Alabama Dental Association

For the purposes of this transcript, the following symbols apply: (u) - unintelligible (ph) - Things that are difficult to decipher but can still be heard will be written out as heard phonetically. [ ] - These brackets denote transcriber's comments and will be placed at beginning and end of comment.

Transcribed Audio: Dr. Gaines Thomas [Moderator and President of the Alabama Dental Association]: tonight let's talk...

Lower Voices: (u) Dr. Gaines Thomas(cont): um, I think that..

Lower Voices: (u) Dr. Gaines Thomas(cont): let's move to discussion, uh, right above that, on the Sarrell Dental Clinic and Doctor Studstill (ph) hereSecond Man (interrupts Dr. Gaines Thomas): ... we had some comments about that.

Lower Voices: (u) [throughout as if a TV is on in the background] Dr. Studstill: well actually we've got somebody who has a lot more information than I do about the Sarrell Clinic and that's Dr.Roger Smith (ph).. uh, Dr.Smith, hope you're still in the room.

Man: laughter [into second microphone, seemingly] Dr. Studstill(cont): oh, praise the Lord. Would you like to come forward where people can hear you with microphone?

Lower Voices: (u) [throughout as if a TV is on in the background??]

First woman: why don'tcha put the (u).. why don'tcha put that in front of the podium?

TIME @ 54 seconds Dr. Roger Smith: I don't know if all of you who are uh aware...

Second woman: Is he driving you ballistic?

Lower Voices: (u) [throughout as if a TV is on in the background??]

Dr. Gaines Thomas: (u).. okay, thank you.

Second woman: Did he ask who did it? [and continues as Dr. Roger Smith Speaks] Dr. Roger Smith: uh, but the problem in the state of Alabama, uh, for the dental profession, um, is not for profits... um, I mean you're all probably familiar now with Sarrell Dental.. in various sections.. throughout the state, uh, the northern part of the state (u) Lower Voices: (u) [throughout as if a TV is on in the background??]

Dr. Roger Smith(cont): Let's see, uh, there are other.. uh, not for profit's. One, uh, just started up in Woodlawn by the Church of the Highlands, Robert? (ph) Third Man[presumably]: (u)..Take his turn.. (u) Fourth Man: just, just use this one. Might work better. [reference to microphone] Lower Voices: (u) [throughout as if a TV is on in the background??]

Dr. Roger Smith(cont): [clears throat] and the problem with these is that they're comin' in and they are submitting claims to Medicaid.. uh, all kids, and any other insurance, um, that, uh, patients may have when they come visit them. The problem in our community is .. that, they don't really have, uh, a dog in the race. They don't own any of their buildings. They are donated or they may pay a dollar a month or a dollar a year in rent. Uh, they do not pay, uh, income tax. They do not buy a business license. And they get their supplies much cheaper than anyone in this room can hope to buy for. And they are competing for...us, every dentist in the state of Alabama that has put their.. kinda butt on the line with opening up his own practice, or dental practice.. and, uh, it's, you know, it's not a level playing field.

And they are continuing to spread and have plans to spread even more. Um, there's another company that, uh, Sarrell has kind of, um, working, ya know, chosen that model to work on, is FORBA. It was formed in Buffalo, Colorado (ph) several years ago and uh.. they have plans by now, to say now they serve 750,000, uh, people in the, uh, United States right now. They have plans to expand that to two million people I think by the year, uh, 2012. So, ya know.. in order to protect dentistry we have to band together in some way to control this. Uh, my suggestion would be that, um, they be required any not for profit be required to acquire a certificate of need from a government board involved, ya know, made up of the dental society before they open a, uh, business. Um, they've kind of cherry picked certain places, um, and gone in, ya know, cause of the population there tends to be so high. You don't see 'em going out to Greene (ph) county, Eutaw [Alabama]or anywhere like that where there's a true need. And so I, I think that this is something that we need to address and get some legislation passed, uh, the uh, and, and ya know if they are gonna TIME @ 4:14 (u) legislate pass a certificate of need, then they should be able to get, have to get another certificate of need if they plan to open up another uh, location.

TIME @ 4:27 Dr. Gaines Thomas: (u) Fifth Man: Anybody have any questions?

Dr. Gaines Thomas: Go ahead. Uh, Guy (ph)?

Dr. Guy Rosenstiel: Aren't, aren't these organizations corporately owned?

Dr. Roger Smith: Uh.. they're not for profits, uh... I don't think they really have any ownership under the way that they're set up. The, uh, FORBA, uh, the ones, the Small Smiles that operate in the state.. they are corporately owned. There, there's no, there's not a dentist that I'm aware of. At uh, ya know, you read through some of these articles I've got in here and their websites where you get access to uh get more information there. Um, uh, and according to, you know, what I've got in this paper there's a bank in uh Saudi Arabia (ph) that uh I think ultimately owns, holds the paper on, uh, FORBA now which is now based out of Nashville... here.

Karen McCaffrey: Now, uh, I was on the board when FORBA actually came to the board and you know wanted to set up a practice and it is the ones in Alabama or at least the way it started out it wasn't owned by a dentist. So the problem is the way the Practice Act was written and I think it's even if they're (u) owner, I don't think they can do anything about it, so, that might need to be with them.

Dr. Roger Smith: I thought that the law stated you know that a non-dentist could not own any portion of a, uh, practice that provided, uh, dental care?

Karen McCaffrey: Yes, well when he came in, you know, he said he was looking to be the owner.

That's how they got in...

Dr. Roger Smith(cont): Right.

Karen McCaffrey(cont): Now but where it's gone from there, I don't know...

TIME @ 6:14 Dr. Roger Smith: because FORBA was originally started by a dentist and, ya know, in Colorado (ph) and, and it's then since spread that, that it's also changed hands, um. If you try to run a paper trail, good luck, ya know.

Dr. Gaines Thomas: (u) TIME @ 6:27 Eight Man: [cough] Small smiles recently uh... what was it, twenty four million they had to pay back in Medicaid costs.

