Dentist Able To Treat Patients Too Soon

It just amazes me how easily a person can attend dental school, graduate and immediately be given the opportunity to tear into a person's mouth, especially a child's.

No wonder so many go to dental school instead of medical school or take the time to attend another couple of years of college to actually become a pediatric dentist.  And explains why dentistry has become such a joke, which it shouldn't be since oral health is so important.

In medical school it's years before you are allowed to attack the care of a patient on your own, to become a dentist and treat patients is a piece of cake in comparison.  No, I'm not saying it's easy by any means nor do I think I could do it, however from what I've heard many Small Smiles dentist are doing I'm not so sure my 5 years old grandchild might not do a bit better job.

What bothers me is the fact these dentist pass a test, (yes they actually do have to do some work on actual teeth before graduation but so does a cosmetologist so that doesn't mean a whole heck of a lot) then left to roam from state to state simply applying for a licenses to practice and after a few questions from state dental boards are granted those licenses.  And unless there are complaints (and a whole lot of them and sometimes this mean little) they are left to run loose.  This is why filing complaint is so important!  If not you, then who? 

I know from doing all my research into this very few dentists licenses are actually revoked and in most instances one state will slap them on the wrist, maybe even two slaps, the next state knows this but will grant them a licenses anyway as if there is some dentist shortage or something.

This just seems wrong to me.  There is a bit of oversight of dentists.  But nothing near enough when looking at how places like Small Smiles, Kool Smiles and the like have been allowed to open renegade dental offices.  Many of these clinics have licenses hanging in their offices of dentists the staff have never seen or heard of, let alone any of them actually working on patients.

Of course many of the staff don't understand why these licenses are hanging there (it's to skirt the laws of particular states) but I encourage them to report this behavior to your state dental boards.  If there is a dentist licenses hanging in your office and you've never seen this dentist this should raise some red flags and I hope that you ask yourself why.

Anyway, states need to be taking a much closer look at their dental laws, rules and regulation and put a high powered microscope on their dental boards.  It's time for individuals to take some action here and let your law makers know there is a python in the wood pile and clean up this mess.

That is one thing I can thank companies like Small Smiles for, their tyranny bringing to light much that is wrong and what needs to be cleaned up and I don't mean tomorrow, I mean last week.

Another Child Abused At The Hands of Dental Staff.

This is Ginny's story:

Recently I took my 5 y/o son to a Pediatric Dentist in Overland Park, KS. I begged for something before hand for him, knowing that he would be very scared.

They called in Valium 10mg, 30 min before his appt. He was needing 2 fillings that were side by side. They also advised me before hand that Nitrous gas was going to be used.

Once the gas started, he began to get a combative, screaming, and kicking. He begged for me to help him. It felt like a dagger to the heart.

They said that they would need to use a papoose board, with my permission, so that they didn't drill into his cheek or gum. I advised them that he was a little claustrophobic and wouldn't like it.

They said they needed to finish the procedure. He was screaming no no no and was asking them to wait because he had to tell me something, ("kids try using all tactics", is what I was told).

I kept talking calmly to him telling him it would be over soon, and it was ok and mom was here. When they turned it into a safety issue, you think you are doing the right thing.

Watching your child be strapped down, with a 130-140# tech laying over them, screaming, nearly throwing up, you feel like a criminal & a failure as a parent.

He kept saying he couldn't breath, and the tech kept telling him that if he was crying he was breathing. I am a RN, and would never treat my patients like this. You are trained safety first, but he is my child and I knew that they couldn't leave his procedure half done.

I asked several times if they had used lidocaine, they said that he wasn't hurting he was just mad. He was never given local anesthesia.

I was told by a tech that if I felt that it would help they could try it but it may interact with the Valium, and cause a worse issue than what we had.

I try not to let office staff know when I go somewhere what my profession is because then they seem to treat you differently. When it was all over almost 45 minutes later, he was soaked in sweat from his head to his socks.

