Leesburg Virginia couple charged for practicing dentistry without a license

 

Posted at 11:48 AM ET, 05/13/2011

Leesburg couple accused of illegal dentistry

By Maria Glod

A Loudoun couple who allegedly ran a dental office in the basement of their Leesburg home have been charged with practicing dentistry without a license, officials said.

Nelson A. Castro-Diaz, 47, and Matilde A. Lindarte-Vargas, 35, had a full-service office in their home in the 1200 block of Tennessee Drive that included a dental chair, waiting room and a receptionist desk, according to Loudoun Sheriff’s officials. Authorities said the office catered to the Latino community.

The couple told investigators they had worked as dentists in their native country, according to sheriff’s spokesman Kraig Troxell. Troxell said he didn’t know what country the couple were from.

Castro-Diaz and Lindarte-Vargas were released on their own recognizance, authorities said.

Small Smiles Dental Center wants to put my child to sleep for dental treatment-Good idea?

 

I can’t answer that. 

But I can tell you that the nasal spray of “midazolam” along with nitrous oxide gas- inhalation sedation (IHS) - was studied on 100 children between the ages of 3 and 13, who were originally referred for “general anesthesia” and 96% of the required dental treatment was completed successfully.  There was no need for general anesthesia and parents were present with the children during the procedure. 

The National Institute of Health recommends this technique instead of Dental General Anesthesia. (DGA)

You can read the study for yourself here:
The safety and efficacy of intranasal midazolam se... [SAAD Dig. 2010] - PubMed result

Of course skilled dentists and staff as well as life saving equipment and medication is a must! 

I can tell you general anesthesia is close to death, and I’ve lost count of the number of children who have died in the last two years. (8) and rising.

I can tell you seven studies of Inhalation sedation, using nothing but nitrous oxide (along with local numbing), without the nasal spray have taken place.  These studies also used children who had been referred for general anesthesia.

The studies were reported to have a “remarkable degree of consistency in the reported treatment effectiveness despite other differences in patients”. 

What were the results? 

No more secret meetings and backroom deals for health care professionals who screw up in Washington state

Washington State HB 1493–Signed Into Law April 22, 2011, Effective July 22, 2011

HB 1493 - 2011-12

What is it?

It provides greater transparency into health professional’s disciplinary actions taken by state licensing boards, such as the Washington State Department of Health Dental Board. 

 

HB - 1493

• ŸAllows a complainant in a disciplinary proceeding under the Uniform Disciplinary
• Act to supplement the contents of his or her complaint.
  Requires a disciplining authority to promptly respond to inquiries regarding the status of a complaint.
• Requires a disciplining authority to provide a complainant with the file relating to the complaint.
• Requires a disciplining authority to allow a complainant to submit an oral or written victim impact statement.
• Requires a disciplining authority to inform the complainant with a report on the complaint's final disposition.
• Allows the complainant to make a request for reconsideration of the disciplining authority's decision.

HB 1493 – Analysis

The Original Bill – 1.5 Simple Straightforward pages of meaningful legislation

The Final Bill – Instead of watering down it seems to have been strengthened

The Bill had NO impact on the state budget.  None.  Nada.

There was a substitute bill presented by the Senate.  Compared to the Original Bill:

• Allowed the license holder to respond to any supplemental information submitted by the complainant.
• Required the disciplining authority to promptly respond to status inquiries by the license holder (in addition to the complainant).
• Required the disciplining authority to provide a copy of the file to the license holder (in addition to the complainant).
• Changed "victim impact statement" to "impact statement."
• Limited the circumstances in which the complainant may request reconsideration to situations in which (a) there has been no statement of charges or allegations and (b) there is new information relating to the original complaint or report.
• Required the disciplining authority to notify the license holder of any request for reconsideration and allows the license holder to respond.

On March 1, 2011 the Third reading of the bill took place in the House and a vote was called.  Twenty-nine (29) representatives voted no, all Republican.

