Thursday, August 25, 2016

WHISTLEBLOWERS IN ACTION: Dr. Steven Pesis Discusses How Unethical Use of HIPAA Contribed to Patient Abuse at University of Pennsylvania

Dr. Michael Davis
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. He may be contacted via email:
By: Michael W. Davis, DDS

Dr. Steven S Pesis DDS
Dr. Steven S. Pesis studied psychology at Queens College before receiving his DDS at The University of Michigan School of Dentistry. He then received advanced training in general dentistry by attending the AEGD residency program at the Kornberg School of Dentistry at Temple University. During his residency he was educated in a variety of complex dental cases, including full mouth rehabilitations, implant dentistry, esthetic dentistry, Invisalign and dental anxiety. Following his residency, he worked in public health dentistry until he joined the Penn Dental Family Practice at the University of Pennsylvania. He also taught as Clinical Associate in the Department of Preventive and Restorative Sciences for the University of Pennsylvania School of Dental Medicine.
Born and raised outside of Detroit, Michigan, Dr. Pesis is a member of a family of dentists. His father and uncle share a practice in Michigan, while his brother practices in the public health sector for Philadelphia. He hopes to use his knowledge of dentistry and psychology to provide patients with the best possible care, educate future dentists and to further the advancements in the dental field.


Dr. Steven Pesis is a public safety whistleblower, who acted in accord with his ethical and legal obligations to expose patient abuses under the American Dental Association Principles and Code, Pennsylvania Commonwealth administrative statutes under the dental practice act, as well as internal policy of the University of Pennsylvania (U/Penn). As a result, Dr. Pesis alleges he was wrongfully terminated from employment by U/Penn. Dr. Pesis filed a legal action against the Trustees of U/Penn and Peter K. Kauderwood, assistant dean at U/Penn School of Dental Medicine.

See: Suit Claims Penn Dentist Was Fired For Reporting Unneeded Treatment
Dr. Davis: Dr. Pesis, I sincerely thank you for taking the time and effort to address matters of this case. Our readers will fully appreciate you are unable to address certain specifics and details of this issue, because of ongoing litigation. However, could you give our readers an overview and outline of your case? 

Dr. Pesis:Thank you for taking the time to discuss these issues, Dr. Davis. You are a true dental professional, constantly advocating for patients and bringing these issues to the public. The importance of quality care for dental patients, honesty and integrity are the cornerstones of dentistry and should not be overlooked.
My situation began close to a year ago. The Penn Dental Faculty Practice also known as the Penn Dental Family Practice (PDFP) renovated a large portion of a new building at the University of Pennsylvania in order to relocate one of its three offices. The cost quickly began to increase and once completed, the project was rumored to be severely over budget. This office at 3737 Market, known as the University City location, was to be the crown jewel of the PDFP and many of the top producing dentists were transplanted from the other offices to this new location. After all of the commotion, I remained as the only full-time dentist at the PDFP Locust Walk location and I was designated by Dean Denis Kinane of the dental school as the Clinical Advisor for this location.
Shortly after the opening of the new office, the Locust Walk location hired a new dentist in order to fill the void left by the relocation of multiple dentists. During the new doctor’s first few days working at Locust Walk, I received reports from doctors and hygienists that he was extremely aggressive in his treatment plans, over-treating patients as well as billing incorrectly. The clinical advisor from another office also discussed similar concerns with me regarding the new dentist. We both investigated the information and determined that there were real concerns regarding the new dentist’s billing practices and treatments of patients. These findings were finally reported to the clinical director, Dr. Alisa Kauffman. Shortly after the reports were made, I was terminated from employment from the University of Pennsylvania. I was pulled into an office and told that I had violated HIPAA and that I was being terminated from my clinical and teaching positions. I spent nearly an hour explaining that these allegations were false and that everything I did followed HIPAA protocol and did not violate the university privacy policy. One of the last things I said was that regardless of what my fate is, PDFP owes it to the patients to investigate the new doctor’s practices. To my knowledge, no investigation was conducted into the claims that were made and to this day, individuals at the PDFP remain scared to report any wrongdoing by the new dentist for fear of retaliation.

Dr. Davis: The defendants in this case seem to be utilizing patient confidentiality protections under federal HIPAA statutes, to defend their actions. We commonly see corporate dentistry use similar tactics to silence employee whistleblowers. This appears to be a twisted perversion of the intent of the federal statutes. Would you care to comment?