The doctor was calm during all of this and never raised her voice once. The techs though had this look on their faces like they were going to control this child, the first one yelled out the door for help then two more came in.

Over all there was the dentist, and 4 techs in the room. He is very very strong and kept getting his hands out of the restraint and pinched them. He was asked not to pinch because it wasn't nice. I wanted to tell them put yourself in his shoes, I would be scratching your eyeballs out of your head if you were holding me down, so get over it!

Never again will anything like that happen again to any of my children. My daughter went 1 1/2 years ago and had a baby eye tooth pulled that wasn't ready to come out but because all of her perm teeth were being twisted, had to be pulled. That was a different doctor same facility.

I fired that doctor from seeing my children because of her treatment. It took me over a year of talking and reassuring my daughter that the next experience would be better, for her to return to the dentist.

And after my sons appt. and not using lidocaine, I was discussing it with my husband and I truly do not think that she was ever given lidocaine or any other anesthesia except for nitrous gas.. I am appalled.

I am calling Monday morning to ask what her anesthesia was for that appt. She is 9 and is to start braces in 2 months at this facility. If I find that she wasn't given local when they pulled her tooth, I will make a decision to turn them in to the ADA and also to transfer care.

It is up to us to protect our children and I have failed both of them in this department. If anyone feels that it is wrong, it probably is and they need to remove their child from the situation.

I will never be afraid to cause waves again. If we don't protect them who will?

Dr. Robert F. Andrus-Still Small Smiles Front Man?

According to Beta Health Association Complete Specialists Directory (not dated so I don't know how "updated" this actually is) Dr. Robert F. Andrus's specialty is Pedodontics (children's dentistry). Of course as with anything to do with Small Smiles, this simply isn't the case. His current Colorado licenses lists him as a General Dentist.

Of course I knew this was probably BS since this same list has Michael DeRose's Specialty as Pedodontics as well and we know that simply 'ain't so'.

Why do I mention Dr. Robert F. Andrus, DDS you might be asking yourself? Well, on this same list it says that Dr. Andrus works in the Michael DeRose office located at 1022 Liberty Lane, Pueblo, Colorado along with Drs. Ed DeRose, Michael DeRose, Jim Mobley, Randy Ellis, Hate Haerr.

Of course there are hundreds of dentist associated with Small Smiles/FORBA and Michael DeRose but this guy seems to stand out a bit since he's applied for and received dental licenses in Kentucky, Nebraska, New Hampshire, South Carolina, Virginia and Kansas just to name a few.

So how does this associate him with Small Smiles? Well, there is an article on glsennca.org called "Small Smiles defies traditional system". In this article it says that Terry Dickinson was wary of corporate dentistry coming to the state of Virginia and would be keeping an eye on Small Smiles.

It also says that Todd Cruse, chief development officer for FORBA would be managing a Small Smiles clinic owned by a Colorado dentist, Dr. Robert Andrus. This same article says a Dr. David Jones, DDS (not of the Monkees fame) closed his private practice to come to work for Small Smiles in Roanoke (bet he regrets this move by now).

Anyway I don't know if Dr. Andrus still is fronting for Small Smiles, using his name on licenses and such but he sure did at one time and he's all but held hands with Micheal DeRose and I'm not sure they've not done that as well.

After the first Small Smiles Report

Over the course of a few months, after Roberta's first report, there were a lot of follow-ups and communications between a lot of organization and state agencies and FORBA, now known as Church Street Health Care Management.
November 2007:
At that time, Maryland had 3 companies that managed their dental program.

1. Amerigroup who contracted out to Doral who contracted with FORBA (this drives me insane!)
2. United Healthcare - Mid-Atlantic Medicaid Plan (United Medicaid/UHCMA) who contracted with Dental Benefit Providers, Inc.
3. JAI Medical Systems

All these companies started investigating Small Smiles clinics Nov. 9 and Nov. 12, 2007.

November 9, 2007 Mike Lindley tells employees there would be audits that they estimate may take 30-45 days and during which time they could not seek reimbursement, but they had made the decision to continue to treat patients.  (because they felt so strongly about taking care of the underprivileged, all services would be "at no charge". 

