This is a repost from March 2008
The Wichita Eagle
March 15, 2008
- Original The Wichita Eagle article:
A Wichita dental clinic that serves mostly low-income children is drawing criticism from some parents and other dentists, in part for using procedures that the critics say traumatize its young patients.
They say Small Smiles Dental Clinic of Wichita routinely restrains children during treatment, does not allow parents to accompany their children to treatment and does work that doesn't seem necessary.
In addition, the dentists are concerned that Small Smiles tries to give the impression it is staffed by dentists who are specialists in children's care. And, they say, it is corporate dentistry, a practice not allowed in Kansas.
Small Smiles dentist Reza Akbar, in an e-mailed statement, said, 'We are proud of the high-quality, compassionate care we provide.... Last year, we served more than 11,000 children, and the feedback I have received has been overwhelmingly positive. I am unaware of any concerns raised by parents.'
Akbar is the owner of the clinic, according to a Small Smiles spokesman.
Small Smiles, which opened in 2005, turned down requests for interviews or visits. An out-of-state spokesman for Small Smiles, who asked not to be named, said by e-mail, 'This is a concerted effort by the company to focus on patient care in the midst of recent scrutiny.'
In November, ABC News and an affiliate ran stories about Small Smiles offices in the Washington, D.C., area. The stories told of frightened children, the use of restraints and the prohibition of parents in the treatment area -- the same concerns echoed by parents and dentists in Wichita in interviews with The Eagle.
Many Medicaid clients
Small Smiles' advertising notes that it serves Medicaid and HealthWave children. The Small Smiles spokesman said 98 percent of Small Smiles' Wichita patients have Medicaid or HealthWave, programs that provide medical and dental coverage for low-income children and some others who meet income guidelines.
Many dentists do not accept Medicaid patients or accept only a few because the reimbursement for their care is less than what is paid by private insurance. But Crystal Walker, a pediatric dentist, said four of the five pediatric dental practices in Wichita do accept Medicaid patients. Some general dentists also take those patients, and dental care is offered to Medicaid patients at GraceMed and some other clinics.
In 2007, Small Smiles got more than $4.5 million in Medicaid and HealthWave dental payments from the state, according to the Kansas Health Policy Authority. The clinic declined to say how many dentists it employs.
The clinic uses what amounts to assembly-line dentistry, some say.
'They go in, they do the cleaning, they do the diagnostic, they get everything done that they can in one day,' said pediatric dentist David Brown.
'It was like an assembly line,' said Shelbi Meisch, whose daughter was a Small Smiles patient. 'There was just nothing about the experience that felt like you were getting good care.'
Restraining patients
Though parents said they were not allowed to accompany their children into the treatment area, the Small Smiles spokesman said that's not policy: 'Parents decide in consultation with their dentist whether or not to be present during their child's care,' his e-mail said.
Jeff Davis said he and his wife were asked to sign a consent form giving Small Smiles permission 'to do everything from yell at the child to physically restrain them to tie them down.'
Meisch, as well as Delicia Akbar, whose children also were Small Smiles patients, said uncooperative children -- including theirs -- are immobilized in a 'papoose board.' Akbar isn't related to the Small Smiles dentist.
The Small Smiles spokesman provided a copy of a consent form used at Small Smiles in Rochester, N.Y., and said the one in Wichita is similar.
It asks parents to agree to 'protective stabilization,' described this way: 'The child is wrapped in the device and placed in a reclined dental chair.' Pictures on the form show a child with what looks like a blanket and a shaped back piece.
Medical suppliers describe a 'papoose board' as a rigid board with wide fabric straps that have Velcro fasteners. Separate straps hold limbs inside the wrap, providing a snug-fitting restraint that immobilizes the patient.
The Small Smiles spokesman said, 'Our records indicate that protective restraint was used in fewer than 3 percent of all patient visits in Wichita last year.'
Akbar took her three children to Small Smiles. She read and signed the consent form 'but my understanding of the restraint was not something.. to strap them down.' She said the papoose board was used on her 9-year-old.
