Friday, March 09, 2012

Virginia Regulatory Town Hall–Board of Dentistry is holding an open meeting today concerning a rule change requiring training in the 6 Links to Survival

March 9, 2012
Virginia Regulatory Town Hall website

First I want to say that I understand “good” reasons when someone opposes something. There are always two sides and views to everything. It’s the lame and idiotic excuses that gall me to no end.

Today is the 5 year anniversary of Raven Maria Blanco’s death. Raven died because a dental office was not prepared for a medical emergency. 19 children have died in the last five years from ill-prepared dentists and staff, when 6 common sense steps could have made the difference.

Comments from the public closed on February 19, 2012.  Below is a sample of those who sent comments opposing the rule change. 

These are copied and pasted as they were posted on the regulatory agency website. My comments are in [italics and brackets]


Commenter: Watchdog for Coalitions Against The Dental Profession (CADP)

Be Cautious! Don't be Fooled, Don't play into the empathy game!

This Raven Blanco Foundation may be a plublicity stunt to raise funds, that support their self created non profit slary jobs. Everything about their web site is very exploitive. They list no financial discloures, no board of directors/advisors. They are certainly following the guide for creating an issue that will bring them money and influence, and as they say power. And like all these nonprofits, they appeal to ones suffering to gain support.  They can be dangerous, just like all of our local dental nonprofits, run by non dentist, unlisenced advocates if you will, who want to be policy makers over dental matters of which they are trully ignorant. I would question the credibility and intentions of this group. Leave the emotional baggage out of any descision making. Dont treat victims as equals, they are not!

[ Apparently the group has problems with “unlicensed” citizens advocating for change in events that directly affect them. This is confusing to me. Who else would advocate for change? Those unaffected?  Financial “disclosures” are available online and Mr. Blanco, President and his Executive Director who puts in about 50 hours a week draw ZERO dollars from the foundation!  ZERO!  Rather, Mr. Blanco gave a large some to the foundation! Yes, I would question the intention of this group as well, since you will be amazed at what you find. You’ll also find out what wonderful people they are and how much they help other parents whose children are killed by ill-prepared dentists who are sedating children. They assist with emotional support, and financial support.  Helping families with funeral expenses or organize fundraising.They travel to every dental convention they possible can and promote safety in sedation dentistry. How can anyone be faulted for promoting safe sedation of children? The spokesperson for this group sounds as though they know the Blanco’s, are locals and have an ax to grind.]

Commenter: Dr. E. Thomas Elstner, Jr.

Training for medical emergencies

There should be provisions for practitioners who do not administer local anesthetics in their office setting.  Currently there is no ACLS focusing on the dental setting.

[if this person is referring to Advanced Cardiac Life Support (ACLS), then with 8 deaths in the last 12 months, maybe ACLS should be focused on the dental setting.  Think?]

Commenter: Dr. Paul W. Callahan

Another costly regulation that does nothing to help public welfare

It is the responsibility of ALL Virginia Regulatory Boards to protect the public.  Any death is is one too many, but statistically it is probably safer to go to the dentist that cross the street.   These proposed regulations are already the Standard of Care in most offices.  A regulation such as this would cost hundreds of thusands of dollars for most practicioners to follow; meaning the time spent documenting training, paying for training for a large staff when not everyone needs to be trained at the same level, etc.  So who pays for all this unnecessary documentation and training?   The average Virginia resident in the form of increased dental fees.   Is this what we want for our patients?

[This is just a wild guess, but I doubt your patients would mind a slight increase in your fee to know you were prepared to save their life if an emergency arose.]

Commenter: Dr. Elaine Sours

Oppose renewal of license linked to new requirements

I would oppose action by the Virginia Board of Dentistry to adopt the Petition for Rule-making with conditions to seek renewal of a dental license.  It is government interference and micro-management to demand  blanket compliance.  Dentist are caring and  compassionate  health care providers who already overwhelmingly  meet the emergency needs of our patients without a Board mandate.