[Am I the only one who doesn't think they knew how things would end and they could float these clinics for a couple of months, no problem]

Oh What A Tangled Web

Doral Dental is a Third Party Administrator (TPA) of Government Medicaid Dental Programs according to answers.com.

My first question is why in the world does any agency (Medicaid) need a THIRD party anything. Wouldn’t first party or second party at most be plenty?

Amerigroup is a Medicaid Managed Care Organization (MCO) but following along the thinking of Doral's designation, I guess Amerigroup would be considered a Second Party Administrator.

Your state Medicaid services would be the first tier I suppose.

So your state gets your hard earned, and taken away from you, tax dollars allocated to them to spend on the poor and those in need for medical treatment, called Medicaid. (In some states they give it a local name such as in Massachusetts it’s called MassHealth, in Tennessee it’s called TennCare, but it’s just Medicaid.)

Evidently the states don’t know what to do with the money, they need experts to distribute it so they hire companies like Amerigroup to spend your tax dollars for them.

In Maryland they have hired 7 of these companies, one isn’t enough I suppose. Amerigroup is one, AmeriChoice, Coventry Diamond Plan, Helix Family Choice, Jai Medical, Maryland Physicians Care, and Priority Partners are the others.

All of these companies then find it overwhelming to do the job so they hire Third Party Administrators such as Doral Dental. Doral Dental then goes out and gets contracts and hires the actual providers, your dentists and dental clinics such as Small Smiles.

Some of the Second Tier companies such as Jai Medical contract directly with the providers, Small Smiles, so I guess hats should be off to them for by passing those Third Party Administrators. Getting rid of the middle middle men I suppose. (more money for them to keep right)

However even the Third Tier companies like Doral find it overwhelming to spend all that money and will hire companies to help them decide where to spend it as they did in Tennessee by hiring Managed Care Services, a company who just happened to be owned by a state senator, John Ford, now on trial. (Amazing how many “consulting” firms are needed to decide where to spend all those Medicaid dollars isn’t it.)

Honestly, we have management companies managing management companies who hire consulting firms to help manage the management.

Well, evidently the rival firm of Doral, FORBA which just happens to own Small Smiles that are Doral Dental providers in other states wanted to sue Doral for Doral not letting them in on the TennCare Medicaid dental pie. This brought to light Senator Ford’s involvement and everything hit the fan and federal charges were filed but so far only against Senator John Ford, why no charges are being filed against FORBA and Doral for offering the bribe money is beyond me. I mean aren’t the ‘johns’ of hookers also charged?

Well anyway this brings me to Doral overseeing Small Smiles clinics in Virginia, Maryland, Ohio, Kentucky and a host of other states for those Second Tier Administrators like Amerigroup.

Doral says it’s conducting internal investigation of all the allegations on the mistreatment of children and fraudulent Medicaid billing, but what good is that exactly. I mean Doral sends it’s patients to Small Smiles in several states, yet is in competition with Small Smiles own management, FORBA in other states. (Head spinning yet? Mine sure is.) And the icing on the cake, Doral who is looking into these allegations is in deep doo doo in Tennessee for bribing a state senator! Don't think any kind of 'clean bill of health' Doral was to give Small Smiles would mean a whole lot, what do you think?

When pressed Doral will just throw the responsibility back to Amerigroup, saying they are the ones who push for all these children to be mistreated, (clearing throat) I mean money to be made, Amerigroup says it’s Small Smiles, and Small Smiles throws up it’s hands and says they don’t know anything about children being mistreated or Medicaid being ripped off.

And do you think the states know, well heck no. They don’t even seem to be smart enough to manage the Medicaid dollars in the first place and they have hired a umpteen packs of Foxes to watch one hen house.

But when all said and done there really is no competition or rivalry. They are all in the same bed, using the same horrible methods to steal millions and millions of your dollars and mistreating and abusing innocent children to get the job done and sending at least some of the huge profits to an Islamic bank is Bahrain that must not be making enough money of oil prices.

