Dr. Chris Salierno: Good Dentists Can Make Bad Decisions

Interview with Dr. Chris Salierno

By Michael W. Davis, DDS | January 9, 2013

 

 

Dr. Chris Salierno Introduction

Education
Dr. Salierno received his B.S. from Muhlenberg College and his D.D.S. from SUNY Stony Brook School of Dental Medicine. He completed his formal training at Stony Brook Hospital’s General Practice Residency program where he focused on implant prosthetics. Dr. Salierno practices general dentistry in Melville, New York. 

Leadership
Early in his career Dr. Salierno served as president of the American Student Dental Association. He has continued to lend his leadership skills to serve his colleagues, as well as the public, by serving on a variety of committees that promotes enhanced professional ethics for the dental profession—including advocacy for new dentists.

His published professional papers and educational lectures have elevated quality care in dentistry. He writes and lectures internationally on a variety of subjects including, implants, occlusion, TMJ disorders, and practice management.

Much of his lecture content is available on his blog, The Curious Dentist, which also features candid discussions about everyday dentistry. Dr. Salierno is  co-editor of The Surgical-Restorative Resource, which focuses on the team approach to complex dental care. He is a past Chair of the ADA New Dentist Committee, and is currently the President of the Suffolk County Dental Society.

 

Interview Questions

Dr. Davis: Dr. Salierno, your blog, “The Curious Dentist”—directed at our junior colleagues— is very eye opening. It is troubling to see the minefield recent dental  graduates often must navigate. Senior doctors like myself often have no idea what challenges our next generation of doctors are facing with future employers.

One example, of course, is transferring the tax burden of federal FICA taxes from the employer, to the employee dentist, therefore increasing the employer’s bottoms line. Employers habitually misclassifying “employees”, as “independent contractors”. This, of course, is illegal and in direct contradiction to well established and routinely enforced IRS Guidelines.  

We have seen employers configure employee dentist compensation, using a convoluted structure of percentage of collections or billable services which would require a doctorate degree in economics and quantum mechanics to decipher. In numbers of cases, employee dentists are not getting a fair deal. 

There is also indisputable evidence of the pressure experienced by our junior colleagues to provide high-skill services, such as molar endodontic therapy in a rapid cut-rate manner. None of this serves the best interest of the patient, nor the dental profession.

Dr. Salierno, could you please highlight a few of these problem areas for dentist employees. In fact, I’d love for you to publish a paper specific to these issues, and give a lecture to every senior dental school class, prior to graduation.

Dr. Salierno: I’ve actually participated in an initiative just like you’ve suggested. The ADA’s Success Program brings leaders into dental schools to give presentations on subjects like ethics, practice management, and career choices. Programs are offered for first through fourth year and I’m happy to say that the majority of schools take us up on it. The main message to students is that they are not alone, no matter what challenges may face them in the years to come.

The changing landscape of dental Medicaid: Part 2

By Michael W. Davis, DDS, DrBicuspid.com contributing writer
January 9, 2014 -- In the first of this two-part series, Dr. Davis explained how the present degree of dental Medicaid fraud, waste, and abuse is not sustainable and how it is slowly changing. Read that part here.

In reaction to the public's concern about the excessive abuse of child restraints, a number of Medicaid mills have jumped onto the conscious sedation bandwagon. The best option of treatment is to sedate in a hospital setting with IV sedation, a properly trained anesthesiologist to continually monitor the child's vital signs, with reversal medications at the ready, and the capability of nearly instantaneous airway resuscitation. Since Medicaid often doesn't pay adequately for hospital cases, the children's safety is too-often compromised.

Too often, the dentist has little-to-no advanced life support training. A child going into shock from an adverse drug reaction already has tiny blood vessels in which to attempt to stick an IV line. Their airway is small and often further compromised by enlarged tonsils, with a natural anatomy that already appears anatomically constricted and funnel-like.

I won't say it's not feasible to do this care properly, but a doctor has to deliver conscious sedation (often involving multiple drugs) and monitor all vital signs, while simultaneously roundhousing sedated children with steel crowns and pulpotomies. However, under the present Medicaid program, there are huge financial disincentives to provide this style of care properly. Corners get cut and children get harmed, too often permanently.

So, what is the fallout for the dental profession? Certainly the negative press has added a degree of distrust from the public. Trust is difficult to obtain and easily lost. And once lost, it's even more difficult to regain.

 

Read the rest of Part 2 by clicking here

The changing landscape of dental Medicaid: Part 1

The changing landscape of dental Medicaid: Part 1
By Michael W. Davis, DDS, DrBicuspid.com contributing writer

January 8, 2014 -- Some experts examining the Affordable Care Act (ACA) have estimated a 25% to 33% increase in eligibility. What they may miss is that enrollment eligibility for potential patients does not necessarily equate into actual patients having access to dental care. Eligibility for services is a different element than access to those services. While this makes perfect logic to small or large healthcare business owners or managers, it may be outside the comprehension abilities of Washington bureaucrats.

