1999 Year in Review

Folks who fish a lot know their chances of hooking a big one are not too great, but they keep on fishing anyway. Sometimes a line cast into the water produces nothing, sometimes only a bite. But once in a while the hook snags a really big one -- the line plays out so fast it sings, and the fishing pole bends at such a sharp angle that it threatens to snap.

"You should’ve seen how that big’un fought," brags the seasoned fisherman to another after the battle is won. "That one was a keeper."

And so was the year 1999 for the California Dental Association. It was a keeper in many ways, even though not every cast of the line produced results. There were successes -- and failures -- in CDA’s legislative agenda and in the effort to bring fluoridated drinking water to more Californians. A new diversity initiative came into focus, and a forward-looking budgeting process came into play. The association also had its day in court -- the U.S. Supreme Court. Dentistry has a new specialty, oral and maxillofacial radiology, and The Dentists Insurance Company turned 20 and opened its glitzy new Esquire Plaza complex, complete with an IMAX theater and 22-story office tower. And the Direct Reimbursement program soared to new heights last year, far surpassing l998’s business conversion record.

Diversity Rules

An important issue last year should have been easy to spot by anyone who cared to take a look: The graduating classes at California dental school were a rainbow of diversity. The former majorities, white males, are now the minority, making up only 44 percent of the average graduating class in 1999. Most were Asian at 48 percent, with African American, Hispanic, and Indian ethnicities steadily increasing their position. Women, who in years past made up from 20 to 30 percent of each class, last year reached a record high of 37 percent.

Attesting to CDA’s realization of the need to include diverse groups in its membership, an ad hoc Diversity Steering Committee presented a Strategic Plan for Organizational Diversity and Inclusiveness to the 1999 House of Delegates. The delegates voted in favor of the plan that lists specific strategies, defines tasks for implementation, and outlines measurements for success.

"It’s going to be critical that all practicing dentists understand the differences and embrace the changes of our diverse profession," said committee Chairman Russell I. Webb, DDS. "That’s what the diversity and inclusiveness initiative is all about."

In a move that exemplified the association’s focus on diversity, CDA’s Board of Trustees in August nominated periodontist Debra S. Finney, DDS, to the post of CDA treasurer. Her election at November’s House of Delegates puts a woman for the first time on a path to the top level of association leadership.

"I was not nominated because I am a woman," Finney said. "I think the biggest significance is that the association realizes the importance of diversity."

By the Numbers

CDA’s House of Delegates last November passed a balanced budget for 2000 of $16.1 million, after several years of budgeting on the fly and using windfalls and other nondues revenue to boost operating budgets. The balancing act was the product of lots of hard work by CDA’s chief financial officer and his staff and the volunteers on the Finance Committee.

"We worked closely with the members of the Finance Committee to give them information to help them make decisions they were comfortable with," said CFO Richard Krolak, PhD. "And this year we’ve become more aggressive about managing the budget and holding directors accountable, and the net result is that we had a budget everyone was proud of."

Steven D. Chan, DDS, CDA treasurer for 1998-99, said that in the past the association was, "in crisis mode, constantly problem-solving and putting out fires.

"Rich, working with his staff and with the Finance Committee, was able to identify where we could manage money better, and how we could move to better management of our funds," he said. "We also tried to piece together prior years’ budgets, which helped us to look forward. We learned from history how to evolve to a better system and a better corporate model."

A Slow Year Under the Dome

Legislatively, 1999 got off to a slow start with Sacramento adjusting to a Democratic governor for the first time in 16 years. Sacramento -- and CDA -- is still going through that adjustment period while continuing to receive clues about the new governor.

"CDA got some of those clues when two of our bills were vetoed because the governor’s fiscally prudent nature preferred administrative action to legislative action," said Elizabeth M. Snow, director of the Government Relations Office.

Snow said the Davis administration will be moving to appoint a dental director, as was proposed in SB 1235, and has already undertaken an independent comprehensive study of Sacramento’s Geographic Managed Care program that was required in SB 856. Davis, however, vetoed both bills.

"We also held off any increases in the cap on MICRA and kept any change to a cost of living increase," she said. "This was quite a victory, although the bill is still in the Senate and could be amended next year."

In the waning days of the 1999 state legislative session, Davis and the Legislature agreed on a package of managed care reforms that did not include a provision for enrollees in dental plans to obtain an independent review of dental claims.