And let us not forget this same scenario is happening with United American Healthcare and it’s Third Tier Management group Omnicare. (As Doral Dental is to Amerigroup, Omnicare is to United American) FORBA/Small Smiles is also a dental provider for Medicaid enrollees of United American Healthcare in various states just like they are for Doral Dental and Jai Medical.

United American Healthcare, through it’s OmniCare company was paying Senator John Ford $8500 a month for his services in getting key legislation through the Tennessee assembly. Legislation that would greatly benefit FORBA/Small Smiles as well as it’s own interests. (You can read about this at various places on the net, so I’m not getting into all of those allegations here)

Point is United American Healthcare did nothing to curtail Small Smiles treatment of children in Maryland. Doral Dental terminated 4 individual dentists and is ‘investigating’ (chocking on that word) Small Smiles practices before it sends more of it’s enrollees to Small Smiles and in November Jai Medical Systems sent a letter directly to Todd Cruse putting Small Smiles on probation and requiring Small Smiles to allow parents to go back with their children, make sure all personnel are licensed BEFORE they treat children, not go to school while practicing, and were going to do surprise visits and random patient surveys.

In light of the recent allegations of United Healthcare and Doral Dental being in hot water up to their eyeballs for bribing a state senator, I don’t think either of these companies should be ‘overseeing’ or ‘investigating’ wrong doing of Small Smiles or any other company, do you?

Partial List of Small Smiles/FORBA Corporate Office Staff

updated 4-1-2009

Al Smith (President, COO), Adam Snell, Alicia Sandovel, Amanda Greenhood, Amanda Skelley, Anna Casarez, Arnie Carlsen, Bob Andrus-FIRED Fall 2008, Brad Gardner, Brad Williams, Brandon Dyson, Cha Jones, Chante Green, Chanthalay Onevathana, Chase Trivett, Chris Gallina, Chris Hatch, Chris Pershin, Christian Diehl, Christine Peasron, Daniel Dunn, Donnie Watson, Dorothy Vigil, Jacob Kochenberger, Jake West, Jeff Osterman, Jenna Kochenberger, Jody Kay McFarland, John Fujishiro, Juliana Johnson, Kallene West, Kathy Morales, Ken Knott-FIRED with Bob Andrus, Kevin Reilly, Kimberly England, Lara Lott, Linda Zoeller (she's the one who files all those many many state corporate filings), Lisa DeRose, Lisa Mullinix, Liz Tran-FIRED March 2009(wonder if she's related to the Tran who opened Kool Smiles), Lizz Lown Krummel, Lori Bland, Lorri Stelner, Mark Oreskovich, Marla Grossman, Marschelle Chatman, Melissa (Missy) Green, Michael Lindley, Michele Campbell, Mike McDulla, Phyllis Brown, Rodney Cawood, Shari Reed, Skye Lown, Stephanie Pena, Steve Nitchen, Suzy Selgenthaler, Tammy Green, Tim Richter, Todd Cruse, Trevor Blazer, Vince Benfatti, Vinny Branchael.

All these people are listed as employees of FORBA either at the Nashville Office or the Colorado Office that located within DDMarketing (Dan DeRose Marketing)

If you are on this list and no longer employed with Small Smiles, let me know and I will note it.

Small Smiles Old Consent Form v. New Consent Form

Small Smiles Old Consent Form that says there is no known danger in strapping a child down in a straightjacket/papoose board.

See Here

Small Smiles New Consent Form telling parents a dentist, not assistant or hygienist but a DENTIST must inform the parents how, when and why a straightjacket/papoose board needs to be used as well as informing them their child could die if they use one.

See Here

Changes Made In Maryland Due To Small Smiles Abuse of Children

Changes are being made for children needing dental care in Maryland, in part to ABC 7 I-Team's Small Smiles investigation.

The changes will affect tens of thousands of families who've had a tough time finding quality care. The overhaul will bring greater oversight and encourage more dentists to accept Medicaid families.

