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

---

Accepted Jan 24, 2011.

Aspen Dental Fix it: Toothache Becomes Headache

Published in The Daily Journal print book April 16, 2011

Nicole Leonhardt
nleonhardt@daily-journal.com

Michael Christ, of farming Grant Park, had a toothache so he went to the dentist to put together the problem, but assumingly the caring he received landed him in the crisis room — twice, his doctor told him.

On Mar 18, Christ’s 21st birthday, he went to the appointment his father, Ron Christ, done for him at Aspen Dental, 1501 N. Illinois Route 50, Bourbonnais.

The dentist took X-rays, wrote him a medication for amoxicillin and told him to make an appointment for possibly an descent or base waterway when the infection settled. The subsequent to week the infection had gotten worse so Michael called for other appointment.

This time Christ was then seen by a not similar dentist, a woman. She suggested him to go to the crisis room, since she mentioned Michael had been prescribed the incorrect antibiotic.

Christ went to Provena St. Mary’s Hospital, where they administered a not similar antibiotic, clindamycin.

“She mentioned he should have been on clindamycin when he was seen the initial time. She mentioned it was it was improper to be on amoxicillin,” mentioned Christ’s father.

After Christ was administered the scold antibiotic he proposed to feel better, but struggled to secure an appointment to have the tooth fixed. The infection came back and this time his eye proposed to swell. On April 9, Christ’s parent called Aspen Dental for an crisis appointment for his son. He was told there was no permanent dentist at the trickery and nothing could be done that day.

But that dusk Christ’s parent received a call from Dr. Shamohammadi, a proxy dentist hired April 5 by Aspen. Shamohammadi suggested the parent to ensure Christ went back to the crisis room. The dentist betrothed to see the group initial thing this past Monday.

Christ received a stronger sip of verbal clindamycin and an injection during his second crisis room revisit and the lump subsided.

This past Monday, Shamohammadi saw Christ and endorsed two other area dentists for a base canal. Because Shamohammadi’s location at Aspen was temporary, he would be leaving the trickery on Friday and longed for Michael to be seen by a veteran who could follow by with his care.

Christ’s parent asked the front table receptionist for a return for his son’s two appointments — the first, that cost $19 and the second, that was $50.

Instead of a return being issued, the military were called. Shamohammadi told military the parent had done nothing incorrect and the situation was dropped. Later that day Shamohammadi left the trickery for good, 4 days before his appointment at Aspen was ostensible to end.

Christ’s father, Ron, contacted Fix It! that evening.

He longed for his allowance back since his son had not received proper care. He suggested Fix It! to verbalize with Shamohammadi. Shamohammadi told Fix It! he was essay a e-mail to the Illinois Department of Financial and Professional Regulation, Aspen Dental Management, Inc., the Better Business Bureau, and the Illinois Department of Human Rights to inform multi-part instances of bad high quality caring he’d witnessed during his partial time at Aspen, inclusive the Christs’ situation. He sent Fix It! a duplicate of the complaint.

“The military subdepartment forthcoming to a dental use due to your pacifist activities is about as far as we can take it,” Shamohammadi mentioned in the letter.

Present at the rumpus that resulted in military involvement, Shamohammadi told Fix It! Ron Christ had not acted inappropriately — he acted similar to a parent whose son received bad caring that could have lead to serious complications such as blindness.

“In my veteran viewpoint a stronger antibiotic indispensable to be used and a follow-up fast was vital to ensure safety,” mentioned Shamohammadi. Because of that he endorsed a return is to Christs.

Referring to the complaints about Aspen minute in his letter, Shamohammadi mentioned he believed many patients deserved refunds since similar to Christ they received reduction than preferred caring after being seen by multi-part proxy doctors.

Shamohammadi mentioned in his e-mail it was clear at least 8 or 9 doctors had been “providing not similar diagnoses” and modifying and varying treatment plans. He told Fix It! he could not pick out the dentists who saw Christ by his map out since there were “so many scribbled signatures.” The bills the Christs received did not add doctor names.

When Fix It! spoke Wednesday with Kasey Pickett, executive of communications at Aspen Dental Management, Inc., she mentioned both doctors whose licenses are related with Aspen’s Bourbonnais location — Isam F. Hamati and Nadia Z. Chowhan Iqbal — did not work at the location.

“They are seeking for a new full-time dentist,” mentioned Pickett.

To keep Aspen open after Shamohammadi’s leaving a one-time proxy dentist was called back to the location, mentioned Pickett.

Pickett mentioned an scrutiny had been non-stop at the Bourbonnais Aspen location to look in to the problems Shamohammadi spoke of in his letter.

She moreover had great headlines is to Christs.

“We are refunding allowance related with caring at Aspen together with casing the ER bills,” mentioned Pickett. “The studious didn’t have a great experience and that’s what the use is striving for.”

Ron Christ mentioned he received a examine Thursday for $300 to cover Michael’s visits and mislaid wages. It had been sent overnight mail. He mentioned he will send Aspen the crisis room bills when he receives them. He estimated the complete at around $1,200. The Christs mentioned they feel Aspen done its most appropriate bid to pill the situation, but Shamohammadi is not satisfied.

He mentioned he has right away sent the e-mail that includes other complaint from his time at Aspen — a managerial staff that pushes dentists to see too many patients in a day to be able to enlarge profits — to dental regulatory bodies in every state that has Aspen locations since he believes the same problems are widespread.

“I am abashed for my colleagues of the contention that act for your organization. we am moreover abashed of what you have done to my profession. You have managed to take this prestigious industrial specialization and have incited it in to a reason for profiteering,” mentioned Shamohammadi in his letter.

Pickett mentioned whilst the firm will look in to the allegations done about the Bourbonnais location “the things that are summarized are of course not indicative” of how other Aspen offices operate.

Who Wrote This? Superman Cape Technique

 

Anyone want to take credit for writing this?

Comments are open, let’s hear it.

 

PROTECTIVE STABILIZATION

Protective stabilization, broadly defined, is the restriction of a patient’s freedom of movement to decrease the likelihood of injury to the patient or the dental personnel while allowing safe completion of the dental procedure.

Protective stabilization may involve another human (dentist, dental team member, or parent), a stabilization device (protective wrap, mouth prop, towel), or a combination. Use of a mouth prop as an aid for a cooperative

patient is not considered to be stabilization.

In your discussions with parents regarding protective stabilization, remind them that active stabilization - stabilization by the dentist and/or dental assistant – is described in the list of behavior management methods that they approved when they signed the health history form. Review this type of stabilization with the parent again, if necessary.

Dental staff who stabilize children should use their hands to limit the patient’s movement. Lying next to the child or partially on the child is not acceptable. The dental team should use the least restrictive stabilization that is safe and effective.