In 2007, the U.S. Health and Human Services Office of Inspector General (HHS-OIG) issued a troubling report, which stated 31% of reviewed dental Medicaid submissions were improper. Again, please take note of that number -- 31%!

That degree of dental Medicaid fraud, waste, and abuse is not sustainable. The taxpayer cannot and should not fund such a dysfunctional program, no matter how well intentioned. Throwing limited public money at problems of disadvantaged children with dental needs, without adequate oversight, regulation, and enforcement represents an abuse to the American taxpayer. That unfortunate reality is slowly changing

Read the entire story here

Crime Watch

In New Holland, Pennsylvania a woman admitted stealing $3,743 from the dental office of DRr. Robert-Bers Techer, where she was employed. She also altered some bookkeeping records so  family members could received $1,608 in dental treatment.  She has been arraigned and released on $25,000 bail and faces a preliminary hearing on January 16, 2013. Total $5,351.

In Maryland, Spencer Brown, husband of Lisa Valentine, DDS, who worked for the practice billed Medicaid for services that were never provided totally more than $156,000. Maryland’s Attorney General “settled” with Brown for $25,000 in damages and restitution of $156, 918 in restitution and will spend one year in jail. (probably less). 

Let’s see how it turns out for the lady in New Holland, Pennsylvania.

Corporate dentistry’s latest attempt to silence critics and trample on the 1st Amendment–Comfort Dental sues professors.

Dr. Melvin Ball is a part time professor at the University of Colorado School of Dental Medicine. In December 2013 Dr. Ball was speaking with colleagues in teacher’s lounge at the university. During the conversation it’s alleged Dr. Ball voiced his opinion and confusion about Comfort Dental’s business model. Outrageous! (sarcasm).  Comfort Dental is also targeting three other professors, Sally Preston, DMD; Thomas Borris, DDS, and James Woolum, DDS seeking $2.45 million in damages.

[My God, where were these campus speech police back in the 60’s.  Berkley would have to close the campus if professors weren’t allowed to voice their opinions!]

Comfort Dental and it’s founder, president and CEO Rick Kushner, feel “they” were defamed when Dr. Ball spoke of his own experience as a doctor of dentistry saying, “I know you cannot provide consistent, quality dental care when all you care about is your bottom line.”

[I use the word “feel” loosely, since I’m not sure how a corporation actually “feels” anything. ]

Comfort Dental is also claiming they suffered damages because Dr. Ball stated he “can’t understand how he [Kushner] gets away with it.” God help those of us who do not hold an MBA! Comfort Dental also claims they suffered damages when Dr. Ball invoked Godwin’s law; allegedly Dr. Ball referred to Kushner as being “like Hitler”.

[Don’t ya wonder who the snitch is or how many there are?  Must be several since they cover the entire campus apparently.  Oh, wait, was all this detail obtained from surveillance cameras?  Wouldn’t that be interesting.  hmm…   That could open up a while new area of law, criminal, tort and “s”ort…]

The complaint against Dr. Preston states she told her class it was typical of Comfort Dental dentist to do shoddy work after of her students related a story from a Comfort Dental patient who had come to the dental school’s emergency clinic for treatment after two trips to Comfort Dental where the patient was less than satisfied and left in pain.

[ I suspect any dental care provided by Dr. Rick A. Kushner would be highly illegal and unethical since his dental license is expired nearly 2 years ago – February 2012.]

3 year old Finley Boyle has died after careless sedation by dentist and staff in Hawaii dental office.

This is the saddest picture I think I’ve seen in many years and should be the one that comes to mind the next time ANY dentists want to sedate a child.  Sadly these deaths are more common than you may think.  In 2011 there were 8 that were reported, who knows how many were not.

On December 3, 2013 baby Finley was sedated at Island Dentistry for Children. Dr. Lilly Geyer was the dentist in charge, but who actually administered the deadly cocktail 5 different drugs?  According to court documents a “technician” gave Finley the lethal cocktail. Not surprising to those of us who watch this sort of news, questions have arisen as to the whether Finely actually needed the extensive treatment recommended at her November check-up by Dr. Geyer.

Court documents say when Dr. Lilly Geyer discovered Finley had gone into cardiac arrest, the doctor ran down the hall to a pediatrician’s office in the building to get him to come and perform CPR.

