Why is Mark Birner of BDMS/Perfect Teeth, a DSO in Colorado, leading his name and dental licenses to Affordable Care, a DSO in North Carolina?

On May 30, 2017, an entity was registered in New Jersey called, Dr. Birner, PA.  The Manager being Mark Birner.

The “Incorporator” was Sonia Surasky, a paralegal for Affordable Care dba Affordable Dentures and Implants, headquartered in Raleigh, North Caronlina.

The mailing address for Dr. Birner, PA is 156 West State Street, Trenton, NJ, home of State Street Partners, a lobbying firm!

In a legal case recently filed in New Jersery against Affordable Care (which I will get into later),

Affordable Care says it assigned its lease to certain clinics in New Jersey to Dr. Birner, PA.on June 5, 2017.

Excerpts from Exhibit B:

What’s this? A Management Agreement between Dr. Birner, PA and Affordable Care?

Sounds to me that Dr. Birner, PA has complete control of the Premises yet Affordable Care is still the landlord of the dental practice. Huh? I think this is not just double speak, it’s triple speak.

WHAT? But the dentist has spent nearly $200,000.00 to purchase the equipment, furnshings, and other assets”.

Ah Ha!  Mark Birner, owner of Birner Dental Managements (a DSO) operating as Perfect Teeth, is lending his name and dental license to be the “designated dentist” who supposedly leases the premises where yet another dentist operates an Affordable Dentures clinic.

Just my opinion of course but looks to me like the Association of Dental Management Organization is more like a cartel. 

Patients Wonder Why Dental Boards Do Nothing About Bad Dentistry: Here’s why

Below is a list of a few dental boards who have Board Member who work for private equity/corporate owned dental chains.  Keep in mind in most states this is illegal. So what does that make these board members? Just saying…

Last updated: 12-7-2017 6:38PM

Arkansas

Dr. Richard Smith - Monarch Dental

Colorado

Mark William Adams, DDS – ClearChoice Dental Implant Centers

Dr. Vidhyalakshmi Sampath – Bright Now! Dental DSO

Florida

Joseph V. Calderone, Jr.,  DMD – Heartland Dental d/b/a DeBary Dental Care (to find search Heartland for dentist near zip code 32713)

Georgia

Dale Mayfield, DMD - Kool Smiles
Gregg Goggans - Smile Doctors (Dental Board Vice President)

Illinois

Julie Galloway, DDS – Heartland Dental

Indiana

Jeffery Snoddy,DDS – Heartland Dental

Iowa

Monica Foley, DDS  – Heartland Dental

William McBride, DDS – Midwest Dental

Maryland

Robert R. Windsor, DDS – Dental Care Alliance (Unconfirmed)

Michigan

Gregory Heintschel, DDS – President and CEO of My Community Dental Centers

Minnesota

Douglas Wolfe, DDS – Kool Smiles (Unconfirmed)

Nevada

Ali Shahrestani, DMD– Pacific Dental Service

New Jersey

Steve Goldstein , DDS– Dental Care Alliance

George McMurray, DDS – Allied Dental

Daneil DiCesare, DMD – Allied Dental

Pennsylvania

Andrew Matta, DMD – Chief Medical Officer and Founding Partner of North American Dental Group

Texas

Kimberly Haynes-Reese, DDS – Aspen Dental

H. Jorge Quirch, DDS – Heartland Dental

Virginia

Jamiah K. Dawson, DDS – Affordable Dentures and Implants

Washington

Lyle McClellan, DDS – Director of Doctor Development at Williamette Dental Group

Aaron Stevens, DMD – Williamette Dental Group

Check your state boards members.  If you find a member affilliated with a DSO, please email me and I will keep the list updated.

Related:

Big Step Forward: Dental Board Gives Voice to Group Dental Practices at State Level

Gov. Abbott Appoints Aspen Dental Dentist to to Texas State Board of Dental Examiners

Agency Capture at it’s finest!







http://www.kbtx.com/content/news/Local-dentist-named-to-State-Board-of-Dental-Examiners-458947533.html

Checking her dental licenses at the board and it’s sparkling clean.

However:

June 3.2016-Kimberly Haynes, DMD, received non-discipline remedial plan because of a complaint from a patient.  She was found to have fallen below the minimum standard of care, failed to keep adequate records and no informed consent from the patient among other things.

I'm told, David Tillman, the presiding officer is a weak leader and appointed for that very reason. I'm told board member Bryan Henderson, DDS is pro-DSO.  Kimberly Haynes, DMD, as we see is an Aspen dentist and H. Jorge Quirch, D.D.S is a Heartland dentist. One more and the DSO's will have a majority. Not that it matters because I'm also told the hygienists back the DSO's as well.

Texas State Board of Dental Examiners is a RAGING DUMPSTER FIRE!

Here is an article you may have interest in posting on DTM.   All of this information is in good faith and written for the purpose to expose the mismanagement at the Texas State Dental Board. 

----------------------------

It has been six months since an investigative reporter has exposed Kelly Parker's mismanagement and unethical behavior as the executive director at the Texas State Board of Dental Examiners.  Since then, the Board Members have done NOTHING.  She has brought disgrace onto the Board and dental profession as evidenced by negative media reports and multiple employee complaints.

Several employees brought their concerns directly to Board members only to hit a wall.  Employees jeopardized their own jobs by contacting Board members to report what was happening with the executive director they appointed.  Dr. Steve Austin, DDS, the presiding officer of the Board, refused to even listen because he feared being involved in any type of subsequent employee hearing.  See email below.

Kelly Parker shut down criminal investigations which allowed dentists and other licensees to potentially get away with criminal activity.  State Senators Jose Menendez and Charles Schwertner, as well as the Governor's office, were alerted to this fact.  Hello?!  Where are these officials??  Where are the Texas Rangers?  Or the Attorney General's Office?? 

At least nine former criminal investigators can testify in this matter.  NONE of them have yet been contacted by anyone, not even the senators or governor's office even though they said they would "look in to it."  Many of these investigators still have copies of their investigative reports that were written.  These ex-investigators are just waiting to share their stories with the appropriate authorities.

All but THREE criminal investigators left the Texas Dental Board this year because of Kelly Parker.  There are NO criminal investigators left in the entire Dallas region, the San Antonio region, or the entire Houston region!  None of them have been replaced.  After the entire investigative supervisory staff left this year, she promoted one sergeant to lieutenant who resigned his position after just a few weeks of having to deal with Kelly Parker.  He quit the agency shortly thereafter as well.  The mismanagement and unethical decisions coming from Parker prompted many people to leave without having another job to go to.  Once again, NONE of the Board Members want to address the nightmare they created.