Dr. Roger Smith: Yeah.

Eight Man: Was that in Alabama? Now that's what I was fixin' to ask... if, if Alabama was included, and... but my question is, is there anything in that Mobile Dental Clinic legislation that they're using as a gray area to get it through. Is there anything in there that we can kick Small Smiles out for that amended (ph) collection whether it's in this state or another state.

TIME @ 7:00 Ninth Man: Those are... real good questions... if I can.. ya know, I've read it, and I've read it, and I've read it, I've read the pages. There is one small line of the practice in there. That, and first of all let me just say the, the board of Dental Examiners is not responsible for that piece of legislation, ALDA is not

responsible for that piece of legislation. What happened was the board was required, and probably everybody in here knows the history. The board was, was asked to write up legislation to control the mobile dental clinics because of some of the problems associated with mobile dental clinics. Well the board was in the process of writing legislation to control only the mobile or portable dental clinics, when the board was involved with some other controversies, and not only that, nothing in the state was passed, I mean our legislature was having problems, they were having fist-fights and all of the above and at the last minute a, um, individual from the 501-C3 Sarrell, their lobbyist presented their own bill to the legislature, their lobbyist presented it, their lobbyist pushed for it (TIME @ 8:16) (u) our lobbyist let us know (u). But the, uh, bill was passed and it was attached to our Practice Act. And it's, read it.

In my opinion it only pertains to mobile dental clinics or portable dental clinics and in my opinion there is not anything in there that allows a non-dentist to own a practice. How we got in the situation we are in right now, I don't know. Um, ya know... when, when you talk with those individuals you understand that they are in, and very unfortunately, I was told this in.. not a very nice setting, they are very politically connected, they are, they have a lot of backing behind them. And they will tell you in no uncertain terms, that yeah, we're, hey, you shut us down, we'll take you to court and see how.. but you look at the court of public opinion because here we are providing a service to indigent care, Medicaid clinics, All-kids. And you wanna shut that down, you're gonna take... So they are using the access to (u) TIME @ 9:32 ..they are using a lot of politically effective motivation to fight this, but right now in my opinion.. I don't... know, I don't know anything that can support the existence of a 501-C3, other than a portable .. dental .. clinic.

Dr. Gaines Thomas: Paige? (ph) Dr. Paige Collins: Okay, well, I think I have a simple solution.

Dr. Gaines Thomas: Great.

Ninth Man: There is no simple solution.

Dr. Gaines Thomas: [laughs] Dr. Paige Collins (cont): I am hopeful, for I am on the Medicaid task force and we could not give money to the “503-C corporation� until the Practice Act is changed.

TIME @ 10:09 ~ Ninth Man: For portable dental clinics, not for, it was only changed not for the 501-C3 fixed dental clinics, it was only changed for the portable dental clinics because they wanted to send their, their local clinics to out-reach, out-lying areas. And they did have, they wanted to be assured that Medicaid paid for this. It wasn't for the fixed-clinics it was only for the portableDr. Paige Collins [interrupts]: so we were paying 'em for the fixed clinics?

Ninth Man: no, you're... only, the, the, the jurisdiction was only for fixed-dental clinics Dr. Paige Collins [interrupts]: Yeah, I knowNinth man (cont): or, excuse me, for portable dental clinics. I know that it might come back to hurt us

TIME @ 10:45 Dr. Paige Collins: But, the, could, can Medicaid not refuse to pay them for the fixed-dental clinics?

Ninth Man: They have wonderful numbers, so we are really in a dilemma in that there may be a few other providers in the state but, but when they go before the legislature....It's not that we are, ya know, and , and, and what I'm saying here, I'm not saying that Sarrell is doing anything unethical or isn't meeting a need that doesn't need to be met... I told you that we have never audited them... We've never followed up a complaint.. we've never done anything against Sarrell. It could be Mother Teresa (ph) feeding the homeless, that doesn't make any difference, there, it, there is not a legislative entity that allows this, regardless of the type of services provided. But, when they go before the legislature and they say “we are meeting a need that if we don't meet it's, it's unmet in your state� and those rich dentists that are preventing us from doing this, Woman [Very close to microphone and speaks over top of 'Ninth Man' as he finishes his statement]: See.. this is where that legislative network would be.. invaluable.

Ninth Man (cont): [partially obscured by previous woman's statement] (TIME @ 11:46)...It makes us look bad in the court of public opinion and that (u)...

Dr. Paige Collins: but I don't think we were paying them for the fixed clinics before that, I think[Many people speaking simultaneously] TIME @ 11:54 Man Interjecting: (u)...know we are now, but before that I would not have paid for it...(u) Dr. Gaines Thomas: Let me just interject that.. I..

Ninth Man [continuing during multiple speakers]: ...when I was young and naive I actually thought that they were union-based health care clinics that are allowed. I thought, I didn't know the difference, I thought they were young and dumb health care (u) (TIME @ 12:13) and see they all started out as a nice church group that took it upon themselves to provide care for indigent kids. And from there-Man 10: pretty soon [Many people being speaking simultaneously] Ninth Man: They were allMan 10: free clinics...free care Dr. Gaines Thomas: It's alright, go ahead Ninth Man: Free clinics.. free care.. and it's not free they were reimbursed

Man 11: (u) we were reimbursing them.

Man 12: Um, the uh, the facility originally set up in Woodlawn, first of all, that the buildings were bought um by Church of the Highlands they were given free to a physician uh that, uh, that worked at Cooper Green. And he and an attorney have formed an LLC and they're running a business out of this free facility. And, um, they're treating, um, medical patients they're treating, uh, dental patients and, uh, I think they also have a pharmacy there and plans for Optometry. Now ya know that's, that's their first site and they have plans to open up other sites uh, as well. Ya know, I mean.. where do, ya know, where do you pull the plug?

Man 13: Uh, Paige (ph), my understanding.. back in 06 and 07 the Sarrell proposal to ALDA ya know I believe it was in the 06 year because the uh, quote mobile dental clinic bill was part of the ALDA bill.