The AAPD Guidelines recommends vital signs should be monitored and documented at least every five minutes for patients who are sedated.  However, as was learned in the dental malpractice case in Syracuse, NY the AAPD guidelines are “options”.  Dentists on the stand testified under oath, the AAPD guidelines have little influence in the decisions many dentists make in treatment. (sorry, I tried not to do there)

According to the Boyle’s attorney, Rick Fried, only 3 notations were made as to Finley's vital signs and they went unchecked for 26 minutes after the technician sedated her.

I can only conclude Dr. Geyer and staff as careless idiots.

As promoted by the Raven Marie Blanco Foundation, every dentist office should be prepared to handle a medical emergency and recommends The Six Links of Survival. 

See the RMBF Public Service Announcement

However, dentists are fighting this “tooth and nail”.  State dental boards are doing little to protect the public and everything to make it easier for dentists to increase their income stream by offering sedation.

Below are several links to various stories, don’t miss out on the comments.  As you will see in the comments, the first thing people do is blame the victim or in this case the victim’s parents.  What is usually not stressed in the stories is that the child probably did NOT need such extensive treatment, if at all.

WFAA-TV Dallas with reporter Byron Harris and team win award for “Denticaid: Medicaid Dental Abuse in Texas”

It has been announced that Byron Harris and the investigative team at WFAA have been honored with the Alfred I. duPont Silver Baton Award by the Columbia University School of Journalism. One can only imagine what didn’t make it on air in the “Denticaid” series. 

Kudos to WFAA-TV Dallas for supporting Byron and his team. 

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WFAA-TV, Dallas & Byron Harris
“Denticaid: Medicaid Dental Abuse in Texas”

 

A relentless two-year long investigative series that brought to light rampant pediatric dental Medicaid fraud

In this series of dogged reports, WFAA-TV and reporter Byron Harris uncovered a corrupt system in which hundreds of millions of taxpayer dollars went to dentists who billed the government for questionable orthodontics and other procedures that, in some instances, harmed children.

One Dallas-area dental clinic cruised poor neighborhoods, luring kids with food and cash before performing extensive, unnecessary and often harmful dental work all without parental consent. WFAA’s detailed reporting featured whistleblowers, hidden camera video and the tireless pursuit of one dentist living in a mansion the size of Versailles. Because of this reporting, the Texas Medicaid commissioner and the state’s dental director resigned, and congressional hearings were held.

Byron Harris, reporter; Jason Trahan, producer; Billy Bryant, photographer and video editor; Carolyn Mungo, executive news director; Mike Devlin, president and general manager.

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Don’t miss this enlightening discussion between Byron and his team.

Behind the Story - WFAA from Alfred I. duPont Awards on Vimeo.

Interview with Dr. Jay W. Friedman

 

Interview with Dr. Jay W. Friedman

by: Michael Davis DDS
December 17, 2013

 

Dr. Jay W. Friedman has had a significant impact on the oral health of the public. His commitment to public health has spanned seven decades from the 1950s to the present. He pioneered in the development of quality standards for dental care, group practice, and dental insurance. An accomplished clinician, he has been a consultant to a number of state and national organizations. Notable are Dr. Friedman's remarkable contributions in leading the challenge against the prophylactic extraction of third molars, as well as advocating for adding dental therapists to the oral health work force. 

Dr. Friedman earned his Doctor of Dental Surgery degree from Columbia University in 1948. Subsequently, he practiced general dentistry in Farmingdale, New York from 1948-1954, including two years in the U.S. Air Force Dental Corps. In 1955, Dr. Friedman became the director of an innovative group practice dental cooperative in Seattle, Washington, which served as a prelude to his pursuit of a life in public health. He received his MPH in 1962 at the University of Michigan, followed by an NIH Fellowship. Friedman then moved to Los Angeles, California, becoming actively engaged in research, writing, consulting, and clinical practice. Between 1964 and 1977, he served as a researcher at the UCLA School of Public Health. His 1972 Guide for the Evaluation of Dental Care was distributed widely by the U.S. Public Health Service; it set the standard for monitoring dental practice. In 1974, he co-edited, with Jerge, Marshall and Schoen, Group Practice and the Future of Dental Care. In 2002, he reissued a revised edition of his Consumer Reports Book, “The Intelligent Consumer’s Complete Guide to Dental Health.” In 2012, he received the John W. Knutson Distinguished Service Award in Dental Public Health from the Oral Health Section of the American Public Health Association.