It is estimated that over HALF the agency employees have left since Kelly Parker and Nycia Deal started running the agency into the ground.  Due to the large number of vacancies that have been caused by Kelly Parker, the agency HAS to be behind hundreds and hundreds (if not over a thousand) of complaints waiting to be investigated.  She has no one to investigate these complaints!  They are apparently trying to use various staff to clear out complaints.  NO ONSITES are being conducted at dental clinics, NO SANITATION/STERILIZATION inspections are being conducted, so how can they be claiming they're protecting the public??? 

Kelly Parker and Nycia Deal shut down onsite inspections and the ability to allow investigators to issue sanitation citations to violators.  That has been stopped for well over a year.  What is the purpose of that?  Makes as much sense as stopping criminal investigations!  With all the changes being made, one could easily argue that they are in the business of protecting DENTISTS, NOT THE PUBLIC!!

An independent outside audit should take place.  Chances are extremely high that numbers about backlogged cases are being hidden.  The same goes for the severely backlogged cases that are being bungled by Dr. Brook Bell and her dental division.

Kelly Parker has lost her second executive administrative assistant.  This is the second one in a row to just quit.  She lost her communications director, too.  Kelly Parker reportedly received a large number of negative feedback from a department-wide survey that was sent about her.  This should be very telling that all of these new employees already have nothing but negative to report about her and her management style.

In the two years that Kelly Parker and Nycia Deal have so poorly mismanaged the TSBDE, are they any better off than where they were two years ago?  ABSOLUTELY NOT.  In fact, they're probably in such a state of disarray, it will be a MONUMENTAL task for a new executive director to come in and right this sinking ship.

The real shame is that none of the Board Members care enough about their profession, much less the public, to deal with the problem they created by putting Kelly Parker and Nycia Deal in charge to make blunder after blunder.  Hundreds, if not more than a thousand dental complaints are not being tended to.  Hundreds, if not more than a thousand complaints are waiting to be reviewed.  The entire state of Texas only has three experienced investigators left.  People have been leaving the agency in droves.  They cannot retain staff.  Morale is abysmal. 

The TSBDE is now a raging dumpster fire and the Board Members seemingly ignore these facts.

                                                                                                                                                                     ---Anonymous

Dental Dreams, LLC Settles with MassHealth for $1.3 Million

September 5, 2017

BOSTON – The U.S. Attorney’s Office and the Massachusetts Attorney General’s Office announced today that Dental Dreams, LLC, a national dental chain with locations in Massachusetts, has agreed to pay $1.375 million to resolve allegations that it improperly billed the Massachusetts Medicaid program (MassHealth) for unnecessary and unjustifiable dental procedures.

“Dental Dreams enriched itself at taxpayer expense by improperly billing Medicaid,” said Acting U.S. Attorney William D. Weinreb. “We will continue to work with our law enforcement partners to ensure that federal and state health care dollars are spent properly.”

“This dental chain’s extensive improper billing violated state regulations and cost our state’s Medicaid program more than a million dollars,” said Massachusetts Attorney General Maura Healey. “As a result of this joint investigation, today’s settlement provides restitution to MassHealth and ensures that these funds are properly used to benefit its members.”

“Medicaid is designed to provide health care services to some of the most vulnerable members of our society and it’s our agency’s mission to ensure government health funds are spent properly,” said Special Agent in Charge Phillip M. Coyne of the U.S. Department of Health and Human Services Office of Inspector General. “Working with our Federal and State partners, we will continue to hold accountable any medical professional who, just to enrich themselves, bills Medicaid for more intensive and expensive services than those actually provided.”

“The company took advantage of a vulnerable patient population when it submitted claims to MassHealth for medically unnecessary and unreasonable dental procedures,” said Harold H. Shaw, Special Agent in Charge of the Federal Bureau of Investigation, Boston Field Division. “Today’s settlement underscores the FBI’s commitment to investigate health care providers who overbill federal and private health insurance programs to maximize profits. We urge anyone with information regarding overbilling practices to contact us.”

The settlement resolves allegations that Dental Dreams overbilled the Massachusetts Medicaid program for surgical extractions of teeth and for a specific kind of oral examination.

The settlement resolves a lawsuit filed by a former employee under the whistleblower provisions of the False Claims Act, which permits private parties to sue on behalf of the government for false claims for government funds and to receive a share of any recovery.

Acting U.S. Attorney Weinreb, Massachusetts Attorney General Healey, HHS-OIG SAC Coyne and FBI SAC Shaw made the announcement today. The case was handled by Assistant U.S. Attorneys Michelle Leung, Sonya Rao, and Kriss Basil of Weinreb’s Civil Division and Assistant Attorney General Stephany Collamore of Healey’s Medicaid Fraud Division.

September 2017 Conference: Top Trends in Dentistry Not Heard Anywhere Else

Concerned Dentists of Texas Presents: Business of Dentistry 101

When: Friday, September 15, 2017 (9am-5pm) during the Southwest Dental Conference
Where: Dallas Omni Hotel Cedars Room, 555 S Lamar St, Dallas, TX 75202
Registration: Concerned Dentists of Texas (CDOT)
Contact person: Jackie Stanfield, DDS, concderneddentistsoftexas@gmail.com 
                            (972) 355-2273

Topics include:

• Problems facing dentists, new or retiring, involving dental practices owned and operated by Private Equity companies and Wall Street Hedge Funds.
• Understanding dental employment contracts: the vulnerabilities and consequences.
• Discussion about the business model of dentistry such as Dental Service Organizations (DSO’s): the impact on dentists, staff and patients.
• Legal issues and potential ramification facing dentists today.
• Medicaid Fraud
• Government and Legislation issues: overreach and/or underreach.
• Solutions: what you can do to protect your patients, yourself, your business and financial future.

Rare appearance together by following speakers:

Lunch will be provided by the following meeting sponsors: 
Dr. Rene Scott
Frank Brown, ADS Watson Brown and Associates
Johnette Green, Wells Fargo, johnette.green@wellsfargo.com
Dr. Shab Krish, MJ and Sleep Therapy Center of North Texas; and
Josh Knowles, Allstate

Concerned Dentists of Texas (CDOT) is committed to the well-being of the dental profession and the patients we serve.

