Reporter discusses frontline coverage of debate over expanded use of dental therapists Date: 02/29/16
By Mary Otto
A recent news package in The Seattle Times by reporter Will Drabold took a look at how the controversy over dental therapists is unfolding in the state of Washington.
Drabold examined the challenges faced by poor Medicaid patients in seeking dental care. He spoke with health care advocates who believe that technically-trained mid-level providers could bring much-needed care to poor and isolated communities. He also interviewed tribal leader Brian Cladoosby, whose Swinomish tribe had just defied state restrictions to hire a dental therapist. And he spoke with state dental association officials, who made it clear that they like the American Dental Association – believe dental therapists lack the training to perform these expanded duties.
Dental therapists, who often are compared to nurse practitioners, are trained to deliver a range of services including screenings, cleanings, preventive care, fillings and extractions. While the therapists do work under the supervision of dentists, dental groups often contend that dentists alone have the training to perform what they consider irreversible surgical procedures, such as drilling and extracting teeth.
In spite of resistance from organized dentistry, variations of the therapist model already are being used in Alaska’s tribal lands and in the state of Minnesota. Dental therapists have been approved in Maine and are being considered in a number of other states.
Since Drabold’s project ran in January, members of the Seattle Times’ editorial board have called upon Washington to explore licensing therapists.
“Too many of Washington’s residents insured by Medicaid are not able to get the dental care they need, which endangers their general health as well,” they noted in an editorial.
In this Q&A, Drabold discusses how he approached the project and what he learned in his reporting. He also offers encouraging words to other journalists who might find themselves writing about the dental therapist controversy as it unfolds in their states.
Q: What got you started on this project?
A: From May through July 2015, I was the David Boardman Investigative Reporting Intern at the Seattle Times. This is a fairly unique internship at a newspaper because it gives college students an opportunity to work with the Times’ Pulitzer-Prize winning investigations team. A reporter on the team got a tip that the Swinomish were planning on moving forward with hiring a dental therapist – even though dentists and the state had blocked such a move – and passed it along to me. The story was the culmination of weeks of reporting from that kernel of information.
Q: Can you tell us a little about how the story evolved over time?
A: Initially, the story was focused on the Swinomish. But I quickly found that the data on the state of dental healthcare in Washington, and often nationwide, was so abhorrent that we needed to consider that angle as well. I’ll stress this again: a quarter of the state’s residents are on Medicaid, but only a fraction have access to dental care.
Q: In your project you cited interviews and campaign-finance records to support a conclusion that dentists and the Washington State Dental Association had worked for five years to thwart efforts to bring dental therapists to Washington State. Some of your sources told you that Kevin Van DeWege, a Democratic state representative whose district includes most of the Olympic Peninsula has played a key role in keeping therapist bills from leaving committee, due to the influence of the dental lobby. Van DeWege defended his record and told you he opposed therapists due to concerns about the level of training they received. Can you tell us how you approached that piece of your reporting and how the evidence added up?
A: The interviews began with conversations with the dental association and tribal leaders. I heard their sides of the story. This was a story where the opposition of one side (the dental association) was not difficult to identify. They are openly opposed to therapists, as is their parent organization: the American Dental Association. Conversations with a myriad of dental health professionals and advocates, some of them outside of Washington, made it clear the dental lobby had substantial influence in Olympia. From there, I reviewed finance contributions by the dental association to various lawmakers — including contributions to key legislators on committees that have reviewed the dental therapist proposals. Kevin Van DeWege was an example of the association’s targeted giving. I have to credit FollowTheMoney.org with keeping campaign-finance records in an easy-to-track format. I highly recommend their database.
Q: Many dental groups contend that only dentists have the training to do some of the procedures the therapists are performing. How have dental groups reacted to the project and the editorial?
A: Angrily. I have received hate mail from across the country with varying levels of vitriolic language. The prevailing response has been: “Let dentists remain the sole provider of health care in the mouth.” However, a few dentists have reached out, saying they support therapists. This is why we made it clear it is not all dentists – but primarily the dental association – are opposed to therapists.
Q: Do you have a few words of wisdom to share with reporters who may find themselves tackling this issue themselves in the coming year in their own states?
A: Access to consistent, reliable, effective dental health care is a critical problem for the country. And it has been for years. Everyone agrees on that, so this is a subject worth any reporter’s time. My main advice is to stay persistent and curious on this topic and realize a large community is interested in this subject. If you write about this, you will be surprised, perhaps overwhelmed, by the level of response your story receives.