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From the States Legislation & Litigation
Legislation A m endm ents to state M edicaid or sim ilar law s occurred in Colorado and Florida. State dental laws were am ended in Montana, N ew Hampshire, and N ew York. Louisiana and Virginia am ended their law s relating to m alpractice to define the standard of care fo r health practitioners. New Jersey has expanded its peer review im m unity and has extended the requirem ents fo r reimbursing dentists under individual policies o f medical plans. The N ew York public health law now prohibits use o f posttreatm ent dental radiographs m erely to verify services fo r third parties. A controversial m easure adopted in New York requires that those who provide standardized admission tests for postsecondary or professional schools m ust disclose the substance o f the tests to those taking the test. A Pennsylvania proposal to require dentists to list charges o f dental laboratories on billings of patients w a s defeated.
NEW PROVISIONS IN FLORIDA DENTAL LAW CONFORM WITH US SUPREME COURT DECISIONS LIMITING STATEIMPOSED RESTRICTIONS OF PROFESSIONAL ADVERTISING T h e “ s u n s e t” p h e n o m e n o n h a s p r o d u c e d a n e w d e n ta l la w in F lo r id a . M u c h o f th e p re v io u s la w is re ta in e d . T h e n e w p ro v is io n s re fle c t c o n fo rm a n c e w ith re c e n t U S S u p re m e C o u rt d e c is io n s lim itin g s ta te -im p o s e d re s tric tio n s o n p ro fe s s i o n a l a d v e r t i s i n g . O t h e r n e w p r o v i s i o n s r e f i n e t h e d e n t i s t ’s a u t h o r i t y t o d e l e g a te f u n c tio n s to a u x ilia r ie s a n d s p e c ify p r o te c tio n s fo r th e d e n tis t- p a tie n t r e la tio n s h ip in “ m u lti- d e n tis t p ra c tic e s .” T h e F lo rid a b o a rd o f d e n tis try w ill h a v e n in e m e m b e rs : 6 d e n tis ts , 1 d e n ta l h y g ie n is t, a n d 2 m e m b e rs fro m th e p u b lic . T h e b o a rd w ill c o n tin u e to r e q u ire a c lin i c a l e x a m i n a t i o n o f a l l l i c e n s u r e a p p l i c a n t s . B u t t h e b o a r d ’s e x a m i n a t i o n p r o c e d u r e s a r e s u b je c t to s ta t u to r y r e q u ir e m e n ts s u c h a s “ a m a n d a to r y s t a n d a r d i z a tio n e x e r c is e fo r a ll e x a m in e r s p r io r to e a c h p r a c tic a l o r c lin ic a l e x a m in a ti o n .. . ” A d v e r tis in g b y d e n tis ts is g o v e r n e d b y a c o m p r e h e n s iv e s e t o f s tr ic tu r e s a n d g u id e s . T h e f u n d a m e n ta l g u id e e m p h a s iz e s t h a t th e p u r p o s e o f a d v e r tis in g is to p r o v id e th e p u b lic w ith “ a n in fo rm e d s e le c tio n o f d e n tis ts w h ile p ro te c tin g th e p u b lic fr o m fa ls e o r m is le a d in g a d v e r tis e m e n ts .” A d v e r tis in g o n r a d io o r te le v i s i o n is p e r m i t t e d b u t is s u b je c t to b o a r d r u l e s “ w h i c h r e f le c t t h e s p e c ia l c h a r a c te ris tic s o f s u c h m e d ia .” S ig n ific a n t a tte n tio n
is g iv e n to a d v e r tis e m e n ts o f
r o u tin e d e n ta l s e rv ic e s a n d fe e s c h a r g e d fo r th o s e s e r v ic e s . S p e c ific r o u tin e s e r v ic e s fo r w h ic h fe e s m a y b e a d v e r tis e d a re o u tlin e d i n th e s ta tu te . O th e r ro u tin e
F e e s fo r C o lo ra d o e ld e rc a r e d e n ta l p la n a r e p e g g e d to c o n s u m e r p r ic e in d e x .