One example of a less restrictive form of stabilization is the use of a pillowcase to restrain hand and arm movements in a patient who is otherwise compliant.

The pillowcase is held open behind the patient; the child inserts his arms into the pillowcase, the pillowcase is pulled up to the child’s armpits, and he is then assisted into the dental chair. Once the patient is supine and lying on the pillowcase, his arms are stabilized.

Colorful children’s pillowcases are available, and can be described as a “Superman cape” or other child appropriate analogy.

Dr. Paul Casamassimo Happy Medicaid Dental Coffers Still Open For Business - Small Smiles

Well of course he's a happy man.  He's on the advisory board of Small Smiles & Church Street Health Management.  The Governor kept the coffer open for him and his buddies today! 

There are 7 Small Smiles locations in Ohio~

Maybe Dr. Casamassimo didn't have this run across his desk.

Burns Ohio Complaint

Dr. Paul Casamassimo has been with Church Street Health Management since 2007 when it was FORBA Holdings, LLC, along with Dr. Arthur Nowak, and Dr. Joe Bernat. Other than adding Dr. Anupama Rao Tate. Dr. Tate was the only addition to the board after the $24 million fraud settlement and Corporate Integrity Agreement was implemented.

With the budget crunch in so many states, to get Governor Kasich, whom I really like, to NOT cut some of the wasted funding to adult and children Medicaid dental programs is astounding. However, like us all, he is a layperson when it comes to "dental" needs, and can't tell fact from fiction. No fault of his own. It's the perfect example of letting the "professional" take the reins.

Now, if Ohio, like all states, would cut the reimbursement fee just for stainless steel crowns by 30% it might, just might, get the Medicaid fraud from these dental mills back under control.

No, I do NOT apologize to Dr. Paul Casamassimo, he was the fool who put out this video, he's the fool who hooked up with Dr. Adair and Small Smiles all by himself.  In this video statement what was he trying to suck or kiss?

Related:

Small Smiles Quality Initiatives are Rubbish

Allison Luke - No longer Chief Compliance Officer at Church Street Health Management

Lorri Steiner has been with Church Street Health Management for a very long time.  I would say at least 4 years, maybe a little longer.

Up until last Friday, April 8, 2011, she has been SVP of Financial Operations.  Currently she is carrying the title of Chief Compliance Officer!

Well, at least she is going into this eyes wide open!  She's been around long enough in the financial operations to know how much they need to make each day and how to get it done.  Now, does she know how to cover it up so that it goes unnoticed?  Time will tell.

Anyone notice Lorri was put into this position just about the same time they were able to land an in house attorney, Erika Ruiz.  I'm sure Lorri and Erika can get the job done.

(By the way, there is NO Erika Ruiz listed at the Tennessee Bar Association.  There is only one Ruiz and it's not Erika when you search the Board of Professional Responsibility here )

What happened to Allison Luke, you ask?  

Allison Luke was hired in November 2008, according to Church Street Health Management's own press release, dated 11-5-2008.

Lately her job has been more of that of "fireman" putting out fires created by Small Smiles dentists, staff and corporate heads who are determined to continue on with their bad ways.  After just over a year into the Corporate Integrity Agreement you would think things would be getting a bit better, well, not so much.

Did she figure out it was a lost cause trying to maintain any kind of "Compliance" with Small Smiles Dental Centers?  

Did she get tired of stretching the truth?  Was she tired of rounding 4.2 percent to 5 when it benefited the companies appearance.  Did she tire of rounding a 3.9 to 3.0 when told to do so?

Well, maybe she will do the right thing now and spill her guts to the OIG.  Keeping crimes a secret kind of makes you guilty doesn't it?  Especially when it's you that writes that quarterly report and you sign it, Allison Luke, SVP of Compliance.

Keeping big secrets and covering up fraud will sure weigh heavy on your mind.

Lorri, do you really know what you are in for here?  Me thinks you are in way over your head and guess whose head will role when the rubber meets the road.  Yours.

Related:

Quality Initiatives Are Rubbish

Moriarty-Leyendecker: Spotlight on Small Smiles

 

Spotlight on: Small Smiles

In 1967, Small Smiles was one of the first clinics in the nation to extend dental services to Medicaid patients - a generous and welcome gesture, since Medicaid paid far less than insurance or out-of-pocket payments for dental procedures.

By 2010, Small Smiles was churning through patients at the impossible rate of one every ten minutes. The company's dentists strapped children as young as two into a straitjacket-like device to perform dental procedures. Parents are no longer permitted in the waiting rooms and cannot watch their children as they go through multiple fillings or even intense dental surgery.

Worst of all, the procedures being performed are frequently not medically necessary.

How did this happen? How did such unethical methods spring out of a community-serving dental practice generously willing to take Medicaid patients at a time when few dentists were? Where did it all go wrong?

The answer lies in the owner. Who, it turns out, is remarkably difficult to locate.

Read the full article here
Recently filed lawsuits against Small Smiles Dental brings media attention

Read all the other Small Smiles Articles at Moriarty.com

 

Related:

Should dentists use restraints on kids?
Syracuse area families sue Small Smiles dental clinic for mistreatment of children

New York Dental Malpractice Lawyers Sue Syracuse Small Smiles Dental Clinic–From Central New York Injury Lawyer Blog

 

New York Dental Malpractice Lawyers Sue Syracuse Dental Clinic - Central New York Injury Lawyer Blog

Michael Bersani wrote a passionate post on his blog.   He referred to this as “Dental Battery” not “Dental Malpractice”.    I agree.  Yes, “Battery” is included.

Here is a snippet:

By Michael Bersani on April 8, 2011 9:45 PM | Permalink

New York dental malpractice lawyers agree on one thing: You have to turn down most calls about dental malpractice. Most alleged dental malpractice cases are going nowhere. We get calls from people all the time. They got a bad result from their dentistry work, and they want to sue. But usually the bad result was a "known risk" of the procedure. When it's a known risk, usually there's no case. Sometimes there really was dental negligence, but then the injury is too small to really warrant a dental malpractice lawsuit. Getting a case with provable negligence, plus a significant injury, well, that doesn't happen every day.

Read the full blog post here.

