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Unsafe anesthesia use in dental procedures for children continues to be an issue Date: 09/06/16


Brooks Egerton

By Mary Otto

In the wake of the Dallas Morning News’ seven-part "Deadly Dentistry" series, Texas media outlets are now following the story of yet another child left dead after a dental visit.

Daisy Lynn Torres suffered complications from anesthesia while undergoing a procedure in an Austin dental office last spring, a medical examiner recently concluded, according to the Austin American-Stateman.

Now the Texas State Board of Dental Examiners has opened an investigation into the death of the 14-month-old girl.

Meanwhile a forensic dental examiner who reviewed Daisy’s records at the request of the medical examiner’s office raised questions about whether the child even needed treatment in the first place.

Brooks Egerton, who left the Dallas Morning News in a newsroom buyout since the publication of "Deadly Dentistry" late last year has been following the coverage. He reflected on the death and offered advice on how reporters should approach these stories.

Q: Stories in the Dallas Morning News and in other media outlets have focused on the March death of Daisy Lynn Torres. A dental examiner recently determined the toddler’s death was related to the anesthesia she received while undergoing a dental procedure in an Austin dental office. According to news reports, there was an anesthesiologist on site at the clinic where Daisy Lynn suffered complications. How do you see a case like this in the context of the issues you explored in your 2015 Deadly Dentistry series?

A: I’ll respond first by saying that the Torres case is doubly unusual. A medical doctor reportedly administered the anesthesia. I saw rather little of this in my reporting across the country. Oral surgeons and other dentists who provide general anesthesia or relatively powerful forms of sedation often do so while also performing the dental procedure. This is a lucrative business model. It also runs contrary to the medical model, in which one highly trained professional performs surgery while another typically oversees pain management and consciousness. All that said, I am familiar with deadly dentistry involving medical anesthesiologists; your readers may wish to look up the California dental and medical board cases against Dr. Thomas Teich and Dr. Barry Friedberg, respectively.

In addition, Daisy was strikingly young – reportedly 14 months old – to have undergone elective surgery. Many providers shy away from non-emergency sedation of kids under age 2. Such patients may be more susceptible to the risks that all dental patients face, and questions exist about the effects of general anesthesia on the brain development of very young children. That said, some dentists persist in going down this road. Your readers may wish to look up the Texas dental board’s recent suspension of Dr. Kendra Behram. I haven’t seen any news coverage of her case, but online board records say she oversedated a 17-month-old (in addition to allegedly also endangering older children).

The Torres case is not unusual in another regard, however: It involves allegations of unnecessary treatment

Q: Would you talk a little more about what you think reporters should be looking for in cases of death and injury related to dental anesthesia? What kind of meaningful reforms should they be asking state lawmakers about?

A: I will answer this question by suggesting a few rules for reporters. First,

Don’t assume that anesthesia is the only issue or even the main issue. As I reported in Chapter 2 of Deadly Dentistry: “The risks go far beyond oversedation. Others include inhaling objects, bleeding, accidental stabbing, deliberate violence, unsterilized equipment, intoxicated dentists and facial fire.”

Second, don’t assume that children are the main victims.

Third, don’t assume that your state’s public regulatory records tell anything close to a full story. As I reported in Chapter 3 of the project, there’s a national pattern “in which state dental enforcers ignore many malpractice cases and leave the public in the dark. The starkest example is in New York. Insurers reported death payments for 31 dentists there from 2004 to 2013, federal data show — more than in any other state. Yet New York did not discipline a single dentist for a death during that time.”

What we all need — “we” meaning not just journalists, but all dental patients — is more data. I believe dentists should be required to tell regulators about all patient deaths, unplanned hospitalizations and medical emergencies that might have any relationship to treatment or lack of treatment. I believe that these reports should be public records (with patients or their survivors choosing whether to be identified). Then some more powerful analysis could begin.

Q: Your project involved open records requests to all 50 states and the District of Columbia, as well as hundreds of interviews. With the help of colleagues including data journalist Daniel Lathrop, your series delved into the systems that states use to track and report dental deaths. You raised questions about how many of more of these deaths and injuries may be going unreported nationwide and how many dentists may be going undisciplined. Have you heard of any states that are looking at useful steps to address the problems with accountability you revealed?

A: California is the only state I’ve heard of in which proposed legislation (dubbed Caleb’s Law, in honor of a young dental patient who died) would begin to address the accountability issues our series raised. And even here, the focus is far too limited, in my opinion. The law focuses on pediatric dental anesthesia safety, even though the majority of deaths I identified were of adults and some didn’t appear related to heavy sedation or general anesthesia.

Q: Since the Deadly Dentistry series ran, you left the Dallas Morning News but you and others at the paper have continued to write about the problems. For instance in a January case Houston dentist Bethaniel Jefferson failed to call 911 for “several hours” after a 4-year-old patient suffered seizures and oxygen deprivation, causing “severe brain injury,” according to state records. The dentist had been previously fined $3,000 for mishandling another young child’s sedation, you wrote. The dentist denied wrongdoing. Are you planning any more updates on these or other cases?

A: I remain interested in these issues but have no current plans to publish updates.