They are:

Gary Alexander - R Jan Angel - R Mike Armstrong - R Katrina Asay - R Barbara Bailey - R Vincent Buys -R Cary Condotta - R Larry Crouse - R Bruce Dammeier - R Richard DeBolt - R Susan Fagan - R Larry Haler - R Mark Hargrove -R Paul Harris - R Norm Johnson - R

Brad Klippert - R Joel Kretz - R Dan Kristiansen - R Jim McCune - R Jason Overstreet - R Kevin Parker - R Kirk Pearson - R Charles Ross - R Matt Shea - R Joe Schmick - R Shelly Short - R Norma Smith - R David Taylor  - R Hans Zeiger - R Bill Hinkle - R was “excused”

 

By April 7, it was voted on by the Senate.   One “Lone Ranger” Senator voted no.  Who you ask?  That would be Senator Doug Ericksen (R) of Washington state.

Another Teenager Dies During Dental Treatment

There is another child death for 2011, I believe that makes 4 so far.  Miciah Bonzani from outside Pittsburgh died May 5, 2011.  Story plus video at the link below.
New Kensington Teenager Dies Unexpectedly - News Story - WPXI Pittsburgh
I will be updating when I can dig up more details. 
Prayers to her and her family. 
God help us!

Small Smiles Dental Centers: Reporting of Adverse Events

The Corporate Integrity Agreement requires Church Street Health Management to self report what is referred to as “Reportable Events” that take place at their Small Smiles Dental Centers across the US. 
What is a “Reportable Event” as seen by Small Smiles Dental Clinics:

1. Billing that would generate more than $4000 in overbilling – Keep erroneous or any fraudulent bilking billing under that mark and they are good to go.  Is that per child?  Could also be defined as a matter that a reasonable person would consider a probable violation of civil, criminal or administrative law applicable to federal health care programs . Or a matter that a reasonable person would consider likely to render CSHM insolvent.
2. Quality of Care Reportable Event– Adverse Events (AE).  These are a bit more difficult to define, since they are in the eyes of the beholder.  Basically anything that involves a violation of the obligation to provide items or services of a quality that meets professionally recognized standards of care.  In my opinion, that would include unlocking the door to any of the now, 72 clinics. The great White Paper King, Steven Adair is making those decisions.  Not a good choice in my opinion.  What is his pay based on?   Does he get a “production” bonus too? It may be that these are only events reported that cause a Corrective Action Plan (CAP) to be initiated.  What is a CAP, you ask?  Well, it could be a simple letter of instruction to the treating dentist/staff member,  a DVD for them to watch, or further training that they decide will do.
3. Event that would cause law enforcement to be notified–  I wonder if that means local law enforcement or the Feds?  You know what I mean, a dentist punches a patient in the face or staff forges names and signatures on documents?  Could also be defined as a matter that a reasonable person would consider a probable violation of civil, criminal or administrative law applicable to federal health care programs .  Again I feel that unlocking the doors on these houses of horrors should be criminal since I promise something illegal happens in each one of them everyday.

If CSHM doesn’t correct the billing within 30 days or

Don Meyer–Rubin Meyer Communication

If  you read much or post complaints about Church Street Health Management (CSHM) and their illegal dental clinics, Small Smiles Dental, you are bound to run across the name Don Meyer at some point.

Mr. Meyer is their talking head, spin doctor, public relation person at Rubin Meyer Communicaiton, founded in 2007. The sweet page they have set up especially for CSHM is here.

So who is Don Meyer?  Well according to Source Watch, he helped craft the Pentagon’s Public Affairs strategy on September 11, 2001 after the WTC attacks.  “Meyer devised public affairs tactics to support military actions in Afghanistan and Iraq.” 

In May 2004 he left Donald Rumsfeld side and returned to H&K (Hill & Knowlton as VP.  Meyer worked to promote the United Arab Emirates owned company, Dubia International Capital.  Funny how he now promotes another Arab company, Arcapita who owns the CSHM/Small Smiles Dental Centers.  He also spent 6 years on Capital Hill.