Michael Lindley still referred to being employed with Keys Group in 2007 and 2008 & US v Keystone Education and Youth Services

US v Keystone et al accused the M. Lindley and Al Smith group of characters of restraining children, and more Medicaid Fraud.  Appears to be a lifestyle for these folks.
US v Keystone Education and Youth Services; Keystone Marion, LLC; Universal Health Services,
Currently a Subsidiary of Universal Health Services (UHS), UHS was not named as a defendant in all the allegations of the suit, because; “UHS indirectly acquired the other two defendants in or around October 2005; accordingly, UHS is not included in “Defendant” for allegations to the extent that they are related to the events occurring prior to that time.” (page 3, paragraph 10)
UHS acquired the group of Keys companies in October 2005, from Michael Lindley (“Lindley”), Marty Weber, Ameris Healthcare Investments, LLC, Rainer Twiford, Al Smith (“Smith”), Mike White, Rodney Cawood (“Cawood”), Buddy Turner, Jeff Cross, Gail Debiec, Brad Gardner, Brad Williams, Don Wert, Rob Minor, Mike McCulla, Jim Shaheen, Rod Gaeta.  See purchase agreement here.
If the jokers actually “sold” the company,  I can’t imagine why Michael Lindley would contribute to Alexander for Sentate in 2008, twice saying his occupation was Keys Group Holdings.  One contribution was April 19, 2007 for $2300 and again February 27, 2008 for another $2300.  My guess it was really “recapitalization of income” instead of a sale.
Just as in the Small Smiles Dental Centers scam, Keystone’s facilities.. “With only a few exceptions, Defendant restricted admission to the Youth Center to patients who would qualify for reimbursement of the medical costs under the Medicaid program”  (page 3, paragraph 13)
Related:
Federal, state prosecutors join suit against Keystone Marion Youth Center- March 5, 2010

Justice Department asked to investigate Chad Youth Enhancement Center – January 29, 2008

Nashville Scene “Handle With Care” expose’ by Elizabeth Ulrich- November 8, 2007 (the same week the story of the Small Smiles Dental Centers operated by Michael Lindley, Al Smith and others was announced.  That must have been a bad week for them.

Bad Medicine –December 13, 2007- A Nashville youth facility is a nightmare for kids, staffers say, but the state’s licensing body sees no cause for concern, by Elizabeth Ulrich.

Excerpt: ”Checo Perryman, a former counselor at the facility who now runs his own business that teaches an alternative method to Handle With Care, says it was so common for Hermitage boys to smack their chins on the floor during restraints that the facility’s staff named the bloody scabs on the boys’ busted chins. They called it the “Hermitage Hall tattoo.
“What happened behind those walls was very scary and very sad,” he says. But not all restraints end in injury. For some residents, restraint leads to a drug-induced haze that eventually lulls them to sleep—or, as some in the mental health world refer to it, chemical restraint, quite simply because the drugs can be used to restrict residents deemed out of control.
Among incident reports in the DMHDD files, there is tale after tale of restraints that end in some sort of injection. Some of the medications are listed by name—Abilify or Zyprexa, drugs that are used to treat schizophrenia and severe mood disorders. In most of the records, staffers refer to injections with a simple, generic term: PRN, short for a Latin phrase meaning to give drugs as needed.
Davis says that, for Hermitage Hall residents, those unidentified PRN shots usually mean a syringe full of Thorazine—one of the most powerful antipsychotic drugs, which critics liken to a chemical straitjacket.
Even though Hermitage Hall doesn’t always include the name of the drugs administered under the PRN umbrella, Robinson-Coffee says the injections aren’t cause for concern. She says her department could check any of the estimated 100 patient records at Hermitage where “all that stuff is documented.”

Guess who operates Hermitage Hall.

From WSRY Channel 9 : State scrutinizing Small Smiles dental clinic as families sue

 

WSRY Channel 9 in Syracuse is doing a fantastic job exposing the horrors of Small Smiles.  They are digging deep, interviewing patients, talking to New York state officials and trying to get some answers on why,  in 2010, children are still being abused, strapped in straight jackets for unnecessary dental procedures.  Some as young as 1 year old!

They are asking some hard questions and so are those making comments. 

You must head on over to their site and read the story.  Most interesting are the comments, as usual.  People come out, tell their stories and express their utter disgust with Small Smiles Dental Centers. 

The video is amazing!  See and hear the stories of these poor children and what the state has to say about it!  WSYR, you rock!

State scrutinizing Small Smiles dental clinic as families sue

While at WSRY Channel 9, be sure to click r”ecommend” to your facebook friends.  Spreading the word about these thugs is what is needed to finally “shut ‘em down”. 

I challenge everyone to share it on facebook, twitter, digg, where ever…  Let’s take it viral!

Now go on over to WSYR News Channel 9!

Pleading filed in lawsuits against Small Smiles Dentistry in New York reveal corporate greed of unimaginable proportions.

 

Out of the 234 paragraphs in the 51 page Syracuse in Complaint against the FORBA/CSHM/Syracuse Small Smiles Dental Center I think paragraph 234 is one of my top favorites  It just might be my all time favorite paragraph ever!  It reads like this:

As to all causes of action, defendants’ conduct described
above was gross, wanton, reckless, outrageous and malicious, was
actuated by evil and reprehensible motives sufficient to transcend the
bounds of societal norms and involved a high degree of moral culpability such that punitive damages should be awarded by the jury.

There are Seven Actions (Counts) against FORBA and all the named defendants  I started to insert the word “alleged” but I know these slithering slim balls too well to give any illusion they might not be liable and guilty as charged.  The Seven Deadly sins for these folks are:

1. Fraud
2. Battery
3. Breach of Fiduciary Duty
4. Breach of General Business Law sections 349-350
5. Malpractice
6. Negligence
7. Informed Consent

Syracuse Complaint

Schnectady Albany Complaint

No doubt the folks at King and Spalding are busy little bees this week, but it’s not like they have known it was coming.  Heck they’ve known for months, just wasn’t sure what kind of story would be told.

What about the new “staff attorney” snookered into joining Church Street Health Management this week, Erika Ruiz.  Geez, what a week to join a new company.  Wonder how far she is willing to take it to the mat for these thugs.

Alfred Green, Michael Lindley,  Rodney Cawood, Brad Gardner, Todd Cruse, you know they have to be loving another round of legal battles, OK, well not them exactly but I bet their attorney are loving it!  Woo Hooo…  Bonuses for everyone this year at the many many many firms they have on the payroll. 

Wonder how the Bahrainian banker is doing?  Not that I give a crap.  I know one thing, I hope the rebels (whoever the heck they are), in Bahrain see what this asshole allows and encourages to be done to children.  At the “beheading” I want a front row seat.

Let’s send all these barbarian dentists and corporate “fat cats” over to Bahrain and let them try this kind of torture on the children in Bahrain!  Hell, we are paying for it anyway.

You know, I’m really beginning to dislike the letter combo “ba” Bahrain, Barbarian, Barack.

20 families file lawsuits in NY on behalf of children abused at Small Smiles Dental Centers–More to come?