Gentle Smiles, LLC and Dr. Annie Watson, DDS Settles Fraud Allegations with Masshealth

AG Healey Returns $500,000 to Masshealth in Settlement With Springfield Dentist Over Alleged Improper Billing

August  21, 2017

BOSTON – Attorney General Maura Healey announced today that her office has reached a settlement with a pediatric dentist in Springfield, returning $500,000 to the state’s Medicaid program (MassHealth) and resolving claims that the dentist improperly billed the program for services.
The settlement agreement resolves allegations that Dr. Annie Watson, DDS and her dental practice, Gentle Smiles, LLC, improperly billed MassHealth for palliative care (emergency pain treatment) between March 2010 and June 2013, and failed to comply with MassHealth rules associated with the use of that emergency treatment billing code.

The AG’s Office began an investigation into Dr. Watson and Gentle Smiles upon a referral from MassHealth, which identified Dr. Watson as the top biller of the palliative care code among all MassHealth dental providers.

Palliative care is the emergency treatment of dental pain that relieves the pain but is not curative and can include draining of an abscess or prescribing pain medication or antibiotics. In order to bill this code, the patient’s dental record must contain a description of the treatment provided and must document that the treatment was given on an emergency basis.

The AG’s investigation revealed that Dr. Watson routinely billed for palliative care without any supporting documentation, including when patients only received cleanings and x-rays.
Under the terms of the civil settlement, Dr. Watson and her business will pay MassHealth $500,000 as restitution for improper billing. The settlement also requires that Dr. Watson and her employees review and comply with all applicable state and federal statutes, and all regulations governing participation in MassHealth.

MassHealth provides healthcare products and services to eligible low-income individuals, including people with disabilities, children and senior citizens.

This matter was handled by Managing Attorney Lee Hettinger and Investigator Deborah El Majdoubi, both of the AG’s Medicaid Fraud Division. MassHealth assisted in this investigation.

Bethaniel Jefferson indicted on a felony charge of causing serious bodily injury to a child by omission

Photo: Craig Hartley Craig Hartley, Freelance

Excerpts from Houston Chronicle Story:

A former Houston dentist was formally charged Monday (July 24, 2017) with failing to properly treat a sedated 4-year-old patient who was left with permanent brain damage in what should have been a routine procedure.

The child's mother, Courissa Clark, said she was "overjoyed" when she heard the news.

"We're really grateful that justice has been served and the person that did this to our baby is finally being brought to justice," Hall told the Chronicle.

"When little Nevaeh was taken to the dentist that day, (her parents) turned her over to the dentist trusting that the dentist would protect and look after their little girl," said attorney James Moriarty. "But she overdosed her on sedatives."

The girl was sedated at the Diamond Dental office about 8:30 a.m. Jan. 7, 2016, prosecutors said in a statement. Three hours later she suffered a seizure, and her oxygen level and temperature fell dramatically. Prosecutors say it took more than four hours before anyone called for medical assistance.

Jefferson was reprimanded by the Texas Board of Dental Examiners in 2005 and 2012, prosecutors said. The board revoked her license in November after a state administrative judge ruled that she "fell below the minimum standard of care, failed to uphold the duty of fair dealing and committed dishonorable conduct when providing dental care."

The Chronicle's investigation cast a spotlight on Medicaid dental clinics that had flourished through treatment of pediatric patients whose low-income families qualified for government assistance.

Medicaid dental claims in Texas quintupled between 2005 and 2015 to $1 billion a year after the state doubled reimbursement rates in 2007.

Jefferson now faces trial on a first-degree felony charge.

"This indictment should send a message to the medical community that they will be held accountable for abandoning their patients in times of crisis," prosecutor Stan Clark of the Texas attorney general's Medicare fraud unit said in the statement.

"While accidents in the health care industry occur more than everyone would prefer, practitioners must react appropriately and contact higher level medical care providers when they realize their patient is distressed beyond their capabilities," he said.

Read the Entire Article Here

3-year-old Daleyza Avila-Hernandez’s Death at Children’s Dental Surgery Center and a Louisana Psychologist.

On Monday, June 12, 2017 3-year-old Daleyza Avila-Hernandez died at Saint Joseph’s Hospital after what was a simple procedure at Children’s Dental Surgery Center, in Stockton, California.

According to Fox40 News, Daleyza was referred to Children’s Dental Surgery Center by a dentist at Western Dental.

“I don’t want this to happen to another mother like it’s happening to me,” said Araceli Avila, Daleyza's mother.

“All I did was I took my daughter to the dentist because they were going to fix her teeth, and about 30 minutes later they brought her back dead,” Avila said.

The mother says she was not allowed to go back with her child during the procedure but while waiting for her daughter she saw an ambulance arrive.

“And I stood up and went outside because I was like 'they are coming for a kid,' but I never thought it was for my child," she said.

Within moment a nurse appeared and told the mother something went wrong and her daugther’s heart stopped, and that “maybe she had underlying heart issues”.

The mother disputes that saying her child “was a very healthy”. Avila and her husband, Jose Hernandez, recalled seeing the toddler "vivacious and full of life" just before the procedure.

According to FOX40 website:

“FOX40 spoke to David Thompson, the administrator of Children's Dental Surgery Center in Stockton, who says they only do general dental procedures -- such as filling cavities and putting on crowns.

Her parents say Daleyza went in to have two teeth pulled and have caps put on two other teeth.

Thompson says the girl had a reaction to the anesthetics, was stabilized and then sent to Saint Joseph's Hospital. They don't know why she died.

"It’s a terrible, terrible tragedy honestly and our thoughts and prayers are really with the family right now," Thompson said. Thompson said staff members at the center were well trained and have years of experience.

"We’re committed to helping kids every single day. That’s our mission, that’s why we’re here. It’s risky. Not everyone wants to do it," he told Fox 40.

The Dental Board of California released the following statement:

"The Dental Board of California is aware of the tragic situation. An investigation is underway so specific details of the case cannot be shared at this time.  Consumer protection is the board’s highest concern and we want to extend our deepest sympathy to the family."

The Stockton Police Department is also investigating. Spokesman Joseph Silva says at this time the case isn't suspicious or considered criminal, but it is still an active investigation.

According to ABC10 Children’s Dental Surgery Center is a non-profit ambulatory surgery center located in the 1500 block of East March Lane in Stockton.

