Complaints Still Coming In: Little To No Improvement Since Steven Adair Joins FORBA/Small Smiles

What exactly is Dr. Steven Adair doing to stop the abusive and poor quality dental care at FORBA/Small Smiles clinics?

A few months ago FORBA announced he was Chief Dental Officer. However I've been told that he's really just a part time advisor and sends out emails now and then. I don't really know exactly what he's supposed to be doing, but so far I'm not seeing much. Maybe he needs to send his emails to me as well.

Rochester, NY, Massachusetts and Cincinnati, Ohio came in over the weekend. Actually all on Sunday. Three emails from three different states and clinics and they all sound pretty much the same. It's hard to deny the fact that this abuse is widespread, isn't it?

Below are three emails I received over the weekend. Actually I got all three of these on Sunday. Just when I thought things might have gotten a bit better I find the same complaints just keep coming in.

Of course my advice to these people were to file complaint with Federal and State authorizes as well as dental boards.

I would also like to offer this:

1. Get copies of ALL of the patient chart including x-rays and make sure the parents compare the original chart to the copied records to make sure they get them all. Our office mgr is famous for only copying the pages she wanted copied which just made me furious.

2. Get those records to another dentist for a 2nd opinion or even to the medicaid office or whatever insurance they have.

3. Check with the insurance carrier or medicaid to see what was actually billed and make sure it all adds up. If it doesn't add up file a complaint with your state Attorney General and Board of Insurance as well as the agency who oversees your medicaid program.

My name is M***** C*********** and I am the grandfather of a three year old girl (A******* *******) that has had a traumatic incident with the Small Smiles clinic here in Rochester NY. A********* had in our opinion been traumatized at the dentist. She was restrained, intimidated and tortured to the point her capillaries in her eyes broke! This so called dentist insisted on capping her baby teeth to reduce further damage to her teeth!!! Her baby teeth!

This procedure resulted with my granddaughter’s gums becoming enflamed and swollen. When my step daughter (Sarah Minor) returned her to little smiles for an emergency visit she described the resident dentist as “jamming” an inspection mirror into her mouth in an attempt to PRY it open! When she freaked he exclaimed “he was bitten earlier in the day and didn’t want it to happen again”. After a short visual exam (not even five minutes) she stated “he did not see anything and for her to brush more”!

That night the pain became so unbearable for her that she was rushed to the emergency department at Rochester General. It was here that the ER dentist told Sarah she had a bad infection and required immediate surgery before it turned into a health issue!! To date she has had one such surgery and is scheduled for another due to the depth of the infection around the capped teeth!

When I did an Internet search to see if this company had any other complaints I could not believe what I read. Everything that was written by other parents – word for word- was what happened to A********. This is how I was directed to your office and am filing an official complaint!

I am going to try and contact the other parents as well as legal counsel to see the extent of our rights but someone from your end has got to do something also .All these new parents are trying to do the best they can and are being taken advantage of.

There needs to be tighter laws and regulations regarding medical practitioners dealing with children. If they think they can tie up our children and torture them with no consequences they have another thing coming!

Sincerely,

M******** L. C*******

For S******* M******** mother of A******* *********

________________________________________

Hello,
I don't know exactly where to begin...but myself and a friend are looking into the Small Smiles practices in MA, after both of our sons had questionable experiences. Her son was put in a papoose restraint for a non-emergency visit. We are serious about doing something, but are looking for advice as to where to begin. Any thoughts?
Rachel

_________________________________________

i read somewhere to contact you about small smiles. I am a former employee of the clinic in Cincinnati, Ohio and for the rest of my life i will be ashamed of the things i was made to do. i attended a dental assisting school and right after that i was sent to work at small smiles i hardly knew anything about dentistry and the laws and regulations in the dental field. small smiles told us we had to do this we don't talk about that we work fast fast fast and do as much as we can but it was never good enough! ever morning they would have a meeting about how we have to make more money in order to keep the place open. i know now that was a lie! things got so bad i watched as a doctor place a mirror so far back into a three year olds mouth that he gagged and then the doctor leaned down by his ear and told him to shut up or he will do it again!! i reported the man to the cooperate office and they promoted the doctor to regional manager!!! i couldn't take it anymore and i wanted to make dental my career and i knew i couldn't stay with small smiles and have a good conscience. Please feel free to email me back or anything I feel an obligation to help shut them down.

New Mexico Watchdogs Looking Into Taxpayer Money Given To FORBA/Small Smiles

Looks like a 'can of worms' has been opened in New Mexico in regards to FORBA/Small Smiles. It appears more 'watchdogs' are jumping on the bandwagon questioning FORBA and it's Small Smiles Clinics, especially in New Mexico.

