Tenet Healthcare (NME) Corporate Integrity Agreements Look Much the Same.

Tenet Healthcare Corporation, formerly National Medical Enterprises (NME) accused of committing fraud by admitting thousands of psychiatric patients who did not need it. Over a period of 3 years had it’s offices raided, settled lawsuits in the amount of $2.5 million, paid $380 million and plead guilty of 8 criminal counts by two of its facilities. This company too, agreed to a 5 year Corporate Integrity Agreement (CIA) on September 27, 1996. Tenet also owned the Redding Medical Center, in California that delivered unnecessary heart surgeries to over 600 patients. They paid the federal and state government $54 million in fines and admitted no wrong doing.

In 2004 Tenet paid another $395 million to 769 patients to settle the lawsuits that followed. You can read about each of the scandals in the books Coronary – A True Story of Medicine Gone Awry, by Stephen Klaidman and Money-Driven Medicine by author Maggie Mahar.  Mentioned in both books, is James Robert Moriarty, of Moriarty-Leyndecker, who is leading up the civil suits against Church Street Health Management and it’s string of illegal Medicaid dental clinics.

2006 Tenet paid total of $900 million in fees to resolve more claims of defrauding Medicare. Tenet was also the owner of the Memorial Medical Center in New Orleans where a doctor and two nurses were arrested on charges of second-degree murder in the deaths of four patients after Hurricane Katrina.

Tenet Healthcare's 1996 CIA compared to the 2010 Church Street Health Management’s CIA, look much the same. Very little of the boilerplate form has changed since 1996.

FORBA Small Smiles Ads For High Turnover Dental Clinics: October 2010

Below are the latest Ads for Employees from Small Smiles FORBA.   I see they are not telling applicants exactly on whom they will be performing dental treatment. 

FORBA Small Smiles are now seeing adults as well as children. 

# 1- Fort Wayne, IN. - HIGH EARNING POTENTIAL! Hiring Lead and Associate Dentists for our office in Fort Wayne and Muncie, IN. call Jacob at 719-562-4460 or email jdkochenberger@forba.com or visit www.forba.com

Key words and phrases:

"Potential"  - wait until you find out what you have to do to get to the "High" part of the "Potential".

*******************

#2- Forba Dental Network is currently searching for skilled and compassionate Dentists to join our stable and successful practices in Indianapolis, Fort Wayne and Muncie, IN.  

General Dentists, Residents, Pediatric Dentists, and Oral Surgeons are encouraged to apply.

For years, the primary mission of our offices has been to meet the dental needs of underserved children and young adults.  Dentists on staff enjoy a rewarding work environment without the administrative burdens of operating a practice.  You will have the opportunity to focus on quality care, while we handle the administration responsibilities.  You'll find a rewarding career with purpose, pride and passion when you join the team!Please call Jenna direct at 719-562-4462

Key words and phrases:

"Stable and Successful"  - As I have said before, if they have to say it, chances are good it is questionable or being questioned.

Indianapolis Clinic – they are looking for someone there because another of many dentists have put in their resignation because of poor quality of care, employees doing jobs beyond their scope, i.e. dental assistants or hygienist doing jobs only the dentist is licensed to do, and the dentist feels procedures are being done that are not necessary.  I do not believe the Muncie clinic is open yet. 

"while we handle the administration responsibilities"  -This could lead to lawsuits, falsified documents, false billing, forging your signature, falsely notarizing your signature, filing hospital and insurance credentials with traced or photocopies of your signature, I have seen heard of claims filed for Medicaid reimbursement under the NPI number of dentists who have not worked there for years.  Heck you might not even need to actually take CE's.  They will do that for you too!

 

Riddle:

Jacob and Jenna Kochenberger are husband and wife.  Kirk Kochenberger married Paula DeRose.  Dr. Eddie DeRose and Mike DeRose are father and son.   Nick Kochenberger's mother is Paula.  Dan and Mike are brothers.  Paula is Dr. Eddie's daughter.  Nick and Jacob are brothers.  Nick is CEO of Cardiology Now.  Is Jacob Dr. Eddie's grandson? Where is FORBA?  Where is Small Smiles? 

Another FORBA Insurance Company Does Not Want To Pay Up - No Big Surprise Here

FORBA Holding and its parent company, Small Smiles Holding seem to be having a magnitude of problems getting their insurance companies to pay up and/or continue coverage.  I am just taking a wild guess here but I think that might get much worse in the future.

Imagine the liability and increase in risk when clinic fully implement the sedation of children, either at a local hospital, surgery center, and in some cases, in house!!!!!!!!!!  Please see Meet The Dead Children On the Right.

Today FORBA filed a lawsuit against Zurich:  See It Here

On January 15, 2010, FORBA signed a settlement agreement with the United States Department of Justice and OIG-HHS whereby FORBA agreed to make a structured settlement payment of $14,285,644.75 (plus interest) to the United States, in exchange for a release of claims against it, its current officers and directors, its parents, subsidiaries, and affiliates, and the Small Smiles Dental Centers arising from the alleged wrongful conduct. 

FORBA also agreed to pay attorneys’ fees in the aggregate amount of $182,183.52 to three relators that filed qui tam actions alleging wrongful acts on the part of FORBA, as well as other defendants.

Pursuant to settlement agreements with each of the states and the District of Columbia, FORBA agreed to pay the aggregate amount of $9,714,355.25 (plus interest) to Alabama, Arizona, Colorado, Connecticut, District of Columbia, Georgia, Idaho, Indiana, Kansas, Kentucky, Maryland, Massachusetts, Nebraska, Nevada, New Hampshire, New Mexico, New York, Ohio, Ohio, Oklahoma, Pennsylvania, South Carolina, Texas, and Virginia in exchange for a release of claims against it, its current officers and directors, its parents, subsidiaries, and affiliates, and the Small Smiles Dental Centers arising from the alleged wrongful conduct.

Payment of $24 million is chump change to protect its current officers and directors, keep them out of jail.  In addition to keeping their families all nice and cozy in their elabrate homes and jet setting lifestyles. 

Since the agreement was signed and the token pledge of the Corporate Integrity Agreement, FORBA has managed to bill medicaid over $131 million in the last 10 months. 

FORBA states in the lawsuit they informed Zurich in November 2007, while the policy was in force, about the investigation and costs involved in defending themselves.  Zurch says too bad, you did not get a draft settlement until August 2009, so you are on your own.

I'm no genius, but does there seem to be a pattern emerging here?  No insurance company wants to cover FORBA,  Small Smiles Clinics, Small Smiles dentists and other employees for all their misdeeds. The ones that have hung on,  are doing so "eyes wide open" and most likely "rates sky high".

I am concerned FORBA and Small Smiles Holding have failed to inform their insurance companies of the hundreds of lawsuits in the works against, the clinics, the dentists, the staff, the directors, the officers down to the cleaning lady.  Ok, that was a lie, I'm not concerned one bit!

To you those dentists who have been fool enough to lend your name to FORBA so they can use you as an "owner", you may be in the worst shape of all.  You would be wise to storm the FORBA offices and demand your rubber stamps back and your names removed from all legal filings, and do so before the shredder gets fired up. 

 Do any of you have any idea all the documents they file a year with your name stamped all over it?

