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We entrust our lives and our oral health to a dental practitioner for the reason that we want to improve our oral health. As an individual, we seek the best care from a dentist. What if a dentist fails to do his responsibilities and is being accused of negligence? If this happens, a dental attorney will be a great help and is a good defense against such cases.

On July 16, 2016, in Tyler, Texas, a three-year-old patient went with her parents to the dentist’s office for tooth extractions and restorative dental treatment by the dentist under general anesthesia provided by the dentist, a dentist anesthesiologist.

The patient and her parents arrived at the dental office at approximately 6:40 AM. The patient’s father reported to the dentist that the patient had been given Children’s Tylenol the night before for nasal congestion, a fact that elevated the patient’s anesthetic complication risk category under the

American Society of Anesthesiologists’ Physical Status Classification (1) from healthy patient to (2) mild systemic disease. The dentist failed to document in the anesthesia record that the patient had been given Children’s Tylenol: nor did the dentist elevate the patient’s risk category from Classification 1 to 2 as a result of the prior administration of Children’s Tylenol and respiratory congestion.

At approximately 6:45 AM, the dentist administered the following medications to induce and maintain general anesthesia: 8%-2% Sevoflurane; 1.0 mg Versed; 20 mg Demerol; 1.5 mg Ondansetron, 0.2 mg Glycopyrrolate; and 500 ml 0.9% normal saline. At an unknown time, the dentist administered Afrin to the patient for her nasal congestion but did not document it in the patient record. At an unknown time, the dentist administered the patient an unknown quantity of Fentany], an intravenous opioid analgesic that can cause significant respiratory depression and other complications, but did not document it in the patient record. The dentist included contradictory information in the anesthesia record, She documented that the patient had been administered two liters of oxygen per minute from 6:45 AM to 9:45 AM in one place in the anesthesia record, but documented that the patient had been administered one liter of oxygen during the same time period in another part of the anesthesia record 9:25 AM.

Dental surgery began at approximately 7:30 AM and concluded between 9:38 AM and 10:00 AM. For approximately one hour during the intraoperative period, the patient was hypertensive and had tachycardia (had a rapid heart rate) without any intervention from the dentist, the dentist did not remain in the operatory continuously. At least one the course of sedation and treatment, the dentist left the patient unmonitored without direct visual monitoring of the electrocardiogram, capnography, plethysmography, and/or audible pre-tracheal stethoscope an unknown time after 9:25 a.m.,

At approximately 8-AM, the dentist extubate the patient and observed that her oxygen saturation levels dropped. The dentist re-intubated the patient and attempted bag-valve-mask ventilation, but the patient’s oxygen saturation and heart rate continued to drop. The dentist began CPR (cardiopulmonary resuscitation), administered oxygen, and applied an AED (automated external defibrillator).

The dentist failed to properly position the patient for effective chest compressions during CPR. During resuscitative efforts, the patient remained in the treatment chair in Semi-Fowler’s position (with her head elevated to 30-45 degrees), rather than fully reclined on a firm, flat surface. The dentist failed to document the patient’s oxygenation ventilation, cardiac function, vital signs, or evidence of a deteriorating heart rhythm prior to application of the AED.

The dentist failed to activate emergency medical services (EMS) in a timely manner and performed CPR for approximately 15 minutes before calling or directing anyone to call 911,

During the time the dentist was performing CPR, she administered 1 mg Atropine to the patient, an administration not supported by the American Heart Association PALS (pediatric advanced life support) treatment algorithms for pediatric cardiac arrest. During the time the dentist was performing CPR, she administered an unknown quantity of date-expired epinephrine to the patient. The dentist did not document the administration to the patient of atropine, epinephrine, or other resuscitative agents used during resuscitation efforts. The dentist did not document the patient’s vital signs during or after resuscitation efforts, nor did the dentist document whether monitoring and intravenous access were continued throughout. The last blood pressure notation was made at 9:25 AM, while the patient was still under anesthesia. No vital signs were documented until emergency responders arrived at the patient’s side at approximately 10:30 AM. The dentist reported to the emergency responders that she had administered 1 mg epinephrine but later stated during an interview that she administered 0.13 mg epinephrine. A partly used, pre-filled syringe found at the scene had at least 0.6 mg expressed from the syringe.

Emergency responders found the patient still in Semi-Fowler’s position in the treatment chair, unresponsive, pulseless, and apneic. They took over resuscitative efforts and transported the patient to a hospital. The patient never recovered, her death was pronounced at 11 AM.

As a response, due to the incident that happened to the patient, the dentist is subject to disciplinary action for gross negligence in that she failed to identify the patient’s increased risk for anesthetic complication: failed to closely monitor the patient and/or appropriately intervene during the course of sedation and the recovery period; failed to completely and accurately document the general anesthesia course and/or failed to timely summons EMS.

The dentist’s mistakes show that there’s negligence which became the basis of the Board’s decision to discipline him as well as his dental license.

The case would have yielded a different result if the dentist was able to hire a dental attorney. So if you also have the same cases or concerns, it’s best to contact Dental Attorney Yong J. An, for further details. You may contact Dental Attorney Yong at (832) 428-5679 to get a schedule for a confidential consultation.