Georgia Also Investigating Over Use of Papoose Boards

The Georgia Department of Community Health (DCH) commented on a possible Class Action Law suit against Kool Smiles, P.C. and the care management organizations (CMO), Peach State Health Plan and WellCare of Georgia.

In a press release dated August 22, 2007 DCH said it was thoroughly investigating complaints by parents/guardians of patients as well as practicing dentists of Kool Smiles, P.C.

Allegations include but are not limited to:

— “Unusual patterns of patient restraint”(such as use of restraining boards for children) and sedation vs. Traditional Pain Management (usage of Nitrous Oxide or IV sedation) .

— “Over-utilization of stainless steel crowns” in children compared to other dentists and normal averages;

Irate Parents Discuss Papoose Boards Used By Ruthless Dentists

So many parents and grandparents are irate over the practice of using Papoose Boards for dental care in children.

Click the link below for a small discuss among some concerned parents.

Yahoo Discussion

Child Dead From Papoose Board and Sedation

SANTA ANA--Four-year-old Javier Villa, who died after having his teeth drilled, was treated by dentists "who were incompetent and grossly negligent in sedating or monitoring the boy," according to a dental expert cited in court documents.

In addition, Dr. Richard Mungo said, Javier may have died because the dentists and their assistants failed to do something as simple as place a towel behind his neck to keep his airway open.

Dr. Miguel Garcia, who supervised the Megdal Dental Care clinic where Javier was treated, also destroyed the boy's chart, altered records, withheld evidence and concealed the amount of drugs given the boy, according to witnesses quoted in a search warrant affidavit filed in Municipal Court.

Separately, the state attorney general's Bureau of Medi-Cal fraud said Thursday that it is investigating the Megdal Dental Care chain for possible criminal fraud, but it would not provide details.

"We cannot comment on an ongoing investigation," Hardy Gold, supervising deputy attorney general, said in a statement.

The Board of Dental Examiners also is investigating a possible licensing violation by the Megdal clinics. State law requires that a dentist who owns two or more offices must be in each office at least 50% of the time.

Dr. Philip Megdal owns nine clinics in Southern California, said Jeff Wall, chief of enforcement for the dental board. Given the nearly full-time hours these offices keep, "I can't imagine" how he can be in compliance, Wall said.

Neither Megdal nor his attorney William Kent could be reached for comment Thursday. Both denied last week that there had been any fraud regarding Medi-Cal, the federally funded program of medical and dental care for the poor. They also said Megdal was the owner of the buildings where the dental clinics are, not the clinics themselves.

The Santa Ana police and the dental board are investigating Javier's death.
Javier, who stopped breathing in a dentist's chair Aug. 4 and died at a hospital a few hours later, had been taken to the Megdal Dental Care office in Santa Ana to have half a dozen cavities treated. He was given an oral sedative and an injection of painkiller.

An attorney for Garcia denied wrongdoing on his client's part, as did an attorney for the second dentist involved.

Mungo told state dental board investigators "Javier was not properly sedated or monitored" by Garcia, who prescribed the oral sedative chloral hydrate, or Dr. Gabriella Pham, who did the actual dental work.

Mungo also said improper positioning of Javier on a restraint board could have been a major factor in the boy's death and that numerous routine safety procedures were not followed.

Javier was strapped to a papoose board, used to immobilize young patients. Mungo said it was vital that the heavily sedated patient's airway remain open. That could be done by placing a rolled towel or pillow under the patient's neck and shoulders, he said.

That was not done, according to statements made to investigators. Nor was the patient's blood pressure, pulse or breathing monitored with standard equipment, according to the affidavit.

"I'm not sure chloral hydrate is the culprit," Mungo said in an interview Thursday. "My concern is the monitoring and positioning of the child. The papoose board is fine, but you need to know how to use it."

Mungo and other pediatric specialists said it was crucial to give the proper dosage of choral hydrate, based on the child's weight, and to have constant, mechanical monitoring of the child's heart rate and amount of oxygen in his blood.

"In the wrong hands it's [chloral hydrate] not so wonderful, it's potentially deadly," said Mungo, a Huntington Beach pediatric dentist who teaches at USC Dental School.

The case highlights a problem involving the sedation of dental patients, experts said. The state requires dentists administering general anesthesia or conscious sedation drugs intravenously to undergo special training and licensing and have equipment to handle emergencies. However, no such rules apply to dentists who sedate patients with oral doses.

