Monday, March 22, 2010

Concerns About Small Smiles Raised By Nevada CUSP in 2006

February 22, 2006 
Health Access Washoe County 
1055 S. Wells Avenue 
Reno, NV  89502

Small Smiles Dentistry of Reno: Mike Rodolico, Mike Roumph

At the last CUSP meeting, Mike Rodolico asked if anyone had any information about the new pediatric dental clinic in Reno, Small Smiles.  No one did.  Dr. Rodolico offered to go on the Internet to research the parent organization and report back at the next meeting.   Dr. Rodolico located several video news clips from a Colorado news station which he played for those present.  The primary concern raised in the video clip included injuries to children who had been restrained in papoose boards and the provision of excessive amounts of treatment during appointments.  

Mike Roumph, who was in attendance representing Small Smiles then made a PowerPoint Presentation about Small Smiles and played news clips from television stations in Oklahoma and Georgia.  The Small Smiles practice in Reno is owned by a Nevada licenses dentist, Dr. Adolph Padulla.  

( I wonder if Mike told them Dr. Padula also owned FORBA, was part of the problem, didn't live in Nevada and didn't practice dentistry.  Had they googled Dr. Padula they would have known he was also licensed in about 15 other states at the time.)

It is managed by Forba Management Company, LLC.  Forba is the largest provider of children’s dental services in the United States.  They manage 40 clinics in 13 states.  The clinics managed by Forba saw over 700,000 children last year.  

The Reno clinic had over 1,100 appointments scheduled when they opened their doors.  It has a staff of 25According to Mr. Roumph, papoose boards are only used on 6% of their cases.  (Bull Crap!)

He stated that dentists receive training in dental school on behavioral management.  (Really?) 

If those techniques are not adequate, then it is up to the provider to make the decision to refer the child for treatment under general anesthesia or to use the papoose board.  

Parents are counseled regarding the use of papoose boards and the parent, the dentist and a witness must all sign a consent form prior to a papoose board being utilized.  In terms of the amount of treatment provided at one appointment, that decision is left to the individual provider.   (Lying like a dog, but it sounds good!)

According to Mr. Roumph, their clinics have a policy (albeit unwritten) that no more than six teeth can be crowned at one appointment.  They are able to provide this amount of dentistry during each appointment because they practice six-handed dentistry (one dentist and two dental assistants).  

(Don't ya love it, Six Handed Dentistry.  One Dentist and two assistants, tying down a child, pinching his nose, scaring the living heck out of him, and doing 6 root canals and crowns, and somehow they thought this was doing something good and just)  

Chart audits are performed on a monthly basis.  Between 10 to 20 charts are randomly selected each month for the chart audits.  Clinic staff meet and review the findings of the chart audits. The findings are used to develop policies and procedures for all Forba managed clinics.  

(Randomly selected, huh?  By whom? and who did those audits?, the finding were used to develop policies alright, like how can we get more done in a shorter amount of time, and what kind of incentives can we use, Super Bowl Tickets anyone?)

Twice a year a physical audit is made of each clinic.  This includes a review of HIPAA and OSHA compliance, billing practices, personnel and additional chart audits.  

A Forba regional manager, who is also a dentist who has been employed by Forba for five years, participates in the physical audits.  These audits are benchmarked against other Forba managed clinics. 

(Yes, they sure are.  And if one clinic is under producing, heads roll!)

The question was raised as to what Small Smiles is doing to comply with the community’s standard of care which is that children who need extensive dental treatment are hospitalized and the procedures are done under general anesthesia.  Mr. Roumph stated that Small Smiles is trying to get hospital privileges for at least one dentist in each of the clinics they manage.  

(OH DEAR GOD!  How did that work out!)

They also have a policy that appointments will not exceed one hour in length (no new procedures will be initiated after one hour).   

(One Hour!!!  Hell NO, they sure won't/didn't or shall exceed one hour, 20 minutes max, for those 6 root canals and caps, that's why the papoose board is needed, heck after shots it takes 10-15 for those to kick in doesn't it, by that time, 99% of those 6 teeth have been derooted and capped, the rest of the time is used to clean the puke and pee up.)

Parents are not encouraged to be in the treatment room; however if the parent wants to be present, the dentist and parent meet and the dentist can make a decision to allow the parent in the treatment room.  

(you guys just never did get your lies lined out on this one did you)

Mr. Nowak was asked if the DHCFP has thought of implementing policies/guidelines related to length of appointments, number of procedures done at each appointment, use of papoose boards and allowing parents in treatment rooms.  Mr. Nowak stated that Forba and the DHCFP have had discussions regarding these topics. 

(During these discussions I wonder if they talked about how to get FORBA to back the hell off, Colorado had to pass a law to get them to cooperate?)

The DHCFP has informed Forba that they will support them in the event that a parent wants more treatment performed at one appointment than a dentist in a clinic managed by Forba deems prudent.  

(Well, I'm sure that was never a problem, nor would I think it would be, but a nice try at spinning it anyway.)

Mr. Nowak also stated that the DHCFP will be utilizing an external quality review organization and their findings may provide additional guidance.     

(Where can a person get a little 'look-see' at those reviews and provided guidance?)                  

Mr. Roumph finished his presentation by issuing an invitation to CUSP members to come by the Small Smiles clinic in Reno to visit at any time. 

He also asked if Dr. Ashley Angaran, who is a Reno native, could be placed on the e-mail distribution list to receive agendas and minutes.  He would like Dr. Angaran to start attending CUSP meetings as a representative from Small Smiles.   

(How's that working out?)

1 Must Read Comments:

las vegas cosmetic dentist said...

I have worked in dentistry for years, and I agree that parent should never be allowed in the treatment room.