Monday, December 29, 2008

Aggressive or Overtreatment

In an interview a Small Smiles lead dentist, Aldred Williams said:

"We aggressively treat these children to eliminate disease in their mouth. Small Smiles makes no apologies for that. I'm not going apologize for being aggressive," Williams said.

The word 'aggressive' really bothers me. What's worse is to think thats the 'training' the dentists get (could call in brainwashing I suppose).

I guess a person could insert "overtreat" in place of "aggressive" couldn't they an it still have the exact same meaning.

Of course I don't think Dr. Williams is there any longer after saying that publicly to the mainstream media.

I got this particular quote from the Good Morning America story on Small Smiles, but it was said in the interview with Roberta Baskin at WJLA aas well, I believe.

Here are other quotes from the Good Morning America and WJLA TV story:

1. Former Small Smiles dental assistant, Deborah McDaniel, said she was fired for objecting to the way children were being handled.

2."They wanted us to tell parents that they needed services on teeth that were healthy," McDaniel said. "They were healthy and they didn't need it."

3. "It's a competition throughout the country to see who can convert the most patients, not give the patients the most care," said Trina Crosby, another former Small Smiles employee.

4. The pressure to convert patients may come from FORBA. In fact, every morning Dr. Williams and his staff review the production goals set by the managers in Colorado.

7."They're sweating. Sometimes they urinate on themselves. They'll throw up," Crosby said.

5."It does no good for anybody but the dentist, I guess, who's looking for a bonus," said Robert Camps, a nationally recognized authority on pediatric dentistry whose Maryland practice serves mostly patients on Medicaid.

6.When Camps saw video of Miguel's dental visit, he was disturbed deeply. "It's traumatic for me to watch. I can only imagine how traumatic it is for Miguel," he said.

7.FORBA, the company that owns Small Smiles, said its dentists and staff are sent to its Colorado offices for training. (but I hear only the "lead" dentists are sent for training)

There were 158 comments on this story, you can read all of them here.

Here are just three:

1. I think ABC news should do an undercover investigation on the Small Smiles chain. I mean in every clinic. In one month's time, you would uncover mistreatment of children, insurance fraud, ADA violations, etc. As someone mentioned before - when a new doc joins a clinic and are yet to be accredited with an insurance company - other docs sign off on the chart and the insurance is billed under the signing dentists name. BTY - although it was never publicized, the chain is now within the 'portfolio' of a middle eastern bank. In other words, FORBA and Small Smiles is actually owned by a Bahrainian business group. There is so much more I could say - I can only pray that this story does not wither away. I would love to see the Federal Government step in and conduct an indepth chart by chart audit at every Small Smiles site.

2. I will join the ranks of the 'former employees'. I my year and a half at Small Smiles, I saw and heard so much abuse to children, that I actually developed an ulcer. I fought on a daily basis about the manner in which the docs, assistants, and hygienists were allowed to speak to the children. I witnessed the lead doc getting about 6 inches from the face of a crying, terrified, restrained child and yell at the top of his lungs, "That's enough. Stop being a punk." We were often directed to separate siblings. Especially older siblings that would overhear any yelling at their younger sibs. Competitions on converting....any employees remember "The Road to the Superbowl"? We were also trained to forbid parents in the back clinical area. If the parent balked (especially when there was a several thousand dollar treatment plan), the lead doc, in all his arrogance, would have me escort the parent to a consultation room, and proceed to tell the parent that dental work is just as serious and important as heart surgery and that they wouldn't be allowed in the operating room. WTF ever! The insurance fraud is OUT OF THIS WORLD!!! I was instructed to bill for prophys (cleanings) when all that was done was about a 2 minute tooth brushing with some toothpaste. No prophy angle, no scaling, nada. But I was told to bil a full prophy. I questioned that so much, I was actually told that if I asked and further questions and/or 'stirred the pot' any further, my job would be in jeopardy. I do have to add, that the original FORBA was much more caring than the 'business men' that bought FORBA at the end of 2006. The 'new' management was PURELY about the money. The 'old' FORBA cared about its employees and patients. The new FORBA - in an email that was accidentally forwarded to me had these requirements for a dentist - 'if she isn't cross-eyed and has all 10 fingers, let's make her an offer' sadly, I regret not forwarding that email to the dentist in question.