New Mexico is where government decided to give FORBA/Small Smiles New Mexico taxpayer dollars as a gift to help FOBA open a couple of clinics. Serious questions are being raised as to why and how FORBA/Small Smiles ending up getting that money.

1. Rio Grand Foundation Story

2. Paul Gessing Article

3. Jim Scarantino Report

4. Mario Burgos Blog

Below is Jim Scarantino's Report:

Nothing to Smile About: New Mexico’s Curious Investment in Small Smiles Dental Clinics

Does New Mexico’s State Investment Council know what is being done with the tens of millions of dollars it has invested in New Mexico venture capital? That doesn’t seem to be the case, at least in the instance of one curious investment.

In its 2007 annual report the State Investment Council (SIC) reported it had acquired ownership positions in 45 New Mexico companies. These investments amounted to $141.4 million. That sum includes the $19 million invested in Eclipse Aviation, which is now in bankruptcy. The report does not disclose how much New Mexico has invested in these companies or what percentage of their stock is owned by New Mexico state government as the result of these equity acquisitions.

The Rio Grande Foundation has been asking the SIC for that information for two months So far, the SIC has not been able to provide an answer. It does not seem to be any more readily available to the SIC than to taxpayers who want to know what is being done with their money.

Except for the Eclipse Aviation investment and the millions invested directly in Earthstone, a Santa Fe cleaning products company, the rest of the SIC’s current investments in New Mexico companies have been made in partnership with a venture capital funds that are based in New Mexico or have an office here, though their principal office may be in another state.

As Charles Wollmann, the SIC’s Public Information Officer explains it, the SIC relies on these investment firms to determine how much is invested in each company. Accordingly, that information is not readily available to the SIC…or New Mexico taxpayers. Indeed, Wollmann has cautioned that some of this information may be proprietary and not for public disclosure.

The Rio Grande Foundation has taken a closer look at Small Smiles, one of the 45 New Mexico companies identified in the SIC’s 2007 report. We have learned that Small Smiles is not truly a “New Mexico company” but is a multi-state chain of Medicaid dental clinics owned by out of state interests and managed by a company whose ownership can be traced back to the small Arabian nation of Bahrain. Our investigation also reveals that by investing in Small Smiles the SIC has bought into a company with a record of abusing child patients and engaging in unethical billing that has put it under government investigation. And, as we have learned, there are more public relations troubles brewing for Small Smiles.

Small Smiles, a New Mexico Company? Try Colorado, Tennessee or even the Middle East.

Small Smiles operates Medicaid dental clinics for low income children and infants in nineteen states and the District of Columbia. It began operations in New Mexico in 2007, opening one clinic in Santa Fe, one on Albuquerque’s west side and one in southeast Albuquerque.

Through its partnership with Red River Ventures of Plano, Texas, the SIC acquired equity in Small Smiles in 2007. Bruce Duty, a director of Red River Ventures, told the Rio Grande Foundation that his company invested a total of about $5.5 million in “Smile Smiles, LLC.” About 10%, or $550,000 of that investment came from New Mexico’s SIC. The rest came from other investors, including the United States Small Business Administration.

There is no New Mexico corporation identified in the records of the New Mexico Public Regulatory Commission as “Small Smiles, LLC.” Instead, the Public Regulatory Commission corporations archive reveals three Small Smiles professional corporations corresponding to each of the three clinics. Each of the Small Smiles dental clinics was incorporated as a separate professional corporation.

None of the directors of the New Mexico Small Smile clinics are New Mexicans.
The director of the Santa Fe clinic and the clinic on Albuquerque’s west side is Kenneth E. Knott. He is a Senior Vice President of FORBA of Nashville, Tennessee. FORBA is one of the nation’s largest dental clinic chains. (More on FORBA below). Knott is a busy man. He is also a dentist, and is licensed in Ohio, the District of Columbia, Connecticut, New Hampshire, South Carolina, Kentucky, Oklahoma, and Virginia. He also is the director of Small Smiles Clinics in Akron and Youngstown, Ohio, Ft. Wayne, Indiana, the District of Columbia, and Reno, Nevada.

The director of the Small Smiles clinic in southeast Albuquerque is Adolph R. Padula. He is a retired dentist from Pueblo, Colorado. He is related by marriage to the DeRose family of Pueblo, Colorado, the founders of the Small Smiles chain of Medicaid dental clinics.

The corporate records of all three New Mexico clinics give either mailing addresses or identify a principal out of state address in Pueblo, Colorado.