No surprise - Congress blocks midlevel dental providers

 

May 3, 2011

Congress Blocks Midlevel Dental Healthcare Provider Projects

No big surprise is it?  Midlevel care providers were simply out lobbied.

Full Medscape Story:

May 3, 2011 — After making strides in recent years, advocates for midlevel oral health provider programs ran into setbacks this year in both state legislatures and the US Congress.

The law allocating spending for the US government through September 30, 2011, prohibits spending on alternative oral health provider pilot programs, and some bills in state legislatures have stalled or died in committee in recent months.

Much of this legislation has pitted hygienists associations and oral health foundations against the largest organizations of dentists.

At the national level, proponents are pushing to fund the "alternative dental health care providers demonstration projects" authorized by last year's healthcare reform law. President Barack Obama has asked Congress to fund 6 such programs with $800,000 each in 2012.

The midlevel providers in these pilot programs could be community dental health coordinators, advance practice dental hygienists, independent dental hygienists, supervised dental hygienists, primary care physicians, dental therapists, or dental health aides.

They would be evaluated for their ability to "increase access to dental health care services in rural and other underserved communities."

Congress debated funding the pilot programs while working on the continuing resolution that allocated money for the US government through September, but in the end they specifically prohibited such funding.

In a written statement, American Dental Hygienists' Association (ADHA) President Caryn Solie, RDH, said her organization was working with "more than 60 others" to get the funding for 2012 "and beyond."

"ADHA is disappointed with the inclusion of a provision in the Continuing Resolution prohibiting funding for the Alternative Dental Health Care Provider Demonstration Grants this year," she said.

She argued that the programs would allow hygienists to help Americans who currently are not able to get oral healthcare.

The American Dental Association (ADA), in contrast, has lobbied against the pilot programs. "We have a long-standing position against any pilots for any program that involves nondentists doing irreversible procedures," said Matthew J Neary, DDS, a New York City periodontist who chairs the ADA's Council on Governmental Affairs.

He said there are better ways to improve access to oral health, such as preventive health programs and dental residency programs in underserved communities.

The ADA does support one model of new oral healthcare provider: the community dental health coordinator, trained to help people in underserved communities navigate through the healthcare system, Dr. Neary said.

However, that proposal falls short of a new practitioner "midlevel" between a hygienist and a dentist, as advocated by the ADHA and some activist groups.

"The more professionals look into folks' mouths and provide education the better, but the fact is that folks need treatment," said David Jordan, director of the Dental Access Project of Community Catalyst.

With funding from the W.K. Kellogg Foundation, Community Catalyst is organizing coalitions in 5 states to advocate for midlevel providers who can prepare and place fillings and extract teeth, in addition to doing educational and preventive work.

Such providers — dental health aide therapists — are already doing this kind of work in Alaska through a federal program for indigenous people, and dental therapists are also being trained along similar lines in Minnesota as a result of a 2009 law.

Community Catalyst supports new dental therapist legislation in 5 other states, Jordan said. He gave the following overview of state legislation:

• Kansas: A dental therapist bill is under consideration in both the state House of Representatives (HB 2280) and the (Senate SB 192).
• Washington: HB 1310 is stalled in the House of Representatives Healthcare and Wellness Committee and is unlikely to be heard until next session.
• New Mexico: HB 495 bill died in the business committee of the House of Representatives.
• Vermont: HB 398 is in the House of Representatives Human Services Committee, but is unlikely to be heard until next year.
• Ohio: A bill has not yet come to the legislature, but on April 27 a public opinion poll funded by Catalyst showed two thirds of Ohio voters in favor of starting a dental therapist program in that state.

Although the group could not claim any clear victories, "We're happy that there was attention, and the need was brought to light," said Jordan.