Dr. Jodi Kuhn

Dr. Olivia Croom

Dr. Helen K. Petersen

Dr. William Nash

Dr. Monica Switzer

Dr. Mark Toncini

Dr. Victoria Fletcher-Barnes

Dr. Medrina Gilliam

Dr. Gloria King

Dr. Latanya Gallon

Dr. Kevin Kingry

Dr. Karen Chu-Gongora

Dr. Randy Ellis 

Dr. Bonnie Mora

Dr. Toni Adderly

Dr. Daniel Spears

Dr. Todd Bjur

Dr. Zane Plamer

Dr. Ken Knott

Dr. Robert Andrus

American Securities - It's All In The Kool Smiles

Here is one you just have to love.  This person is on Twitter.

Says he works at Kool Smiles.  Says he currently lives in Louisville, Kentucky.  See here

Why am I afraid it's the one in the middle who will put his hands in a child's mouth tomorrow!

This is what American Securities wants to give $700 million to own.

 Update:
June 30,2011

American Securities appears to have backed out of this purchase of NCDR, LLC and it's string of Kool Smiles dental centers.

Kool Smiles Vancouver, Washington Complaint

Why on earth Private Equity Firm- American Securities-would even consider contaminating themselves by purchases these shit hole clinics is beyond me.  They must be sadistic bastards is all I can think of, and enjoy torturing America’s low income children.   I would call the review below "glowing” and the child lucky.  After all they didn’t leave with bruises and permanent emotional trauma as most children.  Friedman Fleischer & Lowe are trying to unload these before they go down like ENRON. 

I was just told this week, they had cut staff to the bare minimum to increase the profits getting ready for the big “sale”.   In my opinion, until the staff is cut to zero there are too many employed.

Here is a review from today!

October 25, 2010

I was very excited to take my son to this dental office. The website makes it look so fun and kid centered. From the moment I walked in I did not have a good feeling about it. This was confirmed once we were taken to the dental work room. It was a room with 8 dental chairs all together. The Dr came out to talk with us. He didn't shake my hand or introduce himself to my son or even ask my name. I don't even think he smiled. The other dentists/hygienists were talking badly about one of the other dentist/hygienists every time she would leave the room. There were two other young boys laying back in the chairs and no one was paying any attention to them or talking to them at all. For a business that markets themselves as kid friendly, they really failed at being friendly at all! We sat around for 20 minutes being ignored after the doctor did his exam, just waiting for the fluoride. We're all in the same room and they just ignored us. No one treated my son as a patient or gave him any attention. Then....the only prizes they had for my 5 year old was a rubber lizard or a broken pair of sun glasses. Oh fun. Made my other son an appt elsewhere. We will not be returning.

Unacceptable? You decide

Unacceptable Dental Practices in 2010

1. 1 Dentist seeing an average of 32 patients a day – That is an average of 4 minutes per child.  Same dentist strapped down 100 children and put on 1000 Stainless Steal Crowns.  I bet this dentist did a fine job!  Why is this person not in jail?
2. 1 Clinic (of three dentists) strapping down over 700 children in 88 days – That is almost 7 children papoosed a day in one clinic.  A clinic papoosing 540 is 88 days is not any better, nor is a clinic who papooses 450 in those same 88 days.
3. 1 Dentist tying almost 300 hundred children in 88 days is also unacceptable - That's an average of three a day for 1 dentist.  If I tied up 1 child in 88 days I would be in jail.
4. 17 Dentists all tying up children more than 100 times in 88 days.
5. 1 Child receiving  13 Stainless Steel Crowns, 11 Pulpotomies and 2 fillings in one OR visit.
6. 1 Clinic of 3 dentist clinic strapping down 160 children in 20 days.
7. Approximately 210 dentists doing 7 or more pulpotomies and putting on 7 or more stainless steal crowns on 400 children in 88 days.
8. 200 dentists pulling over 6 teeth at one visit on 100 children in 88 days.
9. One clinic of three dentists seeing 900 patients in one 5 day work week.  - That is 900 patients in 120 hours.  That is an average of 7 minutes per child.
10. No wonder 1000 treatments had to be redone in 88 days, putting children through hell double time.

It should be no surprise many office staff do not know the difference between "filling" and "feeling".
I know I am missing many other outrageous dental practices that have taken place in 2010 but these are on my mind at the present time.

In My Opinion These Are The Top 15 Small Smiles Clinics A Child Is Most Likely To Be Strapped In A Papoose Board

Just an educated guess based on several factors, including parent complaints:

1. Dothan, Alabama
2. South Bend, Indiana
3. Macon, Georgia
4. Savannah, Georgia
5. Youngstown, Ohio
6. Atlanta, Georgia
7. Akron, Ohio
8. Roanoke, Virginia
9. Florence, South Carolina
10. Beaumont, Texas
11. Worchester, Massachusetts
12. Albuquerque, New Mexico
13. Kansas City, Kansas
14. Montgomery, Alabama
15. Oklahoma City, Oklahoma

In 2010, I think Albany, New York (shocker) and Louisville, Kentucky are the clinics your child is the least likely to be tied up in that straight jacket type device.  Not that I recommend ANY of these dental mills! 

Assistant Attorney General Tony West Mentions Small Smiles Fraud and Patient Abuse In Yet Another Speech

October 20, 2010

Assistant AG Tony West delivered the Keynote Address to the Pharmaceutical Regulatory and Compliance Congress and Best Practices Forum today at the Marriott Hotel in Washington, DC.

Read his full statement here

Excerpts:

Since January 2009, we’ve commenced more health care fraud investigations, secured larger fines and judgments, and recovered more taxpayer dollars lost to health care fraud than in any other two-year period.  During that period, our civil fraud attorneys in the Civil Division have used the False Claims Act – a powerful tool that provides for treble damages – to recover about $4.2 billion lost to fraud against government health care programs…

 

…strongly encouraged Civil Division and United States Attorneys throughout the country to be appropriately aggressive in their use of the wide array of affirmative civil enforcement tools at their disposal.  Tools like Civil Investigative Demands, or “CIDs,” which allow law enforcement to speed up civil investigations by obtaining documents and testimony quickly and under oath.  The authority to issue CIDs once rested only with the Attorney General, but amendments to the False Claims Act last year allowed the Attorney General to delegate that authority to me as the Assistant Attorney General for the Civil Division.  I, in turn, have re-delegated much of that authority to U.S. Attorneys around the country so that they will be able to use this powerful investigative tool properly and effectively…

…And then there are those cases we pursue because they cut to the core of protecting both patient safety and the integrity of our public health care programs.  Cases like Small Smiles.  You may have heard about this case.  It involved a nationwide network of dental clinics that provided unnecessary dental services to needy children on Medicaid in order to maximize the company’s Medicaid reimbursements…

…And the stories we learned about during the course of our investigation were horrific:  unnecessary tooth extractions performed on children where healthy teeth were pulled; unnecessary dental surgery such as needless crowns; and excessive baby root canals – one child had 16 root canals in a one sitting…

In that case we not only obtained a $24 million settlement, but more importantly, important reforms to Small Smiles’ practices under new management, as well as the company’s cooperation in our ongoing investigation into individual dentists..

That last point—working cooperatively with companies—is an important one.   To be clear, no company is required to cooperate in the context of a civil or criminal case.  Yet when a company acts responsibly by timely and voluntarily disclosing unlawful conduct, it is the case that the Department may consider such cooperation in deciding whether or how to charge a corporation or to resolve a case, and indeed, it has been my practice to encourage that in appropriate cases.  In addition, when a company cooperates fully with an investigation, the Civil Division typically informs the HHS Inspector General’s office about the assistance the company provided…

It almost sounds like FORBA's Small Smiles clinics are getting a big pat on the back doesn't it.  Since they are "working cooperatively" and all.  They are still using the BIOB (Blame It On Bush) excuse saying all these terrible things happened with the DeRose family owned the clinics.  Never mentioning that one of their top VP's was with the company while under DeRose rule since 2003! 

