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.