Most dentists won't treat children on Medicaid because it pays less than private insurance. The I-Team's investigation showed Small Smiles made up for low fees with high volume. Beginning the first week in July, Maryland Medicaid officials will begin pumping an additional $14 million dollars into the program to encourage more dentists to participate.

"The state is concerned overwhelmingly about two things: We want to make sure we have enough dentists who can provide services to the children, and we want to make sure that those services are of high quality," said John Folkemer with the Maryland Department of Health.

Before, Small Smiles would keep parents waiting in the lobby, and had no special training for dentists who routinely used restraining devices while treating young children.

"We have required them to do some corrective actions," said Folkemer, "and to change some of the policies."

Folkemer says parents must be allowed to stay with their children and dentists now receive training on how and when to use so-called papoose boards.

Also consent forms were changed which had falsely told parents that restraints posed "no known risks" to children. Small Smiles now warns parents of potential "serious consequences" of these restraints, including "physical or psychological harm even death."

"And we [also] will now have one organization that we can deal with to handle any such problems as have been raised as to the quality of care or access," said Folkemer.

Dan DeRose Takes the Stand in Ford Trial

by:Marc Perrusquia

NASHVILLE -- Only one or two top executives at a TennCare contracting firm knew details of then-state Sen. John Ford's secret consulting job for the firm, according to witness testimony and documents presented by prosecutors Tuesday.

The closely held secret of Ford's $190,000-a-year job for state contractor Doral Dental began leaking out in late 2004 after the Wisconsin-based firm was sold to its current New England owners.

Ford, 66, is on trial in federal court here on six counts of corruption connected to payments he received from Doral and another state contractor.

Steven Pollock, Doral's current president, testified that he and others found out around the time of the sale that Ford was involved with two partners in Managed Care Services Group, a firm set up to help Doral win a contract with TennCare, Tennessee's expanded Medicaid program.

Doral started paying Managed Care $40,000 a month -- 40 percent of it going to Ford -- weeks after Doral won a lucrative TennCare contract in 2002.

Pollock said he began asking questions in November 2004 when Ford and his two partners traveled to Milwaukee in hopes of saving their Doral consulting deal, which had come under internal review.

"I asked (an employee) to check whether Sen. Ford was a sitting state senator,'' Pollock told jurors.

Asked why he did that, Pollock replied, "Obviously, as a government contractor, there's typically prohibitions (against) working directly with state officials.''

Pollock said Doral eventually terminated Managed Care's consulting contract, but not before the news media began reporting on Ford's connection. Doral severed the contract in February 2005, just a few days after The Commercial Appeal first reported that Ford was receiving hundreds of thousands of dollars through Managed Care -- income he didn't report to state regulators.

Although he was then Doral's general counsel and vice president of market development, Pollock said he didn't know what Managed Care did for the firm. A succession of Doral executives, including senior vice president Robert Lynn and former chief financial officer Lisa Sweeney, testified similarly over the past two days.

Pollock said that two top executives -- Doral founders Craig Kasten and Greg Borca -- had authority to enter consulting agreements. Neither has testified. Testimony on Monday indicated that Managed Care was formed after Ford and Kasten began discussing a potential TennCare contract.

On Tuesday, prosecutors introduced a 2005 spreadsheet listing Doral's consultants that characterized Managed Care as "a political organization, (with) public officials tied to this organization including Senator Ford. ... Greg (Borca) worked out the relationship.''

The spreadsheet went on to say that when a rival firm had threatened to sue Doral, "MCSG intervene(d) and no suit was filed. Well connected and influential.''

The passage appears to be a reference to FORBA, a Colorado-based manager of Medicaid-funded dental clinics for poor children. Two current and former FORBA officials have testified that they built and briefly opened a clinic in Memphis in 2003 but were forced to shut down after Doral would not let them into the TennCare dental network.