I bet if they really took a look at the practices of the company just in 2010 they would find 'shocking' things still happening.

As recently as October 5th (yes, 15 days ago) one child received 12 stainless steel crowns 3 fillings and 11 pulopotomies all in one session.  Mom outraged.

On the same day another child received 3 fillings, 3 pulpotomies, 1 seal, 1 extraction and 5 stainless steel crowns. 

The very next day on parent was told their child needed 8 stainless steel crowns and wanted to do them asap.

Looking Like A Fool With Your Pants On The Ground II

That what you will be if you take a job with these dental mills.  Stay away.  Keep your dignity. 

New Small Smiles Clinics Opening Soon:

Muncie Indiana

Washington DC II

Mission, Texas

Don’t bee fool enough to sign any contract and commit yourself for years with any of these dental mills. 

Ad are out all over the Internet looking for employees.  Do Not be a fool.  Don’t do it.

I’m wondering what foolish insurance company is covering these clinics and the dentists and other professionals in them. 

Clinic’s Ownership: Tax Questions

No doubt I have asked this question before.  But I am going to ask it again. 
Since FORBA’s Small Smiles clinics are registered with the Secretary of State’s office as being owned by random dentists I have a few questions:

1.  Does the individual dentist file a tax return on those clinics?  If not, YIKES!
2. Does the individual dentist file a tangible property tax return and pay property tax on all that equipment?  If not, YIKES!
3.  When the dentist in question quits , gets fired or leaves FORBA’s employment, and FORBA is forced to register someone else as owner, how is this “sale” explained?   I’m thinking some major tax revenue is being missed here. 
4.  Why am I the only person asking these questions?
If Dr. Katie (Helen Petersen) does NOT own all those clinics in Indiana, what does Dr. Katie own?  What about Dr. Jodi Kuhn in Kentucky?  What about Dr. Ken Knott in Alabama?  (yes, Dr. Knott is still listed as owner in Alabama, or at least he was on December 31, 2009, because he signed (or someone signed) the annual report. What about Dr. William Nash? 
5.  I wonder if Dr. Ken Knott knows they still have him owning those clinics? 
If any of these dentist have not filed tax returns on the income from these clinics, I’d say there might be a problem.
How would this all be explained in an IRS audit?

Who knows, maybe all those tax forms are sent to Corporate Headquarters in downtown Nashville and someone down there files the tax returns and signs the name of the poor innocent dentists. 

Kool Smiles Said to Have Received Offer of $700 Million Clinics

Oct. 4 (Bloomberg) -- American Securities LLC, a New York- based private-equity firm, is the leading bidder for a U.S. chain of dental clinics owned by Friedman Fleischer & Lowe LLC with an offer of about $700 million, according to people with knowledge of the auction.

Friedman Fleischer owns two companies, NCDR LLC and DPMS Inc., that provide facilities and support staff to dental groups operating under the Kool Smiles brand, according to the San Francisco-based firm’s website. TPG Capital also submitted an offer in the final round of bidding, said the people, who asked not to be identified because the deal hasn’t been completed.

The two companies are not really two companies, it's Kool Smiles and Kool Smiles 2.  KS is the clinics in the East and KS2 are the western most clinics.

Read the full article here: Business Week

However since after time passes and the stinch of a company begins to fill the offices of these PE firms, stories like this seem to vanish from the Internet.  So in case that happens, here is the full story:

By Cristina Alesci, Jeffrey McCracken and Jason Kelly

Oct. 4 (Bloomberg) -- American Securities LLC, a New York- based private-equity firm, is the leading bidder for a U.S. chain of dental clinics owned by Friedman Fleischer & Lowe LLC with an offer of about $700 million, according to people with knowledge of the auction.

Friedman Fleischer owns two companies, NCDR LLC and DPMS Inc., that provide facilities and support staff to dental groups operating under the Kool Smiles brand, according to the San Francisco-based firm’s website. TPG Capital also submitted an offer in the final round of bidding, said the people, who asked not to be identified because the deal hasn’t been completed.

Rajat Duggal, a managing director at Friedman Fleischer, couldn’t be reached for comment. Officials for American Securities and TPG declined to comment.

Private-equity firms have resumed dealmaking after a two- year lull following the global financial crisis that started in mid-2007, freezing credit markets and ending the biggest leveraged-buyout boom in history. There were $59 billion in deals in the third quarter, more than triple the amount a year earlier, according to data compiled by Bloomberg.

American Securities, which was founded in 1947 by a Sears Roebuck & Co. heir, has invested in companies including vacuum- cleaner maker Oreck Corp. and the El Pollo Loco chain of chicken restaurants, according to its website. The firm was a runner-up at the recent sales of Air Medical Group Holdings Inc. and Aspen Dental Management Inc., both owned by private-equity firms, according to a person with knowledge of the sales.

Air Medical, Aspen Dental

Leonard Green & Partners, the Los Angeles-based private- equity firm, is buying Aspen Dental from Ares Management LLC. Bain Capital LLC, the Boston-based leveraged buyout-fund manager, is acquiring Air Medical from Brockway Moran & Partners Inc. and MVP Capital Partners.

Kool Smiles caters to children enrolled in Medicaid, a federal-state health insurance program for the poor, and other state health insurance plans, according to Friedman Fleischer’s website. Some firms that looked at Kool Smiles were concerned that it was too reliant on Medicaid payments as governments face deficits, said one person familiar with the auction.

Private-equity firms are increasingly buying companies from each other as more than half the companies that submitted plans for U.S. IPOs in 2010 have yet to complete them. Sales among buyout firms allow the seller to return cash to investors, while the acquirer is able to deploy unused capital that was raised during the boom. Clients saw distributions last year fall to the lowest level since at least 2000, according to London-based research firm Preqin.

Opening Clinics

Smile Brands Group Inc., a separate dental chain backed by private-equity firm Freeman Spogli & Co., scrapped an initial public offering in May. The company, which relies on patients with private insurance for most of its revenue, is now shopping itself in a sale process that is still in early stages, according to a person with knowledge of the matter.

American Securities plans to expand Kool Smiles’ main business of opening clinics in places where access to dentists and other medical services is limited, the person said.

TPG has been pursuing deals. The Fort Worth, Texas-based firm and Goldman Sachs Group Inc.’s buyout arm agreed in July to purchase Belgian diaper-maker Ontex NV for $1.55 billion from London-based private-equity firm Candover Investments Plc. TPG also acquired a 35 percent stake in Creative Artists Agency for an undisclosed amount in a deal announced Oct. 1.

Friedman Fleischer has more than $2 billion under management, according to its website. Its holdings include Korn/Ferry International, the executive-recruiting firm, and Montpelier Re Holdings Ltd., a Bermuda-based property reinsurance company.

--Editors: Elizabeth Wollman, Larry Edelman
To contact the reporters on this story: Cristina Alesci in New York at Calesci2@bloomberg.net; Jeffrey McCracken in New York at jmccracken3@bloomberg.net; Jason Kelly in New York at jkelly14@bloomberg.net.