Corporate Dentistry–A history

One of the major birth places for corporate dentistry is Texas.  Around 1995, Texas allowed managed care programs or HMO's.  The  insurance companies quickly created and sold these dental programs to employers.  However, there was one big problem.  General dentists would not sign up to be a provider because the fees were too low and the dentist would be forced to do "managed neglect" not "managed care". 

The insurance companies, primarily Aetna, decided that they could establish needed offices by guaranteeing a monthly income to a practice in Aetna's preferred location.  There were a couple of dentists in Texas who took them up on the offer. 

They did stock offerings and corporate dentistry was born in Texas even though it was and is still illegal. This relationship continues today.

Under these corporate practices, the insurance companies lists the dental provider as the corporate entity, not a licensed dentist.  Under your HMO dental plan, if you call for your free or low fee cleaning, you are told there is a one to two year waiting list.  If you complain to the Dental Board, their response is they only control licensed dentists not corporate practices. 

If you go in for an exam, you are suddenly told you need hundreds to thousands of dollars worth of work, much of which is barely covered by insurance. The dental work may not even be needed.  Check the complaints on Monarch Dental as an example.  You would think the Dental Board would have stopped the damage by now.

The insurance companies will try to further enhance their profits by using these offices to keep costs low in this economy.  In this economy employers are dropping their PPO dental insurance for the cheaper HMO policies.  Dental insurance companies can then assign these PPO patients, who use to have freedom to chose their dentist, to these corporate offices.  Dental insurance is always beneficial to the insurance companies..  It is non catastrophic unlike health insurance.  It is rarely cost effective for the insured.

Medicaid in the corporate practice has been a recent addition.  Mainly because state and federal agencies have allowed them to see Medicaid patients when it is against many of the state laws. 

To stop the corporate practice of dentistry, you must stop the dental insurance companies from funding it.  Can you imagine the potential liability of assigning and paying insurance monies to illegal corporate practices? 

They are fully aware of the liability, however, to date no one has challenged them.  The potential liability was mentioned to one national dental director now that the public is waking up and complaining.  He is in the process of having the actuaries calculate what it will take to convert the HMO policies to in-network PPOs.
 
Bottom line is that the economy and media exposure like the Ortho story will cause Medicaid to begin to correct itself.  Medicaid was there before corporate dentistry and will be there after. However, the slow economy will fuel the insurance companies to want to foster more corporate dentistry. 

If litigation is contemplated, then the insurance companies have the most to lose.  There is no argument that they are guilty of paying illegal corporate practices and also have large potential antitrust violations. 
a Concerned Texas Dentist

Dental Treatment Codes- Sections

I. Diagnostic                                 D0100-D0999
II. Preventive                                D1000-D1999
III. Restorative                              D2000-D2999
IV. Endodontics                            D3000-D3999
V. Periodontics                             D4000-D4999
VI. Prosthodontics, removable      D5000-D5899
VII. Maxillofacial Prosthetics          D5900-D5999
VIII. Implant Services                     D6000-D6199
IX. Prosthodontics, fixed                D6200-D6999
X. Oral and Maxillofacial Surgery  D7000-D7999
XI. Orthodontics                            D8000-D8999
XII. Adjunctive General Services   D9000-D9999

Another BS study that will only lead to more dental deaths?!

 

Who Paid for the study?

 

Children can be safely sedated by nonanesthesiologists

April 25, 2011 -- NEW YORK (Reuters Health) - Many specialties perform pediatric procedural sedation with no differences in major complication rates, according to findings published online today in Pediatrics.

Intensivists, emergency medicine physicians, radiologists, and hospitalists, among others, have increasingly been providing pediatric sedation, but whether complications are more or less associated with any particular group of specialists has been unclear.

Dr. James H. Hertzog from Alfred I. DuPont Hospital for Children, Wilmington, Delaware, and colleagues in the Pediatric Sedation Research Consortium investigated that question using data from 38 sites on patients who ranged in age from newborn to 18 years. The research team defined major complications as aspiration, death, cardiac arrest, unplanned hospital admission or level-of-care increase, or emergency anesthesiology consult.

