July 16, 2008 in City

State records dental-related deaths, injuries

Member of dental board doubts investigations’ thoroughness
By The Spokesman-Review
 

Information

You can check up on a dentist at the Washington Health Department’s Web site, www.doh.wa.gov. Click on “Provider Credential Search.”

To lodge a complaint about a health care provider, call the Department of Health at (360) 236-4700

Online

Read Dr. Fred Quarnstrom’s letters online with this story at spokesmanreview.com.

When the widow of Spokane Gypsy leader James Marks sued a local dentist in March, claiming that a too-strong dose of anesthesia led to her husband’s death, other dentists reacted angrily, saying a good dentist was being unfairly singled out.

Indeed, Jane Marks’ lawsuit against oral surgeon Dr. Mark C. Paxton isn’t the only allegation that dental surgery caused a death, a review of state records shows.

While dental-related deaths are rare, there were seven reports of patient deaths and injuries among the state’s 5,803 licensed dentists from 2005 through 2007 and 11 reports in the 2003-’05 biennium, according to the Department of Health. The agency does not separately report deaths, so the precise number remains unknown.

Two of the reported deaths – of Marks and an elderly woman – were in Spokane. The Spokesman-Review also discovered a third, unreported death of a Spokane man last year after surgery in a local dentist’s office.

A Seattle dentist who has served for four years on the state’s Dental Quality Assurance Commission is raising questions about the thoroughness of that board’s investigations and the adequacy of the information it provides to the public on dental complaints, according to records obtained under the state’s Open Public Records Act.

Dr. Fred Quarnstrom, a dentistry instructor at the University of Washington and a dentist in private practice, recently informed Gov. Chris Gregoire he’s quitting because the commission isn’t thorough enough in its investigations. In letters sent to the governor and the commission in June, Quarnstrom said he was withdrawing his request for reappointment.

“We have seen cases closed where there were deaths and where non-licensed individuals were giving general anesthesia drugs,” Quarnstrom wrote. “I simply cannot continue serving when I have such profound reservations about how the DQAC process is conducted.”

The dental commission closed its inquiry into Marks’ death within two weeks without looking at all the records or conducting an investigation. Death cases can be closed in Washington on the basis of a dentist’s “self-report,” and additional records are obtained only if the case is referred for investigation.

It was wrong to close the Marks case so fast, Quarnstrom said in an interview. “These cases should not be concluded in secret without investigations. Somebody died here – that’s important,” he said.

State Insurance Commissioner Mike Kreidler had supported Quarnstrom’s reappointment, as did Bernard O. Nelson, of Spokane, a public member of the dental commission, Department of Health documents show.

In the Marks case and in two other recent deaths, the Dental Quality Assurance Commission found no wrongdoing. Because it took no action, the deaths don’t show up on the state Web site where consumers can check dentists’ disciplinary records. Taylor Stair, a case manager for the Department of Health’s investigation and inspection office, said the commission tries to do a thorough job and hopes to make its Web site more user-friendly to allow people to easily search all of a provider’s licenses.

One of those other recent cases involved the death of Henry Dillow, a 25-year-old Seattle man who had four wisdom teeth pulled Oct. 15, 2007. Three days later, he died of a rapid bacterial infection, necrotizing fasciitis – known as flesh-eating disease. The dental board concluded there was no reason to take action against Seattle oral surgeon Dr. G. Galia Leonard.

Dr. Terrance L. Hauck, of Spokane, recently faced a state medical inquiry into his conduct in the death of an 89-year-old, 98-pound woman. She died at Holy Family Hospital in September 2005 after being given IV sedation in Hauck’s office while her teeth were being removed in preparation for dentures. Paramedics were called after she became unresponsive, records say.

The Dental Quality Assurance Commission closed its inquiry into Hauck in September 2006 with no disciplinary action. There is no mention of the woman’s death under his dental credentials on the Department of Health’s Web site.