T h e p ro g ra m
so n s w ith
lo w
fo r o ld e r p e r
in c o m e s
p re v io u s ly
c a r r ie d a te r m in a tio n d a te in 1 9 7 9 ; th a t d a te w a s s tric k e n a n d th e p ro g ra m w a s m a d e p e rm a n e n t. T h e a n n u a l c o s t o f liv in g in c re a s e fo r d e n ta l fe e s b e g in s o n J u ly 1, 1 9 8 0 ; d e n ta l fe e s a re in d e x e d to th e D e n v e r a re a
s e r v ic e s m u s t fit w ith in a g e n e r a l d e fin itio n o f ro u tin e
d e n ta l s e r v ic e s a ls o
s p e c if i e d i n th e la w . A s e p a r a te s e c tio n d e f in in g w h a t is m e a n t b y f a ls e a n d m i s le a d in g
a d v e rtis in g
in c lu d e s
“ la u d a to ry
s ta te m e n ts
a b o u t th e
d e n tis t” a n d
r e p r e s e n ta tio n s th a t re la te “ to th e q u a lity o f d e n ta l s e r v ic e s p r o v id e .” P r o v is io n s g o v e rn in g d e n ta l h y g ie n is ts a n d d e n ta l a u x ilia rie s fe a tu re a s e c tio n d e v o te d to e x p a n d e d fu n c tio n s . T h e d e n tis t m a y d e le g a te o n ly th o s e p r o c e d u r e s th a t a r e r e m e d ia b le . T h e d e n ta l b o a r d is a u th o r iz e d to a p p r o v e t r a in in g p r o g r a m s n e e d e d to e n s u r e th a t a u x ilia rie s a re c a p a b le o f e x p a n d e d fu n c tio n s p re s c rib e d b y th e b o a rd . P r o v is io n s g o v e rn in g d e n ta l la b o ra to rie s r e ta in a s ta tu to ry m e c h a n is m fo r r e g is te r in g d e n ta l la b o ra to rie s . O th e r fe a tu re s o f th e n e w F lo r id a la w r e q u ire d e n tis ts to m a k e c o p ie s o f a p a
c o n s u m e r p r ic e in d e x .
t i e n t ’s r e c o r d s a v a i l a b l e t o t h e p a t i e n t o r h i s l a w y e r , p e r m i t t h e d e n t a l b o a r d t o F lo r id a M e d ic a id p la n s p e c ifie s d e n tu re
care.
The
F lo rid a
M e d ic a id
r e g u la te th e u s e o f g e n e r a l a n e s th e s ia o r s e d a tio n , a n d p re s c r ib e th a t e v e ry p a tie n t s h a ll h a v e a d e n tis t o f re c o rd .
p la n n o w in c lu d e s s e v e ra l a d d itio n a l o p tio n a l s e rv ic e s s e r v ic e s q u ire d
of a
fo r th e
tu re s ” a n d
in c lu d in g
lic e n s e d
d is p e n s in g
“ d e n tu re s
“ th o s e
d e n tis t re of d en
m ade
or
L o u is ia n a s p e lls o u t s ta n d a r d o f c a re
u n d e r th e d ire c tio n o f a lic e n s e d d e n
fo r d e n tis ts a n d p h y s ic ia n s a p p lic a
d e n ta l p ra c titio n e rs is p o s s e s s io n o f
tis t.”
b le
k n o w le d g e a n d s k ill a n d e x e rc is e o f
7 5 4 ■ J A D A , V o l. 99 , O c to b e r 1 9 7 9
by
to
m a lp ra c tic e
c la im s .
The
s ta tu to ry s ta n d a rd o f c a re fo r g e n e ra l
LEG ISLA TIO N
&
L IT IG A T IO N
FEDERAL JUDGE IN ANTITRUST ACTION RULES RELATIVE VALUE GUIDES USED BY ANESTHESIOLOGISTS ARE NOT FEE-FIXING BECAUSE OF “UNIQUENESS” OF SPECIALTY
Legislation & Litigation
U s e o f re la tiv e v a lu e g u id e s in re la tio n to th e d e te rm in a tio n o f fe e s c h a r g e d b y p h y s ic i a n s h a s s p u r r e d a c tio n b y b o th th e F e d e r a l T r a d e C o m m is s io n (F T C ) a n d th e J u s tic e D e p a r tm e n t; b o th a g e n c ie s in s is t th a t r e la tiv e v a lu e g u id e s p r o d u c e fe e -fix in g i n v io la tio n o f th e fe d e r a l a n titr u s t la w s . S e v e ra l m e d ic a l a s s o c ia tio n s h a v e s ig n e d F T C c o n s e n t d e c r e e s , a g r e e in g to d is c o n tin u e u s e o f s u c h g u id e s .
care
c o m p a r a b le to
th a t o rd in a rily
p o s s e s s e d a n d e x e rc is e d b y d e n tis ts in s im ila r c o m m u n itie s u n d e r s im i la r c irc u m s ta n c e s . F o r d e n tis ts
in
s p e c ia lty p r a c tic e , th e s ta n d a r d is th e d e g re e o f c a re o rd in a rily p ra c tic e d b y d e n tis ts
in
th e
sam e
s p e c ia lty .