“Are you ready to ruuumble?” “Let the games begin”  “Shit hits the fan” - are just a few phrases that come to mind today.
Twenty lawsuits were filed this week in NY State Supreme Court on behalf of children abused at  the direction of Small Smiles Dental Center owners and carried out by the hands of Small Smiles dentists and other support employees.




April 5 2011
CBS Albany New York- Former Small Smiles patients file lawsuit

Times Union – Dental chain hurt kids for profit
Syracuse – area families sue Small Smiles for mistreatment of children
Syracuse families sue dental clinic

Defendants in the Syracuse Case are:

FORBA Holdings, LLC n/k/a Church Street Health
Management, LLC;
FORBA N.Y., LLC;
FORBA, LLC n/k/a LIC SAC, LLC;
FORBA NY, LLC n/k/a LIC SAC NY, LLC;
DD Marketing, Inc.;
DeRose Management, LLC;
Small Smiles Dentistry of Syracuse, LLC;
Daniel E. DeRose;
Michael A. DeRose, D.D.S.;
Edward J. DeRose, D.D.S.;
Adolph R. Padula, D.D.S.;
William A. Mueller, D.D.S.;
Michael W. Roumph;
Naveed Aman, D.D.S.;
Koury Bonds, D.D.S.;
Tarek Elsafty, D.D.S.;
Dimitri Filostrat, D.D.S.;
Yaqoob Khan, D.D.S.;
Delia Morales, D.D.S.;
Janine Randazzo, D.D.S.;
Loc Vin Vuu, D.D.S.; and
Grace Yaghmai, D.D.S,

Defendants in the Schnectady Case are:
FORBA Holdings, LLC n/k/a Church Street Health
Management, LLC;
FORBA N.Y., LLC;
FORBA, LLC
n/k/a LIC SAC, LLC;
FORBA NY, LLC n/k/a
LIC SAC NY, LLC;
DD Marketing, Inc.;
DeRose Management, LLC;
Small Smiles Dentistry of Albany, LLC;
Albany Access Dentistry, PLLC;
Daniel E. DeRose;
Michael A. DeRose, D.D.S.;
Edward J. DeRose, D.D.S.;
Adolph R. Padula, D.D.S.;
William A.Mueller, D.D.S.;
Michael W. Roumph;
Maziar Izadi, D.D.S.;
Laura Kroner, D.D.S.;
Judith Mori, D.D.S.;
Lissette Bernal, D.D.S.;
Edmise Forestal, D.D.S.;
Evan Goldstein, D.D.S.;
Keerthi Golla, D.D.S.;
Nassef Lancen, D.D.S.;
Wadia Hanna, D.D.S.; and
Bernice Little-Mundle, D.D.S.,

______________________

Welcome to your new job, Dr. Marlene Navado, welcome.  Dr. Kevin Reilly handed the pot of crap square in your lap didn’t he?  Baaad, Dr. K.  You should have been smarter than a fifth grader.
Good Morning Todd Cruse and everyone else at Church Street Health Management, hope you each slept well last night. 
I can’t help but hearing Karen Carpenter in my head…  “We’ve Only Just Begun…woo ooo…”  (May she rest in peace)

_____________________

Small Smiles Spin Doctors put this propaganda trying to recruit more dentists to join in the abuse and fraud and whitewash the atrocities that have been taking place for years:
http://www.rubinmeyer.com/smallsmiles.html
 

SMALL SMILES
Tooth decay has been called a "silent epidemic" among children from low-income families. So where can these families turn for dental care?
In many communities, they turn to Small Smiles, a nationwide network of caregivers serving low-income kids.
Through highly targeted PR and marketing campaigns, we helped Small Smiles turn local dentists into powerful advocates for children's health and educated families about where they can receive care in their own neighborhoods.
The result: Thanks to Small Smiles, a million children every year get a chance to have a healthy smile, and more parents every day know where to turn for their kids' care.

Ohio taxpayers being asked to pay the bill to abuse children, defraud their Medicaid system and pay for the abusers education - Man what a deal for Ohio

Church Street Health Management, seeking to offer dentists who would come to work for the Small Smiles clinics in Ohio, a hop on the state funded "Ohio Dentist Loan Repayment Program".   

According to Mona Taylor, at the Ohio Department of Health, Small Smiles dental centers would have to have a letter from their corporate owners, Church Street Health Management attached to the application stating they will treat patients regardless of ability to pay for emergency treatment.

Get that letter from the Corporate office and voila' dentists working for Small Smiles will get a special discount of their loan repayment. 

Here's a link to more information.

It's a "safety net" program.  Wonder what "safety net" program they have for the tiny victims.

Let's see the Ohio taxpayer picks up the tab for the unnecessary and abusive treatment resulting in trauma and fraud on these tiny patient.  Then the Ohio taxpayer also gets to pick up the tab in repaying the education loans to the abusers.  

[Ohio, aren’t you guys broke?  Just saying….   Might be something to look into here]

What dentist could pass this great opportunity up?  

Well, one that want's to continue his or her chosen profession without the likelihood of litigation would be one, I suppose.

One that has a lick of common sense would be another.

And thirdly one that ever plans on getting their own malpractice insurance in the future.  One dentist I spoke with who left employment last fall, said they were finding it extremely hard to get their own malpractice insurance and what they did find the premiums were outrageous and deductible was $100K.

In other news, I'm told that Small Smiles is rolling out a "teeth-whitening" program  in hopes of improving their increasingly shrinking bottom line. [probably to pay their increasingly higher malpractice insurance]
 
It's just a guess here, but I'm assuming that will be offered to their adult patients in the "Big Smiles" program, seeing that I don't think "teeth-whiting" products will help stainless steal crowns.

Also recruiting has begun for another clinic in Hartford Connecticut.

General Anesthesia and Young Children; Report says little is knows and evidence suggest major developemental problems

Anesthetic agents are commonly used for a variety of medical procedures in infants and children, but little is known about their effects on the developing brain. A growing body of data from studies in animals suggests that under certain circumstances, such as prolonged anesthesia, these drugs could adversely affect neurologic, cognitive, and social development of neonates and young children. We believe that these findings should be of concern to the scientific and medical communities.

Over the past decade, studies in rodents have found that exposure to anesthetic agents during sensitive periods of brain development (i.e., the brain growth spurt) results in widespread neuronal apoptosis and functional deficits later in development. So far, agents that either antagonize N-methyl-D-aspartate (NMDA) receptors or potentiate the neurotransmission of γ-aminobutyric acid (GABAergic agents) have been implicated, and no safe doses of these agents or safe durations of administration have been defined.

Read the entire report at the New England Journal of Medicine Website here.

What scared the living you know what out of me, is knowing the increase in GA for dental procedures, that may or may NOT be necessary, and there is little to no information on the effect on a child's developing brain. 