Dr. Ray Stewart, president of the California Society of Pediatric Dentists, said Javier's death might put needed pressure on the state to regulate oral sedation.

"There's been resistance on some people's part to have any more governance, but it's just exactly situations like this here that force the governing bodies to say OK, something has to be done," Stewart said.

Neither Garcia nor Pham had been issued general anesthesia or conscious sedation permits, said officials at the state dental board.

A dental assistant gave Javier chloral hydrate at Garcia's direction, according to the affidavit, and injected Lidocaine in his gums to deaden feeling in his mouth. But the affidavit shows a sharp dispute about the amount of drugs the boy received and also alleges Garcia tried to conceal what happened from investigators.

Pham and dental assistant Alejandra Juarez told investigators that Garcia ordered Juarez to destroy Javier's dental chart, which included the notation that the boy had received 16ccs of chloral hydrate. He began a new chart, the affidavit says, showing the boy received 6ccs.

"That is the story," Garcia said to Pham and Juarez when they met shortly after paramedics took Javier to the hospital, according to the affidavit.

Garcia told investigators he ordered a 6cc dose of chloral hydrate and "does not recall" if he was in the room when Juarez administered it, according to the affidavit.
The manufacturer's maximum suggested dose for a child of Javier's size is 9ccs, according to the affidavit.

Garcia declined to discuss those allegations Thursday. "I wasn't the treating dentist," he said. "Even I don't know all the things that went on."

Juarez also said that on the day of Javier's death, Garcia apparently concealed from a coroner's investigator the amount of Lidocaine administered to Javier. Juarez told dental investigators she "retrieved the [Lidocaine capsules] from the trash and handed both of them to Dr. Garcia, and Dr. Garcia gave only one to the coroner," according to the affidavit.

Mungo was critical of the office procedures, training and the fact that one dentist administered the oral sedation while another treated the patient.

Pham told investigators it was "standard procedure" not to place anything under the necks of papoose children, according to the affidavit. During a demonstration with investigators of the technique the office used on Javier, Pham gave no indication that either dental assistant was instructed to keep Javier's airway open, according to the court document.

In addition, dental assistant Claudia Briseno told investigators she understood that her job was to hold the boy's head so that he did not move side to side and he did not cut himself.

Click here for another investigative report from Colorado as far back as 2004 and still there are no national laws saving out children.
My word on this: A little patiences would have saved this child's life!

Papoose Board Used On Child At Dentist

I recently discovered that these pictures show the latest attire a child needs to wear to the dentist.

There's just something about the Papoose Board that seems ... unfair, really really sneaky, a betrayal, and a ruthless display of dominance don't you think.

From reading the reports all over the web, I'm not the only one to feel this way. Some states such as Colorado have passed strict guidelines for the use of these for mentally and physically handicapped children and only as a last resort.

But many dentist are using them as standard procedures to get the job done as quickly and easily as possible. One dentist interviewed said it was more cost effect to tie up the child rather that another method or combination of behavior control.

Caution This Video May Be Very Distrubing:



On January 2, 2008, this particular Dental Office, Small Smiles, has now changed it's policies but basically denies they use them as much as they really do. See more here.

Even companies selling this things clearly state they are for use as a "Last Resort" and modifications are highly recommended prior to their use on a child at a dentist office according to the American Academy of Pediatric Dentistry.



There are laws to stop the restraint of our elderly what on earth makes anyone here think it's ok to do it to our CHILDREN is what I'm asking, and so far I've not gotten any answers.

"Imagine a visit to a dentist office where you walk back to your room and see a child strapped down, struggling for his life and the dentist, office personnel and the child's parents look up with a smile. (I didn't look back with any thing close to a smile!) I wanted to call Child Services!"

Dentist's now have a new little gadget called a "dam" they put in your mouth to make it easier to get in and work. It restricts air flow from your mouth and all you are left with is what you can manage to breath through your nose. You really have to put the whole picture together to understand the trauma of it all.



Now we adults can manage that, but a child has a bit more trouble. Especially when they have been thrown in the natures flight or fight emotion and screaming is more important that anything.