L o u is ia n a h a s a m e n d e d th e la w p e r m ittin g
use
o f c o rp o ra te
id e n ti
f ic a tio n s b y d e n tis ts to r e q u ire th a t a n y s u c h id e n tific a tio n in c lu d e th e n a m e o f o n e o r m o re o f th e v o tin g s h a r e h o ld e rs p lu s
“A
D e n ta l C o r p o r a tio n ”
P ro fe s s io n a l or “A
D e n ta l
C o r p o ra tio n .” T h e L o u is ia n a le g is la tu r e h a s p e titio n e d C o n g re ss to c a ll a c o n s titu tio n a l c o n v e n tio n
to
con
O n e m e d ic a l a s s o c ia tio n , th e A m e r ic a n S o c ie ty o f A n e s th e s io lo g is ts (A S A ), d e c lin e d to c o n c e d e th a t its g u id e s w e re ille g a l a n d fo r c e d th e J u s tic e D e p a r tm e n t to b rin g s u it in a fe d e ra l d is tric t c o u rt in M a n h a tta n , N Y . In a le n g th y o p in io n , th e fe d e r a l d is tr ic t ju d g e a b s o lv e d th e a n e s th e s io lo g is ts ’ re la tiv e v a lu e g u id e s o f a n y t a i n t o f a n t i t r u s t v io la tio n . T h e c o u r t r u l e d t h a t t h e J u s tic e D e p a r tm e n t f a ile d to d e m o n s tra te th a t A S A g u id e s a d v e r s e ly a ffe c te d in te rs ta te c o m m e rc e . H o w e v e r, th e ju d g e a ls o r u le d th a t th e A S A g u id e s c o u ld s u rv iv e th e s o -c a lle d “ r u le o f r e a s o n ” te s t fo r re s tra in ts o n tra d e a n d c o m m e rc e . T h e c o u rt fo u n d n o s u b s ta n tia l e v id e n c e o f “ a n a g r e e m e n t to a d h e r e to a p r ic in g fo r m u la n o r a n y c o n c r e te a n tic o m p e titiv e e ffe c t o n th e m a r k e t fo r a n e s th e s ia s e r v ic e s b y v ir tu e o f th e u s e o f th e A m e r ic a n S o c ie ty o f A n e s th e s io lo g is ts ’ R e la tiv e V a lu e G u id e s .” P e r h a p s th e m o s t c ru c ia l f in d in g o f th e c o u rt is “ th e u n iq u e c irc u m s ta n c e s s u r r o u n d in g th e a n e s th e s io lo g y p ro f e s s io n .” A p p a r e n tly th e ju d g e w a s e m p h a s iz in g t h a t o th e r a re a s o f m e d ic a l p ra c tic e c o u ld n o t m a k e th e s a m e c a s e fo r th e ir re la tiv e v a lu e g u id e s
as
d id
th e
a n e s th e s io lo g is ts .
(US vs
S o c ie ty o f
A m e ric a n
A n e s th e
s io lo g is ts , I n c ., U S D i s t r i c t C o u r t, S o D is t, N Y N o . 7 5 C iv 4 6 4 0 , 1 9 7 9 - 2 T r a d e C a s e s , J u ly 1 9 7 9 .)
s id e r a n a m e n d m e n t th a t w o u ld p re s e rv e th e p r im a c y o f s ta te la w s o v e r ru le s o r r e g u la tio n s is s u e d b y fe d e ra l a g e n c ie s . to s o m e in d iv id u a l p la n s . M o n ta n a
d e n ta l
la w
p ro v is io n s re v is e d .
a d v e rtis in g
T h e n e w a d v e r
T he N ew
Je rse y s ta tu te g o v e rn s th e c o n fid e n
a p r o n to s h ie ld p a tie n ts w h e n d e n ta l ra d io g ra p h s a re ta k e n b y a d e n tis t o r
“ e x c lu s iv e ly
d e n ta l h y g ie n is t. T h e N e w Y o rk p u b
tis in g lim ita tio n in c lu d e s p e rm is s io n
g e n e r a te d ” b y re v ie w c o m m itte e s . A
lic h e a lth la w w a s a m e n d e d to p ro
to p u b lis h a lis t o f fe e s, “ b u t s u c h lis t
n e w p ro v is io n in c lu d e s h o s p ita l p e e r
h ib it
in g m u s t in c lu d e fu ll a n d c o m p le te
re v ie w
s o le ly to v e rify s e rv ic e s p e rfo r m e d
in fo r m a tio n s ta tin g if th e p u b lis h e d
re s p o n s ib ility fo r th e re v ie w o f q u a l
fe e
ific a tio n s a n d
is
m in im u m
o r m a x im u m ,
or
tia lity
o f in fo r m a tio n
c o m m itte e s
“ h a v in g
th e
ta k in g
d e n ta l
ra d io g ra p h s
u n d e r th ir d -p a rty p la n s .
