Texas State Auditor's Office SAO Reports: An Audit Report on Internal Controls and Financial Processes at the Texas State Board of Dental Examiners

Regulatory

An Audit Report on Internal Controls and Financial Processes at the
Texas State Board of Dental Examiners

June 2002

Report Number 02-050

Overall Conclusion

We are concerned that weaknesses in the Texas State Board of Dental Examiners' (Board) complaint resolution process impair the Board's ability to protect the health of Texas dental consumers. The Board's inconsistent application of rules and policies and flawed investigation process severely weaken its oversight of dental professionals. The Board has an ongoing history of weaknesses in its complaint resolution process. Prior State Auditor's Office reports issued in August 1997 and March 2000 made recommendations to the Board to strengthen controls over enforcement. We found that certain weaknesses we identified in these reports continue to exist.

Key Facts and Findings

The Board does not consistently enforce policies regulating dental professionals. As a result, dental professionals who have committed similar infractions have received different sanctions or no sanctions at all. The Board also does not complete investigations regarding complaints about dental professionals in compliance with its own policies for evidence and timeliness. Staff investigators lack the authority and medical qualifications that could expedite the investigation process, particularly for high priority complaints involving death or injury.

Examples of the specific weaknesses we identified in the Board's complaint resolution process include:

• The Board has failed to consistently apply criteria and policies for sanctions and evidence requirements related to complaints.



• The Board lacks controls to ensure that enforcement actions are promptly implemented.



• The Board closed 22 percent of the quality of care complaints we reviewed without obtaining the records of a subsequent treating or second dental professional. Board policy requires investigators to obtain the records of a second dental professional's opinion when they investigate cases involving quality of care.



• The Board is not completing complaint investigations within the time frames established by its own policies. In fiscal year 2001, the Board took an average of 201 days to investigate cases based on a sample of 54 complaint investigations. Board policy states that cases should be investigated within 60 days (for Priority 1 complaints involving death or injury) or 120 days (for relatively less serious Priority 2 complaints).



• The Board does not have a licensed dental professional on staff. Three of four other Texas health profession licensing agencies have licensed professionals involved in complaint investigations.



• The Board's Enforcement Database, which is used in the tracking, processing, and investigation of complaint cases, does not have adequate controls in place to ensure that complaint data is accurate and reliable.

It should be noted that our review of the Board's licensing process indicates that this process is timely and efficient. Although we found no issues associated with the licensing process itself, our findings regarding the complaint process indicate that the effectiveness of licensing is impaired when sanctions regarding license revocation are not implemented.

We tested certain financial processes at the Board for accuracy and compliance with state rules and regulations. Nothing came to our attention that indicated the Board had violated either the State's three-day deposit rule or the State's travel regulations. We also tested the accuracy of two performance measures. We were unable to certify the Board's reported average time for complaint resolution. We certified with qualifications the Board's reported average licensing cost for individual licenses issued.

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