Dr. Michael W. Davis maintains a general dental practice in Santa Fe, NM. He serves as chairperson for Santa Fe District Dental Society Peer-Review. Dr. Davis also provides a fair amount of dental expert legal work for attorneys. He may be contacted via email: MWDavisDDS@comcast.net
Economic Turf Wars over Dental Sedation and Public Safety
By: Michael W. Davis, DDS
Introduction
One can’t evaluate the different parties fighting over dental sedation privileges and the vast sums of money involved, without examination in the context of our toxic dental Medicaid program. Medicaid is a social safety net program jointly funded by the federal government and each individual state. However, administration of dental Medicaid is left to the particular state. Each state handles dental Medicaid very different with a complex variety of outcomes.
Florida
For example, the state of Florida refuses to authorize hospital-based sedation for dental Medicaid cases. Therefore, many of the most severe dental cases go untreated. Institutionalized patients for severe developmental disorders often go untreated. The potentials for ensuing major medical problems may go unaddressed, until the crisis stage for morbidity and mortality (illness and death).
As a result, numbers of Florida dental Medicaid providers deliver in-office sedation upon patients, who truly should only be seen in a hospital setting. Children, who have a much greater compromised airway than adults, are treated en masse with cocktails of different sedation medications, and in risky dose levels. In order to maximize dollar production under a flawed Medicaid fee schedule, these doctors are notorious for a dangerous lack of patient monitoring.
https://appsmqa.doh.state.fl.us/DocServiceMngr/displayDocument.aspx
Authorities rarely deliver more than wrist-slap regulation upon these violators, as their removal from the Medicaid system could hasten the collapse of this broken government program. The poor and disadvantaged are left between a rock and a hard place. They can elect to eat a $hit sandwich or go hungry.
Other providers of Florida dental Medicaid pursue a different scheme. They simply place any “uncooperative” child in restraints (euphemistically called “protective stabilization”). Again because the dental Medicaid fee schedule is so abysmal, these doctors feel justified in maximization of dollar production regardless of a child’s stamina, understandings, and limited abilities. All treatment possible is completed in a single visit. In order not to overdose a child for local anesthesia (generically termed “Novocain”) for their diminutive body weight, these doctors frequently deliver inadequate anesthetic, which generates excruciating patient pain. However, with the child adequately restrained, dental services of extractions, steel crowns and pulpotomies (baby root canals) continue, regardless of a child’s discomfort. Obviously, many of these patients will be in need of extensive psychological counseling for posttraumatic stress. Unfortunately under our programs for the disadvantaged, it’s doubtful this brutal problem of which government bares great responsibility, will ever be addressed. Medicaid dentists too often choose between “juice ‘em (sedate) or papoose ’em (physical restraints)”.
https://appsmqa.doh.state.fl.us/DocServiceMngr/displayDocument.aspx
http://floridajustice.com/wp-content/uploads/2015/11/Schneider-arrest-warrant-affidavit.pdf
https://appsmqa.doh.state.fl.us/DocServiceMngr/displayDocument.aspx
Whistleblowers who step forward in Florida to expose these abuses to authorities are met with institutional roadblocks. These professionals with integrity are forced out of government service by superiors. The rationale is that if the crooks and abusers are severely disciplined and removed as Medicaid dental providers, there will be too few providers to keep the toxic program viable. Government enables the abuse of our most vulnerable citizens and assists in cheating taxpayers. http://media.news4jax.com/document_dev/2016/02/03/Dr.%20Mason_2048400_ver1.0.pdf
New Mexico
New Mexico (NM) allows for dental Medicaid hospitalization and sedation coverage, unlike Florida. On paper and in theory, Medicaid patients will be permitted access to hospital operating rooms and nurse anesthetists for necessary dental care. The reality is quite different. Further, the in-fighting between providers and hospitals is in anything but in the interests of patients.
