Brooksbank, DDS, Esq. at 702-337-6772 or dr.tom@runbox.com.
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