Please tell me how a child is supposed to communicate to a dentist tied down, hand, feet and body restrained and this contraption in their mouth supposed to tell a dentist that they are not numb, that they have hit a "hot" nerve or they are about to choke. I would say that any dentist that does this to a child really doesn't care about anything other than drilling some hole, real or not, and making some fast bucks.

Add to the crying hysterically from the event, the nose becomes clogged and now the child can't breath nor move, so it's not far from death for the children, as they see it for sure. They certainly have no trust with those around them cause they are clearly the enemy!

The restraints do not do the job alone, so if you think the dentist just gently wrapping your child in a loving blanket for comfort is what's happening you are dead wrong!

It's only a way of gathering up the flying arms and legs making it easier to use other physical force to hold the child still. The child can still thrash around. Sometimes the dentist will enlist the parents to assist but many time they will tell you that the parents distract the child so you are asked to leave.
While trying to stop the thrashing around (since they are fighting for their lives) they put their arm over their face to try to restrain the head further.

Sometimes they add HOM-Hand Over Mouth - which further panics the child. The child is sure something terrible is going to be done to him, they see this kind of action in cartoons on tv everyday and it never ends well.

Don't try and tell me that putting your hand over the mouth of a child tied up is ok, and that you can assure me through their thrashing about the dentist will not block the only air way they child has-his nose.


Guess how they get the child to open their mouths, they pinch their nose. So you have a child strapped down and no way to get air! How more cruel is that!


A dentist in Florida had been prosecuted because a child's arm was broken while trying to restrain a child, and yes, he was using a papoose board.

• How did this restraint mechanism come to be called a Papoose Board?
  

• How is it still acceptable for it to be called a Papoose Board?
  

• Native American's are insulted at the use of this name offended by the idea that this restraint technique be associated with a cultural tool used for swaddling Native American babies.
  

• I’m sure this is not what their elders intended it to be used for.
• Call it what it is…A restraining board. In this current usage it has nothing to do with a Papoose…which by the way is: A papoose (from the Algonquian papoos, meaning “child”) is an English loanword whose present meaning is “an American Indian child” (regardless of tribe). The word came originally from the Narragansett.
  

I admit the device would serve its purpose well for what it was designed for, pediatric life and limb saving, but there is no excuse to use it to work on a child's baby teeth.

Using the term Papoose is supposed to somehow sooth the real idea of the straight jacket for children in hopes that makes it more acceptable to use. Sorry, it's not working. It's a straight jacket for a child, period!

Dr. Frank Carberry has been a dentist for 40 years and has worked with children in Third World countries. He said he's treated children with major tooth decay without ever resorting to restraining devices.

"I've got five grandchildren,” he said. “I can't imagine the psychological trauma on that child.”

That's where I am. I never treated my children this way and would never allow anyone to tie up my child for dental care. The idea that I have a son and daughter in law, who are supposed to be well educated, would allow this to be done to my 5 year old grandchild has infuriated me.

I don't know when this practice started, nor who ever thought it was a great idea, but I know I certainly never would ever have considered torturing my children in this manor. I started my children early going to a dentist and not once, not one time did any dentist ever mention using any kind of restraint.

• A recent study among dentists showed that only 14% of them condone restraints such as these for dental care of children. It jumped to 20% if the child was pre-medicated.

• Also a study indexed at medline.com showed that adults who experienced HOM or any other kind of restraint for dental procedures were 50% more likely to never see a dentist again!

• In Europe, dentistry is now seeing that this type of treatment is uncalled for and abusive.

"Dr. Kevin J. Urbanek has a complete review of this abuse here. In summary he states: In summary, research exists that demonstrate physical restraints are both potentially harmful, and are being increasing rejected by both practitioners and patient guardians. Alternatives such as medications are currently being explored and should be strongly considered instead of using physical restraints."

What needs to be studies is the long term affect on the children who suffered this kind of trauma!

The American Academy of Pediatric Dentistry warns that stabilization devices like papoose boards have potential to seriously harm patients and should only be used in extreme cases where a patient is a danger to himself or his care givers.

One study from the AAPD showed that younger more inexperienced parents would more likely to consent to the use of the PB. (Papoose Board) Where parents 35 years of age and above were much less likely.

Dentists are far too often using the "danger to himself or his care givers" as an excuse to exspediate the procedure. Dentist are not taking in to consideration as to the real urgency of the procedure. Just the cost savings of a quick treatment.