Tennessee Case - National Union Fire Insurance of Pittsburgh v. Small Smiles Holding Company Update - September 30, 2010

Case Number 3:10-0743 filed in United States Federal District Court Middle District of Tennessee – Nashville Division

Small Smiles Holding Answer to the Complaint filed by National Union Fire Insurance Company of Pittsburg.  NUFIC is a Subsidiary of disgraced AIG, American International Group.

Judge Joe Brown recused himself; no reason was given.

Order after Judge Brown recused himself, by Judge Juliet Griffin

Small Smiles Corporate Disclosure Statement- It has no parent company and American Capital Strategies, LTD owns more than 10%.  Small Smiles Holding is the parent company of FORBA Holding, LLC.

Joint Case Management Order – This document states an over view of both sides of the case as well as the court's calendar.

 

November 9, 2010 – Deadline for Small Smiles Holding to file a Counterclaim against National Union Fire (AIG)
January 31, 2011 – Deadline for Small Smiles Holding Company to file third-party claims under Federal Rules Of Civil Procedure 13.  Join additional parties under rule 14.  Join additional parties under rule 19 or 20.
January 31, 2011 – Last chance to amend pleadings under Rule 15.

Discovery Schedule:

October 15, 2010– AIG's National Union Fire Insurance Company of Pittsburgh and Small Smiles Holding Company to make initial disclosures of their respective evidence.
February 18, 2011 - Discovery related to motions, except those dealing with "experts"
March 18, 2011 - All Fact Discovery and Discovery related motions are to be completed, except those related to experts. AIG's National Union Fire Insurance Company of Pittsburgh and Small Smiles Holding Company may each serve 50 Interrogatories, which includes all subparts questions.  If they need more, they mutually must agree.
March 30, 2011 – Deadline to ask the court for a Settlement Conference if they decide on an attempt at a settlement in the case (and the FORBA bunch usually settle or dismiss.
April 15, 2011 - AIG's National Union Fire Insurance Company of Pittsburgh  must disclose their expert witnesses and any reports from the experts.
May 16, 2011 – Small Smiles Holding Company has to disclose their expert witnesses and reports from those expert witnesses.
June 30,2011- Depositions of the "experts" must be completed.
July 29, 2011 – Deadline for Motions/Objections to be filed by either party in relation to the depositions taken and the opposing party has 45 days to respond to any Motions/Objections.  Parties have the option to file briefs within 29 days of any response.

Monthly case management conferences are scheduled to address issues National Union Fire Insurance (AIG) and Small Smiles Holding Company are unable to resolve among themselves.

January 9, 2012 – Deadline for parties to file objections to expert testimony and motions in limine.

Trial by Jury Date Set for January 31, 2012 by Judge Todd Campbell; it is slated to last 10-14 days.

 

For Reference – Federal Rules of Civil Procedure (Fed. R. Civ. P.)

Access West Dental, Asheville, NC-Dr. Letitia (Tish) Ballance

I don't know how old or new this ad is but here is an ad for a job listed at ncdental.org for a new graduate dentist and dental assistants and more.

Access West Dental-Asheville, NC-Dr. Tish Ballance, DDS.

Does Letitia (Tish) have her hand in the cookie jar again and looking to physically and mentally abuse more children in North Carolina? If so, as it appears, who is she in bed with this time. I would think she would want to be more than transparent in her new ventures.

I found an article written back a few years, November 2004 I think, talking about how Tish Ballance had been raised in North Carolina, and instead of going into a normal practice as a dentist she wanted to help the poor children in North Carolina by opening her heart and dedicating her life to helping those children of North Carolina, yeah right, Tish. Sounded good at the time didn't it.

From what I can gather it's scheduled to open in July 2008. Interviews were scheduled for these positions on Saturday 4/12/o8 at the Marriott Residence Inn on Biltmore Avenue, according to career builder website.

Now I'm not that educated as most can tell from the half hazard way this site is thrown together but if I had just gotten named and fined with a cohort, Michael DeRose, 10 million dollars, 10 MILLION DOLLARS I don't know that I would still be out trying to do the same thing again with in 2 days! Then again, maybe I'm just a quick study and some people just aren't.

As you can read from the ad, once again it's a newly formed "group", wonder exactly who is involved in the "group".

Is it just me that finds this just amazingly stupid! Change names, change locations, rinse and repeat!

Honestly those with a sense of humor, you gotta just love this one!

ACCESS WEST DENTAL (Asheville, NC) - Great opportunity to live, work, and play in the beautiful mountains of western North Carolina in the progressive Asheville area, earn a great salary with no administration responsibilities, and to dedicate your skills to making a real difference! Join Access West Dental opening soon in Asheville, North Carolina. The newly formed Access West Dental is a private group general dental practice that will concentrate on providing much needed access to quality dental care for the under served children and young adults of western North Carolina. The new state of the art 10,000 sq foot office is presently under construction in west Asheville and will boast a beautiful professionally designed spacious interior, 8 chair fully computerized open hygiene bay, digital radiography throughout with intra-oral cameras, and 10 fully computerized ops to also support the “paperless” office model. In addition, there will be a central sterilization area, 4 private consultation rooms for discreet and informed doctor/patient communications, and a full complement of trained support staff that will consist of 4-5 RDHs, 10 DAs, 5 front desk staff (2 bilingual), plus and office manager and a director of operations. The practice will be open Monday -Thursday, closed a full day on Friday and offers a very competitive guaranteed salary and full benefits package for only a four day work week. New graduates encouraged to apply! Please contact Dr. Tish Ballance at 828-665-4410 or accesswest@gmail.com for more information on this practice opportunity.

Smiles Starters North Carolina Still Delivering Overtreatment to the Underserved via Elysa Bailey de Morias, DDS

Thousands of complaints made on Internet "message" and "review" boards.

Hundreds of legitimate complaints filed. 

At least 8 lawsuits.

Ten Million dollars ($10M) in restitution to the government for fraud. 

Under observation since 2003. 

Under my watchful eye since 2007.

Name changes of the facilities.

North Carolina State Board of Dental Examiners spending hundreds of hours reviewing complaints on former owners, current owners, past employees, current employees. 

Warning after warning issued, Consent Orders for Disciplinary Actions passed out like programs at a school play.

Surprise inspections from state and federal agencies.

It is almost October 2010 and we still we have Elysa Bailey de Morias, DDS.

Elysa may well be a very nice person, there are a lot of people who are stupid and/or crooks. 

 Here is the Compliant and Consent Order for Dr. DeMorias

Highlights

Practicing at Smiles Starters in Greensboro, North Carolina

A three year old girl was seen by Dr. Elysa on November 3, 2008, we will call the child HW.

Dr. Elysa “was unable to conduct an adequate visual clinical exam or take sufficient radiographs to support her treatment plan.

Dr. Elysa decided to develop a treatment plan anyway that consisted of restoration of 6 of HW’s teeth, “with possible stainless steel crowns on three of her teeth.”

Dr. Elysa placed “watches” on six of HW’s other teeth. That should be about all the three year old had in her mouth. Looks like Dr. Elysa was going to get at least ½ of them.

HW’s mother felt this was not right and took her child to a second dentist the very same month.

The second dentist wasn’t able to perform a through examination on HW.

In June 2009, 7 months later, HW’s mom took her to the second opinion dentist again who then was able to perform a full and comprehensive assessment.