Children are dropping dead left and right from sedation dentistry and now to find out no one knows what the actual effect of GA is on the child's grain, but evidence is growing that GA is NOT a good idea! 




Related:
Article at Dr. Bicuspid  Is General Anesthesia Safe for Young Brains

Marissa Kingery Death at Dr. Mazorow’s Dental Office Rule Accidental–I say, Reckless Homicide

Here is Marissa’s deadly poisonous cocktail -

Propofol — the anesthetic that was listed as a “contributing factor” in pop star Michael Jackson’s death
Ketamine
Remifentanil 
Versed

The dosage of each of these drugs have not been released.  Why?

Teen’s death while sedated for dental work ruled accidental

Filed by Cindy Leise April 8th, 2011


ELYRIA — A coroner’s verdict states that 13-year-old dental surgery patient Marissa Kingery died of lack of oxygen to the brain after she was sedated with four drugs.

Marissa “apparently became ill and collapsed” at 8:39 a.m. Dec. 21 following intravenous sedation in the offices of oral surgeon Dr. Henry Mazorow on West 21st Street in Lorain, according to the report from the Cuyahoga County Coroner’s office.

Paramedics took her to Mercy Medical Center, where doctors diagnosed respiratory arrest. She was flown to Rainbow Babies & Children’s Hospital in Cleveland, where she was placed on a ventilator, according to the report.

She was given drug treatment and an operation was performed, according to the coroner’s verdict, which stated supportive care was maintained but Marissa failed to respond and was pronounced dead at 9:40 p.m. Jan. 3.

The death was ruled accidental due to diffuse hypoxic-ischemic encephalopathy — damage to the brain that also occurs in carbon monoxide poisoning and many cases of shaken baby syndrome.

In Mazorow’s office, the drugs propofol — the anesthetic that was listed as a “contributing factor” in pop star Michael Jackson’s death — ketamine, remifentanil and Versed were administered to Marissa in what is commonly known as “twilight sleep” or light sedation.

Attorney Michael Czack, who represents Marissa’s family, did not return phone calls and Marissa’s parents, Amber McEwen and Jason Kingery, also were unavailable for comment.

Marissa’s case is the latest pediatric death being monitored by a foundation founded by the family of 8-year-old Raven Maria Blanco of Chesapeake, Va., who died after being administered sedatives during a dental procedure.

Raven Blanco Foundation’s director of medical emergency preparedness, Dr. Larry Sangrik, said the foundation has tracked 19 pediatric deaths related to dental complications since 1996, including six children who have died since January 2010.

Sangrik, a dentist in Chardon, refused to second guess Mazorow’s decision to administer the four-drug sedation to Marissa, saying, “all the drugs in Marissa’s case are very tightly regulated in the state.” [aren’t all drugs?]

Sangrik has been speaking to the dental community about readiness in dealing with medical emergencies.

“The issue is if you do run into anesthesia complications, then you need to be prepared to address those immediately,” Sangrik said. “Children in particular run out of oxygen very quickly — the volume of air left in their lungs is disproportionately small and is used up very quickly.”

Exactly what was done at Mazorow’s office to revive Marissa is unclear. The coroner’s report does not state whether Mazorow’s staff attempted treatment before paramedics arrived.

Mazorow, who turned 81 in January, did not return phone calls for comment on the coroner’s report. His attorney, Ronald Mingus, declined to talk about the case, except to say his client is no longer administering intravenous anesthesia during dental procedures.

Under Ohio law, Sangrik said, Mazorow was required to have additional training every two years as an oral surgeon with a permit for general anesthesia.

Marissa’s death is under investigation by the Ohio Dental Board, which did not take any action against Mazorow in the 1997 death of 57-year-old Rosemary Johnson of Grafton, who died while having six teeth extracted.

Johnson’s family settled a wrongful death case against Mazorow for $550,000 in 1999, according to court records.

The dental board’s executive director, Lili Reitz, was unavailable for comment, a staff member said.

Meanwhile, Marissa’s death is one of the cases being examined by “Good Morning America” in a report expected to air in the next several weeks, said Raven Blanco’s cousin, Nicole Cunha, executive director of the foundation, which is located in Virginia Beach, Va.

“What we’re finding is most dental offices in America aren’t qualified to handle these medical emergencies,” Cunha said.

Contact Cindy Leise at 329-7245 or cleise@chroniclet.com.

It has been reported that the Ohio Dental Board is investigating but that may be where the problem lies. 

Attorney, Lili Reitz has been director of the Ohio Dental Board for far too many years in my opinion, and has fell asleep on the job.  I have spent hours searching various Laws, Regulations and Act for the state of Ohio and so far, I’ve not found just how the “Executive Director”  becomes Executive Director. 

Reitz has been ED since 1996 after serving as Assistant Attorney General in Ohio.  She graduated from Cleveland Marshall College of Law in November 1990.

It appears you just get appointed as Executive Director by who you know since I’m sure the Dental Board did not post for applicants.  No doubt, having an Attorney as the Executive Director

Look Out Houston - Kool Smiles at 3900 Aldine

RETAIL: NCDR has leased 6,750 square feet for a Kool Smiles dental clinic at 3900 Aldine Mail Route at High Meadow Retail Center. Perry Zieben of Perry Zieben Realty Co. and Nancy Erickson with Cushman & Wakefield represented the tenant. Ed Rammrath with Rammrath Realty represented the landlord, Race Venture.

Does My Son Have To Be Tied Up At The Dentist

This was a question asked by a parent at momapedia.com

May 22, 2010
Question:

Hi.
I'm very worry to take my son (4) to a dentist now. When I took him to the dentist they told me they need to do root canal for his baby tooth. I asked them "My son is only 4 how you are going to do that?". They said "Don,t worry. We are going to tie up him with special chair. Yes, He is going to cry but we did a lot this." Is it usual ? I refused to do that. I can't tie up my son. Few days later, my son's pediatrician called me and said I have to do that to him. I have to? I 'm looking for a dentist who can do that without tie up.
I 'm doing wrong for my son?

Replies:

1.  That's crazy!!! My son had nitrous for filling some cavities because he was afraid to sit still. If the nitrous isn't enough, they can do IV sedation. I would never let someone tie my kid to a chair.

2.  Have them put him to sleep with you in the room the whole time
Tying him up HELL NO!! sorry -mom of 4


3. I would change Pediatricians and Dentists sounds like they are in it together. I also agree with the mama who suggested having the tooth removed rather then giving a 4 year old a root canal. (I've never heard of that). There are plenty of dentists that specialize in "children ONLY".
Keep us posted.
Blessings......

