Dentists File Suit to Halt Hygienist Project at CSUN

Culminating a six-year dispute between dentists and dental hygienists, the California Dental Assn. has gone to court to stop a pilot program run by California State University, Northridge in which dental hygienists provide checkups and cleanings without a dentist in attendance.

The program is the first effort in the country to assess the safety and economic viability of independent practices by dental hygienists, according to the Chicago-based American Dental Hygienists Assn.

The experiment began last month when five dental hygienists in three Northern California cities began providing unsupervised care to patients, said Jerome Seliger, a CSUN professor of public health who is directing the project. Their work--including office care and mobile service for institutions such as nursing homes--is being monitored by dentists, public health specialists and state officials, he said.

The most ambitious part of the project, a clinic in Reseda with eight hygienists, is ready to open but has been held up by the dispute with the state dental society.

Injunction Being Sought

In a lawsuit filed Monday in Superior Court in Sacramento and scheduled for its first hearing today, the dental association is seeking a temporary injunction to keep hygienists from opening private practices. The suit alleges that state health officials did not adequately review the CSUN program before approving it.

The suit names as defendants CSUN, the Office of Statewide Health Planning and Development and other organizations and individuals. It is aimed at “stopping the program until the state can go through the review process mandated under the law to ensure the safety of patients,” said Paul Lombardo, legal counsel for the association representing 14,000 dentists.

“The program as proposed would allow a hygienist to see patients, to make judgments about their physical condition, which they may not be qualified to make,” Lombardo said. “While we’re told the patients are then going to be encouraged to see a dentist, they might not.”

In California, licensed dental hygienists can practice only under supervision of a dentist. The CSUN project was put together under the Health Manpower Pilot Projects Act of 1972, which allows experiments in alternative health care under carefully monitored conditions, said Jean Harlow, an official with the Office of Statewide Health Planning and Development.

“California is the only state in the country with legislation that allows this kind of testing of new health-care ideas,” said Tobelle Segal, a dental hygienist in the program who is slated to be office manager of the Reseda clinic.

“Dental-Hygiene Duties’

The state has approved and monitored more than 100 programs to test systems of providing health care that would otherwise violate state laws, Harlow said.

Segal said hygienists in the CSUN program will perform only procedures that are now allowed under general supervision--where a dentist is available but not necessarily in the same room. They will clean teeth, administer fluoride treatments, perform general dental examinations and take X-rays, Segal said.

“We’re not interested in doing anything but dental-hygiene duties,” she said.

Rates are similar to those charged in dentist offices, she said.

Planning for the project started in 1981, when the California Dental Hygienists Assn. asked Seliger for help in drafting a proposal. The state gave initial approval to the plan that year over the objections of the California Dental Assn., Seliger said. Each year since, the Office of Statewide Health Planning and Development has re-examined and approved the project as it evolved, Seliger said.

“The overall goal is to see whether or not dental hygienists can operate independently of dentists,” the project director said. “Can they bring new people into the dental system, provide quality care and do so in an economically viable way?”

He said CSUN is responsible for “the overall academic integrity” of the project, including training participants, who already are licensed as hygienists, in health management; collecting data on the types of patients served and studying the economic viability of private practices.

The care delivered to patients will be monitored by Dr. James Freed, a professor of dentistry and public health at UCLA, who will periodically visit the hygienists and examine their records, Seliger said.

So far, five hygienists have completed 300 hours of clinical training and gone into practice, one each in San Francisco and Sacramento, and three who run a clinic in Los Banos.

Record keeping for all the practices will be done through the Reseda clinic, which will be run as a nonprofit corporation, Segal said.

Not Enough ‘Review’

Lombardo, the dental association’s lawyer, alleges that the project got under way without adequately complying with state requirements for “a good many public meetings and hearings . . . notices sent to interested parties, advice and comment from professional associations like the California Dental Assn.”

“There was some review in 1981--not enough, we think. And none occurred in 1986,” Lombardo said. “We’re trying to ensure that the state goes through all the procedures so that public health and safety can be assured.”

Connie Tussing, president of the American Dental Hygienists Assn., said the California program should not be stopped because it will provide “valuable data needed by both dentistry and dental hygiene.”

“This is merely a demonstration project that would provide data about dental hygiene in an independent setting. We do not have that data in the United States at all,” she said.

Segal complained that organized dentistry has consistently opposed independence by hygienists.

“Dentistry is saying, ‘Don’t think. Don’t even try to advance your profession. We like it the way it is. We don’t think you have any capabilities,’ ” Segal said.