Really? Non-Profit? Hmmm…

Staff according to Children’s Dental Surgery Center website:

According to his LinkedIn page Perry Solomon, MD is an Anesthesiology and Cheif Medical Officer at HelloMD, described as:

“HelloMD is the leading digital healthcare platform for the cannabis industry. Patients use our service to connect with a doctor, get a medical cannabis recommendation over live video (Telehealth), and gain seamless entry to thousands of cannabis products, dispensaries and advice on medicinal efficacy.
We are the largest reliable source for cannabis information about medical conditions and products, have our unique platform called Answers where questions are posted from all over the world and are answered by our physicians, product manufacturers and other patients, building a community of like minded people.”

Solomon’s LinkedIn page also says he is:

• Medical Director at Children’s Dental Surgery and Central California Dental Surgicenter.
• Medical Director for Cardiac Rehabilitation for Tenent Healthcare
• Owner of Bridges Mecical Clinic

Sung “Caleb” Cho, DDS operates Ygnacio Dental in Walnut Creek, CA.

Looking at Children’s Dental Surgery Center website, for reasons unknown the title of the page linked to the Patient Information Packet is Sierra Kings Dental Surgery. Huh?

Since search the business entity names at the California Secretary of state site revealed zero results for the company names, a little more research finds Central California Dental Surgery Center is actually US Dental Surgery Center, Inc. incorporated in March 2008 by Philip Goldberg.

March 2015 annual report at the California Secretary of State’s website shows US Dental Surgery Center is owned and operated solely by Carol E. Freeman, 429 Chateau Grimaldi, Mandeville, Louisiana 7047. Carol E. Freeman appears to be a licensed Psychologist in Louisiana doing business as CAROL E. FREEMAN, PHD, LLC

The January 1, 2017 annual report for US Dental Surgery, Inc shows no change and Carol E. Freeman still listed as “owner”.

So what in the hell is a psychologist, from Louisiana doing operating dental surgery centers in California?

And exactly what is this “referral partnership” between her and Smiles Depot, Northern Valley Indian Health, Western Dental, Charter House, Shasta Community Health Center, Fremont Dental, Access Dental and ProDental, as shown on Children’s Dental Surgery Center website?

Texas State Board of Dental Examiners Loss of Investigators and Staff, is Michael Melanson’s Gain

 

By: Debbie Hagan

 

Reports abound this week about the Texas State Board of Dental Examiner’s finding insufficient  of wrong doing by Dr. Michael Melanson as it related to the death of Daisy Lynn Torres:

AUSTIN (KXAN) — The dentist who was treating a 14-month-old girl for cavities when she died after going under anesthesia has been cleared of any wrongdoing by the Texas State Board of Dental Examiners.

Dr. Michael Melanson was working on Daisy Lynn Torres’ teeth at the Austin Children’s Dentist in northwest Austin on March 29, 2016 when she suffered complications and died. The child’s autopsy report ruled that anesthesia caused her death.

There was an anesthesiologist on-site during Daisy Lynn’s appointment, according to a 911 recording and a spokesperson from Austin Children’s Dentistry. However, what as at issue in a lawsuit is a portion of the autopsy including a report from a forensic dental examiner, Dr. Robert Williams. The report questioned why the child was having a dental procedure before she died. The report prompted Austin Children’s Dentistry to suspend Dr. Melanson, who no longer works at the practice, last July.

At the time, the dental office said he would remain suspended until the State Board finished its investigation.

Read entire story here.

I think the keyphrase here is “finshed its investigation”. 

Melanson’s attorney Mike Yanof said, “The dental board has closed its investigation and they found insufficient evidence to support proceeding further in the matter.”

Could that be because there are no investigators left to investigate? The last Lieutenant Investigator, Travis Mott, took a demotion back to Sergent and Kelly Parker has “decided to make investigators file clerk, arranging fild folders for the Dental Review Panel, according to once source.

One reader wrote:

I am seething upon hearing this, as there was testimony in the autopsy report by forensic dentist Dr. Robert Williams that no dental disease was present upon autopsy of Daisy Lynn Torres. The child need not have been administered general anesthesia or subconscious sedation to the level to create death.  While the dentist may not have caused the death, the circumstances that precipitated the death surely involved the dentist's and clinic's actions to cause a surgical procedure to be done. If the TSBDE foing "no evidence," what about the misdiagnosis of dental disease in the name of bilking Medicaid?

The civil lawsuit will, no doubt, march ahead.  However, given the past evidence of this dentist's shaky affiliations and representations of skills, competency, fraudulence, and ill-will, the TSBDE just didn't look. Just as they glazed over my claim...they are toothless.

I agree.

Texas State Board of Dental Examiners: Decaying Rapidly Under Direction of Executive Director Kelly Parker

By: Debbie Hagan

DTM has learned that in recent weeks the following people have submitted letters of resignation or already ended their employment with the Texas State Board of Dental Examiners(TSBDE):

1. David Durkop, Lieutenant Investigator for Texas Dental Board;
2. Greg Gilchrist, Lieutenant Investigator for Texas State Board of Dental Examiners;
3. Donnie Head, Assistant Director of Investigations at Texas State Board of Dental Examiners Jones, Director of Investigations;
4. Lisa Jones, Director of Investigations, and;
5. Jeff Roach, Lieutenant Investigator for Texas Dental Board

Additionally, other than the Legal Division, every department head has walked out and quit without notice, including the Licensing Department head.

So what happened to the already troubled TSBDE?

Ms. Kelly Parker is what happened.

The TSBDE hired Ms. Parker as the new Executive Director in September 2015. Then they gave her Cate Blanche to run the board as she saw fit and things changed drastically.

Prior to Kelly Parker’s hiring the standing Orders from Director of Investigation Lisa Jones to the board investigators were to share anything they had with other law enforcement agencies.

Parker quickly changed that and demanded that she give her stamp of approval the sharing of any and all information with other agencies—law enforcement or otherwise.  If agencies called investigators requesting information, they were to be directed to the Legal Division, pronto.

Parker is not focused on public safety, not justice, not oversight nor fair resolution. Parker's focus is on "Days to Case Resolution”, nothing else.

“Days to Case Resolution” is how the Board is rated by the Legislature as well as internally by the Board for the Investigative Division. The speed of the case is much more important than the quality of the case. Criminal cases take more time and manpower than Administrative cases, resulting in few, if any, criminal cases being worked.

