Saturday, May 19 2012 10:00 PM
Parents: Dental Board investigators headed to Bakersfield
State dental board officials will come to town in early June to investigate long-simmering allegations that a Bakersfield dentist mistreated children while they were strapped to a papoose, or stabilizing board, several local parents say.
Many of the parents involved also allege excessive, unnecessary or flawed dental treatments from Dr. Edward Dove.
"I struggle with the fact that it's taken a long time, but at least movement is coming quickly now," said parent Chris Cook, who has led a grassroots mobilization effort. "I'm exhausted but that doesn't mean I stop -- he ain't getting away from me."
Dove did not respond to an interview request, though he said last year that he gives excellent care, has never hurt a patient and the parents are "making it up." Dove, who has a clean disciplinary record, also said last year that the papoose board was necessary to keep some of his young patients immobile during treatment.
Since the parents banded together with a Facebook page last summer, the Bakersfield Police Department has conducted "a couple of investigations" into Dove's care, said Sgt. Joe Grubbs. He said police have been unable to substantiate any criminal wrongdoing, and are not actively investigating Dove now.
News of the Dental Board of California visit follows the decision by a high-profile Colorado attorney not to take the local parents' case.
Jim Moriarty, who is currently representing a young patient in a case of alleged pediatric dental abuse that's received national lawmaker attention, said the Bakersfield case involved too few local parents, a weak expert on his side, and too much "he said/she said." He also said being an out-of-state attorney was challenging.
Despite that setback, which parent Cook called "extremely shocking," the parents' case is still building momentum. Along with the coming dental board visit, they've collected about 1,000 signatures for an online petition to revoke Dove's license. Several weeks ago, Cook's son was featured with other Bakersfield children in an Inside Edition television segment, which investigated dental papoose boards.
To papoose or not?
Papoose boards, many of which have Velcro straps, are used to hold young patients in a stable position while procedures can be safely done.
Many of the parents' complaints against Dove stem from the slaps and scratches that reportedly happened while their children were restrained on the board, under partial sedation. Parents weren't allowed in the room during the process, something Dove has said is important since they can interrupt and distract from care.
The American Dental Association responded to that Inside Edition show with a press release detailing guidelines on when such stabilization should be used.
The American Academy of Pediatric Dentistry says papoose boards might be used when young patients require immediate diagnosis but can't cooperate due to "a lack of maturity or mental or physical disability;" when the safety of the patient, dental staff or parents would be at risk; or when movement of sedated patients needs to be reduced.
In general, papoose boards aren't considered part of routine dental care, said Dr. Paul Casamassimo, a pediatric expert at the Nationwide Children's Hospital in Ohio and a past president of the American Academy of Pediatric Dentistry. For a typical, healthy child, it would not be the first course of action.
[Dr. Casamassimo has failed to mention since 2008 he has been on the the board of advisors to one of those Private Equity dental chains-Small Smiles. I would like to ask Dr. Paul Casamassimo why he’s done nothing to stop the use of the papooose board, mainly used to expedite treatment, in the Small Smiles Dental Centers. In fact Dr. Casamassimo and Dr. Steven Adair, Small Smiles new Director of Clinical Quality Initiatives and Education and asshole buddies as they say, putting on a CE course together in Adair’s home town of Hilton Head, North Carolina.]
"Most people undergoing procedures in a dental office can stand still," he said. "It would be a hysterical child, or one who is too young to understand what is going on who would need the papoose."
At Ohio State University, a resident in one of Casamassimo's programs is working on a thesis project looking at parental attitudes toward papoose boards as well as other techniques like oral sedation, anesthesia and distraction/positive reinforcement.
Thirty years ago, parents would have said they'd rather have their children held down and the job done, Casamassimo said. Now, though, he has seen a 180-degree shift, as parents prefer putting children to sleep for extensive care.
[Is it the parents, Dr. Casamassimo or is it your pocketbook that prefers sedation. I call BS on that 30 years ago crap, 30 years ago no one had ever heard of such a thing. Were you papoosed Dr. C?]
In a previous interview, Dove pointed out that using general anesthesia is much costlier than using the papoose board, which can be a factor for parents struggling financially.
Another shift in dental practices is the increasing movement toward having parents present during care, Casamassimo said. He said the group of dentists who preferred that parents stay out of the room is largely retiring and a new generation wants the family more involved.
[Increased shift toward parents being present?? Would that be because of this blog and the lashing you’ve taken for the past four years. If not for the force of the Federal Government, Small Smiles would still be keeping parents in the waiting rooms.
[I want to know when the shirt was away from having parents present? Actually, that was something Dr. Casamassimo and some of his colleagues hatched to not let parents know what they were doing to the children back in those rooms. Dr. C is as much a part of this problem as anyone. He’s held various offices at the AAPD for decades!]
Regardless of whether parents are in a room, they should actively understand the extent of the procedures, the pros and cons, and be comfortable with it, he said.
That's not what Bakersfield parent Kristy Andreas says she experienced when she took her then-3-year-old son, Evan, to see Dove. If she had understood Evan would be papoosed, she would have insisted on staying with him, or at least behind the door, she said.
Evan says he was scolded and hit during his dental procedures, Andreas said. In addition, Andreas found Dove's care faulty. She ended up getting not just a second but a third opinion to prove it, all of which she said she has documented in her dental board complaint.
Attorney setback
Late last year, Colorado attorney Moriarty told The Californian he was poised to represent Bakersfield parents and was planning a visit here to ink the deal. Earlier this year, he said he was having an expert review some of the children's dental records. But last week, he said he had decided not to take the case.
Moriarty's other dental clients have been in the headlines recently for a case against a dental management company. Such management companies, which are often backed by private-equity money, are the subject of a U.S. Senate inquiry.
Moriarty said some private-equity backed dental businesses routinely bilk Medicaid patients, mistreating them in the process. Even though Medicaid reimbursements tend to be very low, the idea is that the businesses can make money if they practice "assembly line medicine."
"They routinely papoose and grossly sedate children, routinely refusing to allow parents to be present," he said. "They do that to keep parents from knowing what they're doing."
Moriarty said he was drawn to the Bakersfield case because of the parents' mobilization efforts. Ultimately, though, there was too much "he said/she said" and it would have required working with another California-licensed attorney since he was out of state, he said. Besides, he specializes in going up against private equity-funded dental businesses. Dove owns his own business.
Moriarty was clear that he still supports the California parents' mission.
"What Chris Cook and the other families did -- banding together, raising hell and bringing attention to the authorities --brings to light" conduct which otherwise would not be brought to life, he said.
That's exactly what local parents hope to accomplish June 9, when they say dental board investigators will interview their children at the Bakersfield Police Department.
If a dental board investigation finds a preponderance of evidence some violation has occurred, the next step is for the case to go before an administrative law judge, said Russ Heimerich, a spokesman for the dental board. He would not comment on any specific details of the Dove case.
But that could take some time. From January to March of this year alone, the dental board received 969 complaints. From the intake of a complaint to disciplinary action -- if it is deemed necessary -- takes about 1,100 days on average.
"I know some people want it wrapped up in an hour, like CSI," Heimerich said. "But these aren't investigations that happen overnight."
Staff writer Jason Kotowski contributed to this report.