4. i don't think you're necessarily doing the wrong thing IF your son can/will sit still during the procedure. I think sometimes it's the tying down that's more tramatic for them than the dental procedure, but the child HAS to sit still. So, if he will, then look around for a dentist who won't automatically tie him down. If you're not sure that he will, then you should explain to him what is going to happen and why so he can be prepared, maybe even demonstrate by tying him into a chair with a sheet, and then take him. If he needs the work, you have to do whatever you have to do to have the work done. By the way, is it really necessary to do a root canal - can they pull the tooth? Baby root canals are expensive and if he's going to lose his teeth soon anyway, it might be just as good to pull the tooth rather than try to save it. As the dentist if they see the adult tooth in the x-ray and an opinion on how long it will take to come down.

 5.  That's crazy!!! My son had nitrous for filling some cavities because he was afraid to sit still. If the nitrous isn't enough, they can do IV sedation. I would never let someone tie my kid to a chair.

6.  I would go to a different dentist. Why does a 4 year old need a root canal? I would rather have the tooth pulled. Root canals are not a good idea in any case, but especially not for baby teeth. There is a court case pending about a chain of dentists who restrain children like that. They did it to be able to give less anethesia and they did tons of root canals. They did this for money. It was shocking to see the hidden camera details. Seriously, go to a different dentist.

7.  Absolutely AVOID the papoose board. Here's what they DON'T tell you...a child can actually MOVE the papoose board while restrained. I know this, because at SIX months, my daughter did. I was on that like stink on s***. The dr used one without my knowledge. (ex-husband gave permisssion) When I walked in the room she was screaming and two nurses AND my ex were holding down the board saying, "Gee. Isn't she a strong one?" WEll, you can guess what happened next!! The procedure was stopped before it started and I took my precious one to a children's specialty clinic. And I don't care what they say, to this day she is terrified of anything that looks like a hospital. Don't mean to scare you, really, I don't. I just wish she didn't have to go through that and wouldn't wish it on anyone's child!! You never know how the child will react until it's actually happening, and then the damage is already done. Please see a CHILDREN's specialist, and listen to these other great moms.
Just Me!

8.   I was restrained on a papoose board when I was a young child to get stitches in my leg. I am now 43 and this was 37 years ago. I can remember every single detail and it was one of the most horrible things I have ever felt. I have 2 boys and I would explore every other option before I agreed to this. I believe this is a torture device and I hope you can come up with a better resolution for your daughter. Good luck to you!

9.   Follow your instincts. No papoose board.
Start by understanding there is no emergency here.
Cavities in a four year old who brushes his teeth with a good fluoride toothpaste progress very very slowly.
Why not wait six months to a year and then start over.
Also you might look for another pediatric dentist with a management technique that is a little better.
all the best,

Mike McCulla–Another Nashville creep working along side Michael Lindley and Al Smith - for a long time now.