Additionally, despite it being a violation of Texas law, the Legal Division decided that the DSOs could own, operate or maintain a dental office as long as the DSO did not direct clinical care. We all know that never happens, right?

Gosh, wish I could just decide to change the speed limit law to suit me on any given day.

Throwing another turd in the proverbial punchbowl, was Parker’s insistence that a new database go “live” on September 1, 2016, the beginning of the fiscal year, ready or not.

It was not!

There are two databases: Versa(VR) and Paper Vision(PVE) that are supposed to “talk” to each other, so to speak, and work with the Health Care Professional Council, which consists of 5 agencies; the board of dentistry being one of them.

There are no Standard Operating Procedures in place and the databases being incompatible with each other which means all data has to be entered twice; once into VR and again into PVE.

PVE was so not ready investigators learned for months all the data entered and reports marked “approved” that was to send the matter on to the next “work step” it went to a virtual “dead letter box”.

Why?

Because the next “work step” had not even been created yet! That’s right, folks, it went nowhere and to no one!

Talk about waste of time, money and resources!

With the recent departure of supervisors, the Board has lost close to 40 years of dental investigative experience and over 100 years of law enforcement experience. This is not a common investigative skill set and can take several years to develop.

Texas State Board of Dental Examiners Refers Investigation to Local Police Departments. Should People Just Call 911 Bypassing the Board Completely?

By: Debbie Hagan

Last week, News 4 in San Antonio, Texas ran a story about how the Texas State Board of Dental Examiners farms out it’s duties to the local police station instead of investigating themselves. Thanks to a tipster, who says the dental board isn’t the least bit interested in making any changes, I’m publishing the story here, not to critique the story but to comment on the luncy of the content.

Dental board refers out criminal investigations

by APRIL MOLINA

March 14, 2017

“The Texas State Board of Dental Examiners receives dozens of complaints each year; among them, drug diversion and addiction, practicing dentistry without a license and dentists performing unnecessary work.”

Uh, I would say it’s more like hundreds of complaints; maybe even thousands.

"It is I think appropriate that the dental board evaluate all complaints and if they find wrongdoing, either civil or criminal, then it's incumbent upon our dental agency, our dental board to take action," said Texas State Senator Charles Schwertner.”

The citizens of Texas think the board should as well, but over the last several years, I think they have seen the dental board take less and less action. In fact I would say the TSBDE is the least effective of all dental boards, well maybe other than California.

“The dental board has always investigated the administrative side of complaints and for more than a decade board investigators have also had the ability to conduct criminal investigations, often handing cases over to the local district attorneys for prosecution.”

"In hopes of protecting my community and protecting the citizens of Texas I passed this bill that gave them the capacity to have licensed peace officers," said State Senator Jose Menendez.

Menendez's 2003 law enabled the dental board to hire experienced dental investigators with the authority to investigate criminal cases without delay.”

Apparently the TSBDE were not doing their job in 2003 either! Over 14 very long years later, the Texas State Board of Dental Examiners have had the full force for the law behind them to investigate criminal acts of dentists? WOW! Who knew, right? I bet Lisa Jones, the Director of Investigations, should, could and would put the handcuffs on the criminals.

“In late 2016, a whistleblower tipped off the News 4 Trouble Shooters that a decision was made to re-direct criminal investigations at the end of 2015.”

“Re-direct” to where? To be “re-directed” they have to have once been “directed” to someone or someplace, right?

“3 months after Executive Director, Kelly Parker, took over, the director of investigations sent out this email to staff: "Per Kelly, as of today, we will no longer investigate the criminal aspects of a complaint. We will not be filing cases directly with the D.A. any longer. If you have a case with a criminal element, work the administrative side of it and refer the criminal elements to a local police department with jurisdiction."

Say what!! 3 months in and she took this approach? Who hired this Kelly Parker, anyway? And who is she to decide? Clearly, the ED has way too much power. Who’s directing the Director?

At a hearing of the Committee on Public Health in 2012 Lisa Jones, Director of Enforcement for the TSBDE stated she had been with the board for 10 years and Director of Enforcement for over 7. At the hearing Jones stated there had been 153 case of fraud reported and only 5 dentists in 5 years had their licenses revoked or voluntarily surrendered. When asked about cases turned over the local District Attorney’s Jones stated in the last 2 years they had turned over 200 cases and only 5 had some sort of conviction. Lisa Jones is still the Director of Investigations.

The Executive Director at the time was Glenn Parker, who couldn’t attend, but sent a letter. Committee Chair Lois Kolkhorst read from a letter sent in by Glenn Parker, where he made it clear local District Attorneys were reluctant to prosecute these cases, since murders and such took precedence. So, are you telling me, Executive Director of the Texas State Board of Dental Examiners, Kelly Parker, thinks sending a file over to the local cop’s desk would get better results!

SERIOUSLY!!

Kelly, hon, you have a Director of Investigations, right there in your office. I bet you see her at least one or two times a week. She gets paid to “investigate”. Yet you believe you and your office staff are just too busy with ….uh…work….uh… so important that the local police station should do it! I can’t even get my head around that!

Where are you going to “re-direct” the investigations next, the local dog catcher’s desk?

“Parker would not agree to an interview, but sent us this statement: "Other agencies exist for the purpose of pursuing the criminal violation and it would be wasteful and redundant for the dental board to do so, too."

Well, Good God Almighty! Taxpayers wouldn’t want any ‘waste”! (sarcasm)

Ms. Parker, for years, those same agencies along with the state legislators—and the public— have been asking why your agency has done little to nothing to take care of dental related crimes and violations. Earn that $92,000 a year, darlin’! Now, there’s some “waste” for you to ponder.

Facts Reveal ALEC “Overregulation Threatens Market-Driven Solutions in Dentistry” Study is Pure Crap!

By: Debbie Hagan
The below story was posted on Group Dentistry Now; the propaganda machine for the Dental Support Organization(DSO) industry. I first called the whole story “horse shit” but I was wrong—when I’m wrong I’ll admit it. I now need to make that correction and rephrase; it is utter “bull shit”. And this ALEC (American Legislative Exchange Council), well, it’s the “horse shit”. (see ALEC Exposed) and has been under scrutiny for a very long time; some questioning if is even legal—google it. Of course this makes it a perfect match for the DSO industry, right?  ALEC chairman of the board is Mr. W. Preson Baldwin, from the lobbyist group Centerpoint360, which received $442k from the Association of Dental Support Organizations in 2015. (see page 8 of the ADSO tax return) Centerpoint360, received $268K in 2014. Now read the story with the hidden facts revealed. When you are finished ask yourself this: “If it’s so overregulated, why are three of the four examples listed, citing state legislation or regulation was only “sought” and not passed or simply withdrawn completely. Sounds to me like the title should have read “Underregulation Boosts Market-Driven Solutions in Dentistry”.

