A group of lawmakers wants to increase the state dental board’s regulation of dentists in Hawaii by clamping down on the ones who misrepresent themselves as certified specialists and legally requiring board approval of dentists who administer anesthesia and various types of sedation.
Rep. Della Au Belatti, chairwoman of the House Health Committee, and a handful of other representatives co-introduced several bills relating to dentists last week, less than a month after a 3-year-old girl died following a botched dental procedure that put her in a coma.
The girl, Finley Boyle, suffered cardiac arrest and severe and permanent brain damage after visiting licensed dentist Lilly Geyer at Island Dentistry for Children in Kailua to undergo four baby “root canals” for 10 cavities, according to a negligence lawsuit filed by the child’s parents, Ashley and Evan Boyle.
The state Department of Commerce and Consumer Affairs is conducting its own investigation into the dentist’s office, which is now closed.
Coincidentally, the department also adopted new administrative rules on Monday for dentists and dental hygienists, including amendments that tighten up regulation of the kind of sedation experts speculate Finely received. But Department of Commerce and Consumer Affairs spokesman Brent Suyama said the Hawaii State Board of Dental Examiners first proposed the sedation rule changes long before the incident, roughly five years ago, and held a public hearing last July. Neither the department nor the dental board is commenting on the Boyle case, Suyama said.
Now the Legislature is poised to consider whether existing dental laws need to be strengthened. Belatti said the measures were in part inspired by the Finley case but that they also aim to improve children’s dental health in Hawaii in general, particularly in light of the Pew Center on the States’ 2011 “The State of Children’s Dental Health” report, which gave Hawaii an F.
HB 2460 would create specialty license categories for dentists certified to practice one of the nine specialties recognized by the American Dental Association, including pediatric dentistry. It also explicitly prohibits licensed dentists from practicing or marketing themselves as specialists if they don’t have the extra training.
HB 2459 would require any dentist who administers general anesthesia, intravenous-conscious sedation or conscious sedation to get written authorization from the Board of Dental Examiners, codifying in statute the administrative rule changes that were just adopted by the Department of Commerce and Consumer Affairs.
“For me, Finley Boyle’s death has been a heart-breaking tragedy, and it’s been a huge wake-up call for the dental community,” Belatti said, adding that she hopes the package of bills sparks a lively debate about ways to prevent similar incidents from happening in the future and longer-term strategies for improving dental care.
Alleged details that have been reported in the media and included in the lawsuit suggest that Geyer may have both distorted her qualifications and over-medicated Finley. Civil Beat reported on these issues in a story that ran just two days before HB 2460 and HB 2459 were introduced.
Questions are being raised about Geyer’s qualifications as a “children’s dentist,” and some dentists have proposed increasing state oversight of practitioners who market themselves as specialists. Certification in one of the nine dental specialities includes several years of extra accredited residency training, while general dentists typically only have to go to dental school before going through the licensing process.
Geyer’s office was named “Island Dentistry for Children,” yet she isn’t listed in the American Academy of Pediatric Dentistry’s directory, which includes all pediatric dentists in good standing with the academy. The lawsuit also contends that Geyer was ill-prepared to deal with the emergency once the child went brain dead, another allegation that has put her qualifications and medical protocol under scrutiny.
John Nishimoto, the attorney representing Geyer, has declined to say whether Geyer got the extra training in pediatric dentistry, citing the pending lawsuit.
But Brent Ching, a pediatric dentist at Kapiolani Medical Center, said efforts to tighten up state dental regulation are misguided because most incidents involving malpractice trace back to individuals’ intentions. Tacking more state laws onto existing administrative rules and statutes, he said, won’t necessarily weed out the bad dentists.
Instead, policymakers should focus on ensuring advertising media don’t allow dental professionals to falsely market themselves, Ching said. He also noted that, while dentists are accountable to the public, parents and other consumers should do their part to educate themselves about their dental care providers and any procedures they agree to.
“Don’t fix what’s not broken,” Ching said. “The board isn’t designed to do away with people’s careers.”
Ching pointed to a law Hawaii legislators passed back in 2005 that loosened up licensing requirements for dentists in the state. Geyer, who is also licensed under her last name Tsou, was quoted as supporting the change in a Pacific Business News story.
“The bottom line is none of this would’ve happened if they (the Legislature) had kept things simple,” Ching said.
But while the Finley case in part served as inspiration for some of the bills, other measures aim to improve children’s access to quality dental care, said Belatti, who’s been working on dental health initiatives for the past two years in collaboration with the Department of Health and other stakeholders.
House Bill 2457, for example, would help develop a dental sealant program for high-needs schools, while House Bill 2456 would require every child to have a dental examination prior to entering a school in Hawaii for the first time starting with the 2015-16 school year.