c re d e n tia ls o f p h y s i
u s u a l a n d w h e th e r o r n o t a n y a d d i
c ia n s
t i o n a l c h a r g e s m a y b e m a d e _____ ” T h e
m e n t o r re a p p o in tm e n t to a m e d ic a l
c o n tro v e rs ia l
M o n ta n a b o a rd o f d e n tis try n o w in
o r d e n ta l s ta ff o f a h o s p ita l, o r o f
m e n t fo r s ta n d a rd iz e d te s tin g p ro
c lu d e s fiv e d e n tis ts a n d tw o d e n ta l
q u e s tio n s o f th e c lin ic a l o r a d m in is
g ra m s.
h y g ie n is ts .
tra tiv e c o m p e te n c e o f p h y s ic ia n s o r
q u ire m e n t a p p lie s to a p titu d e te s ts
added
d e n ta l b o a rd . e rn in g
th e
to N e w The
new
s e e k in g
a p p o in t
N ew
Y o rk e d u c a tio n la w d is c lo s u re
in c lu d e s re q u ire
T h e n e w e d u c a tio n la w re
d e n tis ts . . . o r . .. th e s c o p e o f h o s p ita l
u s e d b y p o s ts e c o n d a ry
o n e la y
p riv ile g e s o f p h y s ic ia n s o r d e n tis ts
s io n a l s c h o o ls
H a m p s h ire
. . . o r . . . th e d is m is s a l o r d is c h a rg e o f
m is s io n to th o s e s c h o o ls . T h e A D A
O n e d e n ta l h y g ie n is t a n d p e rso n
o r d e n tis ts
p ro v is io n
d e n ta l
and
p ro fe s
fo r d e te rm in in g
ad
gov
s a m e .” T h e n e w p ro v is io n o f th e N e w
d e n ta l a p t i t u d e t e s t is i n c l u d e d . T h e
h y g ie n e
J e rs e y in s u r a n c e la w , a p p lic a b le to
la w n o w re q u ire s th a t th e te s t a g e n c y
m e m b e r s tip u la te s th a t “ th e d e n ta l
re im b u rs e m e n t o f d e n tis ts
h y g ie n e m e m b e r s h a ll n o t e x a m in e
v ic e s c o v e re d u n d e r m e d ic a l p la n s ,
C o m m is s io n
a p p lic a n ts fo r th e c lin ic a l p ra c tic e o f
e x te n d s th e re im b u rs e m e n t re q u ire
th o s e w h o to o k th e te s t o n re q u e s t.
d e n tis try .”
T h e la y
fo r s e r
d is c lo s e te s t re s u lts to th e N e w Y o rk o f E d u c a tio n
and
to
m e m b e r “ s h a ll
m e n t to in d iv id u a l h e a lth in s u r a n c e
n o t e x a m in e a p p lic a n ts in th e c lin i
a lre a d y d e liv e re d , u n le s s th e p o lic y
P e n n s y lv a n ia
c a l p ra c tic e o f d e n tis try o r . . . d e n ta l
s p e c ific a lly lim its re im b u r s e m e n t to
d e n t a l l a b o r a t o r y c o s t s o n d e n t i s t ’s
h y g ie n e .”
p e rs o n s o th e r th a n d e n tis ts .
b illin g d e fe a te d .
p ro p o s a l re q u irin g
T h e P e n n s y lv a n ia
D e n ta l A s s o c ia tio n N ew
J e rs e y p e e r re v ie w
e x te n d e d
to
im m u n ity
h o s p ita l p e e r re v ie w
c o n v in c e d
th e
N e w Y o rk a d o p ts tw o m e a s u re s g o v -
le g is la tu re th a t th e id e n tific a tio n o f
e rn in g
r a
l a b o r a t o r y c o s t s o n a d e n t i s t ’s b i l l i n g
w as
c o u ld re a d ily b e m is le a d in g a n d c o n
u se
o f
c o m m itte e s ; r e im b u r s e m e n t fo r d e n
d io g ra p h s .
T he
tis ts u n d e r m e d ic a l p la n s e x te n d e d
am ended
re q u ire
to
d e n ta l
d e n ta l use
la w
o f a le a d
fu s in g to p a tie n ts . J A D A , V o l. 9 9 , O c to b e r 1 9 7 9 ■ 7 5 5
LEG ISLA TIO N
&
V irg in ia
s e ts
d e n tis ts
in v o lv e d
s u its .
LIT IG A T IO N
s ta n d a rd
fo r
c a re s ta te w id e . A lo c a l o r c o m m u n ity
m a lp ra c tic e
s ta n d a r d w ill b e a p p lie d o n ly if th e
T h e n e w V irg in ia la w a p p lie s
p ra c titio n e r c a n sh o w , b y a p re p o n
in
o f care
to r e v ie w p a n e l s a s w e ll a s to c o u r t
d e ra n c e o f e v id e n c e , th a t a c o m m u
a c tio n s . T h e
n ity
new
p r in c ip a l g o a l o f th e
la w is to m a k e th e s ta n d a r d o f
s ta n d a rd
is
m o re
This colum n was prepared by B ernard J. Conway, ADA associate executive director: legal and legislative affairs.
a p p ro p ria te
th a n a s ta te w id e s ta n d a rd .