Posted By: GroupDentistryNow March 16, 2017
The American Legislative Exchange Council (ALEC) recently published a 12 page research paper entitled, ‘Overregulation Threatens Market-Driven Solutions in Dentistry’.  ALEC is America’s largest nonpartisan, voluntary membership organization of state legislators dedicated to the principles of limited government, free markets and federalism. Comprised of nearly one-quarter of the country’s state legislators and stakeholders from across the policy spectrum, ALEC members represent more than 60 million Americans and provide jobs to more than 30 million people in the United States.
In the paper, the author, Mia Palmieri Heck, discusses and analyzes the increasing regulatory and legislative efforts to restrict and even ban dental support organizations in several states.  The ALEC study points to the many benefits of dental support organizations, including increased access to care, lower cost of providing that care, and better patient outcomes when dentists are free from the distraction of non-clinical (support) activities. For a list of clinical (services only a licensed dentist can do) versus non-clinical activities (duties which may be provided by a non-dentist), please see graphic below.
Even with all of the aforementioned benefits, dental licensing boards in several states have tried to limit or restrict dentists’ ability to contract with a dental support organization through regulatory and legislative means.  The main function of a state dental licensing board should be to protect paients from harm, as well as to monitor, regulate, and oversee the licensing process.  The licensing board should not be in the business of creating anti-competitive regulations and legislation to benefit and protect the solo practice owners that may sit on the board.
Example of state overregulation of DSOs:

• North Carolina – [2015] The Unites States Supreme Court ultimately confirmed the findings of a lower court that the NC Board of Dental Examiners had unreasonably restrained trade in violation of the federal antitrust laws.
• Texas – [2014, 2015] The Texas State Board of Dental Examiners proposed new rules restricting the ability of dentists to enter into contracts with ‘unlicensed persons’ for non-clinical functions.  The board also tried to expand its authority to take disciplinary action against dentists who chose to contract with a DSO.  The board received numerous public comments and letters protesting these proposed rules, including a letter from the Federal Trade Commission.  These proposed rules were eventually withdrawn by the board.
• Maryland – [2014, 2016] Maryland’s state board tried to adopt regulations making it nearly impossible for DSOs to operate in the state, even though dental support organizations have operated in Maryland for decades.  The MD administration did not approve these regulations, so the MD state dental association and board of dental examiners sought legislation restricting the business functions a DSO could provide.
• Wisconsin – [2015]  The Wisconsin state dental association sought legislation that would give the dental board authority to regulate dental support organizations on matters related to non-clinical activities.  The bill did not pass mainly due to state legislators, many of whom are members of ALEC.

Mia Palmieri Heck
Heck is Director of ALEC’s Health and Human Services Task Force.  She leads the nationwide effort to promote free-market, pro-patient health care reforms at the state level. In her immediate past position she served as an executive at a Texas-based child and family services provider, where she led the strategic planning and program development efforts for the agency.
To review the entire study, which is the source for the majority of the content in this piece, click HERE.

See all of the ADSO tax returns here

Comfort Dental Agrees to Washington State Permanent Cease and Desist

 
By: Michael W Davis, DDS, Guest Contributor
Dr. Michael W. Davis maintains a general dental practice in Santa Fe, NM. He serves as chairperson for Santa Fe District Dental Society Peer-Review. Dr. Davis also provides a fair amount of dental expert legal work for attorneys. 
 
 



Comfort Dental Group, et al, a Colorado corporate dental entity has signed and accepted a Consent Agreement (permanent cease and desist order) with the Washington State Department of Health, on February 28, 2017. Comfort Dental admits engaging in the unlicensed and unlawful practice of dentistry. Comfort Dental was active in the sales and management of so-called sub-franchised dental practices, outside the bounds of Washington statutes.

Unlicensed parties, and not duly licensed dentists of dental practices, were selecting dental laboratories for patients, dental supplies, office supplies, & janitorial services. The dental corporation's restrictive covenant on doctors was deemed overly restrictive and outside the bounds Washington statues. Further, Comfort Dental's restrictions on the ability of a doctor to transfer their practice ownership was also deemed unlawful. The 5% "royalty" fee Comfort Dental charged licensed doctors on gross collections was determined unlawful, as it allowed Comfort Dental an excessive beneficial ownership in dental practices.

Respondents of Comfort Dental agreed to Pay a fine of $340,000, agreed to the permanent cease and desist order to discontinue their unlicensed and unlawful practice of dentistry in Washington, and reform each of their Washington State dentist contracts to comply with state law.
Reporter's note: This outcome in Washington State, in which the dental profession, public and state government stood up for consumer rights, is in stark contrast to Colorado. In Colorado, the dental profession and state legislators capitulated to the interests of corporate dentistry and Comfort Dental.

February 28, 2017 - Comfort Dental Stipulation and Agreed Order with Washington Department of Health

Reporter's note: Here's an interesting facet to this story. If Comfort Dental fully complies w/ their consent agreement w/in an allotted time frame, their $340,000 fine will be reduced to $25,000. However, in public record evidence submitted in the earlier legal action of Drs Carl & Craig Bahr, verus Comfort Dental, et al. (case now settled & sealed), in an email from Comfort Dental founder & president Dr Rick Kushner, he stated that w/out control of the dental lab, Comfort Dental wouldn't be viable as it is today (loss of corporate control & money). It seems the Comfort Dental business model (as it exists today) may collapse, w/out control of the lab & mandatory lab utilization by franchisees (dentists). This is seemingly at distinct odds w/ expressed terms of the settlement w/ WA State.
Evidence of the earlier cited civil case clearly demonstrated problematic issues w/ the mandated dental laboratory, which was operated by Dr Kushner's brother. One might assume doctors would be free to select what dental lab operated in their patients' best interests. However, that's almost NEVER the case w/ corporate dentistry.
So, now it will come down to a serious effort at state enforcement. Is the WA State AG's office a paper tiger, or a true protector of the public interest & enforcer of the rule of law? We'll see..
Related: TOXIC TROIKA FOR DENTAL PATIENTS

Lawyers battle over whether dental procedure was necessary for child who died

By: Jennifer Kendall
Posted:Mar 08 2017 10:28PM CST
Updated:Mar 08 2017 10:28PM CST
Wednesday, lawyers argued in district court about whether a 14-month-old who died after a dental procedure in North Austin actually needed dental work done.
A medical examiner's report said Daisy Lynn Torres died due to complications of anesthesia, but part of the report has led to a defamation lawsuit against a forensic dentist
Read the entire report here

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Dr. Michael Melanson was an employee of Austin Children's Dentistry, whose President is Brian J. Peters.