Dan DeRose, FORBA's former CEO, testified Tuesday that Ford had tried to discourage him from suing Doral. Echoing testimony from a lobbyist a day earlier, DeRose also said Ford tried to solicit payments from him for his legislative influence.

"He asked me if I knew what his nickname was. I said no. He said, 'They call me Mr. 15Percent,''' DeRose said. Prosecutors asked DeRose if he had asked Ford what he meant by Mr. 15Percent. DeRose responded that he had, saying, "His response was 'I can take care of your problems.'''

DeRose stood his ground when defense attorney Isaiah "Skip" Gant suggested he had made inconsistent statements regarding the Mr. 15Percent comments.

"I'll always remember it,'' DeRose said on redirect. "It was startling. ... I'd never been solicited for money like that.''

The very idea that Dan DeRose is on the witness stand trying to say his hands are clean in this just blows my mind!!!!

FORBA's Todd Cruse on Witness Stand In Tennessee Senator Trial: No Big Surprise Here

In my opinion Todd Cruse is no better than Senator Ford. I've been trying to tell my readers for months that FORBA, Todd Cruse, Michael DeRose, Doral Dental and the whole bunch associated with FORBA are crooks!

I'm looking forward to other senators to get nailed from doing dirty business with FORBA in the near future.

How many children did Small Smiles/FORBA and Doral Dental, who manages the management of FORBA, abuse to give Senator Ford his 1.7 million dollar cut. Let's see, at $220 per baby root canal that's close to 8,000 teeth just for one senator's payoff.

As you can clearly see, FORBA/Small Smiles just can't seem to keep their asses out of the spot light now can they?

July 8, 2008
Contact Chris Echegaray at 664-2144 or cechegaray@tennessean.com

Former state Sen. John Ford and his business partners were paid roughly $1.7 million in consulting fees from a TennCare contractor, according to a key government witness who testified in federal court on Monday.
Ford, 66, is accused of receiving consulting fees from two TennCare contractors, Memphis-based OmniCare and Wisconsin-based Doral Dental, from 2002 to 2005 while he served as a state senator on the general welfare committee and the TennCare oversight committee.
Ronald Dobbins, a Pennsylvania businessman who was one of Ford's partners in the consulting firm Managed Care Services Group, testified that the Memphis Democrat received 40 percent of the consulting fees from Doral Dental and the other partners got 30 percent.
Dobbins initially worked for United American Health Care, the parent company of OmniCare.
He testified that after leaving the company he created the consulting firm, Managed Care Services Group, in 2001. He said the initial consulting partnership was between Ford and him.
Then he found out that Ford had invited Osbie Howard, the chief executive officer of OmniCare, to join them. Howard handled the money, Dobbins told the jury.
Dobbins testified that he collected around $300,000 from Doral Dental over three years for doing little to no work.
Dobbins testified he had no knowledge of what Ford was doing on Doral's behalf.

'Mr. 15 percent'

Todd Cruse, a lobbyist for Forba, which operates dental centers for low-income children, was trying to get work through TennCare in Tennessee through Doral. Cruse sought out legislators in the districts where the dental centers were being opened, he testified. He sought out members of the black caucus, including Ford.
Cruse testified that after a dinner at a PF Chang's in Memphis, he approached Ford about Forba having a shot to work in the state.
"He chuckled," Cruse said. "And he said, 'They call me Mr. 15 percent.' When a legislator says he's known as Mr. 15 percent, it sorta sticks with you."
In cross-examination, federal public defender Isaiah Gant attacked Cruse for not reporting the 15 percent comment to anyone.
Gant also noted that Dobbins was initially the subject of the investigation into wire fraud. Dobbins received immunity in exchange for his testimony and cooperation with the government.
Ford is charged with two counts of wire fraud and four counts of making false statements on official documents. The wire fraud charges carry a maximum penalty of 20 years. The maximum sentence for each of the four other charges is five years.


I would like to say that Todd Cruse may at one time been a Lobbyist for FORBA, I don't know where he crawled in from, but he's now listed as:

Senior Vice President of Development tcruse@forba.com 615-986-1709