Some dentists use the argument they clearly informed the child or child's parents and the child or child's parent/parents agreed to putting on the restraint. Come on, No child thought they would be tied up and tortured when they agreed to this!

• Parents who agree to this all I can ask is: Where is your damn brain!

Filling 4 year molars on a 5 year old child does not constitute Extreme Case, as in my case.

The only extreme case here is the mental status of a parent who would allow this.

Long Term Damage:

Deaths:

• A few children have died from being strapped to one of these boards because the dentist could not see the lethal allergic reaction the child had to the lidocane. Here's one story.

• One woman says, "now I suffer from mild-moderate claustrophobia. I'm not saying this is always the wrong choice, but I wouldn't wish this upon anyone."

• Other children report nightmares, not wanting close contact such as hugs, and one child refuses to sleep with a blanket to cover him.

One little girl told her mother that she dreams every night she is in a coffin and wakes up gasping for air. This has disrupted the entire family to the point they have had to seek professional care with biofeedback to help the child over come these fears.

More than one child has ended up with broken arms and limbs from fighting the restraints.

Many children and been brought into full blown Asthma attacks and seizures due to the trauma of papoose board and pediwrap boards. Your dentist office is NOT equipped to handle this kinds of emergencies.

Read the story of this poor child in Charlotte, NC

• Are those fillings this important to you, are you willing to kill, mame and mentally damage your child over a filling, cap or other nonemergency dental work??

• Find yourself a qualified Dentist, or keep them at home!

Here's another story of Dentist who have lost licenses from this practice.

Here a mother explains the trauma her child experienced:

"At 2 1/2 years old, I took my son to the dentist for the first time. All he had done was a brushing and teeth counting. He hated it! He kicked and screamed, and begged to get up. About 3 months later he had a horrible accident in which he fell and pushed his four front top teeth up into his gumline. He ended up having to have the left front tooth pulled. In order for the dentist to do this she had to place him in a papoose board and strap him down. He freaked out! He screamed like he was on fire, he threw up, he gagged, and he hyperventilated to the point of almost passing out."

You know what really burns my butt, it's these parents worried about the violence on TV, cartoons and children's classic fairy tales, but would take their children to the torture chamber, aka, poorly qualified Dentist!

A Report from California:

A trip to the dentist probably doesn't rank high on anyone's to-do list. Now, imagine if your dentist skimps on appropriate amounts of anesthesia before submitting you to painful procedures.

That's just one of the things California Attorney General Bill Lockyer is alleging in criminal complaints against 20 dentists throughout the state. He's charging them with defrauding the state Medi-Cal System of $4.5 million, health benefits and workers' compensation fraud, conspiracy, grand theft, child abuse, elder abuse, assault and intentional infliction of great bodily injury. (due to using these restraints sweetly called Papoose Boards)

Here is another mother's experience using these typed of dentist, her child busted a blood vessel:

I have a 3 year old and when he went in for a cleaning, the experience was good- probably 4 stars-the nurses were kind but I felt like the Doctor was a little cold. We had to bring my son back for a root canal because of a dead tooth and the experience was traumatic, horrifically scary for my son and we will not go back. The Doctor did not discuss the possibility of any type of sedative with us for this procedure nor did he tell us in advance that my son would be placed on a board and basically placed in a straight jacket. While that may be necessary to complete the procedure, letting parents know what to expect is critical to a good experience. During the procedure, my son, who was so scared that he literally popped blood vessels in his face and neck was told in a firm voice by the dentist "You are yelling at me. You can't yell at me any more. I can't do my job when you are yelling." While certainly, yelling is going to be difficult to deal with, as a doctor who sees patients this young and chooses to perform these types of procedures on them, a certain amount of empathy is required to be considered a good dentist. If my children were older, I'm sure the visits would all be good ones. However, my fellow is 3 and I am disgusted.


Another outraged mom:

My son had 2 cavities. I took him to my dentist and as soon as he got in the room the strapped him to a papoose board and 4 ppl worked on his mouth. No one tried to comfort him. They just held him down with the papoose board which looks basically like a strait jacket. It made his arms and legs immobile and his head was between two boards. When we left he was hysterical. HIs lips were bruised. I did not sign any consent form for them to do this. I decided I was not taking him back to get the other cavity filled there ever. This is 2009, and is ridiculous! Clearly it was not for the comfort or safety of my child, it was for the convenience of the dentist.