Verrazano Narrows Bridge connects the boroughs of Brooklyn and Staten Is land and was photographed by Dr. Sanford E. Klein, a general practitioner who lives in Roslyn Heights, NY.
7 5 6 ■ J A D A , V o l. 9 9 , O c to b e r 1 9 7 9
NEW PROVISIONS IN FLORIDA DENTAL LAW CONFORM WITH US SUPREME COURT DECISIONS LIMITING STATEIMPOSED RESTRICTIONS OF PROFESSIONAL ADVERTISING T h e “ s u n s e t” p h e n o m e n o n h a s p r o d u c e d a n e w d e n ta l la w in F lo r id a . M u c h o f th e p re v io u s la w is re ta in e d . T h e n e w p ro v is io n s re fle c t c o n fo rm a n c e w ith re c e n t U S S u p re m e C o u rt d e c is io n s lim itin g s ta te -im p o s e d re s tric tio n s o n p ro fe s s i o n a l a d v e r t i s i n g . O t h e r n e w p r o v i s i o n s r e f i n e t h e d e n t i s t ’s a u t h o r i t y t o d e l e g a te f u n c tio n s to a u x ilia r ie s a n d s p e c ify p r o te c tio n s fo r th e d e n tis t- p a tie n t r e la tio n s h ip in “ m u lti- d e n tis t p ra c tic e s .” T h e F lo rid a b o a rd o f d e n tis try w ill h a v e n in e m e m b e rs : 6 d e n tis ts , 1 d e n ta l h y g ie n is t, a n d 2 m e m b e rs fro m th e p u b lic . T h e b o a rd w ill c o n tin u e to r e q u ire a c lin i c a l e x a m i n a t i o n o f a l l l i c e n s u r e a p p l i c a n t s . B u t t h e b o a r d ’s e x a m i n a t i o n p r o c e d u r e s a r e s u b je c t to s ta t u to r y r e q u ir e m e n ts s u c h a s “ a m a n d a to r y s t a n d a r d i z a tio n e x e r c is e fo r a ll e x a m in e r s p r io r to e a c h p r a c tic a l o r c lin ic a l e x a m in a ti o n .. . ” A d v e r tis in g b y d e n tis ts is g o v e r n e d b y a c o m p r e h e n s iv e s e t o f s tr ic tu r e s a n d g u id e s . T h e f u n d a m e n ta l g u id e e m p h a s iz e s t h a t th e p u r p o s e o f a d v e r tis in g is to p r o v id e th e p u b lic w ith “ a n in fo rm e d s e le c tio n o f d e n tis ts w h ile p ro te c tin g th e p u b lic fr o m fa ls e o r m is le a d in g a d v e r tis e m e n ts .” A d v e r tis in g o n r a d io o r te le v i s i o n is p e r m i t t e d b u t is s u b je c t to b o a r d r u l e s “ w h i c h r e f le c t t h e s p e c ia l c h a r a c te ris tic s o f s u c h m e d ia .” S ig n ific a n t a tte n tio n
is g iv e n to a d v e r tis e m e n ts o f
r o u tin e d e n ta l s e rv ic e s a n d fe e s c h a r g e d fo r th o s e s e r v ic e s . S p e c ific r o u tin e s e r v ic e s fo r w h ic h fe e s m a y b e a d v e r tis e d a re o u tlin e d i n th e s ta tu te . O th e r ro u tin e
F e e s fo r C o lo ra d o e ld e rc a r e d e n ta l p la n a r e p e g g e d to c o n s u m e r p r ic e in d e x .
T h e p ro g ra m
so n s w ith
lo w
fo r o ld e r p e r
in c o m e s
p re v io u s ly
c a r r ie d a te r m in a tio n d a te in 1 9 7 9 ; th a t d a te w a s s tric k e n a n d th e p ro g ra m w a s m a d e p e rm a n e n t. T h e a n n u a l c o s t o f liv in g in c re a s e fo r d e n ta l fe e s b e g in s o n J u ly 1, 1 9 8 0 ; d e n ta l fe e s a re in d e x e d to th e D e n v e r a re a
s e r v ic e s m u s t fit w ith in a g e n e r a l d e fin itio n o f ro u tin e
d e n ta l s e r v ic e s a ls o
s p e c if i e d i n th e la w . A s e p a r a te s e c tio n d e f in in g w h a t is m e a n t b y f a ls e a n d m i s le a d in g
a d v e rtis in g
in c lu d e s
“ la u d a to ry
s ta te m e n ts
a b o u t th e
d e n tis t” a n d
r e p r e s e n ta tio n s th a t re la te “ to th e q u a lity o f d e n ta l s e r v ic e s p r o v id e .” P r o v is io n s g o v e rn in g d e n ta l h y g ie n is ts a n d d e n ta l a u x ilia rie s fe a tu re a s e c tio n d e v o te d to e x p a n d e d fu n c tio n s . T h e d e n tis t m a y d e le g a te o n ly th o s e p r o c e d u r e s th a t a r e r e m e d ia b le . T h e d e n ta l b o a r d is a u th o r iz e d to a p p r o v e t r a in in g p r o g r a m s n e e d e d to e n s u r e th a t a u x ilia rie s a re c a p a b le o f e x p a n d e d fu n c tio n s p re s c rib e d b y th e b o a rd . P r o v is io n s g o v e rn in g d e n ta l la b o ra to rie s r e ta in a s ta tu to ry m e c h a n is m fo r r e g is te r in g d e n ta l la b o ra to rie s . O th e r fe a tu re s o f th e n e w F lo r id a la w r e q u ire d e n tis ts to m a k e c o p ie s o f a p a
c o n s u m e r p r ic e in d e x .
