What we can learn from the failed effort to pass ‘Caleb’s Law’ in California

Mary Otto

About Mary Otto

Mary Otto, a Washington, D.C.-based freelancer, is AHCJ's topic leader on oral health and the author of "Teeth: The Story of Beauty, Inequality, and the Struggle for Oral Health in America." She can be reached at mary@healthjournalism.org.

Laurel Rosenhall

As part of her beat covering politics for the nonprofit media organization CALmatters, Laurel Rosenhall has documented the long battle of two bereaved parents working to convince California lawmakers to tighten state law as it relates to dental anesthesia.

After their son, Caleb, died two years ago, Tim and Eliza Sears launched an initiative to require that two highly trained professionals – a dentist or oral surgeon and an anesthesiologist, nurse anesthetist or similar specialist – be present when providing dental care to children under anesthesia. They say such a requirement might have saved their child. The couple has faced significant resistance in their quest, as Rosenhall reported in her July 11 piece, “Dental Lobby Wins Again: Grieving Parents Shelve Caleb’s Law Rather Than Dilute It.”

In this new Q and A for AHCJ, Rosenhall discusses her coverage of the troubling questions raised by a dental anesthesia death. She offers advice to other journalists who may find themselves reporting about a similar tragedy in their communities.

Why is the Sears family convinced that the team approach to dental anesthesia would keep children safer?
After Tim and Eliza Sears lost their son Caleb in 2015, they learned that oral surgeons are the only medical professionals allowed to both administer anesthesia and operate on a patient. In hospital settings, these complex tasks are performed by two different people, allowing one of them to devote full attention to the patient’s response to the anesthesia. Caleb, who was 6 years old, died following a tooth extraction. He had stopped breathing during the procedure, a risk when small children undergo general anesthesia. State investigators found that the oral surgeon who operated on Caleb made many mistakes in attempting to rescue him and waited too long to call 911. Caleb’s family believes that his life could have been saved if a trained anesthesia provider, devoted to monitoring his response, had been involved in the procedure.

Medical experts have rallied to the Sears’ cause and testified on their behalf, offering evidence to bolster their case. Tell us about the research they have brought to the debate?
The American Academy of Pediatrics, together with the American Academy of Pediatric Dentistry, have issued guidelines that recommend two highly-skilled providers (including one devoted to monitoring the patient’s response to anesthesia) when children undergo oral surgery. They say extensive research sets show this is the safest way to go. However, when California dental regulators looked into the issue recently, they found a paucity of high-quality research. One reason is that until recently, state law did not require dentists to report patients’ deaths in a uniform manner, making it hard to establish trends. The Sears family’s advocacy has addressed the data-collection problem with a new law that requires dentists submit a specific form when a patient dies. But since this issue is regulated state by state, there could be many places in America where data on dental deaths is incomplete. When the Dallas Morning News investigated children’s deaths from dental surgery in 2015, the journalists found a lack of quality data from their state.

The Sears family has faced strong opposition from the state dental lobby. The California Dental Association and other dental groups argue the new restriction would be costly and that the system is safe the way it is. However, you have written state data to support the dental groups’ claims about safety are incomplete. You have also written that dental groups have donated heavily to lawmakers who have stopped short of passing the rigorous law the Sears are seeking. You do a lot of writing about lobbying for CALmatters. What drew you to this particular battle in the first place and what about it has kept you coming back to it?
My beat is state politics, not health, and I had heard about the political power of the California Dentists Association ever since I started covering the statehouse several years ago. It is a widely-held observation in Sacramento that always struck me as odd. Dentists are not represented by a labor union (the way nurses and teachers are in California). They don’t have an impassioned customer base (the way gun manufacturers do). How could these decentralized small businesses, dispersed in neighborhoods around the state, wield so much political clout? When I heard about the Sears family’s advocacy after their son died, I saw twin opportunities: to tell the human story of their effort to keep others from experiencing their pain, and to examine the influence of the dental lobby.

A law called Caleb’s Law did go into effect this year, but it was not all that Caleb ’s parents had hoped to achieve. Does it make any significant changes to the system?
The version of Caleb’s Law that is now in effect has three main components. It gets at the state’s spotty collection of data about dental deaths by requiring dentists to complete a new form when a patient dies. It requires the state perform a study to assess how California’s dental anesthesia regulations stack up to those in other states. And it requires that parents whose kids are undergoing dental surgery be notified that anesthesia is administered in different ways in different settings.

That is far short of the goal the Sears family was working toward – a law requiring two highly-trained professionals, including one dedicated to monitoring the anesthesia response, for children undergoing oral surgery. But it was the toughest policy they could get to pass through the legislature.

Another California child, Daleyza Hernandez-Avila died recently following a dental procedure. Did that girl’s death have an impact on the most recent statehouse discussion about strengthening Caleb’s Law?
Yes, it did. Daleyza was 3 years old when she died in June following dental surgery. Lawmakers discussed her case this year as they debated, and ultimately rejected, a new and tougher version of Caleb’s Law. News reports said that the clinic treating Daleyza routinely used two highly-trained providers during oral surgery: an anesthesiologist and a dentist. This case clearly weighed on legislators considering the law to require two providers. They pointed to it as evidence that the two-provider model wouldn’t necessarily prevent tragedy. This echoes an argument dentists have made all along: that deaths are rare, but they happen in all kinds of settings.

In your coverage, have you heard about any other states that might have better or stricter laws related to dental anesthesia for children?
No, what I heard was that California’s dental sedation and anesthesia laws are pretty similar to those in other states. If any readers know of a state that has a model policy in this area, I would be most interested to hear from you.

Has there been a resource that you have found particularly useful in covering the fight for Caleb’s Law? Do you have any advice for fellow reporters who might want to look into this issue in their states?
On the political front, I suggest taking a look at the campaign contributions and lobbying expenditures that dentists and dental associations make in your state. The amount of information you will have access to depends on the reporting requirements in your state. But the Washington Post recently reported on the influence dentists wield at the national level by using an anecdote from Maine as the lead example. So I imagine this pattern holds well beyond California.

On the policy front, you could see what kind of bills addressing dental anesthesia have been introduced in your state. I suggest inquiring with the committee in your state legislature that tracks issues related to professional licensing (or the so-called “scope of practice” for various medical professionals). You could also check with the committee that handles health policy.

On the medical front, I would suggest paying attention to the small news briefs or quick TV segments that air when children die from dental procedures. Perhaps you can track them in a spreadsheet or make a note in your calendar to follow up several weeks after the incident is first reported. It takes a while for the state dental board to complete an investigation, but you can find out what records are publicly available at each stage in the process. You can also inquire with the dental board (or the appropriate regulatory authority in your state) to find out what kind of data is available on deaths from the past, and whether there are public investigative reports that you can review. Some of these have incredible detail.

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