Introduction

Dr. Davis: Dr. Friedman I’m honored to interview you, both because of your work to advance public health dentistry over the years, but very specifically your efforts to reduce the routine removal of asymptomatic third molars (wisdom teeth). Extraction of these asymptomatic teeth most often generated no patient benefits. All the while, patient risks of morbidity and mortality were elevated, especially injury to the jaw nerves causing numbness of the lip and tongue, jaw fractures, post-operative infections, and the potential risks from sedation. A number of young adults faced serious clinical injury, inclusive of untimely death. Dr. Friedman, I’m not overstating, that your work to educate our dental profession actually saved many lives. In the face of your work, you were highly criticized by elements of the oral surgery community, whose potential income was threatened. Regardless, you took the high road, in advancing the dental profession, in service of the public welfare.

Interview Questions

Dr. Davis: Dr. Friedman, in recent years we’ve seen advancement of corporate owned and managed dental clinics. These private equity backed dental clinics have a fiduciary responsibility, to place the interests of shareholders to the fore, and generate profits. By contrast, doctors have both an ethical and legal responsibility, to place the patient’s interests to the fore. The conflict of interest seems obvious. Would you like to elaborate?

Dr. Friedman: It is not only excessive third molar extractions that should concern us. They are just one part of a pattern of what I call FUN (Functionally Unnecessary) treatment, which may be physically and fiscally harmful to the individual and exploitive of public funds. It applies to the whole gamut of dentistry, including unnecessary x-rays, cleanings, fillings, crowns, replacement of missing teeth, and the array of “cosmetic dentistry.” Nonetheless, I believe the majority of dentists are well-intentioned and provide care they believe is in the best interest of their patients. That they―we―are not immune to FUN treatment is due in part to deficiencies in our education and the need to generate money to pay rent, utilities, supplies, salaries, and our own income.

Corporate owned dental clinics and private dental practices share the same objective, which is the generation of profits. In a capitalistic system, corporate shareholders benefit as if their investment produces the profit rather than the workers who perform the service. In a private practice, at least the dentist is part of the workforce. He or she may share some of the “profits” by awarding bonuses to auxiliary staff. In many private practices, the staff is given incentives to generate income and a bonus in the same manner as the corporate practice. So in that respect, I do not see a big difference between the two systems.

The Medicaid gravy train continues

If you read this blog, then you know profits with Medicaid dentistry is made on high volume, gross excessive treatment, all at a single visit. The prime example is Small Smiles and their Production Per Patient (PPP) mantra handed out to their employed dentists. As testimony revealed in a New York malpractice case, "PPP is the Golden Goose", said one Small Smile executive. As was put another way by one of Small Smiles managers, “you eat what you kill”. 

It’s undeniable, years ago, Small Smiles Dental set the gold standard of excessive treatment by restraining children with use of the papoose board. 

As heat from press, parents and few state dental board followed some Medicaid accepting dentists and dental chains decided sedation would be the key even more profits, leaving the least amount of yuk in everyone's mouth—the children, the parents and especially the public.

Weekend "get-a-way" sedation courses were developed, lobbyist hired and representatives of the dental community were sent on press junkets stressing the need for higher reimbursements from insurers and Medicaid; all to accomplish the same thing—Production Per Patient. Now, as ABC news has reported in 2012, we have children being overdosed, brain damaged and dying at an alarming rate.

All the while, government regulators appear to be hiding under their desks. It is understandable that the bulk of the dental profession has given up. It’s been proven over and over there is no money to be made in Medicaid dentistry, if provided ethically. Add government corruption and ineptitude to the mix and it’s like the sadistic relationship between the addict, and their co-dependent enabler; life and death danger to both.

Family says 3 year old Finley Boyles was given too much anesthesia.

 

December 11, 2013

KAILUA, OAHU (HawaiiNewsNow) -

A three-year-old girl is in critical condition following a procedure at a local dentist in Kailua, Oahu.

Three year old Finley Boyle is at Kapiolani Medical Center.  It's unknown if she had any pre-existing medical conditions but we do know a lot of lives have been changed forever.

Photos show three year old Finley Boyle's bright smile.  Family friends say on December 3 she was brought in for a dental procedure at Island Dentistry in the Kailua Professional Center when something went horribly wrong.

The friends say Finley was given too much anesthesia and sedatives.  She then went into cardiac arrest and now has severe brain damage and will never be the same.

Friends say the dentist is Dr. Lilly Geyer.  Her office, called Island Dentistry for Children, has a sign up saying it is currently closed.  Not even the delivery man was let in. There were people in the office but they weren't talking.

"We have no comment," said an unidentified man inside the office.

The Island Dentistry website has also been taken down, but a screen grab from the archived website says the practice opened in 2006 and has 2,000 patients.

The "about us" section of the site also says Dr. Geyer "is certified in Basic Life Support, Advanced Cardiac Life Support, as well as Pediatric Advanced Life Support."  However friends say when Finley began having complications the staff ran to the pediatrician's office down the hall and that doctor came to help with CPR.