Someone needs to stop this dentist before he kills someone. Other’s have come forward with similar stories, none willing to speak out of course.
Detroit Free Press - Ashton's story: Michigan Child Nearly Dies
Ashton Adler is the subject of "Ashton's story: Michigan Child Nearly Dies," in which his mother describes complications he had with dental sedation. / Photos by JARRAD HENDERSON/Detroit Free Press
Rebekah and Jason Adler and their sons Gabe, 5, and Ashton, 7, at their Royal Oak home.
The case of a 6-year-old Royal Oak boy whose family charges he was unresponsive for nearly six unsettling hours after a dental sedation procedure last year is under investigation by Michigan health care regulators.
The allegations by the family of Ashton Adler, now 7, involves one of Michigan's few known cases involving a child experiencing complications from dental sedation. The incident is the subject of a new video by a national nonprofit organization that monitors deaths and serious complications of children undergoing such procedures.
"Ashton's story: Michigan Child Nearly Dies," is a video interview with Rebekah Adler, the mother of the boy interviewed by the Raven Maria Blanco Foundation. The Virginia-based foundation, which has tracked 45 pediatric sedation deaths around the country, recently led its website with the Adlers' story to show parents and caregivers to "trust their instincts" and "walk away" if they question sedation procedures, Executive Director Nicole Cunha said.
The Adlers contacted the foundation after reading a February report in the Free Press on controversies over state regulation of dental sedation. The article described the national controversy over pediatric sedation deaths and regulatory measures under debate by Michigan and other states to increase training and safety in the field.
Michigan has had no known sedation deaths, according to a spokesman for the Michigan Dental Association. And there have been very few complaints involving sedation dentistry practices, said Rae Ramsdell, chief of the Bureau of Health Professions with the Michigan Department of Licensing and Regulatory Affairs.
The foundation's video does not name the dentist, but the couple's complaint to Michigan regulators lists him as Troy pediatric dentist Dr. Jian-Fu Zhu. The complaint, which the Alders filed June 8, 2011, with Michigan's licensing department, is under investigation, Ramsdell said. No formal charges have been filed.
Zhu declined to comment. He referred a call from the Free Press to Lynda Farnen, a Roseville attorney.
"We're involved in an ongoing investigation," she said. "Under those circumstances, there's very little I'm going to say. Dr. Zhu believes that all the care and treatment he rendered was appropriate and within the standard of care." She declined to answer other questions.
The state website lists no violations on Zhu's record.
Credentials seemed fine
The Adlers say a brochure they picked up in his office on the day of the visit gave them confidence they made the right choice.
Zhu also came on good recommendations from their family dentist, the Adlers said.
The brochure identified Zhu as a board-certified pediatric dentist and clinical assistant professor of pediatrics at the Wayne State University School of Medicine, as well as a previous co-director of the pediatric residency program at Children's Hospital of Michigan in Detroit.
WSU medical school records show that Zhu has not worked there since 2005.
He left Children's Hospital several years ago, a spokeswoman said.
He remains a board-certified dentist, a credential that indicates he passed a tough national exam.
Pediatric dentists undergo at least one month of hospital or office training with an oral surgeon or dental anesthesiologist that allows them to perform light or moderate sedation techniques -- drugs that help people rest during a procedure but that allow them to respond to voice commands easily.
In their complaint to the state, the Adlers say they were told to give two different sedation drugs to their son, a skinny 47-pounder at the time, before undergoing a root canal and five fillings.
The Adlers claim that:
• They were left to give the drugs to their son on their own. When Zhu returned and found Ashton apparently had spit out some of the medicine, Zhu gave them a third cup of medicine to give to their son and then left them alone again. The Adlers say they don't know which medicine and how much of it was in the third cup, requiring emergency room doctors at Beaumont Hospital in Royal Oak to monitor Ashton for more than four hours to observe his breathing and vital signs because he was so listless when they arrived.
• Their son was unmonitored for long stretches throughout the dental visit and was sent home asleep. A staffer for Zhu told them, "We can't be with our patients from start to finish of a sedation process," Rebekah Adler said.
• Zhu didn't awaken the boy before sending him home, did not check his vital signs and gave the parents no reason to think there was a problem.
The allegations, if true, would violate standards of the American Dental Association and the American Society of Pediatric Dentistry, of which Zhu is a member.
The guidelines require "no administration of sedating medication without the safety net of medical supervision." They also say that children must recover to pre-sedation levels of consciousness before discharge; that dentists must document the name and dosages of medications given, and if children receive different sedative drugs simultaneously, they might need more monitoring before discharge. The guidelines say a child should be able to remain awake for "at least 20 minutes when placed in a quiet environment."
Before Jason Adler left Zhu's office the day of the visit, he said he asked for his son's X-rays and medical records. He received only a bill, marked "statement for services rendered." Scribbled on it were references to two sedative drugs: "hydroxyzine 50 milligrams and chloral hydrate 1,700 milligrams."
The statement did not mention that Ashton also received laughing gas, or nitrous oxide, the Adlers say.
Dr. Norbert Kaminski, a Roseville dental anesthesiologist and president of the Michigan Dental Society of Anesthesiology, said the dosages exceed guidelines from the federal Food and Drug Administration and standard reference manuals for dentists, such as the "Drug Information Handbook for Dentistry" from Delta Dental and LexiComp's Dental Reference Library.
Kaminski computed dosages for the boy and said Ashton was given five times the dose of hydroxyzine and two to three times the dose of chloral hydrate, and that even lower doses are recommended when the drugs are used together. Combined with the laughing gas, Ashton was pushed into a level of sedation that Zhu, as a pediatric dentist, was not licensed to perform, Kaminski said.
Kaminski has campaigned statewide to toughen Michigan's sedation regulations.
Michigan is one of only two states that do not require permits for dental professionals performing sedation, Kaminski said. Permits help consumers readily identify what level of sedation a dental practitioner can offer, Kaminski said.
The state Board of Dentistry is reviewing whether to toughen standards in the field. So far it has balked at requiring permits, which would tell consumers whether a dentist has the right training to do either awake sedation or deeper sedation. The board had planned to take up the changes at its April meeting but postponed the discussion, possibly until its next meeting June 14.
'I just want justice'
The Adlers say more parents, even people like them who are familiar with sedation, need to ask more questions before and during a visit. The couple has watched a younger child with a brain injury undergo sedation for brain tests. But now they have to relive their fears -- something will go wrong every time he has another sedation procedure, Rebekah Adler said.
"I just want justice," she said. "I want the people of Michigan to know this can happen to them."
Contact Patricia Anstett: 313-222-5021 or panstett@freepress.com
More Details: Questions parents should ask before pediatric dental sedation
• How much training have you had?
• How do you monitor children to see whether they stay properly sedated?
• Does the office have rescue equipment in the room where the procedure is done, and how often does the staff practice using it?
• How long do you monitor a child before discharge?
• Will I receive a pretreatment report describing what is being done and what drugs will be used in the procedure?
By Patricia Anstett
Detroit Free Press Medical Writer
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