t i e n t ’s r e c o r d s a v a i l a b l e t o t h e p a t i e n t o r h i s l a w y e r , p e r m i t t h e d e n t a l b o a r d t o F lo r id a M e d ic a id p la n s p e c ifie s d e n tu re
care.
The
F lo rid a
M e d ic a id
r e g u la te th e u s e o f g e n e r a l a n e s th e s ia o r s e d a tio n , a n d p re s c r ib e th a t e v e ry p a tie n t s h a ll h a v e a d e n tis t o f re c o rd .
p la n n o w in c lu d e s s e v e ra l a d d itio n a l o p tio n a l s e rv ic e s s e r v ic e s q u ire d
of a
fo r th e
tu re s ” a n d
in c lu d in g
lic e n s e d
d is p e n s in g
“ d e n tu re s
“ th o s e
d e n tis t re of d en
m ade
or
L o u is ia n a s p e lls o u t s ta n d a r d o f c a re
u n d e r th e d ire c tio n o f a lic e n s e d d e n
fo r d e n tis ts a n d p h y s ic ia n s a p p lic a
d e n ta l p ra c titio n e rs is p o s s e s s io n o f
tis t.”
b le
k n o w le d g e a n d s k ill a n d e x e rc is e o f
7 5 4 ■ J A D A , V o l. 99 , O c to b e r 1 9 7 9
by
to
m a lp ra c tic e
c la im s .
The
s ta tu to ry s ta n d a rd o f c a re fo r g e n e ra l
LEG ISLA TIO N
&
L IT IG A T IO N
FEDERAL JUDGE IN ANTITRUST ACTION RULES RELATIVE VALUE GUIDES USED BY ANESTHESIOLOGISTS ARE NOT FEE-FIXING BECAUSE OF “UNIQUENESS” OF SPECIALTY
Legislation & Litigation
U s e o f re la tiv e v a lu e g u id e s in re la tio n to th e d e te rm in a tio n o f fe e s c h a r g e d b y p h y s ic i a n s h a s s p u r r e d a c tio n b y b o th th e F e d e r a l T r a d e C o m m is s io n (F T C ) a n d th e J u s tic e D e p a r tm e n t; b o th a g e n c ie s in s is t th a t r e la tiv e v a lu e g u id e s p r o d u c e fe e -fix in g i n v io la tio n o f th e fe d e r a l a n titr u s t la w s . S e v e ra l m e d ic a l a s s o c ia tio n s h a v e s ig n e d F T C c o n s e n t d e c r e e s , a g r e e in g to d is c o n tin u e u s e o f s u c h g u id e s .
care
c o m p a r a b le to
th a t o rd in a rily
p o s s e s s e d a n d e x e rc is e d b y d e n tis ts in s im ila r c o m m u n itie s u n d e r s im i la r c irc u m s ta n c e s . F o r d e n tis ts
in
s p e c ia lty p r a c tic e , th e s ta n d a r d is th e d e g re e o f c a re o rd in a rily p ra c tic e d b y d e n tis ts
in
th e
sam e
s p e c ia lty .
