In 2014, the Washington’s Dental Quality Assurance Commission (DQAC) charged Runar D. Johnson, D.D.S. with unprofessional conduct related to his credentials, his infection control procedures, and his care of three patients. According to his Web site:
Runar D. Johnson, D.D.S. offers an alternative to traditional dentistry with treatment and materials that are compatible with most people. Some services offered are non-toxic dental procedures, mercury removal and detox, jaw orthopedics, (which may involve braces or appliances), TMJ/Myofacial pain treatment, The Aligner System and ozone therapy. Teeth and jaw function affect the entire body, so it is essential to understand how these relationships interact and how nutrition plays a part.
The site also states that he “recently . . . graduated from The School of Integrative Biologic Dental Medicine as a Board Certified Naturopathic Physician.” This school is not accredited by an agency recognized by the U.S. Secretary of Education.
The DQAC’s statement of charges (shown below) alleges that he (a) represented himself as naturopath although he is not licensed as a naturopathic physician in the state of Washington, (b) administered tests and treatments that are outside the appropriate scope of dentistry, (c) failed to keep adequate records, and (d) did not meet infection control standards.
In 2001, Johnson signed an agreed order under which he was reprimanded and fined $10,000 for failing to cooperate with a board investigation of his orthodontic treatment of a patient. He was also ordered to take additional training, pass a jurisprudence examination, and have his current and future orthodontic cases reviewed by an orthodontic consultant. The order notes that he had (a) failed to submit requested documents, (b) tried to intimidate the patient into withdrawing the complaint, (c) failed to create and maintain appropriate records, (d) failed to perform necessary procedures, and (e) failed to refer the patient to an orthodontist when the patient’s condition had worsened.
STATE OF WASHINGTON
DEPARTMENT OF HEALTH
DENTAL QUALITY ASSURANCE COMMISSION
In the Matter of
STATEMENT OF CHARGES
FILED Dec 03, 2014
The executive director of the Dental Quality Assurance Commission (Commission), on designation by the Commission, makes the allegations below, which are’ supported by the evidence contained in case no. 2013-3265. The patients referred to in this Statement of Charges are identified in the attached Confidential Schedule.
1. ALLEGED FACTS
1.1 On June 30, 1967, the state of Washington issued Respondent a credential to practice as a dentist. Respondent’s credential is currently active.
1.2 The Respondent is not licensed as a naturopathic physician in the state of Washington.
1.3 On or about April 10, 2013, a complaint was received alleging infection control violations at Respondent’s office, and that Respondent made assertions and rendered care beyond the scope of his dentist license, contrary to the accepted standard of care for a licensed dentist.
1.4 On or about July 5, 2013, the Respondent admitted that he represented himself as a naturopath for treatment of dental oriented conditions, and that he was well trained for rendering naturopathic care. The Respondent also admitted that he recommended nutritional supplement to help TMJ/myofascial pain syndrome in patients.
1.5 The Respondent admitted that he rendered urinalysis testing for mercury toxicity, and that he provided instrumentation for rectal insufflations for his dental patients.
1.6 On or about July 11, 2013, an associate dentist who worked at Respondent’s office admitted that Respondent had provided “ozone therapy” for some muscles around the temporomandibular joint. On or about July 10, 2013, Respondent’s dental assistant #1 admitted that Respondent provided “ozone therapy” for patients with sinus infections and ear infections, and that he provided neck injections. On or about July 10, 2013, Respondent’s dental assistant #2 admitted that Respondent provided urine tests on patients.
1.7 In response to the investigation, Respondent provided patient records. A review of these records revealed:
- Patient A: There was no evidence of periodontal charting. Ozone was utilized to treat the nose and ears using a billing code for oropharyngeal neoplasia. On or about January 9, 2013, Patient A did not want a dental examination but was evaluated by the Respondent for a sinus check.
- Patient B: The Patient indicated that “insufflation [provided by Respondent] helps with lower abdominal pain.” On November 6, 2012, Respondent recommended rectal insulation for lower abdominal pain and provided insufflation instrumentation to the patient.
- Patient C: The patient charting for Patient C demonstrates that from March to May 2013, Patient C was treated for ear treatment.
