North Carolina’s dental authority allows dentists to sedate patients before ensuring they have the “skills, equipment, drugs, support personnel and procedures” in place, according to a new report by the Office of the State Auditor.
The report follows the deaths of two patients who had undergone dental sedation in 2012 and 2013. The auditor found also that the N.C. State Board of Dental Examiners does not conduct follow-up inspections of sedation dentists, and that it does not verify that dentists have completed requisite continuing education for sedation and anesthesia permits.
More than 600 dentists in North Carolina hold permits allowing them to use medications to calm patients nerves or change their state of consciousness.
The recent deaths were the first that the state dental board has linked to dental sedation. One patient, a 57-year-old woman, died late in 2012 after sedation at the office of Cary dentist Toni Mascherin. The dental board reported in 2013 that Mascherin’s patient was “not a good candidate” for sedation, and that the dentist had at first ignored signs of distress, such as the patient turning blue.
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Later in 2013, a 71-year-old man died after sedation at the office of Zachary Harrison in Williamston. The board found Harrison didn’t properly dose the patient, that he contacted the man’s cardiologist after the sedation was underway and that he didn’t administer a “reversal” drug.
One of the state audit’s major concerns is that dentists can practice sedation and anesthesia under “temporary permits.” Dentists can begin to practice sedation under a 90-day permit by completing an application and sending the dental board proof of proper training.
Only later does the board conduct an inspection of the dentist’s facilities and staff, according to the audit. In other words, the report states, a dentist could go for three months without the state authority checking his or her competency in drug dosage, equipment sterilization and medical monitoring.
Previously, those temporary permits could be extended to six months. The dental board banned extensions in September.
Once dentists have their full permits, they might go for years without further inspection by the dental board. The auditor found that the dental authority doesn’t conduct periodic on-site inspections of any of the state’s 4,600-plus active dentists.
“Without periodic inspections, substandard practices could go undetected for extended period,” the audit warns. That means dentists might be using staffers who don’t know how to help a patient who has overdosed or had a medical emergency during sedation, or that patients might not be properly evaluated prior to sedation, according to the audit. Crucial medical equipment, such as blood-oxygen monitors, might also fall into disrepair.
The dental board also has done little to ensure that dentists are taking required education courses, according to the audit. Dentists practicing sedation are required to take annual life-support classes, and six hours of training in sedation-related topics every two years. While dentists must report their hours of education, the board does not verify those claims.
The state auditor recommended the dental board “reconsider” its issuance of temporary sedation and anesthesia permits; set up a “risk-based” schedule for inspection; create standardized checklists for those inspections; and verify that dentists are completing their continuing education requirements.
The dental board “accepts” the audit’s recommendations, according to a letter from Chief Operations Officer Bobby White. The board opened its own review this spring, and its review committee already has recommended the discontinuation of temporary permitting and the verification of continuing education. No action has been taken on the recommendations.
White warned that the board will need to find or reassign “significant” resources to conduct periodic inspections. “However, the board is committed to implementing this recommendation as quickly as possible,” he wrote.