"But we have received indications that Gov. Davis may be interested in looking more closely at the dental issue in the 2000 legislative session," said Bill Lewis, GRO policy analyst.

On Jan. 1, AB 2006 took effect. The law set up a Board of Dental Examiners certification process for dentists to use oral conscious sedation on children under age 13. It was passed in late 1998 in response to the deaths of two pediatric patients in California dental offices.

Finally, California’s sharps injury prevention law that went into effect July 1 had some CDA members stuck for answers about how to comply with the new regulation. The requirements are not limited to needles -- they apply to all sharps, including needles, explorers, scalpels, curettes, burs, and wires. But other than four safety needles, there are no dental devices on the market that comply with the new rules. This means an exception applies for all dental instruments, but dentists must document the exception, so there is more paperwork.

Fluoridation Inches Forward

Community water fluoridation continued last year in fits and starts, as some communities embraced the oral health measure, and others opposed it. But the year began on a decidedly positive note, in the form of a huge financial boost for fluoridation. Word came on Jan. 14 that the California Endowment had made a $10 million grant to hasten the process of supplementing selected community water supplies with the proven cavity fighter. It was seen as a pivotal event to finally begin implementation of AB 733, the landmark but unfunded state mandate passed in 1995 that requires cities with more than 10,000 customers to fluoridate their water supplies.

"I was jumping for joy when I got the news," said Tim Collins, DDS, MPH, California Fluoridation Task Force chairman and dental director of Public Health Programs and Services for the County of Los Angeles Department of Health Services. "I’m really excited about this, and I’m glad the Endowment has recognized that this is an important public health measure."

The Endowment’s grant was seen as a big step toward making AB 733 a reality, perhaps providing an impetus to convince other private funding sources to follow the California Endowment’s lead. But as the year progressed, the initial euphoria and hopefulness was tempered at times by hard reality: Even though some funding was available, a few cities didn’t want fluoridation or even voted to defy the state law.

In Santa Cruz, an extremely thin margin of 74 votes in a special election on March 2 gave the city the dubious distinction of becoming the first city in California to challenge the state law. Timothy F. Comstock, CDA’s executive director, believed that the views about fluoride held by Santa Cruz residents who voted against fluoridation are not typical for the state.

"The antifluoridation measure was the product of an out-of-town antifluoridation effort that based its campaign on rumor and innuendo," he said.

Bad news surfaced again last spring when two San Diego County municipal agencies also came out against the state’s fluoridation mandate. A bright spot soon followed when the Sacramento City Council on March 30 voted unanimously to accept a $1.41 million grant from the California Endowment to fluoridate the city’s municipal water supply, the first city to accept a portion of the $10 million grant. The vote paved the way for more than 390,000 residents to begin enjoying the benefits of fluoridation as the new millennium began.

In Los Angeles, where the City Council late in 1998 had approved fluoridation, the plans hit a snag. A lawsuit contended that the Los Angeles Department of Water and Power hadn’t provided sufficient notice to the public of its plans to fluoridate the city’s water supply, delaying the project. On Nov. 16, a Los Angeles Superior Court judge threw out the lawsuit seeking to reverse that city’s plan to fluoridate, thereby supporting community water fluoridation. Meanwhile, in the north state, Yuba City received an $81,000 grant from the Sacramento-based Sierra Health Foundation to help pay for equipment to fluoridate that city’s water system.

As the year wound down, more good news came with the League of California Cities’ decision in October to vote against two antifluoride-related resolutions during its annual general assembly in San Jose. Teran Gall, DDS, CDA’s director of Special Projects who attended a preliminary League meeting, said the science of fluoride was debated to some degree but, "Members of the League in their wisdom saw through the smoke and mirrors being presented by the opposition, and refused to hear the resolutions on the general assembly floor."

CDA Has Its Day in Court

It was to be the end of CDA’s long-running legal battle with the Federal Trade Commission to determine whether the agency held regulatory purview over nonprofit associations and whether the association’s advertising restrictions harmed competition. But in its May 24 ruling, the U.S. Supreme Court left part of the case open, returning the advertising issue for further consideration to the U.S. 9th Circuit Court of Appeals in San Francisco. The 5-4 decision set aside the 1997 appeals court decision that said the FTC properly decided that CDA’s ethics rules illegally harmed competition.