So how does this tie Small Smiles to the Middle East? Follow the thread a little bit further.

First, we have to go through Pueblo. That’s where Small Smiles began, growing out of the DeRose dental clinic. The DeRoses once owned a string of dental clinics across the country catering to Medicaid patients. They sold their interest in Small Smiles to FORBA. Dr. Michael DeRose, one of the founders of the Small Smiles chain, in 2007 agreed to pay the federal government $10 million to settle charges his clinics had charged Medicaid for unnecessary procedures, such as capping children’s teeth. As reported below, this is an allegation that continues to arise against Smile Smiles clinics even after the DeRoses sold their interest to FORBA.
All Small Smile clinics are now managed by FORBA, which also began in Pueblo. FORBA owns the trademark on “Small Smiles.” FORBA stands for “For Better Access.” It has grown into one of the nation’s largest dental care management companies. It reported revenue of $142.2 million in 2006. That year it was acquired by a Sanus, a Nashville-based holding company, and then moved its main corporate offices to Tennessee. It continues to maintain some operations in Pueblo.

Sanus, in turn, was acquired by Small Smiles Holding, LLC, a company formed for the express purpose of acquiring Sanus.

But Nashville isn’t the end of the line. The terminus is Bahrain. In January 2007, just before SIC’s investment in Small Smiles, Sanus sold FORBA for $435 million to Arcapita Bank of Bahrain.

In sum, instead of investing in a New Mexico company, the SIC’s partner has invested in a company owned by a bank on the Arabian Peninsula. The SIC’s 2007 report, claiming an investment in a New Mexico company called Small Smiles, is incorrect.

Grim Smiles
At the time that the SIC’s money was being invested, Small Smiles was the subject of a damning Emmy Award winning expose’ of its medical and business practices in Washington, D.C. area clinics. WJLA-TV of Washington, D.C. launched its investigative report with film footage of a screaming child being restrained on a “papoose board” while his mother was excluded from the room. The series of investigative reports also discovered that Small Smiles was using unlicensed x-ray technicians and billing Medicaid for hundreds of thousands of dollars in unnecessary dental work, including pulling children’s teeth without a valid medical reason.
“Drilling for Dollars,” triggered a criminal investigation by the Maryland Attorney General. Several insurance companies suspended Small Smiles and directed patients to seek dental work elsewhere. The report elicited complaints from patients and employees around the country that were collected at the television’s website.
In May 2008, New York terminated Small Smiles’ participation in its Medicaid program in response to reports by CBS-6 news of Albany that its Colonie clinic was performing unnecessary procedures such as needlessly crowning teeth. When Small Smiles challenged these claims, more than one hundred parents came forward with complaints of mistreatment backed by photographs. As in Maryland, parents were not permitted to be present with their children during examinations and dental procedures. A dozen parents also reported that their children were restrained on a “papoose board.” Some parents reported their children screaming in pain because the dentist operated before anesthesia took effect or operated without any anesthesia at all. Parents also reported the use of dirty dental instruments. Lawsuits have been filed by several parents against Small Smiles based on these allegations.
Small Smiles has drawn the ire of New York’s United States Senator Charles Schumer. After the New York Office of the Medicaid Inspector General revoked their Medicaid authorization, he issued a statement saying, “"I'm glad they're terminating Small Smiles," said U.S. Sen. Chuck Schumer (D-NY), a staunch critic of the company. "They don't deserve to be in business and certainly not get any federal money." Sen. Schumer says he has seen news reports documenting similar allegations against Small Smiles clinics in Denver, Rochester, and Washington D.C. "They ought to prosecute some of the people who did this," he told CBS-6 via satellite from Capitol Hill. "This goes beyond a mistake. This is hurting our children and ripping off the federal government...and I think there ought to be a criminal investigation of this."

Similar allegations against Small Smiles clinics in Kansas have been reported by The Wichita Eagle and in Colorado by KUSA-TV of Denver.
Debbie Hagan of Owensboro, Kentucky collects complaints from Small Smiles patients and parents at her blog, “Dentist the Menace.” (www.debbiehagan.blogspot.com). She also receives reports from dentists who have worked in Small Smiles clinics. One person identifying himself as a dentist who worked at a Small Smiles clinic wrote, “I was disgusted with the way children were treated. I wouldn’t take a dead snake to that place.” FORBA has sued Hagan for defamation and posting what it claims are copyrighted internal company documents. That has not stopped Hagan from continuing to run her blog.

The bad publicity for Small Smiles and FORBA may be getting worse. Good Morning America recently aired parents’ complaints against Small Smiles. Additionally, ABC’s nationally televised investigative news program “20/20” has completed a critical report on Small Smiles. According to its producer, Glenn Ruppel that report will air very soon.