Out of 131,751 cases of sedation given outside of the operating room, there were no deaths, and other major complications were rare (122 total).

Sedation was most often administered by intensivists (58,222), emergency physicians (38,293), anesthesiologists (18,343), and pediatricians (12,113). Children were also sedated by pediatric residents or fellows, radiologists, surgeons, dentists, advanced practice nurses, certified registered nurse anesthetists, or registered nurses.

There was no statistical difference between providers' major complication rates either before or after adjustment for possible confounding variables.

Moreover, there was no significant difference between the types of major complication among providers.

"The rapid growth in the use of sedation services by nonanesthesiologists has been the subject of some concern," the researchers conclude. "Our data reveal that, within our consortium, there was no increased danger associated with pediatric procedural sedation provided by nonanesthesiologists."

"The application of our data to sites outside of our consortium will require rigorous evaluation of the skill level of the providers and the institution's systemic safeguards for the care of a sedated pediatric patient," they caution.

Source: http://bit.ly/ggVsDk

Pediatrics 2011;127:e1154-e1160.

Last Updated: 2011-04-25 14:56:07 -0400 (Reuters Health)

 

 

 

Impact of Provider Specialty on Pediatric Procedural Sedation Complication Rates

Kevin G. Couloures, DO, MPH^a, Michael Beach, MD^b, Joseph P. Cravero, MD^b,c, Kimberly K. Monroe, MD^d, James H. Hertzog, MD^a

^aDepartment of Anesthesiology and Critical Care Medicine, Nemours Children's Clinic-Wilmington, Alfred I. duPont Hospital for Children, Wilmington, Delaware;
Departments of ^bAnesthesiology and
^cPediatrics, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire; and
^dDepartment of Hospital-Based Medicine, Children's Memorial Hospital and Northwestern University, Chicago, Illinois

Objective To determine if pediatric procedural sedation-provider medical specialty affects major complication rates when sedation-providers are part of an organized sedation service.

Methods The 38 self-selected members of the Pediatric Sedation Research Consortium prospectively collected data under institutional review board approval. Demographic data, primary and coexisting illness, procedure, medications used, outcomes, airway interventions, provider specialty, and adverse events were reported on a self-audited, Web-based data collection tool. Major complications were defined as aspiration, death, cardiac arrest, unplanned hospital admission or level-of-care increase, or emergency anesthesia consultation. Event rates per 10 000 sedations, 95% confidence intervals, and odds ratios were calculated using anesthesiologists as the reference group and were then adjusted for age, emergency status, American Society of Anesthesiologists physical status > 2, nil per os for solids, propofol use, and clustering by site.

Results Between July 1, 2004, and December 31, 2008, 131 751 pediatric procedural sedation cases were recorded; there were 122 major complications and no deaths. Major complication rates and 95% confidence intervals per 10 000 sedations were as follows: anesthesiologists, 7.6 (4.6–12.8); emergency medicine, 7.8 (5.5–11.2); intensivist, 9.6 (7.3–12.6); pediatrician, 12.4 (6.9–20.4); and other, 10.2 (5.1–18.3). There was no statistical difference (P > .05) among provider's complication rates before or after adjustment for potential confounding variables.

Conclusions In our sedation services consortium, pediatric procedural sedation performed outside the operating room is unlikely to yield serious adverse outcomes. Within this framework, no differences were evident in either the adjusted or unadjusted rates of major complications among different pediatric specialists.

Key Words: pediatric sedation • pediatric anesthesia • procedural sedation • patient safety

Abbreviations: ASA = American Society of Anesthesiologists • PPS = pediatric procedural sedation • PSRC = Pediatric Sedation Research Consortium • OR = odds ratio • CI = confidence interval • NPO = nil per os

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Accepted Jan 24, 2011.