But Hauck is also a medical doctor – and the state’s Medical Quality Assurance Commission decided to investigate. That commission initially charged Hauck with giving the woman “excessive” IV sedation but has backed away from that charge, said Hauck’s attorney, John Versnel, of Seattle. Negotiations to settle the case were under way last week, said Versnel, who represents many of the state’s dentists in disciplinary proceedings.

Hauck was a member of the Dental Quality Assurance Commission when the medical commission’s charges were filed in March 2007. Under state conflict-of-interest rules, he had to step down from the dental commission during the medical commission’s inquiry, Stair said.

Another Spokane case remains unresolved.

Jon Gellner, a 71-year-old Spokane insurance agent who suffered from sleep apnea, went to Spokane dentist Dr. Patrick Collins last year. Collins performed a surgical procedure on Gellner’s palate in his office Aug. 16. After the surgery, Gellner was sent home, where he started to bleed and take blood into his lungs. He was put on a ventilator Aug. 18 and died at Holy Family Hospital on Sept. 1, according to his wife, Jean Gellner.

Gellner’s death certificate lists the immediate cause of death as respiratory arrest resulting from aspiration and pneumonia. No autopsy was performed, and the death certificate does not mention complications from dental surgery.

Gellner’s case has not been reported to the Department of Health as dentist-related and has not been investigated, Stair said last week. A Spokane lawyer representing Gellner is pursuing an insurance settlement, Gellner’s widow said.

Collins did not immediately return a call to his office this week seeking comment.

Collins faced a separate disciplinary sanction last year for a 2006 incident in which he prescribed hydrocodone for an 83-year-old patient whose health history form showed he was allergic to the medication.

The patient suffered nausea and vomiting but did not die, state records say.

Collins stipulated to the dental commission’s charges without admitting unprofessional conduct, agreeing to pay $700 and complete mandatory training in pharmacology and risk management. He was notified last December that he’d complied satisfactorily with the agreement.

The state mandates reporting of all deaths in dental offices or in hospitals following dental work, and the ensuing state investigations usually take three to four months. But the Marks case was closed within two weeks – and then briefly reopened because the commission didn’t initially know he’d died.

Paxton administered general anesthesia to Marks on June 22, 2007. Marks, 62, experienced “respiratory arrest, cardiac arrest, and brain damage,” according to his widow’s lawsuit.

Marks was taken by ambulance to Sacred Heart Medical Center, where he died at 11:59 a.m. June 27. The cause listed on his death certificate: cardiac arrest.

Paxton notified the Department of Health of Marks’ death through his lawyer, Versnel, on July 20, 2007, under the state’s rules to report such deaths within 30 days. The letter indicated Marks had been hospitalized, but did not say that he’d died.

On Aug. 8, Peggy Owen, of the Dental Quality Assurance Commission, informed Paxton that its inquiry into the Marks case had been “closed prior to investigation as it does not appear to be a violation of the law.”

A panel took a second look at the case after it was discovered it was initially coded inappropriately as a patient hospitalization and not a patient death. Department of Health investigators learned of Marks’ death from an article in The Spokesman-Review, Stair said.

The Marks case was re-presented to the commission panel. At its September 2007 meeting, the panel “still chose to conclude it was not a violation of the law,” Stair said, adding that no reason was given.

That’s not unusual, Versnel said. “They don’t sit there and tell you what you did right,” he said.

Russell Jones, the lawyer representing Marks’ widow, said the dental commission shouldn’t have closed its inquiry into Marks’ death without looking at all the records and conducting an investigation. Paxton, who served on the dental commission from 2001 to 2005, has been disciplined before, state records show.

The commission concluded in January 2005 that Paxton violated state regulations by allowing unlicensed surgical aides to start IVs and administer general anesthetic during dental operations. Paxton was ordered to pay a $5,000 fine, stop using unlicensed workers and allow Department of Health inspectors to audit his records and monitor his practice for two years. No patients were endangered, Versnel said.

Marks’ Spokane County Superior Court trial is scheduled to start March 9. Paxton has denied all the charges in the litigation.

The death of her husband, a flamboyant civil rights leader in the Gypsy community, has left a huge void, said Jane Marks.

“This was terrible. It took him away from me before his time,” she said.


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