And, um, it got tied up in the legislature senate wasn't passing anything nothing passed that year. In 07 spring of 07 I believe, uh, was when Sarrell pulled their, their portion of the bill, got their own lobbyist and said well we're gonna see if we can't get it through by ourselves. Now their, I think, the portion of the bill dealing with Sarrell it had sounded it was part[TAPE GOES BLANK @ 13:56] [TAPE RESUMES @ 14:16] [Duplicate audio from previous time on tape starting near the beginning of “Ninth Man's” (TIME @ 10:29) first line of dialog. The tape resumes mid-word (@14:16) and repeats the audio that appears previously on the tape from 10:29 to 13:56.]

Ninth Man [tape resumes play suddenly mid-word]: -assured that Medicaid paid for this. It wasn't for the fixed-clinics it was only for the portableDr. Paige Collins [interrupts]: so we were paying 'em for the fixed clinics?

Ninth Man: no, you're... only, the, the, the jurisdiction was only for fixed-dental clinics Dr. Paige Collins [interrupts]: Yeah, I knowNinth man (cont): or, excuse me, for portable dental clinics. I know that it might come back to hurt us TIME @ 10:45 Dr. Paige Collins: But, the, could, can Medicaid not refuse to pay them for the fixed-dental clinics?

Ninth Man: They have wonderful numbers, so we are really in a dilemma in that there may be a few other providers in the state but, but when they go before the legislature....It's not that we are, ya know, and , and, and what I'm saying here, I'm not saying that Sarrell is doing anything unethical or isn't meeting a need that doesn't need to be met... I told you that we have never audited them... We've never followed up a complaint.. we've never done anything against Sarrell. It could be Mother Teresa (ph) feeding the homeless, that doesn't make any difference, there, it, there is not a legislative entity that allows this, regardless of the type of services provided. But, when they go before the legislature and they say “we are meeting a need that if we don't meet it's, it's unmet in your state” and those rich dentists that are preventing us from doing this,

Woman [Very close to microphone and speaks over top of 'Ninth Man' as he finishes his statement]: See.. this is where that legislative network would be.. invaluable.

Ninth Man (cont): [partially obscured by previous woman's statement] (TIME @ 11:46)...It makes us look bad in the court of public opinion and that (u)...

Dr. Paige Collins: but I don't think we were paying them for the fixed clinics before that, I think[Many people speaking simultaneously] TIME @ 11:54 Man Interjecting: (u)...know we are now, but before that I would not have paid for it...(u) Dr. Gaines Thomas: Let me just interject that.. I..

Ninth Man [continuing during multiple speakers]: ...when I was young and naive I actually thought that they were union-based health care clinics that are allowed. I thought, I didn't know the difference, I thought they were young and dumb health care (u) (TIME @ 12:13) and see they all started out as a nice church group that took it upon themselves to provide care for indigent kids. And from there-Man 10: pretty soon [Many people being speaking simultaneously] Ninth Man: They were allMan 10: free clinics...free care Dr. Gaines Thomas: It's alright, go ahead Ninth Man: Free clinics.. free care.. and it's not free they were reimbursed Man 11: (u) we were reimbursing them.

Man 12: Um, the uh, the facility originally set up in Woodlawn, first of all, that the buildings were bought um by Church of the Highlands they were given free to a physician uh that, uh, that worked at Cooper Green. And he and an attorney have formed an LLC and they're running a business out of this free facility. And, um, they're treating, um, medical patients they're treating, uh, dental patients and, uh, I think they also have a pharmacy there and plans for Optometry. Now ya know that's, that's their first site and they have plans to open up other sites uh, as well. Ya know, I mean.. where do, ya know, where do you pull the plug?

Man 13: Uh, Paige (ph), my understanding.. back in 06 and 07 the Sarrell proposal to ALDA ya know I believe it was in the 06 year because the uh, quote mobile dental clinic bill was part of the ALDA bill.

And, um, it got tied up in the legislature senate wasn't passing anything nothing passed that year. In 07

spring of 07 I believe, uh, was when Sarrell pulled their, their portion of the bill, got their own lobbyist and said well we're gonna see if we can't get it through by ourselves. Now their, I think, the portion of the bill dealing with Sarrell it had sounded it was part- [END OF DUPLICATE AUDIO @ 17:45] of the ALDA bill. It sounded benign in those days, it was.... Someone has donated to this, uh, a charitable contribution to Sarrell, this bus. They had the bus down in Montgomery at the legislature, so the legislators could go and tour the dental clinic bus. And uh, and that their case was that they're providing care. Remember this is kind of the early days of the Sarrell Clinic. Uh, they're providing care for indigent children and they want this bus to be able to go out into under served areas. But at the time, they were being reimbursed at their fixed clinic. They could not be reimbursed by Medicaid for that bus work. So they wanted....and, and that was in the ALDA bill. The next year when it got pulled out, that legislation, if I'm not mistaken, when they were writing their own legislation, it got tweaked and, it, it was different...from, I don't know the exact wording, but it was, it was different from what had been in the ALDA bill the year before. Uh, and I think that was in the 07 session of the legislature that it passed. But it did just, it was named the mobile dental clinic bill.

Man 14: They changed one line. And that one line mentioned the word that clinics... This, that this will not be, uh, perceived to change the agreement, so and they, they're tried to grandfather in other words the circumstances, and that's where it got a little bit gray. They did that, ALDA did not do that and the board did not do that. But it's under (u) if you look at the (u) contained inside the bill, it's called a portable dental clinic, and it pertains only to portable and mobile dental clinics and how can something be grandfathered in that wasn't legal to begin with.

Man 15: Well I, I was just thinking that we weren't payin' em' on Medicaid's dental part , before all of that- (interrupted) Dr. Gaines Thomas: I believe they were. They were only not collecting on what was done in that bus.

Man 15: OK. Dr. Gaines Thomas(cont): Which they pretty much parked the bus until they could, to get legislation through. Robert (ph) ?