Dr. Pesis: It is my understanding that HIPAA was created to protect patients and their information from being used and abused for purposes to which they would not consent. However, HIPAA has become an intimidating federal law that all health care professionals must navigate. The statute is vast and complicated. It is in place to protect patients, so for anyone to use this law to prevent an investigation into the quality of patient care is inexcusable. In other words, the law that should be protecting patients is being used to prevent the reporting of abuse of patients. That is a misuse of the statute.
The penalties of a HIPAA violation are severe. A health care professional can lose his/her license if involved in a HIPAA violation. Many health care professionals are intimidated by the penalties of a HIPAA violation, so they simply walk away from the situation and try to start over. In fact, I was about to give up until I found David McComb Esq. He immediately saw my situation for what it was, PDFP misusing HIPAA as means of squelching a whistleblower.


Dr. Davis: How did U/Penn School of Dentistry financially benefit from the alleged patient abuses and dentist over-treatmen? Did the patient income generated by the alledged abusive dentist in some manner benefit U/Penn School of Dental Medicine Executive Director of Administration, Peter Kauderwood (a non-dentist supervisor)? Were any directives or actions of Mr. Kauderwood to be considered an unlicensed and unlawful practice of dentistry? Again, much of this activity seems to parallel corporate directed dental healthcare, but by an esteemed dental educational facility.
Dr. Pesis: I was not involved in the administration or privy to the fiscal records of the PDFP while employed by UPenn, so, I can only speculate as to how the school of dentistry and Mr. Kauderwood benefitted from the over-treatment by any doctor. I assume that the money generated from the PDFP is used to supplement the dental school. This money is used by the school to pay for the dental school’s expenses and likely to subsidize the expense of the new office at 3737 Market. As for Mr. Kauderwood, he has risen from the head of HR at the dental school to his current position within the past few years. I assume that he remains in his current position and is given raises in pay financed by the monetary success of the PDFP practices. He appears to measure success by the increased production from the practices. So, when a dentist performs more crowns and other work that is unneeded, the production of the PDFP increases which makes administrators, such as Mr. Kauderwood, appear to be a more successful in their jobs. 
Mr. Kauderwood, however, is not involved in the clinical aspect of the dental practice. That is the job of the clinical director, Dr. Alisa Kauffman. Her job is to oversee the clinical aspect of the practices. She is a self-proclaimed geriatric dentist who works in New York three days a week and only comes down to Philadelphia two days a week to oversee the three practices of the PDFP. Dr. Kauffman reviews all treatment plans that are significant and approves or denies the treatments offered by each dentist. She often will not approve a treatment plan until more treatment is added to the plan.
Dr. Davis, if you see many parallels between the PDFP and corporate dentistry it might be due to the board of overseers of the practices. I have been informed that the board of overseers of the PDFP is composed of multiple individuals, some of whom own multiple offices and manage them as corporate dental practices. I believe that these individuals have been pushing for a more lucrative practice. Usually this is achieved by forcing dentists to perform more work. However, most dentists in the practice have extreme integrity and would not agree to performing more work than is needed.

You are also correct in stating that this is not typical practice for a high level educational institution. The PDFP practice at Upenn has not always operated in this method. It is only in recent years that they have changed from a patient-centered practice to what appears to be a money-centered practice. I believe that patients can feel the difference and the practice will end up suffering because of this misstep in management. Hopefully, this will all be resolved quickly and the patients will not suffer for too long.


Dr. Davis: It’s quite evident from your court filing, that you take your professional obligations and responsibilities very seriously. Obviously, the practice of dentistry is not to be conflated with the selling of widgets. We’d love to learn about your views on protections and responsibilities for safeguarding the doctor/patient relationship and why this should never be betrayed, especially by an educational institution. 

Dr. Pesis: I have always felt blessed to have been able to achieve the degree of DDS. I feel an immense sense of pride to be part of a profession which dedicates itself to the health and wellbeing of people. It is my belief that the majority of dentists share my sentiment. However, there are some that treat this profession as any other business, simply trying to do as much work on each patient in order to fund their lavish life styles. I am not speaking of offering state of the art treatment or expensive treatments, I am speaking of advising treatments that are unnecessary or diagnosing issues that do not exist. When a patient walks into any dental office, they are putting trust in that dentist. Patients put themselves in a very vulnerable situation; they are laid on their backs, mouth wide open and we dentists are towering above them with sharp objects. In a dental office, the dentist is in a powerful position and this must be treated with extreme respect. Patients are confiding in us, asking us what they need to achieve oral health and it is our duty to be truthful. Each dentist must be ethical in treating patients or we risk losing the trust which is essential for building lasting relationships with patients.
The patient dentist relationship is like every other we have in our lives. It takes constant effort to maintain, and once the trust is broken, it can rarely be repaired. This is especially true for institutions. The University of Pennsylvania School of Dental Medicine has worked for many years to become a well-respected training ground for some of the world’s best dentists. People respect the name and the brand that the university has built and have immense trust in the dentists who operate within it. So, for anyone to utilize the name Upenn to take advantage of its patients is devastating. In these institutions, when it is necessary, qualified external third-parties, with no vested interests, should be able to monitor the treatment of patients and advise when issues are detected. These panels should also be able to receive reports about any wrongdoing from within the practices and be able to investigate them without any bias and make the proper recommendations to remedy any findings; whether that be to resolve the issue internally or elevate it to the state board of dentistry. If this type of safeguard was in place at Upenn, I would still employed at the PDFP and still instructing my dental students.
It is integral to our profession that dental institutions have the trust of the public because they are training the future generations of dentists. If future dentists are adopting the values of institutions that make financial success the primary benchmark of success, then the profession truly has lost something. It is up to us as dentists to make changes and to allow for proper monitoring of these institutions to protect our patients and the future of our profession.