"In a sense the case isn’t over," said Raoul Renaud, then CDA’s senior legal counsel. "I view it as a statement that the FTC didn’t prove its case, and CDA is pleased to have been vindicated by the high court. CDA said all along that the FTC didn’t prove that the association harmed competition, and the Supreme Court agreed."

However, on the issue of whether the FTC has authority to regulate nonprofit associations, the court gave it a mandate, unanimously ruling that the agency acted within its authority in 1993 when it sued CDA, alleging its disclosure requirements barred members from advertising nonspecific discounts or quality of care.

Consumers who may want to compare prices and shop around may eventually benefit.

"The ultimate outcome, I predict, will be that advertising guidelines such as CDA’s will be deemed acceptable," Renaud said. "Assuming that is true, consumers will benefit by seeing advertising that is truthful, complete, and contains more and not less information."

ADA Approves a New Specialty

The ADA House of Delegates at its October annual session approved Oral and Maxillofacial Radiology as the dental profession’s first new specialty in 36 years.

Delegates voted to approve a specialty recognition application from the American Academy of Oral and Maxillofacial Radiology, after deciding that the group had met all six criteria for specialty status.

"We are pleased to welcome oral and maxillofacial radiology as the newest recognized specialty of the American Dental Association," said new ADA President Richard F. Mascola of New York. "This is another way the ADA is further advancing the profession of dentistry, by recognizing that new technology and complex oral health care procedures may need a specialist in oral and maxillofacial radiology."

AAOMR reports that there are four actively practicing board-certified oral and maxillofacial radiologists in California, out of 112 in the country.

Before the ADA House action, the last area of dentistry granted specialty status was endodontics in 1963. With the addition of oral and maxillofacial radiology, dentistry now has nine recognized specialties.

Lights Shine at Esquire Plaza

The $60 million Esquire Plaza project, primarily underwritten by The Dentists Insurance Company, officially opened July 15 amid festivities designed to draw attention to its part in revitalizing a major city business corridor in downtown Sacramento. It includes a 22-story Class A office building, parking garage, and IMAX theater.

Frederick E. Knauss, TDIC president and chief executive officer, said that the new development -- by nature of its design, amenities, and proximity to the state Capitol -- is also good news for CDA members.

"While no CDA member dues were used in the development of the project, it further enhances TDIC’s ability to provide quality insurance services to its members," Knauss said. "Esquire Plaza was just another part of TDIC’s diversified investment portfolio to enhance its ability to provide long-term stable insurance products to the members of organized dentistry."

The CDA subsidiary this year also returned $3.8 million in policyholder dividends, continuing a tradition that began in 1989 that has returned almost $30 million in this fashion. Recognizing TDIC’s strong financial position, the A.M. Best Company, the nation’s leading insurance rating firm, has rated the company "A" (excellent) each year since 1994. Only 15 percent of specialty medical malpractice carriers are rated "A," and none are rated higher.

TDIC was the nation’s first dentist-owned professional liability insurer when it was created in reaction to a crisis that rocked the malpractice insurance market in the late 1970s.

The company also began its 20th year of service to CDA members on July 1.

"California dentists who’ve been our policyholders since day one are the ones to be most honored," Knauss said.

Those dentists, numbering 2,420, have held TDIC insurance policies continuously since the company began issuing them on July 1, 1980.

DR Zooms to New Heights

CDA’s Direct Reimbursement program last year was a rolling juggernaut, with new conversions for 1999 at 130 in late November, far outstripping 1998’s record of 101.

"I feel in a way it’s proof of the pudding," said Michael J. McRae, DDS, Direct Reimbursement Committee chairman. "Our good staff and broker network is showing that DR is viable and proving what we knew all along -- that DR works."

McRae wants to build on last year’s success by putting together a bigger broker network and trying to get brokers more enthused about the program. There are 38 CDA-appointed brokers working on implementing more plans throughout the state.

"Of course we have a long way to go, but I feel we’re on the toe of a logarithmic curve," he said.

In almost 11 years of operation, CDA’s DR program has implemented 675 plans covering more than 40,000 people throughout the state.

Gall, who oversees DR operations, said CDA is finally realizing a good return on its investment.

‘This is due, in part, to a dedicated staff, an active broker network, and employers and employees who are fed up with denied claims, outrageous premiums, and limited provider networks," he said.