Robert: I know they're free. I don't know, I mean I get the impression. If they're not I don't know if they're legal. They're trying... If, if, it's possible, I don't have a problem with it. But what I'm scared about is there's gonna be one at every Wal-Mart, in the south, if there's nothin' stoppin' em, and you can't stop em, we can't stop em. I'm not sure how to resolve it... I think the certificateMan 16 [interrupting]: I been practice... that was in our, see, Barbara (ph) and I discussed that in one of the topics that I personally discussed that I felt was a very very good point would be some type of certificate of need that pertained to all these sites and not to an overall.. popular.. not to a group and that each site had to be approved. They had to present the need, the committee had to ask for the need, and then it would only be looked at after they‌ the dentists from the area somewhat, ascertaining it was there ...

TIME @ 20:45 Woman [Very close to microphone and speaks simultaneously over Man 16 as he finishes his statement]: I have a question about this, I just don't want to say it.

I'd say it's so simple. Not that that's right.

Man 16 (cont)[coming from beneath woman speaking over him]: And, then I'd like to carry (u) TIME @ 20:53 one step further. Like a lot of real estates will have some offices will have someone in the office who, her license is on the line and you think that there are some problems? I think we just need individual worksheets. Signed (ph)... actually has to have some person on the line too for their particular, um, locations.. but right now that, that's straight forward.

[Other voices close to the microphone reduce intelligibility of previous line] Man 17: Well that, that, that's arguin' the fact that if, if, if twenty five thousand bought Senator Coleman's (ph) out in the first go-around, I mean is twenty five thousand enough to get a mid-level provider (ph). It, it, it is, think about it, I mean after we set it up to be approved without it, here's my thoughts, twenty five thousand buys you a lot better in Alabama, I mean Montgomery especially. And the other thing is, uh, he's gonna make him think that, I mean, basically he threatened us and left that time.

[Females whispering close to microphone] Man 18: I know he did.

TIME @ 21:50 Man 17: But he was wrong, if you go back and read Senator Coleman's (ph) bill.. it not only says that the dentist or any previous (u) TIME @ 21:58 can hold the dentalist responsible for it. You read it.. bottom line, he's wrong, he says you don't answer to you. He does, cause it says dentist and operator of the facility. I went back and read Senator Coleman's (ph) bill and it said that in thereMan 19: as you should do, that's correct, but, but security's set purpose ... it's... like our statutory control of those practices remaining is... connected one hundred percent to the license. If someone has a dental license and there's a violation of the client then... and they are not responsible and don't tell, tell the client and correct the violation, you're, you're gonna lose your license. These operators don't even have a sight policy.

We have no statutory control over them because they don't have a dental license. And we, in effect, don't have anything we can do, you know, we can say “stop that� but we have no control to make them stop. That's like a bleaching (ph) clinic.

Dr. Gaines Thomas: (u) TIME @ 22:57 Guy? Guy: My comment was to Robert's, uh, altruistic comment but that, there's Mother Teresa, in Alabama.

And I hear, tell stories that the treatment measured there is not normally considered standard care.

Dr. Gaines Thomas: Ken? Ken: May I ask a question to Liz (ph) you said that there was no way to sanction operators because they don't bring their licenses, this is just a hypothetical, how would you sanction a non-dentist who was practicing dentistry?

Man 20: The only way you can do, that's a great question, because that happens right now all the time.. bleaching.. If, if there's a bleaching kiosk, there's one up the street from me right now. So yes they

were presented with a cease and desist order.. based off, ya know, the the count of successful cases (ph) that go to the supreme court. They look at that and say “oh, well, okay, thank you very much”. The only way you can stop that individual is to take them to court. You gotta take, get, you've gotta get the Sheriff (u) TIME @ 24:01 to serve injunctions. Then you have to, um, take legal action in that person's jurisdiction to shut them down … the same with vendors... we have vendors we have just shut down and it took months and months to do because you have to go before the Sheriff, you got to get an injunction, you have to prove it to the Sheriff this will (u) TIME @ 24:21 certain that they are do... doing something illegal and even then there's poor results... penalty for, you wouldn't, uh, practice, uh... the penalty for practicing dentistry without a license. It'd be up to a thousand law suits. There are far too many. I promise you that. Look, we don't have a, um, a mechanism, so someone is fired for taking out a license we can't go over there and padlock the office we can only go to the police and, or, a Judge in that area and ask for his help with shutting down that person. We have no jurisdiction unless they answer to the law.

TIME @ 24:56 Man 21: Hypothetically they could be shut down individually if (u) [obscured by cough] gets.

Dr. Gaines Thomas: Comments?

Man 22: It's just in our business that... (u) TIME @ 25:05 about the services, so if you're protecting the public, and somehow what you did [frequently obscured by noise in the room] you would have to monitor those complaints….. dentists have complained about our services and their directives of treatment...(u) TIME @ 25:21 something has to... because we get permission, think about it, in that area when they, they said they're, they're, they're providing services, that just like, anybody saw the Gooch(ph) report? I read somewhere where they did 8 or 10,000 a year?

Man 23: I understand, did... as a hypothetical question you know, I can't, I could, if someone says to me um about an individual, it's very... ya know, we have to ask... ask them questions about it. But, I think it would be okay to sign the certificate saying, that we monitored those.. we monitored those complaints from Sarrell's board does not have any complaints coming in they didn't address.

Man 22: Literally to have sixty percent of Medicare is enough to those that they are hearing in the street. We see as dentist and know that we, uh, ya know, the treatment was improper and shouldn't have been done. So, I don't have an answer but I'm told that these complaints are comin'... and maybe, maybe we can look at, uh, seeing how we can address the improper treatment of the patients. I don't know, the idea that they, they giving proper service to the people that would come. Just... something is goin' on very wrong here. And, and, if, if.. you don't need to let somebody die before we do (u) TIME @ 26:55 Dr. Gaines Thomas: Steve?

TIME @ 27:00 Dr. Steve Mitchell: Anybody who knows anything about the relationship with the school and our department having Sarrell Dental (u) TIME @ 27:07 by our students being on the plan. It's Business.

