Opioid Safety, Respiratory Compromise

Dentistry and Death: More Laws or More Education?

By Michael Wong, JD (Executive Director, Physician-Patient Alliance for Health & Safety)

Editor’s Note: Last week, we asked whether the use of birth control is a patient safety risk because of possible development of blood clots. In this post, the question is – do we need more laws or more education to help prevent anesthesia-related deaths in dental procedures and oral surgery.

Most people would not associate dentistry with death – discomfort perhaps – but not death.

However, the death of Caleb Sears forces us to consider the possibility of death in dentistry – or, more accurately, oral surgery:

Caleb Sears was a healthy six-year-old living in the Bay Area. He was in his first year of elementary school and just starting to read and write. He loved playing with his little sister, climbing trees, singing Les Miserables, and making up funny stories about llamas and time machines.

In March 2015, Caleb went with his parents to his oral surgeon’s office to have a tooth extracted, a normal dental procedure. Caleb stopped breathing after general anesthesia was administered. The oral surgeon was performing the procedure without key elements that would have made the anesthesia administration safe for Caleb. He suffered irreversible massive injuries and died because there were no adequately trained support personnel available or sufficient monitoring equipment.  

Sadly, this is not the first time that a story about a child’s death while undergoing or recovering from a dental procedure or oral surgery has been discussed on this blog:

 

9-year old Solomon Womack Died After Receiving Opioids Following a Tonsillectomy - http://wp.me/p5JhsL-1K6

9-year old Solomon Womack Died After Receiving Opioids Following a Tonsillectomy – http://wp.me/p5JhsL-1K6

17-Year Old Mariah Edwards, Recovering After a Tonsillectomy, Died After Her Monitors were Muted - http://wp.me/p5JhsL-sJ

17-Year Old Mariah Edwards, Recovering After a Tonsillectomy, Died After Her Monitors were Muted – http://wp.me/p5JhsL-sJ

17-year-old girl, Sydney Gallegher, died nearly a week after she suffered cardiac arrest while having her wisdom teeth pulled - http://wp.me/p5JhsL-1gU

17-year-old girl, Sydney Gallegher, died nearly a week after she suffered cardiac arrest while having her wisdom teeth pulled – http://wp.me/p5JhsL-1gU

These are just a few deaths that have been discussed on this blog. Unfortunately, there are many more.

So, what can be done to help prevent further deaths?

Caleb’s parents, California assemblyman Tony Thurmond (who authored the bill), and their supporters believe that a law mandating “good behavior” is what is needed. They believe that a law is required. As reported by Outpatient Surgery, the proposed law in California:

“would force dentists and oral surgeons to be more open about the dangers that exist when oral surgeons administer anesthesia without having a separate anesthesia provider present. Caleb’s Law, named after Caleb Sears, who stopped breathing and went into cardiac arrest during what was supposed to be a routine tooth extraction, would require dentists and oral surgeons to inform parents and guardians that risks are greater when general anesthesia or deep sedation is provided without a separate anesthesia provider or without using capnography, EKG and continuous pulse oximetry to monitor patients. The law would also require the California Dental Board to collect, study and share data about deaths and injuries from dental anesthesia.

As described, the proposed law seeks to decrease the risk of adverse events or death by making sure that dentists and oral surgeons “inform parents and guardians that risks are greater when general anesthesia or deep sedation is provided” and this greater risk occurs when:

  • there is not a “separate anesthesia provider”; or
  • “capnography, EKG and continuous pulse oximetry [is not used] to monitor patients.”

Are they right that a law mandating disclosure or using proper equipment (capnography, EKG and continuous pulse oximetry) to monitor patients is what is needed?

After the death of a patient from opioid-induced respiratory depression, I remember asking the hospital’s CEO where the patient had died whether his hospital was going to do the “right thing” and make adjustments in how his staff handled the delivery of opioids and the monitoring of patients who receive opioids.

That was almost five years ago, and I’m not aware that changes have occurred in that hospital. So, perhaps only a law would force the hand of such people. Perhaps Caleb’s parents and California assemblyman Tony Thurmond are right – a law is needed. Do you agree?

Do you believe that people should be forced to do the “right thing”? Perhaps better or more education and awareness about the need for safer procedures is what is required?

Please tell us what you think by commenting by commenting below.

One thought on “Dentistry and Death: More Laws or More Education?

  1. Pingback: Drawn Curtains, Muted Alarms, And Diverted Attention Lead To Tragedy In The Postanesthesia Care Unit | Physician-Patient Alliance for Health & Safety

Leave a Reply

Your email address will not be published. Required fields are marked *