Here is a quote from a parent on a message board that pretty much sums up my feelings and anger on this issue:

"A cavity is not worth a lifelong traumatic memory like this. If I found out the dentist covered my daughter's mouth and told her to shut-up ...I'd give him the beating of his life right then and there and then warn him if he called the police he'd get 100 times worse when I got out of jail."

Have any of these Pro Papoose Board Supports even considered the
psychological safety of the patient!

Another recount from a mom: (DS=Dear Son)

I'd only been that dentist once before. DS has Medicaid and I thought it seemed like a lot of work, too, but I told them to do whatever was needed right then so he wouldn't have to go through it again. He also didn't give DS any sedation other than the shot in his gums and he cried so hard he threw up blood. I was crying too, and the dentist said, "This is typical of a child his age to cry, he can't feel anything, he's just afraid of the noises." Uh, hello? DS was afraid because he was strapped down, had a drill in his mouth, blood going down his throat, and some stranger telling him not to cry. I was so mad at myself for letting this happen, and even madder at the dentist. I had called all the dentists who accept Medicaid in my area and none offered anesthesia/sedation. I thought he'd be drowsy from the shot (he wasn't) and I wasn't expecting all that to happen - torture! Argh! Sorry, this turned into a long rant here....

updated: 1-15-2008

This may be one reason some dentist resort to papoose board instead of other types of sedation for persons under 13 years of age. Permits, Education, More Training. Below is from the Kentucky Board of Dentistry.

• Dental Anesthesia Permits
  Any dentist who wants to administer general
  anesthesia, I.V. conscious sedation, or oral
  sedation for patients under the age of 13, must
  first secure a permit from the Board. To
  receive a permit, an application with supporting
  documentation of education and experience
  must be submitted along with the permit
  application fee. An office inspection must also
  be done before anesthesia can be performed in
  a dental office. A permit will not be issued for
  any of the above types of permits until all
  requirements have been met. Until a permit is
  issued, anesthesia cannot be administered.
  University of Louisville is requesting your
  participation

Dr. Penelope Dunlap - Angola Indiana Dentist–11 Felonies

An Angola dentist accused of diagnosing fictitious cavities lost her bid Friday to regain her license to practice when the Indiana Board of Dentistry voted 6-0 to continue Dr. Penelope Dunlap’s suspension.

Five members of the board abstained but did not give a reason.

Dunlap was initially given a 90-day suspension in November that was expected to run out in February, before the board was scheduled to meet again.

The latest 90-day suspension will last until May 4, just past an April trial date that has been set on 11 felonies Dunlap has been charged with in Steuben County. * * *

In November, the state Attorney General’s Office filed a complaint with the Indiana Board of Dentistry seeking an emergency suspension in reference to questionable cavities in three patients.

In December, local prosecutors filed six counts of Medicaid fraud and five counts of attempted theft, all Class D felonies.

Dentist Allegedly Caused a Child's Death

October 27, 2004

WTAP News
Denise Alex
The Ohio State Dental Board has ruled that the actions of a Belpre dentist who administered a lethal dose of local anesthetic to a two-year-old West Virginia boy constituted malpractice.

Doctor James E. Kirkpatrick injected what experts testified was three times the manufacturer's maximum recommended dose of Prilocaine into Hunter Owens.

The boy died less than 90 minutes later on October 27th, 2004 at Camden Clark Memorial Hospital in Parkersburg. Kirkpatrick was attempting to extract eleven rotted teeth from the boy.

The board Wednesday ordered Kirkpatrick's practice closed after ruling that his intentional decision to push the limit of the anesthetic was egregious malpractice.
Kirkpatrick's lawyer says he will appeal the ruling in Washington County, Ohio, where Kirkpatrick lives.

WTAP called Kirkpatrick's office Thursday and a recored message says his office will be closed until Monday, November 7th, 2004

Child Died At DeRose Owned Small Smiles Dental Clinic: Dr. Matthew "Matt" C. Nolen

May 2004 -

KUSA - In May of 2004 9NEWS Investigative Reporter Deborah Sherman began a series of reports on the treatment of children at a chain of dental clinics in Colorado and across the country. These reports have lead to changes in Colorado state law and prompted investigations in a half-a-dozen states.