All the second dentist found, 7 months after Elysa de Morias of Smile Starters saw this child, was a discoloration on tooth A and a minor fracture in the enamel of tooth N. He found NO decay on ANY of the teeth Dr. Elysa de Morias has supposedly found 7 months earlier.

In November 2009, more than a year after Dr. Elysa de Morias wanted to drill away and put stainless steel crowns on 6 of HW’s teeth, HW was seen by yet a third dentist. Dentist three found the very beginning decay on tooth A which he felt probably was not there a year earlier when Dr. Elysa laid claim to a mouth full of restoration needed, but found no other tooth problems what so ever.

All the Board nailed Dr. Elysa for was “violating the standard of care for dentists licensed to practice dentistry in North Carolina by proposing a definitive treatment plan without having conducted an adequate clinical examination and sufficient radiographs.”

Dr. Elysa de Morias agreed that there was sufficient evidence against her, but did not admit any wrong doing but decided not to oppose the allegations and agreed to whatever the Board decided to hand out as punishment.

Elysa Bailey de Morias, DDS has her dental license suspended for 30 days. For the next 2 years she must:

Not do that anymore

Not direct her employees to do that anymore

Allow random inspections and interviews

Complete continuing education designed especially for her at the North Carolina School of Dentistry

Reimburse the board $650.00 for their time and trouble.

Have her name reported to the National Practitioner Data Bank (which is no big deal these days).  Former owner and rumored to be current financier, Dr. Michael DeRose was put on that list many years ago and kept his licenses until 2009!  As did his partner in crime, Dr. Tish Ballance-she is still practicing.

Dr. Elysa Bailey de Morias has been in operation in North Carolina since September 2007!  Imagine the number of underserved she has overserved.

The Possibilities

I'm sure I've missed some billing codes and this isn't exact, but it sure is close.

North Carolina Reimbursement rates:

D0150 – Comp oral evaluation - $44.61
D1120 Prophylaxis (aka cleaning)- $27.21
D0210 Intraoral-complete series w/bitewings $71.79
D1203 Fluoride $16.04
D3220 Therapeutic pulpotomy - $81.09
D3220 Therapeutic pulpotomy - $81.09
D3220 Therapeutic pulpotomy - $81.09
D3220 Therapeutic pulpotomy - $81.09
D3220 Therapeutic pulpotomy - $81.09
D3220 Therapeutic pulpotomy - $81.09
D2950 Core Buildup, including pins $98.25
D2950 Core Buildup, including pins $98.25
D2950 Core Buildup, including pins $98.25
D2950 Core Buildup, including pins $98.25
D2950 Core Buildup, including pins $98.25
D2950 Core Buildup, including pins $98.25
D2950 Core Buildup, including pins $98.25
D2930 Prefab stainless steel crowns –primary tooth $144.28
D2930 Prefab stainless steel crowns –primary tooth $144.28
D2930 Prefab stainless steel crowns –primary tooth $144.28
D2930 Prefab stainless steel crowns –primary tooth $144.28
D2930 Prefab stainless steel crowns –primary tooth $144.28
D2930 Prefab stainless steel crowns –primary tooth $144.28
D2940 Sedative filling $39.77
D2940 Sedative filling $39.77
D2940 Sedative filling $39.77
D2940 Sedative filling $39.77
D2940 Sedative filling $39.77
D2940 Sedative filling $39.77

Total - $2339.99

If the procedures was upcoded to the D3230/D3240 it would be an additional $50 per tooth totaling just over $2600.00.

It's not uncommon to upcode the pulpotomies (D3220) to pulpal therapy (D3230/D3240).

D3220 - Pulpotomies are performed on vital teeth, while pulpal therapy (D3230/D3240) is performed on necrotic primary teeth, with resorbable medicament placed down the canals.

Conclusion

The only conclusion I can come to is Dr. Elysa de Morias  unnecessarily tortures and mutilates children, defrauds the medicaid system and got caught this one time. 

However, all that happened was a slap on the greedy little hand and back to work. 

Nothing was mentioned about the full extent of her attempts, just the actions; “violating the standard of care for dentists licensed to practice dentistry in North Carolina by proposing a definitive treatment plan without having conducted an adequate clinical examination and sufficient radiographs.

Questions

As with all of these cases, we have to ask what caused a person who spent thousands of dollars for her education to attempt not only fraud, but needless suffering of a 3 year old child, and to do it as casually as taking her next breath.

How many patients does she see in a week, a month, that she tries and succeeds in this exact scam?

Why are dentist caught doing this not prosecuted?  Doing an investigation, slapping a seeming large fine on them, but letting them keep right on is doing nothing to stop it.  So I have to assume the powers that be support.

Why do support staff not report this? 

Does it make those in the office who turn their head just as guilty?

It is a Pulpotomy NOT Baby Root Canal

FYI

This term gets thrown around a lot in connection with Small Smiles and the other dental mills, but it's not correct.  It is not what they are doing to the children.

It is really a Pulpotomy!  In short the deciduous (primary/baby) tooth is drilled out, the pulp removed, leaving a chamber.  The tissue within the canals of the baby tooth that was connected to the pulp in allowed to remain.

The chamber is then filled with "resorbable" material.  As the succedaneous (Permanent) tooth behind erupts and pushes out the primary tooth.  The pressure caused by the eruption causes cells to eat up the primary tooth roots, it loosens and falls out.  The roots of the baby teeth pretty much dissolve, and are absorbed into the body.   Remember the tooth you left for the tooth fairy, they didn't have roots.

Without getting into the pro's and con's of various materials poured into the chamber most include zinc oxide and eugenol (clove oil), iodoform paste, and calcium hydroxide.

So when you go looking for root canal on your medical records, you won't find it.  Look for pulpotomy, pulpotomy therapy, or code D3220, D3230 and D3240.

Speaking of the coding, the ADA standard billing codes are used.

In Texas code D3220 will earn a dentist $87.96

In North Carolina D3220 will earn a dentist $81.09

In Kentucky it will get the dentist $67.60

In Alabama only $49.00

Looking at the reimbursement fees, I would think being paid by FORBA on a production/billing basis is going to vary widely.   Dentists will be fighting over what state they get, won't they.

New Kool Smiles TV Ad – Don't Fall For It

Just caught the new Kool Smiles ad.  It's lovely, and you know I'm puking and gagging.

Apparently since Kool Smiles is involved in multiple lawsuits for abusing children, and they are trying to unload this company to some Private Equity firms, they have decided to put out updated propaganda.

The two little happy face o's jump out of the Kool Smiles logo and take you one a whirl-a-way adventure through a Kool Smiles clinic.

"Fun way to keep your family's teeth healthy"

"Our office is built for the whole family, especially kids." as children slide down an indoor slide and climb all over a play yard.

"Plus, everyone is friendly, not just us. (speaking of themselves, those jolly little o's) If you want mommy can come back with you or watch through a window," showing the tiny port hole only allowing direct sight of children in they hygiene area. 

Do you want strangers gawking at you through a window while you get your medical treatment done?  Hell NO!

"We see everyone in the family, even kids as young as one," they boast. 

Yes, those one year olds where they drill and cap all 8 teeth they have just in case they might get some decay between 1 and 6.  Prevention you know.

"If you want quality dental care, in a clean, safe and fun environment, come to Kool Smiles."

It's just an ad folks, still stay far far away.

Dental Licenses Expired, No Problem!

Last week I shot off an email to a state dental board bringing to their attention and looking to filing a complaint about a dental facility whose licenses had expired over 2 years ago.  The facility has been in operation for years.  Its doors have never closed, and they are treating patients as I write this post.

