By Davila H.C.R. No. 296 75R15715 RNS-D HOUSE CONCURRENT RESOLUTION 1-1 WHEREAS, Under current Texas law, a dentist may refuse a 1-2 parent's request to be present during the treatment of a child, and 1-3 the current practice patterns of managed care, financial 1-4 constraints, or the pressing needs of an emergency situation often 1-5 prohibit parents from selecting another dentist who will honor 1-6 their request; and 1-7 WHEREAS, Recent studies indicate that parents often feel very 1-8 strongly about staying with their children during dental and 1-9 medical visits, and there is evidence to suggest that children's 1-10 cooperation increases with a parent present during both examination 1-11 and treatment appointments; and 1-12 WHEREAS, The American Academy of Pediatric Dentistry has 1-13 established guidelines for the dental treatment of children that 1-14 include behavior management techniques such as physical restraint 1-15 with a "Papoose Board" and techniques that involve covering a 1-16 child's mouth and/or airway to obtain the child's attention; and 1-17 WHEREAS, Recent studies have found that these techniques are 1-18 not acceptable to a majority of parents surveyed, raising concerns 1-19 among dentists and patients alike that a parent's consent to 1-20 pediatric dental procedures be adequately informed so as to 1-21 forestall misunderstanding and possible litigation; and 1-22 WHEREAS, In addition to concerns regarding standard treatment 1-23 practices, there also is cause for concern that some dentists may 1-24 cross the line between physical restraint and physical abuse, as 2-1 demonstrated in recent court cases; although such cases are surely 2-2 the exception, it is impossible to assess how widespread such 2-3 abuses might be, since a parent may be excluded routinely from the 2-4 treatment session; and 2-5 WHEREAS, Such concerns are particularly acute regarding the 2-6 state Medicaid program, since some dentists have established a 2-7 high-volume practice to compensate for low reimbursement rates, 2-8 funding for regulatory oversight is in short supply, and parents 2-9 with limited resources may have little choice in selecting an 2-10 alternative dental provider; and 2-11 WHEREAS, A comprehensive study of this issue would help to 2-12 establish the extent of possible abuses in this area and could 2-13 provide the basis for agency action to protect vulnerable children 2-14 from unnecessarily aversive treatments, better inform parents of 2-15 treatment choices, and help dental practitioners avoid malpractice 2-16 claims; now, therefore, be it 2-17 RESOLVED, That the 75th Legislature of the State of Texas 2-18 hereby direct the Texas Department of Health to conduct a study of 2-19 the access to pediatric dental care and the quality of care 2-20 received by Texas children, both in the private sector and under 2-21 the Medicaid program; and, be it further 2-22 RESOLVED, That the study include, but not be limited to, an 2-23 investigation of the following issues: 2-24 (1) how parental involvement affects the quality of 2-25 pediatric dental care and the possibility of abuse; 2-26 (2) an evaluation of current mechanisms for reporting 2-27 abuse of pediatric dental patients and the effect that the lack of 3-1 a parental presence might have on the adequacy of reporting; and 3-2 (3) the role of informed consent by a parent to 3-3 treatment techniques and the effect of parental consent on the 3-4 quality of pediatric dental care; and, be it further 3-5 RESOLVED, That the Texas Department of Health submit a full 3-6 report of its findings and recommendations to the 76th Legislature 3-7 when it convenes in January 1999; and, be it further 3-8 RESOLVED, That the secretary of state forward an official 3-9 copy of this resolution to the commissioner of health in the Texas 3-10 Department of Health.