That being said I will say I'm not aware of a single dentist in the organization who's not an Alabama licensed dentist. Um, I uh, I know that since [someone whispering in the foreground] we were, ya know, had... taking our students to, um, Bessemer's Facility.. my license is on the line for every mistake

(u) TIME @ 27:33 damages. So, ya know, the other thing I would, I would caution you guys.. is the discussion of... is... this group is smart... okay... the court of public opinion is a real thing and whatever is done, we've got to be careful because they've got mayors, they've got city council people, that are saying “Hey, no one will take care of our kids,� and this group has come in taking care of our kids and they don't know the difference, they don't know how they get dentistry standards that ALDA upholds and the reason I'm no longer allowed in the facilities and when they want to do that, they don't know the difference, all they think is this group is taking care of our kids and this group wouldn't. And you need to be very careful you don't give the impression that we're just trying to protect our turf if we try to do something about this.

Dr. Gaines Thomas: Karen, did you have.. yes, are youKaren McCaffrey [former President of the Board of Dental Examiners]: Still, Sarrell can say they are covered under... any of their dentist and hygienist aren't covered (u) TIME @ 28:44 as individuals..

Dr. Gaines Thomas: Ok, Guy? Dr. Guy Rosenstiel: We need to figure out how to accomplish that before someone dies.

Dr. Robert Rudolph: I think Dr. Mitchell's very, very much grateful we've discussed that..but, but it goes back to the court of public opinion if you call and you get that patient and you try to nudge that patient in that direction to make that claim and then if you are investigated or, uh, interviewed by Sarrell's lawyer and then it comes out that you got a new patient that says well they told me to.. uh we're back to that slope where we're gonna lose in the public's eyes pretty much... (u) TIME @ 29:26 yeah just one other thing real quick...I think that pretty much everyone in the room is against what's going on... I mean if you look at our last Alda News there is a Small Smiles advertisement in the back...and I would suggest that we not take it anymore..there's a big ad about..

Page Collins: Really?

Dr. Robert Rudolph (cont'): forty lines advertising for FORBA which is Small Smiles...and then there is one down lower that is also advertising for dental employment Dr. Gaines Thomas: Is this in the classifieds?

Dr. Robert Rudolph (cont'):uh huh ...and there's one in the smaller one and it doesn't give a name..and I thought that was Sarrell but they sound like the same ad...a big ad and a little ad and I don't know you know I'm not saying anybody did anything wrong...but I just say we don't take any more money from them... I don't we help them in any way possible...its kinda bad for us to sit here and talk bad about them.. but then take their advertising money in the ALDA News.

[Laughter and multiple Speakers] Dr. Gaines Thomas: Kim...

Dr. Kim Stiegler: for me its a question of... hmm... was there any indication when you were associated with this clinic that.. the administrative personnel influencing treatment decisions?

Dr. Steve Mitchell: Well, ehTIME @ 30:38 Dr. Elizabeth Osborne Jackson: Can I speak to that? I'm a former Sarrell employee and I would say that they have a very in-depth.. um.. way of enforcing it you know... higher management doesn't but it does on other levels and they prey on young dentists like myself who are unaware that they shouldn't be questioning this. So, they've kinda-sorta got a niche on the market cause they know they prefer to have young dentists who are typically female who will not question the situation. And, I hope, for my own sake, that you at least listen to what Dr. Mitchell says because I worked there, I do think that I provided good care, I look back and say I can't believe I did that, but then again they are still providing service for the area.

TIME@ 31.34 Dr. Steve Mitchell: Um, first of all, [obscured by voice closer to microphone] address you know, the response to Dr. Gaines Thomas: That's fine, go ahead Dr. Steve Mitchell (cont): um, you know. One, I will say that we said we don't want people to die. I think it would be extremely unlikely that, um, that someone could die in their facilities in that they are not venturing into any kind of sedation beyond nitrous (ph), um, because Medicaid will not reimburse for more than X number crowns I can guarantee you they aren't doing more than that because if Medicaid isn't gonna pay for it they're not gonna do it. Okay?... Um, and so, the the the risk of death here is probably not as equal as pediatric dentists,... [someone speaking close to the microphone] the risk of children forever being scarred is probably a, a much bigger reality. How you fight that, I don't know. Um, you know, our major influence on decisions being made, okay? You know, and our department, has now been kicked out because as attending, you know, I am..and I feel like it's my job to teach my students at the highest standard. And you know we are going to teach radio-graphs (ph) on a need basis..we are going to teach procedure, not by insurance but by, ... you know, that just couldn't match the philosophy and so the faculty and the students are (u) TIME@ 33:10 about it.

Dr. Gaines Thomas: Paige.

Dr. Paige Collins [ALDA function?]: It is my understanding that the students are going back to the Bessemer clinic.

Dr. Steve Mitchell: The, uh, as I said, and you know, all I can impress um that I do not speak for the administration of the school.

Dr. Paige Collins: That's what we were told yesterday...

TIME @ 33:42 Dr. Steve Mitchell (cont): Um, we as a department, have, in no uncertain terms, been told that no pediatric dentist from our department be allowed in their clinic. The administration has opted to continue to work with them.

Dr. Paige Collins: um. Also, I think what we need to do, maybe what would need to be kept... like you said that a lot of the providers from other fellow dentists perceiving problems... and maybe document, keep a, you know, keep a file because that way if we do have to go court.. we got this... documentation of what type of work they are providing.

TIME@ 34.06 Dr. Gaines Thomas: Roger..

Dr. Roger Smith: I... don't know if this factual or not.. ummm... I'm not familiar with this..I don't know first hand... but I have been told that the Dean of the Dental School now sits on the board as Sarrell's Chair...and Woman: Correct...that's true...

Dr. Roger Smith(cont): I think that's under the conflict of interest for everyone. And that's something that probably needs to be addressed as well...

Dr. Gaines Thomas: Thank you...Tom..

