Second suspected sedative death a 'huge concern' for NC dental board

akenney@newsobserver.comDecember 12, 2013 

  • A growing field

    Sedation dentistry is becoming more popular in North Carolina. As of September, 615 dentists were permitted to offer sedation in the state, up 23 percent, from 502, in September 2010. During that same time, the number of dentists in the state grew by 7 percent.

    However, only about 13 percent of dentists in the state offer sedation.

— For the second time this year, the state’s dental authority is investigating a death that may be linked to a dentist’s use of sedation drugs – and the case may prompt a state review of dentists’ training for anti-anxiety and anti-pain medications.

The N.C. Dental Board of Examiners said last week it suspects Zachary Harrison of Williamston fatally “oversedated” a patient.

The board has evidence that Harrison gave sedative drugs to “a patient who was not a good candidate for outpatient deep sedation, which resulted in the death of that patient,” according to an emergency “summary suspension” issued by the board on Dec. 2.

The suspension is an interim step, based on preliminary evidence, meant to protect the public while dental investigators look further into the case. Harrison may continue practicing dentistry and may use nitrous oxide, or laughing gas, in the meantime.

Harrison declined to comment, citing advice from his legal counsel. His patient died Oct. 1, and the dentist reported the death to the board on Oct. 4, according to the board’s administrator.

While the investigation into the death is incomplete, it brings new attention to sedation dentistry, a practice that allows almost any dentist, with training, to calm patients’ nerves with drugs such as Halcion. The suspension came two months after a Cary dentist, Toni Mascherin, lost her license following a patient’s death under sedation.

The two deaths are unprecedented in North Carolina and likely will prompt a review of the state’s dental protocols, according to Bobby White, the dental board’s chief executive.

“We’re kind of floored by it here. It’s taken us with a great deal of sadness,” White said. “Two families have suffered.”

In response, the dental board is considering convening an advisory panel, which would focus in particular on training requirements for dentists who want to practice sedation, White said.

“To have two potential deaths this close together – we want to do everything we can to make sure what we’re doing on this end as a regulatory body to make sure that our rules protect public safety,” he said, reiterating that the investigation into Harrison’s practice is incomplete.

State and national authorities have pushed for years to write new standards for sedation dentistry. North Carolina, for example, began issuing sedation permits in 2002 and issued a major revision in 2008, according to White, while the American Dental Association issued new rules on sedation in 2007.

Even so, information about patient crises in dental offices can be hard to find, according to Larry Sangrik, an Ohio dentist who researches and lectures on emergency preparedness for dental practices.

“Sadly, to my knowledge, and I’ve looked at this pretty exhaustively, there is no national data that’s collected on the issue of dental office deaths, or the more general topic of emergencies,” said Sangrik, who offers moderate conscious sedation at his practice and volunteers for the nonprofit Raven Maria Blanco Foundation, an advocacy group formed after a young girl’s sedation-related death.

Sedation isn’t meant to put a patient into a temporary coma, as general anesthesia would, but instead allows the patient to respond to spoken words. The practice can help patients deal with the pain and stress of operations, Sangrik said.

“The key is being able to sedate a patient without putting them into general anesthesia,” he said. “And if you do, can you manage that situation?”

While some dental professionals call for dramatic increases in general training requirements, Sangrik believes the focus should be on improving dentists’ preparation for emergencies.

“Most of the fatal complications that have arisen with sedation could have been addressed if the office were prepared for general medical emergencies,” said Sangrik, who has practiced for 34 years.

And while the dental board’s policy review likely will focus on training requirements, the organization also is looking at its approach to deaths. Prior to last year, the board had never dealt with a death that it determined to be caused by dental treatment, White said.

Due partially to legal obstacles, the board allowed Mascherin to continue practicing sedation in Cary for almost eight months after a patient’s death; it’s unclear whether she did so. The dental board eventually found that Mascherin had improperly ignored the patient’s medical history and an assistant’s warnings that the patient had turned blue, according to the board’s license revocation documents.

With her license about to be revoked, Mascherin announced her retirement to patients and sold her practice.

Harrison’s case has proceeded more quickly, with the dental board taking about two months to issue a summary suspension.

“I think it is fair to say that we have adjusted, to the extent that we can,” White said, referring to the speed of the investigation. However, he cautioned that any medical investigation can be prolonged significantly by legal proceedings and challenges.

When something goes wrong, the state’s dental board relies on dentists to report themselves – and in some cases, they’re allowed up to 30 days to do that.

In Mascherin’s case, a lack of communication kept the dental board from learning of the death for two weeks.

While a medical examiner linked the case to dental sedatives just two days after the death, the board only learned of the incident when Mascherin reported it herself. There is no legal requirement that coroners report suspected dentist-related deaths to the dental authority.

White was unsure when the board might begin a review of its protocols, but the process likely would involve a range of experts.

“This is a huge concern to our board,” he said. “This is the main emphasis of our efforts right now.”

Meanwhile, the state dental board will try to determine whether Zachary Harrison was at fault in the death of his patient. The findings could lead to a range of results, from restoration of his permit to a full revocation of his license.

Harrison, a native of Belhaven, received his undergraduate degree from East Carolina University in 2005, and graduated from the UNC School of Dentistry in 2009. He earned a moderate conscious sedation permit in February 2011, having completed at least 60 hours of lessons and managed at least 10 sedated patients, according to board guidelines.

Dental board records don’t disclose the name of the deceased patient. Harrison may request a hearing before the board at the “earliest available opportunity,” White said.

“We have not made a final judgment,” he said of the Harrison case and the summary suspension. “It’s a kind of interim step. It is to protect the health and public safety of the public during an investigation.”

Kenney: 919-829-4870; Twitter: @KenneyNC

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