Commenter: Dr. Erika C. Mason

I oppose mandatory training and equipment for the dental practitioner

I think that we as dentist are already prepared and trained to handle emregencies in our dental practices and this is just another goverment hoop that we will have to jump through at the expense of our patients. Although it is unfortunate that there were 2 deaths, the percentage of dental procedures daily in thousands of offices prove that we already have a handle on the protocol of handling emergencies in the dental offices. There is already the law in place for those that do sedation to have certification via the DOCS program so I think that is more than adequate to take care of our patients in the case of a medical emergency. Maybe let's focus on better health histories, refusing to do a procedure if blood pressures are at a certain level, and be more proactivce but not reactive in more training. We are already trained. Maybe the Board of dentistry should supply us with a "standard medical history" that makes sure it asks all the right questions, or a standard medical history update each time the patient comes in. Since we all use our own Medical History forms and updates...maybe that is where the focus needs to be to help us screen better for possible medical emergencies.But you always have the situation that the patient might not supply us with the Complete Truth---so that they CAN be treated and we aren't fully informed of possible medical conditions. I think this is a knee jerk reaction and needs to be weighed out more heavily of "mandated training and equipment" might not be the Best answer! 

[SERIOUSLY?! “The certificate from the DOCS program is more than adequate.”  SERIOUSLY?! I believe this commenter has just proved the point on why this rule change is needed!  He thinks a Saturday and Sunday seminar, in sunny San Diego, is plenty of training and will leave with more than enough preparedness for an emergency.  Even if he does not have a complete medical history or not have other information the patient may have failed to supply. This sounds more like a defense against a future lawsuit than a reason to oppose the rule change.

DOCS training is FAR from enough training to sedate, let alone save the life you just sedated.  DOCS should be illegal and is presently engrossed in more than one lawsuit over deaths and near deaths due to their less than thorough training! DOCS is most likely why this rule change has surfaced. If not for DOCS and others like it, this rule change would not be necessary. This person kept making the argument why this is needed, for exactly the reasons he listed- less then complete information, less then optimal screening.]

Commenter: Dr. Barry D. Laurent:

A noble premise but the devil is in the details. Oppose!

I googled the "Six Links Guide" and my heart goes out to the Blanco family for their tragic loss; however I mirror Paul Callahan's sentiments.  How will the board enforce compliance?  Who  will perform the inspections to police the requirements and what about the need for a search warrant?  Who will pay for the enforcement  and what are the consequences should one fail to abide by  all the requirements?  For example, if a dentist must have a commercially available crycothyrotomy kit ( or stated  alternative ); is he or she then required to use it in an emergency and  what happens  when our  frantic effort  causes more harm before EMS arrives?  Most of us  are  caring professionals, and the "Six Links" provides a noble blueprint for us all; but it should remain a voluntary one.

[I’m so baffled at this one, I just can’t find the words. ..”is he or she then required to use it…”  I guess they are going to be to frantically covering up their mistakes before EMS arrives to worry about any life saving techniques!]

Commenter: Art Halstead

Strongly Disapprove

Has there been any study to indicate that such a new, broad training requirement for dentists/staffs would have saved the lives of those people that died?  There are plenty of solutions out there in search of a home as we've experienced from the dental supply industry.  The true costs in time and dollars and the benefits of a bureaucratic approach do not seem to be a wise investment to me.  The buying -in by the leaders of the dental profession, without exposing the strategic costs, is unwise in today's litigious society with a political leadership that is actually looking for ways to cut costs.  I see this as just another step down the road to making the dental operatory into a surgical suite in the face of a favorable cost/benefit analysis that is not there. There is an ongoing regulation of the solo practitioner out of the profession, for no good moral reasons other than the pursuit of a political power game that having dentists on a Regulatory Board is intended to avoid, thereby protecting all concerned in a strategic sense.

[ Frankly, I’d like to see the regulation be prohibiting all sedation other than in a hospital or surgery center setting! But if they are going to allow it, then for God’s sake use every safety precaution possible, right?]

Commenter: William Dougherty III

oppose- all denists are currently trained in CPR

I oppose the extra regulation. All dentists are already certified in CPR.  Regular re-certification is also already mandated.

[CPR is NOT nearly enough, not even close!]