L o u is ia n a h a s a m e n d e d th e la w p e r m ittin g
use
o f c o rp o ra te
id e n ti
f ic a tio n s b y d e n tis ts to r e q u ire th a t a n y s u c h id e n tific a tio n in c lu d e th e n a m e o f o n e o r m o re o f th e v o tin g s h a r e h o ld e rs p lu s
“A
D e n ta l C o r p o r a tio n ”
P ro fe s s io n a l or “A
D e n ta l
C o r p o ra tio n .” T h e L o u is ia n a le g is la tu r e h a s p e titio n e d C o n g re ss to c a ll a c o n s titu tio n a l c o n v e n tio n
to
con
O n e m e d ic a l a s s o c ia tio n , th e A m e r ic a n S o c ie ty o f A n e s th e s io lo g is ts (A S A ), d e c lin e d to c o n c e d e th a t its g u id e s w e re ille g a l a n d fo r c e d th e J u s tic e D e p a r tm e n t to b rin g s u it in a fe d e ra l d is tric t c o u rt in M a n h a tta n , N Y . In a le n g th y o p in io n , th e fe d e r a l d is tr ic t ju d g e a b s o lv e d th e a n e s th e s io lo g is ts ’ re la tiv e v a lu e g u id e s o f a n y t a i n t o f a n t i t r u s t v io la tio n . T h e c o u r t r u l e d t h a t t h e J u s tic e D e p a r tm e n t f a ile d to d e m o n s tra te th a t A S A g u id e s a d v e r s e ly a ffe c te d in te rs ta te c o m m e rc e . H o w e v e r, th e ju d g e a ls o r u le d th a t th e A S A g u id e s c o u ld s u rv iv e th e s o -c a lle d “ r u le o f r e a s o n ” te s t fo r re s tra in ts o n tra d e a n d c o m m e rc e . T h e c o u rt fo u n d n o s u b s ta n tia l e v id e n c e o f “ a n a g r e e m e n t to a d h e r e to a p r ic in g fo r m u la n o r a n y c o n c r e te a n tic o m p e titiv e e ffe c t o n th e m a r k e t fo r a n e s th e s ia s e r v ic e s b y v ir tu e o f th e u s e o f th e A m e r ic a n S o c ie ty o f A n e s th e s io lo g is ts ’ R e la tiv e V a lu e G u id e s .” P e r h a p s th e m o s t c ru c ia l f in d in g o f th e c o u rt is “ th e u n iq u e c irc u m s ta n c e s s u r r o u n d in g th e a n e s th e s io lo g y p ro f e s s io n .” A p p a r e n tly th e ju d g e w a s e m p h a s iz in g t h a t o th e r a re a s o f m e d ic a l p ra c tic e c o u ld n o t m a k e th e s a m e c a s e fo r th e ir re la tiv e v a lu e g u id e s
as
d id
th e
a n e s th e s io lo g is ts .
(US vs
S o c ie ty o f
A m e ric a n
A n e s th e
s io lo g is ts , I n c ., U S D i s t r i c t C o u r t, S o D is t, N Y N o . 7 5 C iv 4 6 4 0 , 1 9 7 9 - 2 T r a d e C a s e s , J u ly 1 9 7 9 .)
s id e r a n a m e n d m e n t th a t w o u ld p re s e rv e th e p r im a c y o f s ta te la w s o v e r ru le s o r r e g u la tio n s is s u e d b y fe d e ra l a g e n c ie s . to s o m e in d iv id u a l p la n s . M o n ta n a
d e n ta l
la w
p ro v is io n s re v is e d .
a d v e rtis in g
T h e n e w a d v e r
T he N ew
Je rse y s ta tu te g o v e rn s th e c o n fid e n
a p r o n to s h ie ld p a tie n ts w h e n d e n ta l ra d io g ra p h s a re ta k e n b y a d e n tis t o r
“ e x c lu s iv e ly
d e n ta l h y g ie n is t. T h e N e w Y o rk p u b
tis in g lim ita tio n in c lu d e s p e rm is s io n
g e n e r a te d ” b y re v ie w c o m m itte e s . A
lic h e a lth la w w a s a m e n d e d to p ro
to p u b lis h a lis t o f fe e s, “ b u t s u c h lis t
n e w p ro v is io n in c lu d e s h o s p ita l p e e r
h ib it
in g m u s t in c lu d e fu ll a n d c o m p le te
re v ie w
s o le ly to v e rify s e rv ic e s p e rfo r m e d
in fo r m a tio n s ta tin g if th e p u b lis h e d
re s p o n s ib ility fo r th e re v ie w o f q u a l
fe e
ific a tio n s a n d
is
m in im u m
o r m a x im u m ,
or
tia lity
o f in fo r m a tio n
c o m m itte e s
“ h a v in g
th e
ta k in g
d e n ta l
ra d io g ra p h s
u n d e r th ir d -p a rty p la n s .
c re d e n tia ls o f p h y s i
u s u a l a n d w h e th e r o r n o t a n y a d d i
c ia n s
t i o n a l c h a r g e s m a y b e m a d e _____ ” T h e
m e n t o r re a p p o in tm e n t to a m e d ic a l
c o n tro v e rs ia l
M o n ta n a b o a rd o f d e n tis try n o w in
o r d e n ta l s ta ff o f a h o s p ita l, o r o f
m e n t fo r s ta n d a rd iz e d te s tin g p ro
c lu d e s fiv e d e n tis ts a n d tw o d e n ta l
q u e s tio n s o f th e c lin ic a l o r a d m in is
g ra m s.
h y g ie n is ts .