Searching the address Brian J. Peters has listed returns results for Southern Pecan Plantation Manufactured Housing Community, owned by Peters’ parents, Robert and Carol Peters.

Whistleblower claims Dental Authority used Restrictive Advertising Guidelines to try to Curb Overzealous Cosmetic Training Program

Special Report:

Did a Canadian Dental Authority have serious concerns about a training program that promoted Cosmetic Over-treatment of Patients and look the other way due to a business relationship?

Red Deer, Alberta, Canada- Former dental council member dentist-author Michael Zuk DDS is asking the Health Minister to look into concerns with connections between a harmful 'cosmetic dentist' training program in the USA, a Canadian dental lab and the Alberta dental authority. According to the general dentist, Canadian and American dentists were brainwashed into flying their patients to Las Vegas for irreversible and sometimes harmful cosmetic veneer makeovers where the professionals were unlicensed and unlikely to be covered by malpractice insurance. He claims the local authority looked the other way due to a close business relationship with the primary dental lab that profited from the additional porcelain work. The dentist was contacted by a victim who had complications after aesthetic treatment within this training program sharing that her complaint was ignored by the authority and this inspired him to speak out about the problem. The dental authority retaliated after Zuk published his book Confessions of a Former Cosmetic Dentist in 2010 with fears the truth would ‘harm the reputation of the dental profession.’

The dentist claims the dental authority decided to make an example of one dentist who had been a known attendee of the cosmetic training program in spite of the fact that she did the right thing in recommending a less aggressive treatment alternative of orthodontics instead of ‘instant ortho’ with veneers. The known risk of more aggressive crown/veneer preparations to straighten teeth is root canal complications, and when this occurred after the patient refused traditional orthodontics, the dental authority had the opportunity to indirectly address the concern. Dr. Zuk suggests the dental authority should known patients have the right to accept treatment alternatives with higher risks after they have been provided with the choices. No treatment is without risks and even orthodontics can result in damage to teeth so a exhaustive war against one ‘cosmetic dentist’ was unwarranted and an honest discussion within and outside the profession should have been made. 

A second indirect action against the wave of cosmetic dental mania was against the use of the term ‘cosmetic dentist’ and office trade names containing the words ‘cosmetic dentistry’. Another dentist was selected to be disciplined for this concern, which is usually considered a practice preference or area of interest and not professional misconduct. Again the dentist was found guilty and suspended.

The third attack related to cosmetic dentistry was against Dr. Zuk’s book claiming the authority did not protect the public from over-treatment and his promotion of a more conservative cosmetic treatment called ‘shorter term orthodontics’. The dentist was found guilty of professional misconduct and the complaint director who was also suing the dentist for $3M for criticism of her performance recommended a suspension of 5 years and costs of $270,000 even though no patient complaint was involved. While the council and appeal committee reduce the actual term to 12 months and approximately $176,000 CAN this was still an amount that would lead the author to appeal to the court system.

The problem with sponsored training courses was not isolated to the dental profession, and as an example physicians realized their treatment recommendations were affected by educational programs backed by certain pharmaceutical companies. Bias is a common problem with programs and research that supports the information may be tainted by financial interests. Besides cosmetic dentistry, most dental services are affected in some way by the promotions of the products and services within the dental industry including lasers and less exotic gizmos that may or may not make treatment safer, more affordable, faster or better.

So to summarize, the dental authority had a concern with a particular cosmetic training program, then suspended a dentist whose patient had a few non-life-threatening complications that were known to be relatively common with the treatment provided, then suspended a dentist who named his practice a ‘cosmetic’ dental office and then suspended a dentist who wrote about problems with cosmetic dentistry and promoted less aggressive alternatives that are used across the globe. The authority had published an internal document written by Dr. Gordon Christensen titled ‘I Have Had Enough’ which profiles the US prosthodontists concerns about the cosmetic dentistry becoming ‘a monster, promoting irreversible treatment on patients’ but the dental authority refused to admit that the public interest was more important than the integrity of the profession. 

In his latest e-book ‘The Ugly Truth about Cosmetic Dentistry’ currently available at no cost through a link on the website AlbertaDentalAssociationProblems.com, Dr. Zuk shares the connection between the dental authority and the suspect dental training program which, according to a malpractice lawyer in San Francisco and an expert witness, was associated with numerous cases of gross over-treatment of unsuspecting dental patients.

The dentist claims dental authorities had misgivings about this specific cosmetic training program but did not take any steps to warn the public, and this according to Dr. Zuk, has been confirmed in writing by a former high level executive from the dental authority. “Instead of taking this problem public, the dental authority addressed the concerns about aggressive promotion of veneer treatment with an elaborate mess of advertising guidelines that banned dentists from discussing the courses attended, use of the terms like ‘smile makeover’ and forbidding dentists from using before & after photos of dental treatment. The authority was clearly were more worried about harming the relationship with the dental lab owner who they awarded with an honorary membership in the dental association than they were with the harm caused to dental patients. The financial support of this large Canadian lab allowed the training program to reach out to dentists and patients across North America. While many patients were likely pleased with their new smiles, many could have been treated with less expensive and less risky alternatives with comparable results. Many cosmetic dentists are not treating patients with bleaching, bonding and braces rather than veneers. Veneer treatment can be the best or worst treatment choice, but the training program at the time was pushing porcelain as a cure-all and many patients were harmed physically and financially in the process,” says Zuk.