Here is the response I got:

"You are correct in that the facility license has expired and we therefore do not have jurisdiction over this facility.

 

Can you believe it.  If the state dental board does not have jurisdiction after a licenses expires then WHO THE HELL DOES! (I'm not just yelling, I'm screaming!!!!)

So if a dentists license expires, and he/she continues to practice dentistry, no worries in this particular state.  You're good to go!

What a screwed up mess! 

Yes, ladies and gentlemen, the state dental boards are there to protect you!  As is evident in the letter I mailed (snail mail) to the Kentucky Dental Board in April and have not heard one word, not had one question answered!  Kentucky state legislators don't give a shit either, I didn't get a response from any of them either.

Yet these lawmakers will sure show up to a grand opening for a photo opt at a dental mill who abuses children won't they?  This happened just months ago in Louisville, KY and in less then two months complaints were coming in, and law suits have been filed. 

Where are those lawmakers now?  Hiding, that's where!

Open Letter To Kentucky Dental Board

Small Smiles DC #2 Opening Soon?

New Small Smiles opening soon in DC?

Small Smiles Still Abusing Children - Corporate Integrity Agreement A Failure

FORBA's Small Smiles Dental Clinics in Oklahoma is looking for 'associate' dentists for its Oklahoma Smiles clinic located in North Oklahoma City while under the cloud of a class action suit recently filed alleging more child abuse and assault on children in these clinics.

As usual the ad talks about working in, and I quote:

"our rewarding work environment!".

About the only thing "rewarding" thing you will likely get in working at any of these clinics seems to be the extremely high risk of a malpractice lawsuit that can and will haunt you for years to come!  Make sure you get "tail" insurance!  In fact, I would demand it!  Legal fees alone could bring you to bankruptcy. I think I would also want "Claims Based" insurance and not "Occurrence Based".  Again, because of claims that could arise way into the future. 

In some states children have many years to file suit for injuries that occurred when they were small.  What if you treated a four year old who lives in a state where he/she can file an injury claim until they are 20, that is 16 years you have to worry about keeping your "tail" covered.  Is a job at FORBA and its Small Smiles clinics worth it.  This is true for Kool Smiles and other dentists "over" serving children for a dollar.

I would not be surprised, after all the claims being filed by former Small Smiles patients, to find malpractice insurance premiums skyrocket for dentist and/or other staff who had previously worked for FORBA's Small Smiles clinics or other dental mills.

"We offer excellent earning potential based on collections with a guaranteed minimum income"

" We also offer a benefits package that is hard to beat (including 401(k) retirement with company match and 100% coverage for health insurance, malpractice insurance, disability insurance, continuing education, dues and fees). Relocation reimbursement offered and licensing assistance provided."

Please contact Jacob at:

Direct Phone: 719-562-4460

Email: jdkochenberger@forba.com

Fax: 719-584-7697

If I were to work for these scumbags, which I would NEVER do if I planned on any type of good reputation carrying through in my career I would pay close attention to the bold terms highlighted above.

I would also worry about the stringent contract presented to me and have my own attorney look it over before signing, as you should for any contract!  Contract always favor the presenter of the contract, i.e. FORBA.

I would also worry about the Corporate Integrity Agreement this company has signed with the Federal Government.  I was told that FORBA requested its employees to also sign this thing.   Do you honestly think, FORBA will protect you?  

Presently they are having problems with Insurance coverage, themselves.  Not sure how they  feel they can offer up something in which they may not have access. 

Here is a comment I recently received on the matter when FORBA approached them to renew their contract under the new "collections" based salary :

As a dentist who just ended their contract with Forba recently, I would agree with you on many points here.  The worst part about the 'percentage' contract is how low it is.

For example, any private practice employer would pay between 25-30% of collections.  I received a printout of the breakdown for the percentage from Forba even though I only had a few weeks left on my contract and I was only a part time hourly doctor. 

Needless to say, the amount of treatment that needs to be conducted in order for a doctor to meet their minimum salary based on the old contract, is about $3000 a day collections (including personal, ancillary, and clinic contributions to overall collections). 

Under my contract with another private practice, I would only need to collect $2000 a day.  What this means is that a doctor would have to collect 1.5x as much as I would to make the same amount of money, and that doesn't include the salary lost with PTO, vacation, and paid holidays. 

This also means that doctors may be more inclined to 'find' cavities than they were when they were on a set salary and could concentrate more on proper treatment and behavior management;  now it means that a doctor might be quicker to use a papoose or more aggressive with treatment planning than with the prior contract, just to make the same amount of money.

 As recently as August 9, 2010 there are reports of tying up children to overtreat!

Hello, my name is William and it is my belief that the Small Smiles dentistry clinic in Dothan Alabama abused my four year old daughter.

She went in for a "small" filling and was tied to a board, blindfolded with a rag and given two root canals and crowns in under twenty minutes.

This was three weeks ago on the 9th of August.

It wasn't until after a couple of days of ranting and raving before I discovered that I wasn't alone. I came across the 20/20 news report and SNAPPED I could not believe that not even a year after a federal suit they are still treating babies the same way.

I never would have taken my babies there had I known that they are the McDonald of dentistry. We trusted the recommendation of our local school system.
I have since learned of several other families who have treated the same way.

Thank you for your concern
William
smallsmilesabuse.com

On a side note here, the creeps running FORBA sure want to take our tax dollars and live like 'kings' but they sure get bent out of shape when you start naming names, don't they?  

Universal Health Services- $210 million for Keys Group/Keystone Education and Youth Services

Universal Health Services 2005 Annual Report
page 89
paragraph 10.27:
Ownership Interest Purchase Agreement, dated as of October 3, 2005, among Harbinger Private Equity Fund I,L.L.C., Keystone Group Kids, Inc., Michael Lindley, Marty Weber, Ameris Healthcare Investments, LLC, Rainer Twiford, Al Smith, Mike White, Rodney Cawood, Buddy Turner, Jeff Cross, Gail Debiec, Brad Gardner, Brad Williams, Don Wert,Rob Minor, Mike McCulla, Jim Shaheen, Rob Gaeta, and Universal Health Services, Inc., previously filed as Exhibit 10.1 to Registrant’s Current Report on Form 8-K, dated October 11, 2005, is incorporated herein by reference.
UHS and Keystone purchase agreement
With this one acquisition,UHS Behavioral Health nearly doubled in size, adding a total of 46 Keystone facilities in ten states – including 21residential treatment
facilities with 1,280 beds,21 non-public therapeutic day schools, and four detention facilities.

The acquisition is expected to generate approximately $165 million of annual revenue. Just as important, it offers UHS exciting opportunities for entirely new behavioral care disciplines.

Keystone’s residential facilities and day schools have earned a national reputation for treating “at risk” young people with autism and other behavioral needs.  .

These young people face serious problems, including disruptive or aggressive behavior, failing grades, addictions, and severe depression.
Generally, their families and schools have tried to help, but lack the resources and expertise needed to achieve breakthrough results.

Accepting even the kids that no one else will take, Keystone offers structure, teaching, discipline, and love – in a safe and supportive environment.  Keystone provides each child with a service advocate, who represents the child’s best interests during every phase of the treatment process. The advocate works to find a program that will help the child. And, he or she serves as a liaison between the facility, the child’s family, and the referral source to ensure the highest
standards of quality care.