Dr. Tom Willis: A couple of points, um.... first of all, the bus has been parked...they used that pretty much as a gate opening thing, they are not using the bus anymore I am sure of that. Um... another point is... talking about a group of clinics in the state that include Whatley (ph) Health Clinic in Tuscaloosa that's 501-C3 you got the Hills Clinic(ph) in Huntsville that's 501-C3, we got some in Mobile Dr. Gaines Thomas: Franklin in Mostow? (ph) Dr. Tom Willis: Yep..and so you got a lot of entities out there, so you are gonna go to the legislature and you are gonna say... we want to shut them down.. or we are gonna go, shut them down and then you are gonna go and call the legislature and say “what the hell are y'all doing?� Ya know, basically that's what's gonna happen.

Dr. Tom Willis (cont): So..we have just ‌.we haven't had a meeting yet and we are gonna form a, a committee within the board not that we going to solve this within the board. But, we are gonna start dialogue on this next Thursday afternoon at 4:30. Now we as the board can't solve this problem..but we are gonna have help from ALDA and... non-members of ALDA and everybody.. so in addition... so probably gonna have to bring this 501-C3 thing to the table... to talk with them.. These are the big elements thats going to be cut up a piece at time and it's out there, it's a threat to the dentistry of Alabama, it's this 501-C3's and we just had a request from a guy in California that wanted a license because now there's a new loophole that you do dentistry in nursing homes and he's gonna hire all these people and he was gonna run it from California and and... and.... go around and have his mobile clinic with suit case with a drill in it. You know... so he'll consider that's a mobile clinic Men [interrupting]: hmm.. interesting Dr. Tom Willis (cont): Its just a bad comedy what's happening out there.

Dr. Gaines Thomas: Robert.

Dr. Robert Rudolph: Followin' up to Dr. Mitchell, uh, are you, I know you don't want to get into it, and I am not asking you to, but could you, could you clarify what you just said I haven't been out here all weekend so was there a comment made that we couldn't send students out there to be supervised by Sarrell Dentist and not by Faculty at UAB... is that what you just said?

Woman close to mic: It's True.

Dr. Steve Mitchell: Um.. yeah I'll confirm it.

Dr. Robert Rudolph: Who's on the steering committee in here?.....[cough] That's Terrible..So the people that we have the problem with is gonna train our students..

Woman close to mic: Yep. ... There's a (u) TIME @ 37:03 he's torn up.

TIME@ 37.00 Dr. Steve Mitchell: You know... Let me, let me tr.. try to give.. I, I, I mean it doesn't (u) TIME @ 37:11 I can't speak for the dental school. I'll say as pre to the director of pre-operable kids who were scheduled... The challenge that I face right you know is that one of the side effects of these clinics, okay... is there are too many kids, now if you've got Medicaid, you've got plenty of options to go somewhere else, but why in the world would you drive downtown and park two blocks from the dental school and haul kids in a stroller up the street., you know, and so, we are having a challenge getting our students hands on experience with children and with these clinics growing and it is becoming increasingly important to even graduate out of dental school knowing, I mean, ya know you needed that education, um, when you're going out, and so.. I don't really [obscured by noise] hear these words from Heu Thomas's (ph) mouth... um.. I only talked.. I know Jim (ph) said this to me, that he's just very concerned that our students have to have that experience and we've got to get it somewhere, and I'll tell you something, if this body came up with a great alternative, I'm listening, cause I'm desperately looking for it.

TIME @ 38:26 Dr. Gaines Thomas: Steve, are, to clarify that, are you saying that undergraduate students go to Sarrell and graduate students don't?

Dr. Steve Mitchell: That is correct, as, as of, as of January, three senior dental students, sometimes four, will rotate three days a week in the clinic um, that is now no longer part of pediatric dentistry, that is now being managed through the Dean's level and they are being attended by a faculty, um, that Sarrell (u) TIME @ 39:00 Speaker: So they are making Sarrell employees adjunct faculty?

Other speaker: Yes TIME @ 39:07 Man: Are they on the payroll [Many people are stuttering and speaking out over one another]

Dr. Steve Mitchell: Um, um, payroll of what?

Man: UAB Dr. Steve Mitchell: No [Many people are speaking over one another] Dr. Steve Mitchell: You know what I can honestly not say that. I doubt it but, just, heck and we can't keep our whole combined dental payroll right now. [laughter and several muffled comments] Man 2: And remember, too, that on the board of Sarrell.. is.. the Dean.. and John Thornton(ph). [mumbles] Dr. Gaines Thomas: Dr. Mitchell?

TIME @ 39:40 Other Doctor: Uh, just a point of clarification, Doctor‌ your were talking just about Bessemer facility or are you talking about all clinics.

Dr. Steve Mitchell: Well, at, at..Dental students have only at this point been [stutter] the, the, the birth of Bessemer was not a typical birth of the Sarrell project, the birth of Bessemer was really Hugh, John and me located this site and said... man this would be an incredible opportunity to educate our students, where there are patients. The school didn't feel like they could legally logistically manage it and so they..umm.... they asked Sarrell to manage it. We didn't protect ourselves. They got all the authority and when we couldn't produce to the level that they wanted, we were kicked out.

[Speaker close to mic whispers] Dr. Chamoun: How, how is much Sarrell Paying UAB, do you know?

TIME @ 40:31 Dr. Steve Mitchell: Um, I , I um... I'll speak to the last month, check it, when it was still under our department. We, our department received for Bessemer, by itself, a 1,000 dollars a day...

Dr. Chamoun: Is Sarrell giving UAB three hundred thousand dollars..

Dr. Steve Mitchell: Um..

Dr. Chamoun (cont'd):in addition to the..what you mentioned?

Dr. Steve Mitchell: We... We have... we have... a... a .. pediatric dental resident rotating in the Anniston clinic, that has now gone to two. There is a reimbursement process there that, you know, I'm

pre-doc, I'm not post doc, so I dunno the numbers ...Um, and then, but there [stumble] are reimbursements for them going there and so they and then there is a reimbursement for Bessemer. All that tied together I'm sure comes up to some sort of money...but Dr. Rudolph: What about one of the... the totally free clinics, like Empower(ph) Dr. Steve Mitchell: Um....