- Respondent regularly injected “Sanum” to his dental patients, a holistic medication that contains mycobacterium.
- The record keeping of Respondent was deficient because some of the records did not include medical history, periodontal charting, patient demographics or insurance information. In addition, upon request by the Department of Health investigator, the Respondent could not produce complete patient records for multiple patients.
1.8 On or about May 28, 2013, an infection control inspection was conducted at the Respondent’s office. The inspection found that Respondent did not conduct regular spore testing. A spore test log was kept but not adequately maintained.
2. ALLEGED VIOLATIONS
2.1 Based on the Alleged Facts, Respondent has committed unprofessional conduct in violation of RCW 18.130.180(1), (4), (7), and (12), WAC 246-817-620, and WAC 246-817-310, which provide:
RCW 18.130.180 Unprofessional conduct. The following conduct, acts, or conditions constitute unprofessional conduct for any license holder under the jurisdiction of this chapter:
(1) The commission of any act involving moral turpitude, dishonesty, or corruption relating to the practice of the person’s profession, whether the act constitutes a crime or not. If the act constitutes a crime, conviction in a criminal proceeding is not a condition precedent to disciplinary action. Upon such a conviction, however, the judgment and sentence is conclusive evidence at the ensuing disciplinary hearing of the guilt of the license holder of the crime described in the indictment or information, and of the person’s violation of the statute on which it is based. For the purposes of this section, conviction includes all instances in which a plea of guilty or nolo contendere is the basis for the conviction and all proceedings in which the sentence has been deferred or suspended. Nothing in this section abrogates rights guaranteed under chapter 9.96A RCW;
. . .
(4) Incompetence, negligence, or malpractice which results in injury to a patient or which creates an unreasonable risk that a patient may be harmed. The use of a nontraditional treatment by itself shall not constitute unprofessional conduct, provided that it does not result in injury to a patient or create an unreasonable risk that a patient may be harmed;
. . .
(7) Violation of any state or federal statute or administrative rule regulating the profession in question, including any statute or rule defining or . establishing standards of patient care or professional conduct or practice;
(12) Practice beyond the scope of practice as defined by law or rule;
WAC 246-817-620 Use of barriers and sterilization techniques.
The use of barriers and sterilization techniques is the primary means of assuring that there is the least. possible chance of the transmission of communicable diseases from doctor and staff to patients, from patient to patient and from patient to doctor and staff. To prevent patient to patient cross contamination, instruments and’ supplies contaminated or likely to be contaminated with blood or saliva and touched during treatment must be sterilized between patients or discarded except as otherwise set forth below. Surfaces and equipment which are likely to be contaminated with blood or saliva and touched during treatment must be decontaminated or covered with a barrier which is discarded and replaced between patients except as otherwise set forth below:
(1) Dentists shall comply with the following barrier techniques:
(a) Gloves shall be used by the dentist and direct care staff during’ treatment which involves intra-oral procedures or contact with items potentially contaminated with the patient’s bodily fluids. Fresh gloves shall be used for every intraoral patient contact. Gloves shall not be washed or reused for any purpose. The same pair of gloves shall not be used, removed, and reused for the same patient at the same visit or for any other purpose. Gloves that have been used for dental treatment shall not be reused for any nondental purpose.
(b) Masks shall be worn by the dentist and direct care staff when splatter or aerosol is likely. Masks shall be worn during surgical procedures except in those specific instances in which the dentist determines that the use of a mask would prevent the delivery of health care services or would increase the hazard and risk to his/her patient. In those circumstances where a dentist determines not to wear a mask during a surgical procedure, such determination shall be documented in the patient record.
(c) Unless effective surface decontamination methods are used, protective barriers shall be placed over areas of the dental operatory which are likely to be touched during treatment, not removable to be sterilized, and likely to be contaminated by blood or saliva. These procedures must be followed between each patient. These include but are not limited to:
(i) Delivery unit.
(ii) Chair controls (not including foot controls)
(iii) Light handles.
(iv) High volume evacuator and air-water syringe controls.
(v) X-ray heads and controls.
(vi) Head rest.