Commenting on the Keystone acquisition, Debra K. Osteen, President of UHS’s Behavioral Health division, stated, “The facilities we are acquiring provide an opportunity to expand our residential treatment facilities,
which have been a solid performer for the division.

“In addition,” Ms. Osteen said, “the acquisition enables us to enter a new business in non-public therapeutic day schools.  We believe there is a need
for this service and hope to expand the current operations and grow in other areas of the country.”

While Keystone was the biggest development of 2005, it was not the only
acquisition made by our dynamic Behavioral Health division.
Structure:
Keys Group Holding,LLC
Children’s Comprehensive Services, Inc
       Keystone/CCS Partners, LLC – 85% owned by Keys Group Holding,LLC and  15% owned by Children’s Comprehensive Services, Inc.
         Kids First Foundation – non-profit
Keystone Nevada, LLC
Keystone Memphis, LLC
Keystone Education Transportation, LLC
Elmira NPS, LLC
Alicante School Elk Grove, LLC
Keystone Savannah, LLC
Keystone Newport News, LLC
Keystone Marion, LLC
Keystone WSNC, L.L.C.
Keystone Oklahoma City, LLC
CCS/Altacare of Arkansas, Inc.
Chad Youth Enhancement Center, Inc.
CCS/Bay County, Inc.
CCS/Meadow Pines, Inc.
Ventures Healthcare of Gainesville, Inc.
CCS/Little Rock, Inc.
CCS/Rivendell of Kentucky, Inc.
CCS/Lansing, Inc.
Associated Child Care Educational Services, Inc.
American Clinical Schools, Inc.
Alabama Clinical Schools, Inc.
Pennsylvania Clinical Schools, Inc.
Tennessee Clinical Schools, Inc.
Keystone NPS, LLC
Keystone Continuum, LLC
Keystone Detention, LLC
Keystone Richland Center, LLC
Keystone DJJ, LLC
Keystone Charlotte, LLC
Keystone JJAEP, LLC

Facilities
Alabama Clinical Schools  AL
Tennessee Valley Juvenile Detention Center AL
Tuscaloosa Juvenile Detention Center AL
Bristol Youth Academy FL
Jacksonville Youth Center FL
The H.O.P.E. Program FL
Nueces County Juvenile Justice TX
Cedar Grove TN
Chad Youth Enhancement Center TN
Cherokee Park Youth Center TN
Compass Intervention Center TN
Hermitage Hall TN
McDowell Center for Children TN
Natchez Trace Youth Academy TN
Upper East Tennessee TN
Old Vineyard Youth Services NC
The Keys of the Carolinas NC
Keystone Newport News Youth Center VA
Marion Youth Center VA
Pennsylvania Clinical Schools PA
Children’s Comprehensive Services of Ohio OH
Turning Point Youth Center MI
Highlander Children’s Services CA
Keystone Carmichael CA
Keystone Desert Hot Springs CA
Keystone Elmira CA
Keystone Grand Terrace CA
Keystone Hemet CA
Keystone Highlander CA
Keystone Laguna CA
Keystone Mar Vista CA
Keystone Ramona CA
Keystone Rancho Cucamonga CA
Keystone Riverside CA
Keystone Steele Canyon CA
Keystone Vallejo CA
Keystone Van Nuys CA
Keystone Victorville CA
Keystone Ventura CA
 
CIT Capital Securities,LLC received $300,000 at closing
Waller Lansden received it’s fees 

Kool Smiles Dentist in Kentucky

Dentists Who Are Medicaid Providers At Kool Smiles In Kentucky

Dr. Kumar Shalesh - left KS a year ago, according to commenter.

Dr. Jennifer Board

Dr. Jing Jing Zhang

Dr. Sara Trombetti (she's been with Kool Smiles and Small Smiles)

Dr. Alia Main

Jennifer Thomasson - according to commenter she is office manager

Dr. Polly Buckey (regional manager and one who refuse to show reporter the papoose boards)

Dr. Anne E. Smothers

Dr. Tu Tran ( stinking founder)

Dr. Solitaire S. Wix

Where is David Strange, he's usually registered in every state like he actually practiced dentistry.  What about Pham, oh yeah, he's not there any longer.

Dr. Roy Shelburne's Warning To Dentist After His Release From Prison

Dr. Roy Shelburne was convicted on Medicaid Fraud charges in 2008.  Here, Dr. Shelburne, released from prison in May 2010, warns dentists.(Interview by Kevin Henry)

• If you work for a dental mill, do you know exactly what was billed by the Office Manager or Corporate after that file left your hands? 
• Did they change your files, did they change your treatment plan? 
• Are the details of what you did and WHY you did it well documented? 
• Do you review your files to see that no one has altered your patients files, you should! 
• Do you use a portable voice recorder after seeing patients to keep a record of your treatment? 
• Do you think the corporate heads really have your best interest in mind? They do NOT!

Raven Marie Blanco Foundation

Raven Marie Blanco was killed by an overdose of drugs at the dental office of Dr. Michael Hechtkopf on March 7, 2007.  She left behind a grieving family who have taken their grief and are using it to awaken the dental community, who have been sleeping at the wheel.  

Children are dying, one a month since April 2010.  The RMBF is asking the ADA and other Dental Organization to take a stronger look at the reasons children are dying in droves.  The RMBF has created common sense solutions that will saves lives in the future. 

So far the American Dental Association has failed in protecting citizens, especially children, from deaths at the hands of dentists here in the United States. 

*********************

From The Raven Marie Blanco Foundation:

The recent rise in pediatric deaths due to dental visit complications is absolutely getting out of control!

RMBF needs your support now more than ever.

We are partnering with Dr. Larry Sangrik, DDS to bring a Continuing Education Memorial Lecture on the "Six Links of Survival" to the dental community in an effort to better prepare them to handle Medical Emergencies.

To honor Raven’s life and perpetuate her memory, we established RMBF. The mission of RMBF is two-fold. Financially, we seek to raise funds for causes which directly impact children.

Our 5-year plan calls for us to place 5000 automatic electronic defibrillators (AEDs) in areas of need across the country, give a grant to assist the dental health needs of underserved children and provide financial assistance for a building project to a South African orphanage.

The second mission of RMBF is to raise awareness within the dental profession about the need for medical emergency preparedness in dental offices. That objective has proved to be even more challenging than raising funds.

When RMBF began, our initial goal was to get dentists to purchase an AED for their office. As we have become more knowledgeable about medical emergency preparedness, we have learned that many of the leading authorities base dental office preparations around a concept called the Six Links of Survival. The Six Links of Survival was developed the Institute of Medical Emergency Preparedness [IMEP] as a medical emergency preparedness program and teaching tool for dentists.

RMBF partnered with Dr. Larry Sangrik to bring a Continuing Education Memorial Lecture on the Six Links of Survival to the dental community in hopes of reducing the amount of unprepared reactions to medical emergencies.

Dr. Sangrik is a nationally renowned speaker, who has lectured to over 7500 dental professionals on this topic.

Our intention is to raise awareness in the minds of dentists about the need to prepare their offices for medical emergencies. 

Six Links of Survival
-Regular dentist training
-Staff training
-Written office emergency manual
-Periodic mock emergency drills
-Proper emergency equipment
-Proper emergency medications

Since 1996 there have been 18 pediatric deaths related to dental complications. Mind you these are only the ones we know about.

That is 18 deaths in 14 years. At first glance the number is sad, but do you want to know something shocking? FOUR of the deaths occurred in the last FOUR months!

