A Williamston dentist will be barred from practicing dentistry in North Carolina for one to 10 years after the apparent overdose death of a patient in October 2013.
Zachary J. Harrison failed to properly consider his 71-year-old patient’s medical and physical condition, failed to properly dose the patient with a sedative and failed to give the patient a rescue drug, the N.C. Board of Dental Examiners concluded in a ruling released Thursday.
Harrison, a 2009 graduate of the UNC School of Dentistry, is the second dentist in as many years to be punished after a patient death involving sedatives. Toni Mascherin, a Cary-based dentist, saw her license permanently revoked last August, prompting a lengthy review of dental sedation rules by the dental board.
The dental board’s action against Harrison is the final step in an investigation that began last October. He has been barred since December from sedating patients.
Harrison’s patient – James T. Williams of Colerain – was due to have his teeth removed Sept. 30, 2013, to make way for dentures. On the afternoon of the surgery, Harrison sedated Williams through a catheter with 10 milligrams of midazolam, then closed the intravenous line, according to the dental board filing.
The board found that Williams didn’t properly consider Williams’ age, weight, and other factors in setting the dose of midazolam, and did not gradually increase the medication, as required by state rules.
At 1:53 p.m., 23 minutes after Williams was given the drug, a member of Harrison’s staff sent a message to the patient’s cardiologist requesting a list of his medications, according to the board.
Dentists are required to gather such information before sedative surgeries, the board stated in its decision; Harrison’s staff had spoken to the cardiologist earlier but failed to discuss his health history and medications, according to the board.
Williams became “unresponsive and pulseless” during the operation, the board found. By 2:40 p.m., the dentist’s office had called emergency services, according to the board.
Harrison apparently tried to revive the patient through chest compressions but did not administer drugs such as flumazenil, which are “reversal agents” meant to counteract sedatives, the board reported. The dentist also did not give Williams oxygen through an available mask, testifying later that he had panicked, according to the board.
Emergency responders took Williams to Martin General Hospital; he was airlifted to Vidant Medical Center in Greenville, where medical staff removed him from ventilation on Oct. 1.
The board suspended Harrison’s sedation permit in December, citing a threat to public safety. Harrison unsuccessfully petitioned the board in January to restore the permit, according to the board.
The dental board said it was hampered in its investigation by the loss of relevant data. Though a machine monitoring Williams’ vital signs should have been printing its data to paper tape, no such tape could be found after the surgery, according to the board.
The absence of tape was “at a minimum, the result of just another in a series of (Harrison’s) negligent acts,” but may also have represented “a deliberate act to hide or destroy evidence,” the board wrote. Lacking that data, the board inferred that Harrison and his staff didn’t properly monitor the patient.
After a hearing in June, the board decided to revoke Harrison’s sedation permit and suspend his license to practice dentistry for 10 years, effective Nov. 1. Harrison may apply for a restoration of the license after a year, assuming he has completed specially designed education courses at UNC.
Harrison, a native of Belhaven, received his undergraduate degree from East Carolina University before attending UNC’s School of Dentistry. 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.
Harrison practices alongside another dentist at the practice in Williamston. Harrison has owned the practice for two years, he said, but he’s unsure what will happen next.
“This is kind of a blow you don’t come back from,” he said. “That’s just the way it is.”
He deferred further comment to his attorney, Kenneth L. Jones, who said they were disappointed with the board’s ruling.
“Dr. Harrison is a caring and compassionate dentist, for whom patient safety is of paramount importance,” Jones said. “Notwithstanding the board’s ruling, there was ample evidence at the board’s hearing demonstrating that Dr. Harrison’s treatment of the patient was appropriate in all respects.”
Jones said he could not say more, because of patient privacy laws and because he and Harrison may appeal the decision in court.
The dental board this year convened several meetings of dental professionals to discuss potential changes to the rules. A panel of the board’s members now is drafting potential changes to the state’s sedation training and requirements for dentists.