AUSTIN (KXAN) – A Texas lawmaker is demanding changes after a KXAN investigation discovers little oversight over dentists putting patients under sedation or anesthesia.
More and more dentists are offering sedation in their own offices but we found you may be at a greater risk because the Texas State Board of Dental Examiners doesn’t conduct inspections of dentist's offices or their use of sedation or anesthesia. Our investigation also discovered the board rarely takes disciplinary action against dentists when patients are hospitalized or die after something goes wrong during a dental procedure involving sedation.
This spring, 14-month-old Daisy Lynn Torres died after she went in for a “routine” cavity filling at a pediatric dental office in Austin. While her official cause of death is still under investigation, we do know the child was under anesthesia. The dentist who conducted the procedure is still allowed to practice.
But Daisy Lynn Torres is not alone.
Brian Gill of Smithville died after what should have been a routine procedure in February 2014.
"I kissed him goodbye and told him I loved him,” said Sharon Gill, who had been married to Brian for 36 years. “And he walked down the corridor and that's the last time I saw him alive. I'll never forget that. I'll never forget him walking down there, and that was it. He was gone.”
Dr. Dan Holtzclaw extracted several of Brian’s teeth and replaced them with implants and Dr. Jaclyn Smith took over after the surgery. Holtzclaw runs the Austin Cosmetic Dental Implant Center and worked with Dr. Smith at her Bastrop office, The Dentists. While Brian was under sedation, something went terribly wrong. His breathing abruptly stopped, he went into cardiac arrest and was rushed to the hospital. Brian died the next day.
Sharon filed a lawsuit against both dentists claiming they "failed to properly monitor Brian's airway, heart rate, and respiration" which led to his death. Both dentists deny wrongdoing in their responses to the lawsuit. Neither would comment for our story. But in response to Sharon's suit, Holtzclaw claims Brian gave them "an incomplete, inaccurate and misleading past medical history." Sharon says that is not true.
In a video on his website, Holtzclaw talks about the particular procedure he performed on Brian.
During Brian’s procedure, Holtzclaw used an IV with the drugs Fentanyl and Versed to sedate him. An anesthesiologist was not present during the procedure but state records show Holtzclaw does have the required certification for administering that level of anesthesia. Sharon believes the dentists should have been watching her husband’s vital signs more closely.
"It shouldn't have happened. It should not have happened. They should have been monitoring better, and they did not,” she claims.
The job of monitoring dentists belongs to the Texas State Board of Dental Examiners. The dentists treating Brian had no prior disciplinary history and neither have been disciplined in regards to his case.
A recent report by the Sunset Advisory Commission, the state's watchdog agency, says "complications from dental procedures using anesthesia have caused serious harm to Texas patients, including death."
Sunset Commission investigators found 112 complaints related to dentists using anesthesia since 2012. Of those, 41 patients died. The Sunset report also says at least 13 of those cases included "violations of the dental standard of care, including inappropriate preparation for or response to anesthesia-related emergencies."
To verify your dentist’s license, see if they have the proper certification for administering sedation or anesthesia and if they have ever been disciplined by the dental board for doing something wrong.
Records KXAN obtained from the dental board show 85 deaths related to dental procedures have been reported since 2010. But the dental board only sanctioned dentists in five of those cases. Thirty-seven cases are still under investigation, 13 of which have been open for at least two years.
The records also show 550 dental patients have been hospitalized since 2010 with board sanctions coming in only 24 of those cases. One-hundred-and-fifty-five of those cases are still under board investigation, with more than half of them pending for more than a year.
KXAN also uncovered the dental board does not conduct any inspections of dental offices where sedation is offered, even though it has the authority to inspect dental offices with moderate sedation permits. This is why some are questioning why the board doesn’t do more to protect patients.
"We are absolutely trying to do our best,” Kelly Parker, director of the Texas State Board of Dental Examiners said. “We have our hands tied to a certain extent.”
Parker says the dental board doesn’t have the authority to inspect dental offices offering deep sedation or general anesthesia and simply doesn’t have the funding or staffing to inspect any dental offices.
“We need help. We need the funds. We need the staff. We need it full circle in order to do what we need to do to protect the public,” said Parker.
State Representative Larry Gonzales, R-Round Rock, chairs the Sunset Commission and promises the legislature will find the money needed for inspections next session.
“We know where the deficiencies are. We know how to address them. You're going to have to have an emergency plan. We're going to do those inspections. That’s what we're going to do, and we're going to pay for it,” Gonzales promised.
The Texas Society of Anesthesiologists thinks that’s a good start.
"I think clearly inspections are just one piece of that. It doesn't guarantee that it is going to be safe," said Dr. Tim Bittenbinder, the group’s president.
Bittenbinder says most complications come from doctors not following proper procedures or not sufficiently monitoring patients.
"There are some oral surgeons and dentists that have gone through a great deal of training, and they provide great care. But if you are going to have folks that are undergoing deep sedation or general anesthesia, certainly I would argue that that person be qualified and not distracted by being part of the procedure piece," Dr. Bittenbinder said.
Whether or not that would have helped keep her husband alive, Sharon may never know.
"It was the worst day of my life. I never imagined that that could ever happen. You just don't think it's going to happen.”
Sharon is now sharing her husband's story hoping to spare others the heart break she's going through.
"I'm hoping that I can do something to not let this happen again. It just makes me so mad that this happened. It didn't have to happen."
There are three dentists in the Austin-area who have been disciplined by the dental board after their patients were hospitalized or died after a procedure. The board orders only indicate a problem with sedation in one case where a patient had to be hospitalized. All three dentists are still practicing.
The Texas Dental Association and the American Dental Association both say patients should follow some very simple, but important steps to help protect themselves or their children.
- Talk to your dentist about patient safety and ask what type of sedation you or your child will receive and who will be monitoring the process.
- Make sure your dentist is properly permitted for the type of sedation being offered.
- Discuss your medical history and medications with them.
- It’s also important for the dentist to consult with your primary physician before sedating you, especially if you have medical problems such as sleep apnea, or cardio-pulmonary issues.
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