Yes, 22% of the deaths occurred in the last four months - add in Maddoux Cordova the 22-month old boy who died in December and you can clearly see that 1/3 of the deaths have happened within the last eight months!

The American Dental Association must update its medical emergency guidelines for dentists and they cannot deny our request that they hold a symposium to study the issue and the 6 Links concept in particular.

Pediatric deaths resulting from complications related to dental procedures are not a rarity people – they are an EPIDEMIC! RMBF will not take no for an answer.

RMBF sent out letters to the American Dental Association (ADA)
requesting that they pursue an update of its 2002 guidelines based on current knowledge, make the information easily accessible to dentists and to commit to regular monitoring of the recommendations to keep them timely.

   

  Raven Marie Blanco Foundation on Facebook - Keep up with the progress

  Raven Marie Blanco Foundation Website - You can help protect pediatric dental patients.

  Raven's Memorial Website

*********************

More children have died since the government has included dental care under Medicaid/SCHIP programs.  Of course this will be explained away as due to the increase in dental care.

If we are going to have those programs, of course dental as well as vision care should be included in Medicaid/SCHIP programs.

The argument to include dental care was that one child had died due to infection.  

Take a minute and meet the children who are now dead.  Many could have been prevented had common sense precautions been taken.

The ADA has not updated their guidelines since 2002!   With the increase in pediatric treatments and skyrocketing deaths this is just unacceptable.

It is hard to believe this foundation needs to exist, but the dental community is resisting adding lifesaving equipment, as an Automatic Electronic Defibrillators (AED) to their repertoire. 

Illinois and Florida have had to pass laws requiring AED's in dental offices, which cost between $1200 - $1800.  However, many dentists are not maintaining or inspecting them on a regular basis, nor is the training in their use sufficient.  Read more here. 

As a side note here:  Papoose boards range from $300 - $500 each. 

Here is a comment from a dental forum regarding AED's:

I don't agree with making AEDs mandatory in ALL dental offices. When was the last time you went to a general practitioner MD's office and he had an AED on hand? It's ludicrous. Now, if you're doing sedation procedures, as this dentist was, then, you are a FOOL to not have such equipment, along with a pulse oximeter. I can't believe he didn't have one. He obviously didn't know how to titrate his dosage properly either, seeing that her blood levels were 3 times the level considered safe for a child her weight. Does the board in his state not regulate who can and who cannot practice sedation??? Here, in Louisiana, we can't even write for Valium for oral sedation as of a couple of years ago without first being re-certified in oral conscious sedation, regardless of how long you have been in practice and doing so.

In Illinois, the law will not apply to dentists who use only local anesthetics such as lidocaine or articaine.  The original legislation included ALL office, but thanks to the Illinois State Dental Society, it was amended.  Thank you so much ISDS. (sarcasm) Read more here.

Dental office can purchase one through the drive-thru sedation training called DOCS. 

Woman Arrested For Kool Smiles Prescription Forgery

I'm wondering a couple things here:

1. Does Bianca work for Kool Smiles

2. Why do they still use prescription "pads".  Even Small Smiles uses electronic prescriptions!  Even though they were stupid enough to put them online.

3. Wonder why it took so long for the CVS on South Cherry to get a clue that Kool Smiles dental clinics probably shouldn't/wouldn't be writing scripts for "large" amounts of Oxycodone?

Hometown Annapolis:

A woman was arrested last night after trying to pass what city police said was a fraudulent prescription for oxycodone at an Annapolis-area drugstore.

Bianca Vivian Robinson, 21, of Poplar Grove St. in Baltimore, was arrested after she tried to get 90 tablets of the painkiller from the CVS pharmacy in Hillsmere at 7:53 p.m. using a prescription from Kool Smiles of Baltimore-Westside, ostensibly for a cousin residing in Baltimore.

The dental office told police a prescription pad had recently been stolen.

The same prescription had been presented at the CVS store on South Cherry Grove Avenue 30 minutes earlier, police said. A pharmacist there said she had been getting scripts for large amounts of oxycodone from Kool Smiles recently.

Police said Robinson was arrested on prescription fraud and other charges.

Potential New Hire Asking Question On Dental Forum About Compensation Based On Production at Small Smiles Clinics

July 7 and July 8, 2010 conversation between members of a forum for new dentists.  Wonder if it was "internal and confidential" then too?  Oh, wait, that was long before I wrote anything about the bait and switch contract for Small Smiles dentists.

New Graduate asks:
Hi,
I will be interviewing for a position with Small Smiles. Here are the major pointers of the compensation and contract:
- Mon to Fri, 8 to 5
- 3 other dentists and 4 hygienists already working there.
- Production based compensation (22% of everything; xrays, hygiene exams, operative, exams, etc)
- Daily minimum $360 (but obviously this hardly happens, as I am told)
- $10k sign-on bonus.
- Average patient is billed $200 per visit, so I am told that I can see two patients at the same time, as well as hygiene exams too.
- 4 weeks paid holiday
- Did I mention this is a chain office?
Any pointers about this opportunity? Is this a good or bad deal for a new grad?

Fred:
Run for the hills

Wilma:
If it's truly a 'daily minimum,' get it in writing.  But. c'mon - a franchise just for low-income with an average per visit charge of $200, and making the offer they are making you?  If that doesn't sound fishy enough.....read this ( http://abcnews.go.com/2020/dental-chain-reaches-settlement-medical-fraud-performing-unnecessary/story?id=9615119 ) and then do as previously posted - run for the hills.

Ed:
I don't recommend franchise dental clinics for patients or people who are looking for work.  I looked at the link above and I thought it was "sensational".  Who really knows what shape the kids were in before getting in the chair.  Most of the mothers look like trailer trash and probably couldn't tell the difference between a cavity and a raisin their kid just ate that happened to get jammed into a hole in their kids "toof".   Sad that this is the only care available.  I suspect their are at least a few who work in these places that truly do care and are trying to do the best with a very bad situation and make a difference in the lives of these unfortunate kids.    
Catch a glimpse of the upper right quadrant of the kid early in this video that was not treated.  Mom says his teeth were perfect before he got in the chair.  Ignorant people see this stuff and think the dentists are evil.   Ed
http://www.youtube.com/watch?v=wdxeG6F41uc&feature=related

Gene:
Small Smile mainly takes Medicaid and Chips insurance patients. They only way to squeeze 200$ out of these low reimbursment insurances is by aggressively over-treatment planning every case ( Which of course they are notorious for) 
The worst part of working at Koolsmiles or SmallSmiles is that you will an office manager who will ensure that you meet these ridiculous production goals. If you do not produce you will called into the office and someone without a dental license will be telling you how to practice. "Dr. New Grad, Why don't start using the Papoose board. We have some Dentists producing 10,000$/ day." They don't give a crap that these kids are screaming in the back rooms and urinating on themselves out of sheer fear from the traumatic experiences they are subjected to.
The other worst part of working at the Smile Center/ Koolsmiles is that they set up the clinic so that the doctors will be fighting for production. You get a bonus if you produce X amount of dollars in operative. This will #1) lead to aggressive treatment planning #2) the doctors camp out in the operative rooms and fight over op patients.
Don't work for these guys or any smile-o-rama.
Barney:
Medicaid offices REQUIRE speed and efficiently to handle the volume of patients needed to offset the low compensation and profit margins.  Right out of school, some docs may not have the clinical skill needed.

_____________________________________