Dr. Davis: I’m concerned that your employment termination from U/Penn would preclude you from future employment in academia. Further, it’s doubtful a dental service organization (DSO), which either beneficially owns dental practices or fronts for private equity companies which beneficially own clinics, would elect to hire an ethical whistleblower. Establishment of a fiscally viable private dental practice might require 5+ years to develop. Your stand for the benefit of the public welfare and ethics of the dental profession could easily cost you many hundreds of thousands of dollars in lost income. Please comment.

Dr. Pesis: Thank you Dr. Davis. I appreciate your insight and concerns. It took me many years of hard work to become an established practitioner with a solid reputation within the PDFP. I put much effort into treating my patients with respect and offering the best possible care for them. The University of Pennsylvania was my future and where I intended to spend my career. I felt blessed to be able to practice dentistry as well as educate students in the main dental clinic. I intended to continue this career path for many years and eventually transition to teaching full time. I was blindsided by this termination, especially because I was only doing what was best for the patients that I care about so deeply.
As all dentists know, a good reputation is extremely important. One’s name and reputation is a dentist’s livelihood. My reputation has definitely taken a huge blow. One day, I was a well-respected dentist with PDFP and the next I was unemployed, being gossiped about by my peers, and having my name dragged through the mud. My family has instilled in me the highest integrity and for UPenn to tarnish my name in the way of falsely using a HIPAA violation is inexcusable. At every interview when the subject of Upenn is discussed I can see my chances of getting the job diminishing in my potential bosses’ eyes. While not getting the job is always painful, the most devastating part is that my academic career is over. One of the main reasons I took the position at UPenn was to start a career in academia. Teaching the future generation was very rewarding and a highlight of my years at UPenn. It was always my intention to gradually transition from clinical dentistry to be involved in academia. I have applied for multiple positions in academia but have had no results. 
You are correct, I have lost and stand to lose a lot of money. Money was never a goal of mine, and although it is difficult to have debt and no income, the hardest part is gaining my reputation back. Being terminated is undoubtedly one of the most stressful things that a person can go through but being terminated falsely and being accused of a HIPAA violation is utterly devastating. I try to stay positive and take pride in the fact that there are people out there like you Dr. Davis, to validate my position and bring these issues to the public. 


Dr. Davis: Dentistry needs heroes. Our profession is in desperate need of those who take the high ground for patient rights, over generation of immediate financial gains. If our profession elects to betray the public interest, for continued short term self-interests, it is doomed. Examples established at our universities help set the table for future generations of doctors.

Dr. Pesis: First of all, I do not consider myself a hero. I consider myself a dental professional and my actions reflect that. We are sworn to protect our patients and that is all I did. Dental ethics are one of the most important aspects of being a dental professional. It is far too easy to take advantage of patients who have little to no idea of what is going on in their mouths. I have always been disturbed at how easy it is to adjust the codes or to treatment plan more than is needed in order to make more money. During my job interview at Upenn I distinctly remember the clinical director, Dr. Alisa Kauffman, asking me what drives me as a dentist. I replied that providing the best possible care for my patients and developing relationships with them is what drives me. Her response troubled me then but given my recent predicament, troubles me even more now. She said “What about money, money doesn’t drive you?” Without hesitation, I replied “It has never been about money for me”. She quickly rebutted “That is going to change.” 
Dentistry should not be treated as a business. Universities should be setting a proper example in action and in the education they provide. If this is not done properly it can lead to rapid decay of our profession. Patients are not cash cows that we can milk by providing unnecessary treatments in order to fill our pockets. Patients are people and should all be treated with respect and integrity. At its core, dentistry is truly all about treating patients and promoting oral health. All dentists are obligated to be ethical and to stand up for patient rights. I might be struggling now but I find comfort knowing that what I am going through will help fight against the injustices that are creeping into the dental profession. Thank you for the opportunity to share my story and views.