In the first part of her investigation called "Papoose Boards" that aired on April 29, 2004, Investigative Reporter Deborah Sherman reported that some parents filed police reports after their children left dentist offices with scrapes and bruises.

These are the same clinics that 9NEWS reported had been hiring dentists not licensed in Colorado to work on some of the state's poorest children.

Children like Adrian and his brother Daniel, Dakota and her brother Chris, Cecilia , Alexis and Angelica.

All of their parents say the children were traumatized by a trip to the dentist.

"She actually threw up on me," said Tamera Elliott, mother of 2-year-old Cecilia. "She was just terrified of going back there." 

Lucia Nevarez said her son Alexis, "went in crying and came out crying."

The moms took their kids to the "Medicaid Dental Clinic" in Aurora or "Children's Dental Clinic" in Thornton. That's where Catherine Richardson says both of her kids left with bruises.  "It was about the size of a half dollar," Richardson said as she pointed to the spot above her 2-year-old daughter's eye. 

Richardson says Dakota was bruised on her head. She says her five-year-old son Chris had a bruise on his wrist when his arms were tied down in the dentist's chair.

9NEWS learned the children were put in restraint devices called papoose boards; unable to move their arms, legs and heads while dentists worked on or cleaned their teeth.

Some of the children were restrained for more than an hour.

Beatrice Ponce says her two boys came out very scared. "Their mouths were swollen from all the work and full of blisters. Their foreheads blistered up and peeled."

The moms say they were told the clinic might use restraints on their kids and they might get red marks.  But the moms say they didn't realize the extent of what was going on because they weren't allowed in the exam room.

"What goes on back there?" asked Catherine Richardson.

"It scares me, you know? These are my babies and nobody can go back there with them."

The Aurora and Thornton clinics were co-owned by Drs. William Mueller of Denver and Michael Derose and Ed Derose of Pueblo. 

The Deroses also owned three other dental clinics in Colorado: Smile High Dentistry in Denver, Small Smiles Dentistry in Colorado Springs and Derose Children's Dental Clinic in Pueblo.

Nationwide, the Deroses owned 22 clinics. Dr. Mueller is part-owner in 12 of them. All of the clinics cater to kids on Medicaid.

The Executive Director of Colorado's Medicaid office, the Colorado Deptartment of Health Care Policy and Financing, was astonished at the police photographs of the children that 9NEWS showed her.

"This is really extreme," said Karen Reinerston. "If these injuries were caused by the papoose board, it is not a nice little blanket that you wrap around them and make them feel like a papoose."

Drs. Michael and Ed Derose and Dr. William Mueller would not talk to 9NEWS on camera. But in an audio-taped interview, Mueller says they use papoose boards to protect children. "They're used so the children won't make a movement in an inopportune time and hurt themselves or cut themselves," said Mueller.

But at a clinic in Phoenix, Arizona, which is co-owned by Dr. Mueller and the Deroses, 4-year-old Jonathan Barrera died from an overdose of anesthetic while strapped to a papoose board.

The Arizona Dental Examiners Board investigated the dentist responsible, Dr. Matthew C. Nolen, saying the restraints "could have masked the signs of respiratory distress...or signs of the child going into convulsions."

Before he began working at the Arizona clinic, Nolen trained at the Medicaid Dental Clinic in Aurora, Colorado.

Nolen testified before the Arizona Dental Examiner's Board. He admitted that most parents did not know about an unwritten policy at the Arizona clinic to restrain every child under the age of 5.

A Board member asked Dr. Nolen "Is the papoose board common in your practice?" Dr. Nolen replied, "Very common."

"Routine?" the Board member asked. "Pretty routine for children," said Dr. Nolen, "under the age of five."

Last April, the Arizona Dental Board revoked Nolen's license. One of its findings: that Nolen had used the papoose board on Jonathan because it was convenient; not because he had been misbehaving.

9NEWS has also learned Dr. Mueller was charged two months ago with gross malpractice at his clinic in Tennessee for "routinely and arbitrarily immobilizing kids up to 3-years-old on papoose boards, without justification, for longer than an hour for routine dental work".

Dr. Mueller denies his clinics have a blanket policy to use restraints.

Still, Colorado Dental Examiners Board is now investigating why they were used on these kids.