Dr. Rudolph: For students.

Dr. Steve Mitchell (cont): Sure.. dental students I believe are going to Empower(ph), from my understanding, um...and those are, those are focused adult care clinics and so, so, um, but um, but yes, if they, they saw children it would very un-often (u) TIME @ 41:49‌ Dr. Gaines Thomas: [addresses unknown person]; Dr. (unknown): Steven, it is my understanding that the contract with post doctoral students will be either up in June or renegotiated in June... is that right?

Dr. Steve Mitchell: Our demands are not...

Dr. (unknown): You said...That is correct... and if that is correct... is there, then, possibly a tendency not to renew it.

TIME @ 42:11 Dr. Steve Mitchell: Um, I think that, um, I would have to just guess on that and I would think that the administration would frown on (u) TIME 42:24‌ Dr. (unknown): Based solely on income.

Dr. Steve Mitchell: Um, and they'll have to answer your questi- (u) TIME @ 42:31 Dr. Gaines Thomas: Ok... give me ahh... let's TIME @ 42:36 Dr. Deborah Bishop: I have one more question Dr. Gaines Thomas: Ok, Debra..

Dr. Deborah Bishop: My question is for uh, Sherry Goode(ph)... um. Do, we been talking a lot about access areas and what constitutes an access or undeserved area... I was sitting in a meeting with public health officials...um...we... about Tuesday this week and they flashed up a...um..slide of the United States and my county, Marchall County, was designated a high need access area...Can you please explain to me why when we have dentists who are twiddling their thumbs...Sarrell is allowed to come in as under serve, to Boaz, and under serve, uh, and who determines this and how can we correct some

of these misconceptions.

Sherry Goode: those are determined by HERSA(ph) and ALL-Kids stuff charity and that just gives them medical and dental and a lot of other skilled professionals...and um. Ah.. I'm lucky the entire state of Alabama it's been designated HISTA(ph) all counties except Shelby and portions of Madison and...um... the entire state that they base on like a.. for under.. um..for like low income populations, they do a four thousand to one ratio, uh... indigent population ratio and uh...so the entire state needs 288 more dentists to overcome this statewide but then they break it down by counties and they can pinpoint how many like Limestone county needs five more dentists to overcome the health professional shortage area for dentists.... So...it's all HERSA's...

Dr. Deborah Bishop: Is there any way to to go back and recalculate this...or say look this is not, I mean... how do...

TIME @ 44.30 Sherry Goode:... you know... they do it every 5 years...

Male voice near microphone: “We don't do that stuff�

Sherry Goode(cont): and they are doing it right now....out of the offices primary care, rural health...they are doing it right now it says the, uh, the, the database is on (U)TIME @ 44:43 and then someone actually calls and they try to determine if they solo practice or multi practice office and then you factor in, uh, the number of dentists in that area you factor up, you factor in the percentage of low income population, you factor in, uh, the facilities like prison when ever so it's a real uh difficult um from (u) TIME @ 45:11 Dr. Deborah Bishop: Will the ..will the presence of Sarrell clinics in these areas factor in..would that make it not an undeserved area anymore?

Sherry Goode: uh, well, they they factor in the number of dentists that have a practice there, they're in the dental database of dentist that are in Sarrell..and so that factors ...into those counties where they have funding and that lessens the number that is needed..to meet that, that that shortage, to overcome that shortage per county Dr. Deborah Bishop: So how many dentists per population per numbers of people is considered adequate?

TIME @ 45:46 Sherry Goode: Well they base, they base the the 4000 to one ratio from low income population.

Male voice near microphone: Four thousand people to one dentist. Ok. Dr. [unknown]:Sherry are you sure, are you sure that transient practitioners are included in the, in the uh provider base because they may not be at that clinic for three months or two months and go somewhere else.

Sherry Goode: [said under guy asking question] They're supposed to be.

Sherry Goode:The person that is doing the designations has to call every office in Alabama...she determines uh...if they have a catalog (ph), if they have um, a solo practice, you know...she's supposed to be able to..she takes the the um board of dental examiners database...and and uses that database uh...it is not an easy process..and someone's actually got to be changing 'em like ...uh, well nothing is impossible but then with HERSA (ph) you know...

Dr. Gaines Thomas: Yeah... is that a federal agency when you HER, HER...

Sherry Goode: I'm sorry...

Dr. Gaines Thomas: You said HERSA as in...

Sherry Goode: HERSA counts the resources for budgeting the dentists ratio. And that's a Federal Agency. [spoken under Dr. Gaines Thomas's following line] Dr. Gaines Thomas: And that's a Federal agency.. ok.. so the feds determine whether or not is an undeserved area.

Sherry Goode: and they do that for all the states and they do that for a number of national health professions.

Dr. Gaines Thomas: Ok..we we're getting late in the day.. so if we can lets keep our comments brief but I don't want to cut it off.. Bill (ph) Bill: do these clinics use that data to determine where they are gonna go...I mean, you see what I'm thinking about? Because I know like in the state of Alabama there are two counties (u) TIME @ 47:22 that's already served.. (u) TIME @ 47:24 so I don't know if they are using..

Woman: Well when you study the traffic that's (u) TIME @ 47:31 into, into those areas that areBill: Right, right... I just didn't want there to be a mis-communication that, that's what was requested because questioning you on ‌. decisions we made that were (u) TIME @ 47:48 Sherry Goode: and like I said I don't have anything against them Bill: I kinda, I don't go one way or the other....the services they're providing is just something that I really concerned with.

Time @47:53 Sherry Goode: I remember that, if I can quickly, we have two county Health Departments that have Sarrell Clinics attached we don't manage them by any means, they are in two of our counties that have dental clinics and we could not staff them...and we had no referral course for those Medicaid children.. so.. Sarrell did come in and work.. you know..they work through it...and I would say that they provided a good service.

Dr. Deborah Bishop: What two are they?