Commenter: Dr. Flavio W. Nasr

Against Over-regulation

I oppose this proposal for several reasons. First, all dentists are trained in CPR. Second, these rules will not prevent additional deaths. Third, adequate training should be spent in screening patients properly (eventhough patients constantly omit information in their medical histories). Please do not over-regulate. Let common sense prevail. Thank you

[Common sense would tell you to NOT sedate someone in a dental chair after a two day training session, so there goes the common sense theory thing]

Commenter: Dr. Fred N. Kessler

Dentists already know how to respond: Use our CPR Training, have an emergency kit, and call 911!

This petition has no basis in reality.  As dentists, we all know how to respond as indicated in my Subject Line.

[ Evidently CPR is not enough.  20 children, let me say it again, children have dies in 4 years. I’m not even counting the adults! A first aid kit, 911 and CPR simply isn’t enough! If it were then they would be the 3 Links to Survival ]

Commenter: Albert Sasala

Patients already feel dentistry is too expensive; Do we really want to add to the expense?

If you pass this regulation, it is not only going to cause a large financial burden onto us (the practitioner), but also the patients that we see.  We will have no choice but to increase our fees to accommodate these changes.  Aren't  the insurance companies already making things bad enough? Does our own legislature also have to contribute to the publics financial burdens?  Don't let a couple of very unfortunate events cloud your judgement.  How long have Dentists been practicing dentistry and how many deaths have occurred in all those years?  You must look at the bigger picture and not at the smaller one just because you feel pressured by media or whom ever.  Do the right thing and rescind this nonsense.

[ “Nonsense?””  A couple of unfortunate events?” “Financial burden?” Another misinformed person.]

Commenter: Dr. Jon Piche


Adding additional regulations will increase the cost of dentistry.  More importantly, what is the need for additional regulations based on.  Where is the data that demonstrates the need for additional regulation and additional training (well actually proof of training since dentists are trained to handle emergencies)!

[ I’ve got that data for you, click over there on “Meet The Dead Children”, there’s your data.  You won’t find any validated data, because NO ONE wants to know. Or try the list over at, where the person who operates that site was recently threatened to remove the content! ]

Commenter: Dr. Lanny R. Levenson

Against Six Links petition

It's my feeling that the "Six Links of Survival as a condition of continuing licensure" would be an unnecessary burden to place on a dental practice.  We take courses in dental emergencies and emergencies in a dental practice.  Dentists are required to have BLS (CPR) training and some opt for ACLS.  I have been a strong believer and was using gloves & masks, autoclavable handpieces, water line treatment, and AED's  before being required by law. 

Please consider the cost benefit before developing regulations  in a situation where the system is working.

[ The unnecessary burden here is on the families of all the dead.]

Commenter: Dr. R. S. Mayberry

Petition for New Regulations

I am opposed to any more uneccesary regulation, this six steps program is just the latest attempt by someone outside of the profession who has an agenda they are attempting to impose. Currently there is a system in place that will handle any potential shortcomings that unfortunately befall people whether in the dental office or the shopping mall. In this day and age of government interference into the lives of citizens it is time for the profession to realize that we cannot prevent every malady that befalls the public. Life is full of potential disaster, such mishaps happen, and in many cases due to some individuals lack of personal responsibility to prevent their own mishaps. Obviously this is not the situation in every case, but the exceptions to this lack of personal responsibility are so few and far between that the undue regulation of all for the sake of the few if not tyranny is close to it. The times are a changing and the trend is away from such folly not towards more of what has placed us in the dire situation that we all face today. Enough government, we've had enough!

[ FOLLY? This person is actually laying blame on a “mishap” squarely on the patient.  Again, reinforcement why this is necessary. “Few and far between!? What would this person consider “frequent”  Is 8 deaths in 12 months frequent to you, sir?]

Commenter: Dr. Ron Vranas


I am opposed to the additional regulations.  Dentists are already trained to manage emergency situations and, if they are using sedation dentistry, are required to obtain regular recertification to keep emergency management skills current. Thousands of sedation cases are performed every day to a successful outcome.  Additionally, whether we are using sedation dentistry or not, emergency situations arise in dentistry and are managed to a successful outcome due to our current standard of emergency care.  While it is devastating to lose someone in any situation, adding regulations to an already sufficient training protocol will not eliminate these rare events.