Jason Hopfer, of the Colorado Dept. of Regulatory agencies said, "If they're doing it simply because it's convenient, that is a concern."

9NEWS talked to an expert, Pediatric Dentist Dr. Bradley Smith, spokesman for the American Academy of Pediatric Dentistry in Colorado. 

Smith says he rarely uses papoose boards in emergencies. "If a child comes in and they've fallen or broken their tooth or cut their lip or had some major oral trauma and we have to do treatment that day and we have no choice at all," said Smith.

Smith also prefers to have parents in the exam room with him while he works. "I want to be able to talk to the parent, I want them to see what I'm doing," said Smith.

The American Academy of Pediatric Dentistry and the Colorado Dental Examiners Board have policies that say restraints should be used only when absolutely necessary, for uncooperative kids, and should not injure them.

But 9NEWS learned that Medicaid in some states pays extra each time a dentist puts a child in a papoose board.

Drs. Ed and Michael Derose and William Mueller would not tell 9NEWS how often they use papoose boards in each of their respective clinics.

So 9NEWS used open records laws to obtain and analyze state Medicaid bills.

9NEWS learned in all other clinics across the state, dentists use papoose boards, on average, 4 percent of the time.

But at Mueller's 'Medicaid Dental Center' and the Deroses' 'Smile High Dentistry', their dentists put 21 percent of kids in restraints. In the year 2001-2002, those two clinics used papoose boards more than 2,500 times. 

The cost to taxpayers for those papoose boards at four of their clinics; $106,473.

Karen Reinerston of the Colorado Department of Health Care Policy and Financing, thinks that is excessive. 

"You shouldn't have to have a kid restrained all the time," she said. "I think it's very scary for the child."

Last year, Reinerston stopped Colorado dentists from charging Medicaid for restraints.

Dr. Mueller sent 9NEWS an e-mail saying he did not personally treat any of the children in the story. 

Mueller also said he is not responsible for the care provided by other dentists in his clinics, because they work under contract and practice under their own licenses.

Mueller would not allow 9NEWS inside his clinic to show the actual papoose boards that his clinics use for children. 

All three sold their ownership in the company in 2007 but continued to Manage them for the new FORBA Holding, based in Nashville for handsome sum. 

Daniel Huynh death

September 28, 2001

A final settlement was reached Thursday in the wrongful death lawsuit a couple filed against a dentist after their 3-year-old son died after being given anesthesia at a Houston dental clinic.

Kenny Huynh and Tracy Phan of Houston, parents of Daniel Huynh, contend their son was given a dangerous sedative cocktail that proved fatal, given his size.

An autopsy showed Daniel died from the drugs' toxic effect. The toddler was given a drink containing Demerol, Phenergan and chloral hydrate when he went in for a root canal and fillings.

"They gave (Daniel) three drugs that an cause problems with breathing, two of which they gave him in excessive amounts" said lawyer Steve P. McCarthy today.

McCarthy, who represented Daniel's parents, said court records also show that the clinic staff failed to monitor the toddler's condition after he was sedated.

When the staff finally noticed the child was in distress, they did not have the equipment on hand to attempt to revive him as required by state law, the lawyer said.

One piece of equipment, a type of stethoscope, was in Tran Nguyen's car trunk, McCarthy added.

The settlement agreement prevents the parties involved from discussing the damages paid by Nguyen. On average, dentist's malpractice insurance pay out between $200,000 to $1 million per occurrence, according to dental malpractice experts.

Daniel's parents say they sued the dentist to bring attention to the issue of wrongful death caused during dental procedures, not money.

Huynh said he and his wife just want more parents to be aware that there are dangers associated with the type of sedation, known as conscious sedation, that took their son's life.

"We had never heard about this until it happened to us," he said. "We want the story to (get) out to the whole country ... so that our son's death means something."

Huynh described his son as a healthy child with a playful nature and a sharp mind who loved going on family trips to places like Hawaii, Lake Travis and the zoo.

Phan, who is expecting a child, said that her son is never far from her mind. She spent the anniversary of his death at a temple to be closer to him.

The couple cautioned parents to ask more pointed questions about the potential dangers associated with the drugs given children during dental and medical procedures, and to find out what will be done in the event of an emergency.

"Don't let this happen to your child," Phan said.