The outspoken dentist who appeared on an investigative television program CBC Marketplace- Money Where Your Mouth Is -where a 15 year-old girl was told by a different dental professional that she needed most of her health teeth ‘capped’ due to some sensitivity that was later treated successfully by Dr. Zuk with Sensodyne toothpastes. Zuk notified the provincial Health Minister and the Competition Bureau of Canada with numerous concerns with about the dental authority’s mismanagement, excessive advertising regulation that limits competition and lack of whistleblower protection. Dr. Zuk is planning a documentary on the subject and is interviewing patients who were flown to Las Vegas for cosmetic dental treatment during the 1990’s and dentists who attended the program and now regret some of the treatment that was promoted.

For more information contact Dr. Michael Zuk directly at 403-347-8008.

Significance of Criminal Indictment to Dr. Edward R. Hills

Significance of Criminal Indictment to Dr. Edward R. Hills

By: Michael W. Davis, DDS, Guest Contributor

Dr. Michael W. Davis maintains a private general practice in Santa Fe, NM. He also advocates for disadvantaged citizens, and provides expert legal work for numbers of attorney clients. His publications and lectures are on ethical and whistleblower issues within the dental profession, as well as numbers of clinical research papers. 
 
 
 

Dr. Edward R. Hills was formally indicted on October, 19, 2016, by the US Justice Department for a variety of alleged criminal violations, in US District Court for the Northern District of Ohio (Eastern Division). Co-defendants included three other dentists, Drs. Sari Alqsous, Yazan B. Al-Madani, and Tariq Sayegh. The government contends Dr. Hills and other defendants engaged in a variety of actions inclusive of Medicaid fraud, bribery, extortion, interference in a federal investigation, witness tampering, tax fraud, defrauding of a non-profit hospital, an interstate kickback scheme, and racketeering. The government also invoked claims of Racketeer Influenced and Corrupt Organizations Act (RICO Act) violations. The indictment was laid out similarly to an action against an organized crime figure and their subordinate mob crew. [Click here to read 93-page, 33-count indictment: https://assets.documentcloud.org/documents/3178765/MetroHealth-Indictment.pdf ]
 
Dr. Hills formerly served as chief operations officer (COO) for Cleveland’s MetroHealth Hospitals from 2010-2014. During that tenure, his salary ranged from over $400,000 to just under $3/4 Mil per year. He also served for 6-months as interim chief executive officer (CEO), following a previous scandal and resignation by Mark Moran at MetroHealth. In this capacity, Dr. Hills had direct supervisory control of the dental residency post-graduate program (which the three other defendants directly ran). Dr. Hills also served on the Ohio State Dental Board from 1999-2008. From 2001-2004, Dr. Hills was the president of the state dental board.

Alleged Extortion of Dental Residents
The government contends foreign national doctors were shaken down (extorted) for cash to apply to the dental residency program at MetroHealth. They were further extorted for additional cash to maintain their dental residency positions. Residents were also forced to work for no compensation, at two private clinics owned and operated by two of the defendants (Noble Dental Clinic & Buckeye Family Dental).

Many of the dental resident doctors were Jordanian citizens, and required an H1B (green card) work visa to obtain an Ohio dental license. Without a green card visa sponsored by an employer (Dr. Hills and/or his crew), these doctors were not eligible for licensure, as they were not US citizens. Obviously, these dental resident doctors were in a particularly vulnerable position.

Double Dipping
Two dentists of Dr. Hills’ crew were allegedly accepting full-time incomes from MetroHealth, as preceptors of the dental residency program, and at the same time running two large scale private dental practices. These were the same private dental clinics were resident doctors were allegedly required to deliver patient dental care, without compensation. These same two crew members allegedly benefited unlawfully, by having MetroHealth fully pay their malpractice insurance premiums.

Dr. Hills allegedly authorized substantial bonuses from accounts at MetroHealth for these two alleged dentist conspirators, in their frequently no-show supervisor jobs (under $93,000 in 4 years). In exchange, payoffs were allegedly afforded Dr. Hills. Kickbacks allegedly included a lap-top and an apartment to entertain Dr. Hills’ girlfriend, bedroom furniture, cash (hundreds of thousands of dollars), a Louis Vuitton briefcase, airplane tickets for the lovers, a flat screen TV, and controlled prescription medications (exact medication name redacted from indictment).

Lawsuit Filed Against Dr. Michael Melanson et. al. Over Death of 14 Month Old Daisy Lynn Torres

 

 

 

Thursday, March 02, 2017 09:26AM

AUSTIN, TX (KTRK) --

The family of the 14-month-old girl who died after a visit to the dentist has filed a wrongful-death lawsuit against Austin Children's Dentistry.

The toddler died while under anesthesia for multiple baby root canals and crowns on four of her teeth.

Her parents believe it was part of a Medicaid scam and are suing the dentist and the anesthesiologist who worked on her.
The cause of death of Daisy Lynn Torres, who died on March 29, 2016, was determined to be the result of anesthesia administered for the treatment of tooth decay, according to the Medical Examiner's Office.

"We haven't heard much, so we are kind of just taking action here, getting some answers so we can get some justice going on," said Elizandro Torres, Daisy Lynn's father. "We want this to be heard so that it doesn't happen again." …

 

…The lawsuit claims the girl's death was part of a corporate scheme to bill Medicaid for unnecessary dental procedures. Her parents are now suing for $1 million. Their attorney, Sean Breen, told us Tuesday night they hope this lawsuit will protect other children from the dangers of pediatric predators and their money-making schemes.

"A big component of people that use Medicaid happens to be people who are low income and sometimes not as formally educated as others and they make for very good targets because they are trusting," said Breen, with Howry Breen & Herman.

Breen says other families have come forward saying their children were also underwent unnecessary dental work at Austin Children's Dentistry…

Read the entire ABC 13 story here.

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More on Dr. Michael Melanson

Dr. Melanson was the fake owner dentist for non-dentist Brian Lynne Walker who owns North End Healthcare, LLC. North End owns and operates 3 ambulatory surgery centers (ASC): Houston Children’s Dental Center, San Antonio Children’s Surgical, and DFW Children’s Surgery Center. All designed exclusively for sedation dental procedures. In fact the website of these clinics list their “privileged” providers and they are only dentists, oral surgeons and endodontists. April 29, 2016, exactly 30 days of the death of Daisy Torres, North End Healthcare began to change its name to Blue Cloud Pediatric Surgery Centers and scrub Dr. Michael Melanson’s name from their website;, replacing Melanson with Dr. Ketan Sukkawala as “owner”.

Being Melanson works for a group that owns surgery centers one must wonder why he didn’t use one of those facilities. Or at the very least understand the need to sedate babies somewhere other than his office!