Mike McCulla – Marketing for Church Street Health Management LinkedIn - http://www.linkedin.com/pub/mike-mcculla/1a/4a0/521
LinkedIn profile used to say he is/was Marketing at Children’s Comprehensive Services.  He’s dropped that and added Universal Health Services.
He’s been with Michael G. Lindley, Al Smith and others for a long time.  Even as far back as when CCS went under the name Pricor.
Mike McCulla, Michael J. Lindley , Al Smith, Rodney Cawood, and Brad Gardner together with others were owners of Pricor.  So this nastiness of treating children badly is nothing new to these creeps.  They have made a very nice living doing it.  Somehow you can find trotting around Nashville with their heads up, and not hanging in shame.  I don’t know how, but they do it, daily.
Purchase Agreement for Keys and CCS – the above named creeps are named as the sellers.  A year later they are abusing children again through their Small Smiles Dental Centers.  Snakes in the grass, no doubt.
Pricor History – It was not a nice company; Texas had real issues with the company.
Type: Public Company
Address: 3401 West End Ave., Ste. 400, Nashville, Tennessee 37203, U.S.A.
Telephone: (615) 250-0000
Fax: (615) 250-1000
Web was: http://www.ccskids.com
Employees: 3,000
Sales: $126.77 million (2000)
Stock Exchanges: NASDAQ
Ticker Symbol: KIDS
Incorporated: 1985
NAIC: 623990 Other Residential Care Facilities; 624110 Child
SIC: 8361 Residential Care; 8211 Elementary & Secondary Schools; 9223 Correctional Institutions
Children's Comprehensive Services, Inc. (CCS) based in Nashville, Tennessee, is one of the nation's leading providers of educational services, psychiatric treatment, and juvenile corrections for at-risk children and juveniles in the United States. Operating in 14 states and serving over 3,700 children and their families, CCS staffs both residential and day treatment facilities that provide services ranging from special education for autistic and developmentally delayed children to more intensive boot-camp programs set up to rehabilitate juvenile offenders. CCS has contracts with both governmental and non-governmental nonprofit agencies in Alabama, Arkansas, California, Florida, Hawaii, Kentucky, Louisiana, Michigan, Montana, North Carolina, Ohio, Pennsylvania, Tennessee, and Utah.
The contemporary privatization of government correctional facilities seemed to have been born out of the inspiration of several groups of investors from Nashville, Tennessee. Nashville was the birthplace of two of the three earliest and largest pioneering companies in the business--Corrections Corporation of America and Pricor Inc.
Pricor was founded in 1985 in response to a need for more and better run prisons in the United States and the belief that there was money to be made offering smaller municipalities private assistance. Prisons were overcrowded and significant amounts of money were being spent on building and maintaining correctional institutions. Pricor and its investors believed that through privatizing the industry it could successfully manage and correct the flawed system of both adult and juvenile corrections, and turn a profit at the same time.
Originally most of the available contracts for private prison operation were with women's detention centers, immigration holding centers, and juvenile justice placements, but Pricor succeeded in obtaining a contract for staffing and managing a maximum security jail in Greene County, Tennessee, in the late 1980s.
Pricor expanded operations into Alabama and Virginia in 1986, opening minimum security detention centers for a total of 170 inmates. In 1987, Pricor leased two facilities from a hospital system in California, and began its California operation. The state of California and its various municipalities remained one of CCS's largest client populations.
While still hoping to make significant strides with adult corrections, Pricor took what contracts it could get and ended up working closely with juvenile offender populations throughout the 1980s. In 1988 the company acquired Advocate Schools, a company dedicated to the care, education, and treatment of at-risk youth in California. Advocate Schools contracted with school districts based on referrals. Offering both community-based programs in which students attended an Advocate School on a day-to-day basis, and residential schools for students with more intensive needs, the school maintained nine community based sites throughout California. The original site in San Bernardino was established in 1982 with other sites opening throughout the 1990s. Nine residential schools made up the remainder of the Advocate Schools campus, making it the largest nonpublic alternative school system in California.
Advocate Schools was cofounded by Amy Harrison and Martha Petrey, who were retained by Pricor as vice-chairman/president and executive vice-president, respectively. Harrison was also cofounder and executive director of Helicon, a nonprofit group that contracted with CCS in a number of joint ventures.
It was during the Reagan Era, with its tougher prison sentences and stiffer drug conviction penalties, that Pricor made its most ambitious attempt to deal with overcrowded prison conditions in metropolitan counties. Pricor convinced rural county jails to contract with the company and offer their largely empty jails to prisoners from more populous regions for a fee. Pricor teamed up with Houston-based N-Group and first pitched the "jails for hire" plan in west Texas in 1990. The companies convinced municipalities to build new facilities with millions in government bonds and Pricor experienced tremendous initial success, with revenues of over $30 million in fiscal 1991. However, the lucrative payoff to Pricor was mainly in short term up-front fees. Eventually the deal turned sour, with the private prisons remaining empty and therefore unprofitable; for its alleged corporate misdeeds, Pricor was named by a Texas grand jury as an "unindicted co-conspirator" with N-Group. N-Group's penalties were far greater, however, as it was indicted on criminal antitrust charges.
With the Texas dealings now a nightmare, the company found itself losing money in 1992. Facing a tenuous financial future in adult corrections, Pricor exited the business in 1993. Instead, Pricor was increasingly moving forward with its juvenile facilities, and in 1994 the company's board of directors approved a re-direction of the company and an accompanying name change. Pricor was now to be known as Children's Comprehensive Services Inc. (CCS). The company was traded under the symbol KIDS on the NASDAQ. By the end of fiscal 1994, CCS was serving over 1,500 children and their families in Alabama, California, Louisiana, and Tennessee.
Pricor benefited greatly with the passage of The Individuals with Disabilities Education Act (I.D.E.A.). The new federal law mandated that states provide every school-age child with a free and appropriate public education. If a public school was unable to accomplish the mandate through its normal operations, a school district was enabled to refer a student to a nonpublic school able to provide the services required. Pricor and Advocate Schools functioned to provide special needs services to school districts all over the state of California.
In addition to redirecting the company in 1994, CCS also undertook a financial restructuring in an attempt to keep the company solvent. In 1993, Pricor had solicited help from T. Rowe Price Strategic Partners Fund II, L.P. in the form of a one-year $1.5 million term loan. The company was also granted a renewal of a $10 million revolving credit facility through its banks. Pricor was in default on the credit and T. Rowe Price and Pricor settled on approximately one-third of Pricor's outstanding common stock shares at a purchase price of $1.8 million for its having cured its default status and for re-securing the loan.
The second part of the financial restructuring involved converting the company's short-term loans from both its banks and T. Rowe Price into long-term obligations. Pricor, now CCS, had commitments to National Health Investors, Inc. for $6.5 million and T. Rowe Price for $1 million. The local First American Bank of Nashville completed the financial overhaul when it extended a line of credit to CCS for the purposes of supplying working capital to keep CCS afloat. All told, the company was dangerously close to bankruptcy and had it not been for the aid of the financial institutions CCS would have more than likely folded.
CCS provided services in a variety of areas for children and adolescents. Treatment facilities were devoted to rehabilitating youth who were sexually abusive, had substance abuse issues, or needed crisis intervention for all sorts of emotional needs. The special education service centers, including Advocate Schools, concentrated their care on students suffering from a diverse range of special needs, including autism and attention deficit disorders.
Children's Comprehensive Services relied on reimbursement from Medicaid, managed care, and private insurance companies. Day treatment programs provided the greatest financial return to the company, but rates varied according to the contracting parties. Some states cut reimbursement costs, greatly affecting CCS's profit margin and sometimes leading to discontinued services, as in the case of CCS of Montana and the Helicon Youth Center in California.
CCS offered programs to deal with a wide variety of problem areas for the child and juvenile patient. The company tailored its operations to very individualized treatment plans and had centers throughout its 14-state region that met the diverse needs of its target population.
In September 1998, CCS acquired Ameris Health Systems, Inc. Ameris' wholly owned subsidiary American Clinical Schools, Inc. operated treatment facilities for juvenile sex offenders in several states. The following December the company acquired Somerset Inc., a California company that provided educational day treatment to children and their families. The company merged with Ventures Healthcare of Gainesville, Inc. in June 1998, making the year an important one for company growth.
In August 2000 CCS opened the Dallas alternative education program as well as Bristol Youth Academy in Liberty County, Florida. The company also expanded the hospital facility it operated in Ohio.
In October 2000 the company retained McDonald Investments Inc. to assist the company with its financial resources. The company was looking at a possible sale to a competitor. It was undetermined at the time whether the company would be divided up or sold in its entirety. Company leadership was looking to McDonald Investments as well to assist them in their decision making.
In November 2000, CCS closed its long established Helicon Youth Center (HYC) and its related school. Helicon Youth Center had undergone a licensing investigation by Community Care Licensing (CCL), a division of California's Department of Social Services, and CCL had some concerns with the center. A two-year probationary agreement was established between CCL and HYC but in the meantime referrals were no longer made by Riverside County and there was a significant drop-off in the number of clients. The company also experienced a decline in students to its non-residential day treatment programs.
As the company entered the new millennium the outlook for Children's Comprehensive Services was mixed. William Ballard, chairman and CEO, optimistically stated, "We believe CCS's prospects for additional profitable growth are supported by the market's continued strong demand for services for at-risk youth. Our pipeline of potential contracts has expanded because of our reputation for quality, the wide variety of services we offer, and increased interest in our specialty programs such as the gender specific treatment programs." Yet the company appeared unprepared to forge ahead on its own. Indeed, CCS ended fiscal 2001 with an offer of a buyout. The details remained undisclosed, but the potential buyer was described as one of CCS's major competitors.
There was no disputing that mental health issues among youth were now at crisis proportions in the United States and that the juvenile justice system was overcrowded and in need of assistance.
With the rising demand for specialty services among youth, CCS, or whomever was involved in its takeover, appeared to be well positioned to help in the education and treatment of some of the nation's highest at-risk youth. A larger public policy question was whether the country and its municipal governments would be willing to pay the high cost of such services to private companies over the long haul. If government entities believed that CCS could provide quality care at a reasonable cost to the taxpayer the contracts would continue to be signed and CCS and its investors would reap the benefits.
Principal Subsidiaries
Children's Comprehensive Services of California, Inc. d/b/a/ Advocate Schools; CCS/ Altacare of Arkansas, Inc.; CCS/ Bay County, Inc.; CCS/ Gulf Pines, Inc.; CCS/ Lansing, Inc. d/b/a/ Rivendell Center for Behavioral Health; CCS of Montana, Inc.; CCS/ Rivendell of Arkansas, Inc.; CCS/ Rivendell of Kentucky, Inc.; CCS/ Salt Lake City, Inc., d/b/a/ Copper Hills Youth Center; Ventures Healthcare of Gainesville, Inc.; Chad Youth Enhancement Center; CCS/Meadow Pines, Inc.; American Clinical Schools, Inc.; Tennessee Clinical Schools, Inc., d/b/a Hermitage Hall; Alabama Clinical Schools, Inc.; Pennsylvania Clinical Schools, Inc.; Somerset, Inc.; CCS of Hawaii, Inc.
Principal Competitors
Cornell Corrections Inc.; Ramsay Youth Services, Inc.; Res-Care, Inc.
Further Reading
"Children's Comp Could Shop Itself," Mergers & Acquisitions Report, October 16, 2000.
"Children's Comprehensive Services Inc. First Quarter Financial Results, Managed Behavioral Health News, November 23, 2000.
"Children's Comprehensive Services Inc. (in Talks to Sell Firm)," New York Times, June 16, 2001, p. B3.
"County Hears Sales Pitch by Jail Firms," St. Petersburg Times, November 13, 1987, p. 1.
"Education Microcap Chalks Up Possible Buyer ... Perhaps," Mergers & Acquisitions Report, June 25, 2001.
Hodges, Lucy, "Removing the Bars to Private Jails," Daily Telegraph, March 1, 1989, p. 17.
"Hospital to Be Used to House Juveniles," Los Angeles Times, Metro Section, November 25, 1987, p. 11.
McCartney, Leslie, "BU-School-Funds," Montana Standard, April 1, 2001.
Company Perspectives:
CCS, created in 1985, is not just a corporation ... or a leader of educational and treatment services in the country ... or thousands of employees dedicated to making a difference in the life of a child ... CCS is all of these things and more.
CCS is about providing services to thousands of children and adolescents who are not succeeding in their traditional educational, family or everyday life setting. CCS is more than just a business, and it's more than a job. It's about getting up every day and imagining and working on an idea to add to a lesson plan, or finding a special computer software program that will excite and inspire a student who has never succeeded in school. It's about praising a child or youth for all the right things they do. It's about operating a detention center knowing that the CCS exceptional and specialized training will ensure a safe and secure setting for the youth, staff and the community.
Key Dates:

• 1985: Pricor Inc. is founded by a group of Nashville
• 1986: Pricor enters the adult private prison business.
• 1987: Pricor leases two facilities in California.
• 1988: Pricor acquires Advocate Schools, a business dedicated
• 1989: Pricor enters deal in the United Kingdom to staff
• 1990: Pricor pitches "prisons for hire" in rural west Texas.
• 1991: Pricor posts earnings of $30 million.
• 1992: Texas project fails.
• 1993: Pricor exits adult corrections business and focuses on children
• 1994: Pricor changes its name to Children's Comprehensive
• 1999: CCS closes its Helicon Youth Center in Riverside County,
• 2001: Possible buyout of CCS by undisclosed competitor
• 2005: Buyout by Universal Health Services

Preview of the Purchase Agreement
OWNERSHIP INTEREST PURCHASE AGREEMENT
THIS OWNERSHIP INTEREST PURCHASE AGREEMENT (together with all Exhibits, Schedules and other documents and instruments incorporated herein by reference, the “Agreement”) is made and entered into as of the 3rd day of October, 2005, by and among Harbinger Private Equity Fund I, L.L.C., Keystone Group Kids, Inc., Michael Lindley (“Lindley”), Marty Weber, Ameris Healthcare Investments, LLC, Rainer Twiford, Al Smith (“Smith”), Mike White, Rodney Cawood (“Cawood”), Buddy Turner, Jeff Cross, Gail Debiec, Brad Gardner, Brad Williams, Don Wert, Rob Minor, Mike McCulla, Jim Shaheen, Rod Gaeta (each a “Seller” and collectively, the “Sellers”), and Universal Health Services, Inc., a Delaware corporation (“Buyer”).
W I T N E S S E T H:
WHEREAS, Sellers collectively own one-hundred percent of the issued and outstanding ownership interests (“Ownership Interests”) issued by KEYS Group Holdings LLC, a Delaware limited liability company (“Keys”), as of the date hereof; and
WHEREAS, Keystone Education and Youth Services, LLC, a Tennessee limited liability company (“Keystone”), and Children’s Comprehensive Services, Inc., a Tennessee corporation (“Childrens”), are each either a wholly owned limited liability company or corporate subsidiary of Keys; and
WHEREAS, Keystone/CCS Partners LLC, a Delaware limited liability company (“KCP”), is eighty-five percent (85%) owned by Keys and fifteen percent (15%) owned by Childrens; and
WHEREAS, Keystone, Childrens and KCP are sometimes referred individually as a “Keys Sub” and sometimes collectively referred to as the “Keys Subs”; and
WHEREAS, the Keys Subs collectively own one-hundred percent of the ownership interests in the entities listed on Exhibit A hereto (collectively, the “Keys Companies”); and
WHEREAS, the Kids First Foundation (“Foundation”) is a non-profit tax exempt entity whose purpose is to provide education and residential facility services; and
WHEREAS, collectively, Keys, the Keys Subs and the Keys Companies are sometimes referred to as the “Keys Group.” The Keys Group provides group home, behavioral health, juvenile detention, educational, and other treatment related services through its wholly owned and operated facilities set forth on Exhibit B hereto (the “Facilities”); and
WHEREAS, Buyer desires to purchase one hundred percent of the Ownership Interests which will be issued and outstanding immediately prior to the Closing (as defined in Section 3.1 below) and Sellers desire to sell to Buyer the Ownership Interests owned by them and to provide for the sale to Buyer of the additional Ownership Interests to be held by the Option Holders (as defined in Section 2.6 below) immediately prior to the Closing, all on the terms and conditions set forth in this Agreement.

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NOW, THEREFORE, for and in consideration of the premises, the mutual promises and covenants contained herein, and other good and valuable consideration, the receipt and sufficiency of which are hereby acknowledged, the parties hereto, intending to be legally bound hereby, agree as follows:
ARTICLE 1
TERMS
1.1 Accounting Terms. Accounting terms used in this Agreement and not otherwise defined herein shall have the meanings attributed to them under GAAP. For purposes of this Agreement, “GAAP” shall mean generally accepted accounting principles used in the United States.
1.2 Defined Terms. All capitalized terms used in this Agreement shall have the meanings ascribed to such terms as set forth throughout this Agreement.
ARTICLE 2
To see the entire agreement, it appears you will have to purchase it.

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