What Did the SIC Know and When Did It Know It?
The SIC does not seem to have been aware of any problems with Small Smiles while its partner Red River Ventures was investing taxpayer dollars in that troubled company. A review of all the minutes of meetings from 2007 and 2008 of the State Investment Council and the New Mexico Private Equity Investment Advisers Council, which advises the SIC on private equity investments, did not reveal any discussion of nor any report on Small Smiles.
The SIC had no response when asked if it was aware of the history of problems of Small Smiles’ clinics. The SIC does say it is no longer categorizing Small Smiles as a New Mexico company.

Below is a Snippet from Mario Burgos Blog Entry:

How is it that the SIC has had so many questionable (I'm being kind here) and ill-fated investments? Well, you might remember that it has been standard policy under the Richardson administration to fire those advisors who did not want to issue rubber stamp endorsements of shady (okay, sugar-coating is not really my style) deals that Governor Richardson wanted to see approved.

That's right, I said, "Deals that Governor Richardson wanted approved." After all, the Governor is the chairman of the SIC. Now, in light of all of the recent scandals, you may be wondering if the Governor has ever received any campaign contributions from anyone connected to Small Smiles.

Well, I'm glad you asked. As it turns out, the Chairman and CEO of the holding company for Small Smiles is Michael Lindley of Nashville, Tennessee. Mr. Lindley did indeed donate a $1,000 to our Governor's presidential campaign. He also gave a $1,000 to Congressman Ben Ray Lujan's campaign.

Of course, my guess is that our Speaker of the House Ben Lujan solicited the funds on his son's behalf. After all, other than the imprisoned former State Senator Manny Aragon, the only other elected official to recieve funds cycle after cycle from Small Smiles in New Mexico is Speaker of the House Lujan.

New Mexico Investment Council Blasted For Small Smiles Investment

Remember a week or so ago I reported on Small Smiles in New Mexico. Plus I had reported last year that I thought it was odd the two top dogs at FORBA had made political contributions to a New Mexico lawmaker. Well, it appears others in New Mexico have taken notice to Small Smiles as well.

Click Here for the Story

State Investment Council needs a closer look

By Paul Gessing/For the Sun-News

Posted: 01/08/2009 12:00:00 AM MST

The pending loss of New Mexico's $19 million investment in Eclipse Aviation raises important questions about how wisely the State Investment Council (SIC) is handling our money. This is not the first private equity investment by the SIC to go sour. New Mexico lost a $7 million investment in TCI Medical, a start-up nuclear medicine company that was supposed to create 100 jobs in Carlsbad but employed just seven people. The SIC also lent about $2 million to Millenium Transit, a bus manufacturing company in Roswell. That company is now in bankruptcy.

The SIC does not seem to know exactly what is being done with New Mexico's money. It claims to have bought equity positions in 52 New Mexico companies, but it cannot say, despite repeated requests by the Rio Grande Foundation, how much money it has in each of these companies or what percentage of each company's stock is owned by New Mexico taxpayers.

The Legislature, at Governor Richardson's urging, has authorized the SIC to invest up to 9 percent of the Severance Tax Permanent Fund in acquiring stock in private New Mexico companies. This is a substantial amount of money. At the end of 2007, the SIC had over $141 million invested in private New Mexico companies.

So far, the SIC's New Mexico private equity program hasn't produced hard returns for New Mexico taxpayers. For years, the SIC claimed its New Mexico private equity program was in the black. But favorable (and inflated) valuations for Eclipse, the largest holding in the portfolio, accounted for those paper gains. With Eclipse in the tank, the false bloom is off the rose.

Even some of the SIC's smallest acquisitions look questionable. Take for instance, its investment in Small Smiles. The SIC's 2007 annual report showed an investment of an unstated sum in this New Mexico company. By directly contacting the venture capital firm that handled this investment, the Rio Grande Foundation learned that about $500,000 New Mexico taxpayer dollars have been invested in Small Smiles. The SIC itself had not been able to answer this question.

Contrary to the SIC's annual report, Small Smiles, is not a New Mexico company. It is a national chain of low-income dental clinics owned by a bank in Bahrain. Furthermore, at the time half a million taxpayers dollars were going to help Arab investors, Small Smiles was being blasted in an Emmy Award winning investigative television series called "Drilling for Dollars." Small Smiles clinics in the Washington, D.C. area were exposed for abusing children by strapping them to "papoose boards." Small Smiles had engaged in unethical billing practices. Parents came forward with complaints of unnecessary dental work being performed on their children without their consent.