'I didn't even think anything negative until the kids came out
Copyright © 2008 The Wichita Eagle, All Rights Reserved.
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Thanks to a heads up from one of my readers, here is an article where Mike DeRose admits they own and operate clinics in Kansas:
Dr. Michael DeRose describes himself as "just a simple little Pueblo kid that wanted to help poor kids."
DeRose, 47, is a third-generation dentist, following in his grandfather's and father's footsteps.
Bruno DeRose graduated from dental school in 1928; Edward DeRose started practicing in 1961. Michael DeRose went to dental school at his father's alma mater, Creighton University in Omaha, Neb., returning to his hometown to practice in 1982.
Michael DeRose said his dad had the heart to treat low-income children, explaining how the family got into the Medicaid business.
"He opened his doors for every patient," he said.
He and his father practiced together and became known to kids around Pueblo as "Spaghetti Eddie and Meatball Mike" because of their Italian heritage, DeRose said. Business grew when they opened a second clinic in Colorado Springs in 1995.
The DeRoses have built something of a dental dynasty, having a financial stake in clinics in eight states: Colorado, New Mexico, Arizona, Indiana, South Carolina, North Carolina, Georgia and Kansas.
"It's really a family-owned business with Dr. (William) Mueller," he said, referring to a Denver dentist who has a financial interest in some clinics.
DeRose said his brother, Dan, provides marketing and management services, and an uncle, Adolph Padula, has a financial interest in some clinics. Neither responded to a request for an interview. Mueller did not respond to a registered letter sent by The Gazette.
The clinics have done well. Michael DeRose bought a home last year in Pueblo West overlooking Lake Pueblo for $3.4 million -- a record price in Pueblo County for what the Assessor's Office terms "a nonagricultural based residence."
The family has a stake in 21 clinics across the nation staffed by about 70 dentists, according to Michael DeRose. Dental offices most recently were opened in Kansas City, Kan., and Florence, S.C., he said.
Plans are under way for expansion.
"We think that there's more places in Georgia that could really use our help," DeRose said. "We've looked at Oklahoma as a consideration. They have a lot of need in the Oklahoma City area, maybe Tulsa."
The clinics are "well-received" because they fill a need, DeRose said.
Small Smiles in Colorado Springs, for example, is in an area where 26 percent of people age 17 and younger live in poverty, according to census statistics.
"There is an epidemic in the United States, and it's hard to believe we can put a man on the moon and yet there are thousands and thousands of poor children that cannot find dental treatment," DeRose said.
It's common at his clinics, he said, to see children with severe decay.
During an interview at the Pueblo clinic, DeRose offered a tour. Treatment rooms are painted with kids in mind: There's a blue- andorange "Broncos" room and another with an "Austin Powers" theme. For younger children, rooms are decked out with "Scooby Doo" and "Blue's Clues."
The dentists go by kid-friendly names, wearing shirts that read "Dr. Mike" and "Dr. Nate."
Edward DeRose is retired from practice but still has a large office at the Pueblo clinic.
Michael DeRose said business has "grown beyond our dreams," but money isn't the motivator.
"Sure, business, if you can make money at it, that's great," he said. "But when it's dual purpose and you can make money yet help people -- that's the best thing you can do."
DeRose said he's had no problems finding dentists for his clinics.
"There's a lot of dentists that have the heart to treat poor children. A lot of doctors really would like to do this but they just feel like they can't make money at it," he said. "We can provide them an opportunity to do something that's their dream. It's the best of both worlds.
"There really is something to be said about sleeping good at night." (I bet he's not sleeping so well at night right now.)
Copyright 2004
Provided by ProQuest Information and Learning Company. All rights Reserved.
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I have already posted on this blog the campaign contributions that Dr. Mohammad Reza Akbar, of Pueblo, CO had made to a Kansas politician in the name of Small Smiles.
Plus if you guys could see an in-house company directory you would see the Small Smiles in Kansas listed as part of the company.
So Kansas, is corporate dentistry like this now legal or are they going to be shut down. It's not like Small Smiles accidentally opened up these clinics. They blatantly broke your laws with intent to defraud your medicaid system.