(vii) Instrument trays.
(viii) Low speed handpiece motors.
(d) Protective eyewear shall be worn by the dentist and direct care staff and offered to all patients during times when splatter or aerosol is expected.
(2) Dentists shall comply with the following sterilization requirements:
(a) Every dental office shall have the capability to ultrasonically clean and sterilize contaminated items by autoclave, dry heat, unsaturated formaldehyde/alcohol vapor (such as MDT Chemiciave®) or ethylene oxide. Sterilizers shall be tested by biological spore test on at least a weekly basis. In the event of a positive biological spore test, the dentist shall take immediate remedial action to ensure the objectives of (a) of this subsection are accomplished. Documentation shall be maintained either in the form of a log reflecting dates and person(s) conducting the testing or copies of reports from an independent testing entity. The documentation shall be maintained for a period of at least five years.
(b) The following items shall be sterilized by an appropriate autoclave, dry heat, unsaturated formaldehyde/alcohol vapor (such as MDT Chemiclave®) or ethylene oxide sterilization method between patients:
(i) Low speed handpiece contra angles, prophy angles and nose cone sleeves.
(ii) High speed handpieces.
(iii) Hand instruments.
(v) Endodontic instruments.
(vi) Air-water syringe tips.
(vii) High volume evacuator tips.
(viii) Surgical instruments.
(ix) Sonic or ultrasonic periodontal scalers and tips.
(x) Surgical hand pieces.
(c) Gross debris shall be removed from items prior to sterilization . Ultrasonic cleaning shall be used whenever possible.
(d) Nondisposable items used in patient care which cannot be autociaved, dry heat, unsaturated formaldehyde/alcohol vapor (such as MDT Chemiclave®) or ethylene oxide sterilized shall be immersed in a chemical sterilant. If such a technique is used, the solution shall be approved by the Environmental Protection Agency and used in accordance with the manufacturer’s directions for sterilization.
(e) Items such as impressions contaminated with blood or saliva shall be thoroughly rinsed, placed in and transported to the dental laboratory in an appropriate case containment device that is properly sealed and labeled.
WAC 246-817-310 Maintenance and retention of records.
Any dentist who treats patients in the state of Washington shall maintain complete treatment records regarding patients treated. These records shall include, but shall not be limited to X rays, treatment plans, patient charts, patient histories, correspondence, financial data and billing. These records shall be retained by the dentist for five years in an orderly; accessible file and shall be readily available for inspection by the DQAC or its authorized representative: X rays or copies of records may be forwarded to a second party upon the patient’s or authorized agent’s written request. Also, office records shall state the date on which the records were released, method forwarded and to whom, and the reason for the release. A reasonable fee may be charged the patient to cover mailing and clerical costs.
Every dentist who operates a dental office in the state of Washington must maintain a comprehensive written and dated record of all services rendered to his/her patients. In offices where more than one dentist is performing the services the records must specify the dentist who performed the services. Whenever requested to do so, by the secretary or his/her authorized representative, the dentist shall supply documentary proof:
(1) That he/she is the owner or purchaser of the dental equipment and/or the office he occupies.
(2) That he/she is the lessee of the office and/or dental equipment.
(3) That he/she is, or is not, associated with other persons in the practice of dentistry, including prosthetic dentistry, and who, if any, the associates are.
(4) That he/she operates his office during specific hours per day and days per week, stipulating such hours and days.
2.2 The above violations provide grounds for imposing sanctions under RCW 18.130.160.
3. NOTICE TO RESPONDENT
The charges in this document affect the public health, safety and welfare. The executive director of the Commission directs that a notice be issued and served on Respondent as provided by law, giving Respondent the opportunity to defend against these charges. If Respondent fails to defend against these charges, Respondent shall be subject to discipline and the imposition of sanctions under Chapter 18.130 RCW.
DATED: December 2, 2014
STATE OF WASHINGTON
DEPARTMENT OF HEALTH
DENTAL QUALITY ASSURANCE COMMISSION
KISHA N. EIKNER, WBSA #43057
ASSISTANT AITORNEY GENERAL
This page was posted on March 27, 2015..