The same complaints about Small Smiles arose in New York, Colorado and Kansas. New York Senator Charles Schumer has called for criminal prosecution and disqualification of Small Smiles from the Medicaid program. New York, in fact, did revoke Small Smiles' Medicaid credentials.

A review of SIC meeting minutes shows not one mention of Small Smiles' difficulties. In fact, Small Smiles wasn't discussed once though a half million dollars were invested in this troubled company.

The Eclipse bankruptcy proves that politicians and their appointees make very poor judges of the next big breakthrough in aviation or other technologies. The fact that even in its smallest investment the SIC seems less than completely informed should make taxpayers concerned about whether their money is being prudently managed.

There is scant oversight of the SIC's investment practices and decisions. Only when a big investment like Eclipse craters does the public learn of losses. It's time the Legislature revisit the discretion it has given the SIC, and provide for greater transparency and more informed decision making. It should also ensure inescapable accountability for those who make the wrong calls in handling the public's money.

Paul Gessing is the President of New Mexico's Rio Grande Foundation, an independent research and educational organization dedicated to principles of limited government, economic freedom and individual responsibility.

Small Smiles Investor Receives Bail Out Money

Cit Group received 2.33 Billion in Bail Out (TARP) money according to the website.

Since I have never professed to understand the complicated maneuvers FORBA/Small Smiles made in late 2006 I'm not going to even try to explain the relationship between Cit Group and FORBA/Small Smiles other than to quote an article from streetinsider.com.

November 20, 2006 3:37 PM EST

American Capital Strategies Ltd. (Nasdaq: ACAS) has invested in Small Smiles Holding Company LLC, a holding company formed to acquire Sanus Holdings Inc., a leading dental practice management company. American Capital's investment takes the form of senior subordinated debt, holding company PIK notes and common equity and supports the acquisition of Sanus by affiliates of Arcapita Inc. and the Company's senior management.
A syndicate led by CIT Group Inc. (NYSE: CIT) has arranged a revolving credit facility and a senior term loan. The Company's management team and private investors are investing in the equity of Small Smiles.

Is Kool Smiles Coming To a Place Near You?

Here is an anonymous email that stated:

I am a dentist that currently works at Kool Smiles. There are many corporate habits that just turn my stomach but I go along because they keep paying me. One thing is that we do not do is change rubber gloves between patients. Can you imagine the health risks that we are taking doing this?

It makes me sick.

Something must be done.

FFl have given Kool Smiles in Atlanta 48 million dollars to expand and DPMS (in San Ramon, CA) another 48 million to expand so they can sell the company off in 2010.

If people are visiting your site, they must be concerned about the impact that you are having with everyone reading your blog. They want to sell the whole thing to someone for hundreds of millions of dollars.

FFL (Friedman, Fleischer and Lowe) has two companies to keep an eye on in their portfolio.

DPMA

From FFL's, Website:

DPMS, Inc. provides various non-clinical services to dental group practices, including providing dental facilities, support staff, and other business services. DPMS's principal client is Kool Smiles, a nationally-branded provider of dental care focused primarily on children enrolled in Medicaid and State Children's Health Insurance Programs. The limited access to care for children on Medicaid/SCHIP plans provides an attractive growth opportunity for Kool Smiles as it continues to expand offices with a mission to provide quality care to this underserved population.

The company was founded in 2006, and is headquartered in San Ramon, CA.

and

NCDR, LLC (Kool Smiles)

From FFL website:

NCDR, LLC provides various non-clinical services to dental group practices, including providing dental facilities, support staff, and other business services. NCDR's principal client is Kool Smiles, a nationally-branded provider of dental care focused primarily on children enrolled in Medicaid and State Children's Health Insurance Programs. The limited access to care for children on Medicaid/SCHIP plans provides an attractive growth opportunity for Kool Smiles as it continues to expand offices with a mission to provide quality care to this underserved population.

The company is headquartered in Atlanta, GA. FFL invested in NCDR in 2004 to provide growth capital and liquidity to founders.

Small Smiles Seeking Dentists In Several Clinics

If you are interested in a job with Small Smiles in any of the following cities:

Aurora, Colorado

Colorado Springs, Colorado

Pueblo, Colorado

Reno, Nevada

Wichita, Kansas

Oklahoma City, Oklahoma

Tulsa, Oklahoma

Montgomery, Alabama

Dothan, Alabama

Roanoke, Virginia

Albany, New York

or

Boston, Massachusetts

and are interested in treating young underserved children they offer excellent base salary, promotion opportunities and benefits (including monthly bonus potential, then click here to apply.