3. I am an employee at a pediatric dental office and very, very familiar with Small Smiles and their practices. Before you judge them you have to look at all angles of the situation. I live in Colorado, and here, there are so many loop holes and in dentistry and things that are not regulated in dentistry that that in itself should be a crime and the state of Colorado should be looking at that and not just be pointing the finger at Small Smalls. Each clinic is so different that you can not judge all of them as a whole. They are a corporation but they are run individually and some by a bunch of morons who don't know dentistry from gardening. Others of the clinics are run by a fabulous staff who really know their patient care, legalities, and methods. The sad part is knowing who is who. I stand up for Small Smiles because I have so many friends in the dental community who work at great clinics and others who work at ones who honestly do not know how to treat their staff or their patients. Like I said above, you can not only point your finger at the clinics. You have to look at the laws and you have to look at the parents who bring their children in. Until I became a CDA - EFDA I did not even know that baby crowns and root canals existed for two year olds, and I did not think that a 14 year old mom with three other kids was going to be handing me this child to do the work on... so you tell me when this 2 year old is screaming and crying after riding on the bus an hour from home with his mom and other 3 brothers and sisters in the cold of you are going to have mom come back to the room with all the other kids???? or tell me that you tell me that you are going to have a meth addicted parent come back and try to calm their child when THE PARENT keeps saying shut up and sit in the chair. Please do not get me wrong either, I am not saying that anyone is a bad person if they are on Medicaid at all, never would i say that.

3 Must Read Comments:

Anonymous said...

Don't forget the threats that are made to the kids on a daily basis that if they don't stop crying they will not see their parents again. This is still an ongoing threat that is being told to the children that are scared and crying. That sure works wonders for a child of a young age to threaten them that will not ever see their mom or dad again doesn't it. If it were me and I was told that at that young age I would be more terrified then ever. Then they wonder why the kids start screaming and crying and they can't even get them in on the next visit.

Anonymous said...

I was personally told to go to the nearest "supercenter" and buy white t-shirts of various sizes for the kiddos that got sick on themselves.

The radios to 'drown out the cries' were provided by FORBA at the opening of the clinic.

One of the sad parts is this - there were two FANTASTIC talented dentists at the clinic - their resumes are now scarred for life with Small Smiles. Although, I feel that they mistreated the kids, they were under pressure to meet production and only doing as they were trained by the folks in Colorado.

I think the government should close down SS and KS - and increase payments to privately owned DDS offices. Perhaps then, the abuse will go away.

Yes-I was an employee for 2 years. Needless to say - I don't list SS on my resume.

Anonymous said...

The facts are that not only do these clinics have dentists and other staff members over-treat teeth that can be consrvatively teated. But they often miss treatment needs that subsequently turn in to cases that need more expensive treatments later on. Staff members are told to do all procedures that they can, whether they are needed or not- just go through the motions, get films even though they are non-diagnostic, brush teeth and call it a prophy. They do whatever they can do and put children through some very unpleasant experiences to do so. And they do these types of things for every child every six months whether they need it or not. That is- whether they are at high risk of decay, or have shown no decay for several consecutive visits. The staff are told by management that they MUST do these things regardless of the need or not. So this goes on from the child's first visit at about age two usually until age twenty one if they are on Medicaid that long. That isa guaranteed 38 visits just to make money on a biannual exam, x-rays and prophy, at minimum. And forget about "preventative" practices. If you practice that way and educate patients and/or their care givers you will not be looked favorably upon if you work in these places.
Also there are more dentists in these places who are sub-par in skills and knowledge and caring about what they do. Screaming at and threatening the children while they are in the chair is common. And that concept of "converting" patients is constantly reiterated. It just bothers the management deeply to let someone go without drilling into them after the usual exam.
Make no mistake about it- it is all about getting as much money as they can as quickly as they can and as easily as they can. This is the belief of the management and most of the dentists alike. They take advantage of state Medicaid systems in a big, big way. No one monitors the quality or effectiveness of treatments. And the dentists know this too. If a billable treatment fails then so what? They do the next thing that they can get money for- They extract the tooth! Thy can not loose. No one questions this.Medicaid just pays the claims without questioning. It is all a shameful set of circumstances for sure.
As one who has worked at a couple of these placeas and has seen the "training" that they give each new employee; as well as has seen the day to day operations and attitudes and treatments provided by other dentists I can say that just about all that is written and said about these horrible clinics is true. One only has to be skilled enough and caring enough and to be in these places for a very short amount of time ( a few hours would do) to be able to see the obvious problems.
Look at the recent repayment by Kool Smiles of over one million dollars because they hired a dentist, (who by the way knew), that defaulted on a federal student loan payback. They never checked on that before hiring the woman. And if they did ask about it the dentist lied. Not that it is bad enough to default on a federal loan payment, being a so-called "professional" and all. This example should tell you something. Stuff like this and worse happens ALL THE TIME in the dental "profession." Unscrupulous and unethical behavior in dentistry is as common as waves hitting the beach.
Yes, Federal and State authorities should be getting involved. We need Medicaid reform. And we need people to hold these dental establishments responsible and accountable for their deeds.