July 26, 2008 in City

Washington dental commission stops short of requiring death investigations

By The Spokesman-Review

The commission that oversees Washington’s 5,800 dentists says it wants every dental death investigated, but it has stopped short of approving a formal process that would immediately identify the involved dentist and require an expert witness to examine the case.

The Dental Quality Assurance Commission, meeting Friday in Spokane, was considering changes in its practices after The Spokesman-Review and Seattle Post-Intelligencer last week reported on the commission’s decision not to investigate three recent patient deaths, including the 2007 death of Spokane Gypsy leader James “Jimmy” Marks.

The stories prompted state Department of Health Director Mary Selecky to write the commissioners last week asking them to revise their procedures to ensure that every death is investigated. Her department had prepared a draft policy that called for all dental-related deaths to go immediately to state investigators, with an independent medical expert assigned to evaluate the case.

Jennifer Bressi, a Department of Health program manager, told commissioners that 14 other states she had surveyed since last week don’t mandate such investigations but tend to do them anyway. Not one of the states she queried has a law requiring them to investigate dental deaths, Bressi said.

Spokane dentist Dr. Pramod Sinha, the commission chair, asked colleagues on the dentist-dominated commission whether they wanted to modify current policy.

It calls for an informal review by a single commission member and presentation of the case to a three-member panel after a dental death is reported. State law requires all dentists to “self report” all deaths and hospitalizations within 30 days.

Only if the panel agrees the case should be pursued is it declared an official “complaint” and referred to Department of Health investigators. If the panel decides not to pursue the case, it is not included on the state’s database of disciplinary action against dentists.

The commission’s inquiry into Marks’ death June 27, 2007, five days after he was given anesthesia in the office of Spokane dentist Dr. Mark Paxton, was closed within two weeks by the initial panel and not investigated further.

Dr. Andrew Vorono, a Tacoma oral and maxillofacial surgeon, said identifying dentists who’ve treated patients who die would make him the “bad guy” and discourage him from treating fragile people.

“Death in a dental office is a major, major concern. … If this goes to a mandatory investigation, every death report becomes public knowledge,” Vorono said.

Lynnwood dentist Dr. Russell Timms disagreed, saying an investigation wouldn’t necessarily result in a “black mark” against a dentist because a practitioner could be exonerated.

Dr. Robert Achterberg, a Spokane pathologist, argued for keeping the commission’s informal panel system. “I caution against a knee-jerk adoption of this,” he added.

But Dr. Robert Faine, of Mercer Island, said thorough investigations are important for public confidence.

“The public perception is we’re having problems. I think a complete investigation is important. If we sweep this under the rug, we aren’t doing our duty,” he said.

In the end, the commission voted provisionally to expand its initial inquiry panel to include five people, including at least one member of the general public. That panel would decide whether a death would warrant further investigation. The state’s draft proposal requiring immediate health department investigations of all dental-related deaths was dropped.

“We are trying to tell the public we are taking this very seriously,” said Issaquah orthodontist Dr. Padmaraj Angolkar, the commission’s president-elect.

Dr. Fred Quarnstrom, a Seattle dentist who recently resigned from the commission out of frustration over its handling of the previous dental death cases, said he wasn’t surprised by Friday’s vote. Quarnstrom complained to Gov. Chris Gregoire in his resignation letter in June that the commission isn’t thorough enough, especially in cases of deaths.

“They basically did nothing Friday. They really don’t want things to change, and they think the past outcomes were appropriate,” Quarnstrom said in a telephone interview.

Spokane attorney Russell Jones, who is representing Marks’ widow, Jane Marks, in her recent lawsuit against Paxton, attended the meeting and said he was disappointed.

“These changes were not made retroactive. The death of Jimmy Marks still will not be investigated,” he said.

It’s not possible to go back and re-investigate a dental death, Quarnstrom said.

“Once it’s disclosed, it’s double jeopardy to go back. That’s why it’s exceptionally important that they go to a full investigation in the first place,” Quarnstrom said.

In another development this week, the Post-Intelligencer reported on a fifth death within the past three years. Mikhail Manyak, a 20-year old University of Washington computer engineering student, died Sunday after an allergic reaction to medicine prescribed after surgery to correct his jaw alignment, the newspaper reported.

Manyak’s death had not been reported to the state, but practitioners have 30 days to report a death or hospitalization related to a dental procedure.

Also, a dental commission panel that met last Friday decided to continue an investigation into the unreported death of 71-year-old Jon Gellner in Spokane last year. He was hospitalized after palate surgery in the office of Spokane dentist Patrick Collins and died Sept. 1.

In a story last week, The Spokesman-Review identified Gellner as the fourth death following a dental procedure in the state in the past three years. His case will now go to state investigators, said Taylor Stair, a case manager in the health department’s investigation unit.

Reach Karen Dorn Steele at (509) 459 5462 or karend@spokesman.com

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