[ Now, here is the one who got the memo.  “Always mention the “thousands” of sedation cases done everyday.” ]

Commenter: Stan Dameron

Dentists handling of medical emergencies

I am opposed to this new regulation.while it is very unfortunate these 2 deaths occurred,I do not believe they are necessary nor would they change future unfortunate deaths.  Every dentist I know already is prepared to handle these situations.  I believe it is already the standard of care to be trained and equipped to handle these emergencies in a limited way until EMS is onsite. Even one death is too much, but I don't.think a regulation will prevent future deaths.  To have two deaths in what has to be millions of office visits shows it is less likely for someone to die in a dental office than many ordinary daily activities.

[ Those who kill from lack of lifesaving training, go on to kill again. Not even the death of one patient is powerful enough to make a change in procedures. ]

Dr. Robert J Feild

Strongly against this reg

I would strongly oppose this regulation as not necessary for general dentists not employing sedation in their practice.  Physicians do not have this level of care in their private offices.  This is just another example of increasing the cost of dentistery and hurting access to care.

Dr. W. E. Saxon, Jr.

Oppose Proposed New Emergency Protocol

The death of any patient is a tragedy.  However, it is overkill.  The supporting material makes comments that are designed to support their petition, but are misleading.  The chance that the second death mentioned could have been prevented by these regulations is very remote.   A comment by one of the petitioners that says oxygen is only for non-breathing patients in many dental offices is undocumented and incorrect.

Dentists are under too many regulations already.  I find it ironic that I cannot give a flu shot, but people without my training are allowed to give them.  I cannot give an employee a hepatitis B vaccine shot.  If a rescue squad came to my office and I needed an emergency drug from their kit that I didn't have, I probably cannot have access to it.  After performing CPR for about 40 years, I find the classes to recertify mainly good for paperwork.  I've even had to correct instructors who have taught things incorrectly.

Dentists are trained and can appropriately respond to many emergencies, as well as finding medical problems and making appropriate referrals.  Current regulations on sedation would seem to cover the two incidents cited.  Comments by supporters of this petition that calling 911 isn't adequate is not fair.  When you call a physician's office, almost everyone has the recording that if this is an emergency tohang up and call 911, etc., in other words, don't come to see them.  This petition has the potential to place more advanced training requirements on dentists and their staffs than currently exist in medical offices.  Please dismiss it.

[Just shaking my head!]


Commenter: Brain Hoard

Six Links petition

I am not automatically opposed to a standard, but

1) Who is proposing this petition for rulemaking? Is it a special interest group, as in a group of malpractice attorneys or some organization that "sells" CE or inspection services to offices that want to register compliance? I would like the Board of Dentistry to respond to petitions from dentists, not special interest groups, and respond to petitions because they are a good idea, not because special interest groups have their own agendas,. Recent example: Sedation permit. Who originally pushed for that? I believe it was a malpractice attorney who stated, in the petition, that "most conscious sedation leads to deep sedation"--I have read no data to support this, and I contacted him and asked him to provide me with such data--he could not respond. And, here we are, a couple years later, in the process of requiring a sedation permit for conscious sedation/deep sedation. I'm not against a permit, but the proposal is worded as though the Board bought into his flawed philosophy that conscious sedation and deep sedation are paired together. If anything, conscious sedation is closer to anxiolysis, whereas deep sedation is closer to GA (Don't take my word for it, look at the definitions established by the American Association of Anesthesiologists And, believe it or not, I'm actually in favor of a permit...I just don't like the though processes involved in developing one).

2) If you do this, then I think the BOD has to make sure that systems are in place in the state of Virginia, easily accessible and relatively inexpensive, to allow dentists to be in compliance. You can't just make a rule and not have the the resources readily available to practicioners to support it. (I have the same comment with respect to the sedation permit).

3) If it's a permit process, is this yet another permit fee for the dentists of Virginia? (Same question with respect to sedation permit...)

4) Who will do the inspections? GPs? Oral Surgeons? EMS personnel? (Same question about the sedation permit. We are supposed to be applying for those permits now, without any indication as to what they will require, who is establishing the requirements, and how the "certification" will take place).

Do you think another class should be taken prior to any 6 Links to Survival training?

If yes, what? 

If you said “spelling” then you are a winner!! 



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