tra tiv e c o m p e te n c e o f p h y s ic ia n s o r
q u ire m e n t a p p lie s to a p titu d e te s ts
added
d e n ta l b o a rd . e rn in g
th e
to N e w The
new
s e e k in g
a p p o in t
N ew
Y o rk e d u c a tio n la w d is c lo s u re
in c lu d e s re q u ire
T h e n e w e d u c a tio n la w re
d e n tis ts . . . o r . .. th e s c o p e o f h o s p ita l
u s e d b y p o s ts e c o n d a ry
o n e la y
p riv ile g e s o f p h y s ic ia n s o r d e n tis ts
s io n a l s c h o o ls
H a m p s h ire
. . . o r . . . th e d is m is s a l o r d is c h a rg e o f
m is s io n to th o s e s c h o o ls . T h e A D A
O n e d e n ta l h y g ie n is t a n d p e rso n
o r d e n tis ts
p ro v is io n
d e n ta l
and
p ro fe s
fo r d e te rm in in g
ad
gov
s a m e .” T h e n e w p ro v is io n o f th e N e w
d e n ta l a p t i t u d e t e s t is i n c l u d e d . T h e
h y g ie n e
J e rs e y in s u r a n c e la w , a p p lic a b le to
la w n o w re q u ire s th a t th e te s t a g e n c y
m e m b e r s tip u la te s th a t “ th e d e n ta l
re im b u rs e m e n t o f d e n tis ts
h y g ie n e m e m b e r s h a ll n o t e x a m in e
v ic e s c o v e re d u n d e r m e d ic a l p la n s ,
C o m m is s io n
a p p lic a n ts fo r th e c lin ic a l p ra c tic e o f
e x te n d s th e re im b u rs e m e n t re q u ire
th o s e w h o to o k th e te s t o n re q u e s t.
d e n tis try .”
T h e la y
fo r s e r
d is c lo s e te s t re s u lts to th e N e w Y o rk o f E d u c a tio n
and
to
m e m b e r “ s h a ll
m e n t to in d iv id u a l h e a lth in s u r a n c e
n o t e x a m in e a p p lic a n ts in th e c lin i
a lre a d y d e liv e re d , u n le s s th e p o lic y
P e n n s y lv a n ia
c a l p ra c tic e o f d e n tis try o r . . . d e n ta l
s p e c ific a lly lim its re im b u r s e m e n t to
d e n t a l l a b o r a t o r y c o s t s o n d e n t i s t ’s
h y g ie n e .”
p e rs o n s o th e r th a n d e n tis ts .
b illin g d e fe a te d .
p ro p o s a l re q u irin g
T h e P e n n s y lv a n ia
D e n ta l A s s o c ia tio n N ew
J e rs e y p e e r re v ie w
e x te n d e d
to
im m u n ity
h o s p ita l p e e r re v ie w
c o n v in c e d
th e
N e w Y o rk a d o p ts tw o m e a s u re s g o v -
le g is la tu re th a t th e id e n tific a tio n o f
e rn in g
r a
l a b o r a t o r y c o s t s o n a d e n t i s t ’s b i l l i n g
w as
c o u ld re a d ily b e m is le a d in g a n d c o n
u se
o f
c o m m itte e s ; r e im b u r s e m e n t fo r d e n
d io g ra p h s .
T he
tis ts u n d e r m e d ic a l p la n s e x te n d e d
am ended
re q u ire
to
d e n ta l
d e n ta l use
la w
o f a le a d
fu s in g to p a tie n ts . J A D A , V o l. 9 9 , O c to b e r 1 9 7 9 ■ 7 5 5
LEG ISLA TIO N
&
V irg in ia
s e ts
d e n tis ts
in v o lv e d
s u its .
LIT IG A T IO N
s ta n d a rd
fo r
c a re s ta te w id e . A lo c a l o r c o m m u n ity
m a lp ra c tic e
s ta n d a r d w ill b e a p p lie d o n ly if th e
T h e n e w V irg in ia la w a p p lie s
p ra c titio n e r c a n sh o w , b y a p re p o n
in
o f care
to r e v ie w p a n e l s a s w e ll a s to c o u r t
d e ra n c e o f e v id e n c e , th a t a c o m m u
a c tio n s . T h e
n ity
new
p r in c ip a l g o a l o f th e
la w is to m a k e th e s ta n d a r d o f
s ta n d a rd
is
m o re
This colum n was prepared by B ernard J. Conway, ADA associate executive director: legal and legislative affairs.
a p p ro p ria te
th a n a s ta te w id e s ta n d a rd .
Verrazano Narrows Bridge connects the boroughs of Brooklyn and Staten Is land and was photographed by Dr. Sanford E. Klein, a general practitioner who lives in Roslyn Heights, NY.
7 5 6 ■ J A D A , V o l. 9 9 , O c to b e r 1 9 7 9