Sherry Goode: they are Talladega and..uh.. Coffee (ph) Dr. Gaines Thomas : Gary (ph) Dr. Gary Yarborough: This, this is a topic that certainly is absolutely necessary and have concerns for us. But I have a concern that this may be one of the trees of the forest that we need to look into the forest..uh..For a long time I've had some concerns and I've listened to the rumors of.....uh, and situations that are happening about how mid level providers and other, other providers are getting into, you know, into the health care programs of the nation and etc. And I know that Dean Thomas(ph) or Hugh Thomas(ph) is come around to every entity in this state looking for ways to shore up the budget and to make sure that they have enough money to do what they need to do to train students and, and make their ends meet..and..I, and I am sure like almost everyone of you in here and, and a good fine quality dentist will come to the school for the education and it is the life blood of our organization and our profession, that that school be shored up and in good shape. And I don't know what the real problem is. I've heard that the legislature thinks they are sending enough money. They're dumbfounded it's not getting there. First UAB gets the money and gets extended and uh.. uh..uh.. distributed in certain ways... and maybe there is a problem there..they are not getting enough..could it be that there's a problem within the school, because these conflicts of interests and these kind of programs and, and associations that other people have? And I don't know..but I would be real careful to tell you that, that those answers aren't firm...but I do know that they are bleeding faculty, they're bleeding quality education, they are bleeding for enough to keep the program going. And I think it is imperative upon this organization to find out where the problem lies and either cure it one way or support it one way..or do something..because if that dental school goes down so does the profession of dentistry in Alabama.

Dr. Gaines Thomas: Thank you Gary....any comments about Sarrell before we move along.

Time @51:01 Dr. (unknown):Uh..I just...one last thing I, I...Its, It's really easy to stand here and throw out the complaints and figure out..you know... what our griefs and gripes are ..but I, I would I like to see The House Of Delegates leave here today without some means of further investigating this and cast (u) TIME @ 51:22 before we do anything. [Voice obscured by someone whispering in foreground]. I just don't want to see us leave here without some type of action..this is something that um..gonna uh., uh impact us, not only us... but particularly the generation of dentists that are coming after us. And deal with corporate entities and Non-Profits who are going to be competing for our, our patients and, and particularly um... making a, a better face for the public and it would like be, uh, ever serving the public's needs, needs as we are...I'd like to see some type of action where we uh.. begin the process of, of finding out what we can do about the problem.

Dr. Gaines Thomas: Well Eric,Roger...

Dr. Roger Smith: I, I would like to say that a possible solution to this could be where the different districts you know that have needs you know...and they're (u) TIME @ 52:16 [obscured by cough] .. build, build their own facility out. And do the same thing, build the same models that they're doin' in, uh, with Sarrell and at Small Smiles and, and those places and staff it with a dentist and then hire, ya know, primary practice out of school to come and work there. And as long as you're gonna experience, course it's to serve that population you're gonna take away from these not-for-profits poppin' up and

spreading everywhere.

Dr. Gaines Thomas: (u) TIME @ 52:49 Man: .. in appropriate guess (ph) Dr. Gaines Thomas (cont): Um, I was just asking Zach(ph) that, the problem you, you run into with a large group like this sitting as counsel or committee is that we could literally stay here for a day or two and talk about it. And, and counsels do that where they, they may, they may meet and talk one evening about one issue for the whole day or two days so... um, we got two appropriate channels I think one would be to use an existing ALDA counsel or an appropriate counsel and uh kinda put this issue in their lap for investigation, a second issue would be a special committee but,uh, I would put those out there, uh, personally I think that's a good comment for us to talk for an hour or two about something and just go home and you'd come back again and say the same thing in two or three months. Uh.. doesn't get us down the road anywhere. Uh, Dr. Anderson.

Dr. Anderson: I propose a motion that we set this issue in a broad dental sense... not just localized to Sarrell just a whole, uh, broad issue to our counsel on Dental Health and Public Information who is our quote-un-quote access to care counsel. Um, staff two representatives from each district, um, on that counsel and then have them bring in any extra pieces they may need, um, to develop future questions and .. tell 'em the problems and come back with solutions to the Board of Trustees.

Dr. Gaines Thomas: Okay Dr. Anderson(cont): and House of Delegates.

Dr. Gaines Thomas: There is a motion to refer this issue to, uh, counsel on Dental Health and Public Information. That's an eighteen member counsel now it, uh, I think so uh they'll have enough manpower. Is there a second to that motion?

Man: Seconded.

Dr. Gaines Thomas(cont): Motion, and a second, any discussion? Nope? Lou (ph)?

TIME @ 54:40 Dr. Lou Mitchell: Uh, the only thing I want to say, I don't want to prolong the debate, but I, I think I would like to ask that counsel to specifically look at the Bessemer facility. And see if our students are getting proper supervision. Okay, the fact of the care being delivered at all these clinics is just, you know, they, they work in some.. but.. [people whispering] essentially the lessons we are teaching our students about things is all so critical and I think, I'd specifically like that counsel to look at that Bessemer Clinic and the supervision of our students at Bessemer.

Dr. Gaines Thomas: Any other discussion?

Dr. Deborah Bishop: I have..

Dr. Gaines Thomas: uh, Debra.

Dr. Deborah Bishop: Well, if you're gonna look at the supervision of our students you might wanna include the Alabama Dental Associates, Children's Hospital, Comp-Care Correctives, Geriatric Rotation, Jefferson County Health Department, Empower, North-Side Dental, Sarrel Clinic in Bessemer, Tuscaloosa County Health Department, Whatley Health Services. Those are the places where our sophomore students are being assigned.

TIME @ 55:43 Dr. Gaines Thomas: Thank you... any other discussion? All in favor of the motion about... signify by raising your hand. Also the same sign.. motion carries. Um... uh, Dr. Anderson, uh.. has asked for a point of personal privilege to make an announcement.

Dr. Anderson: Um, many of you in this room may have worked with Dr. Martin Vincent (ph) from Georgia, he's been very active in the past-END OF RECORDING @ 56:19