How the investigation in Tulsa will impact dentists and assistants – and one person's answer to the question of intermediary professionals
By Kevin Henry, editor
Susan Rogers, the executive director of the Oklahoma Board of Dentistry, spoke with Kevin Henry of DentistryIQ.com about the horrific situation involving Tulsa oral surgeon Dr. Scott Harrington. She shared her thoughts on the situation, what she saw in Dr. Harrington's practice, and what she believes will come of this black eye for dentists around the nation.
Kevin Henry: Now that this case has been out in the media, what are your overall thoughts?
Susan Rogers: We all expect professionals to do what they should do, but there is the 1% out there who doesn't. Whether it's cutting costs or ignoring things because they don't care, there is the 1% who are not professional. In this case, there was a dentist who was allowing his dental assistants to do IV sedations. Patients may see what is going on, but they truly don't understand what it means to have an assistant start that IV. As a profession and as the state board, we don't want to scare people from going to the dentist. We don't want people not to go to the dentist. This has become a huge issue because we believe it's the first documented case of hepatitis C coming from a dental practice. It's a strong strain of it as well because this individual got very sick within one to two months of contracting the disease.
Dr. Scott Harrington's 1977 dental license photo. (Source: Oklahoma Board of Dentistry)
KH: How did this story unfold?
SR: This story came to us. Since 2003 in the state of Oklahoma, there have been only three public notifications from the health department, and it's the first involving a dental office. I have a friend who was affected by one of the other instances and contracted hepatitis C, so when the call came from the health department about Dr. Harrington's practice, I had a very sick feeling because I knew what was coming. When the initial investigators went there, they were physically sick by what they found. I was literally sick the whole weekend from what I heard.
We went in on a Monday morning with an unannounced visit. We started going through the logs, and we were stunned by what we found. I couldn't imagine that there was a dentist stupid enough to allow his dental assistants to do anesthesia. Our first priority was to let the health department complete their portion of the investigation, then get the practice shut down once we found what we thought we would find. I interviewed an assistant and asked her to walk me through me her daily procedures. She told me the first thing she did was to have the patients and come in, and she would start the IV. My first thought was, "Oh my goodness." The doctor would have the assistants log what they were doing. I looked at the log and asked her why there were different drugs in different amounts for different patients. She told me she calculated the dosage in her head. If they were heavy, she added a little more of the drug. I was horrified. I asked her how she knew if they were asleep. She told me she touched the patient's eyelashes and talked to the patient. If they weren't asleep, then the doctor would come in. So she was putting people to sleep with no oversight at all. Oversight and supervision are two completely different things, and neither was happening here. Let's be clear about this – dental assistants can't insert a needle into a patient in Oklahoma. At all. Period. We know that one to four people die each year under IV sedation and for this doctor to allow an assistant to do it is truly unbelievable.
Susan Rogers, executive director of the Oklahoma Board of Dentistry, responds to the Harrington investigation during a press conference in Tulsa. (Source: Cory Young/Tulsa World)
Next, we went through the needle protocol and I was counting the violations in my head. I asked the assistant to pull the instruments out of the autoclave and I was stunned. When we do an investigation, the first sign to us that something might be wrong is old, dingy equipment. It doesn't save money to have outdated equipment or cut corners when it comes to safety. In this office, we found an old autoclave where the instruments were being wrapped in a baby diaper towel. I looked at the instruments and saw they were rusted. One was peeling or had debris still on it. I couldn't believe it.
The dentist kept saying that he had practiced for 36 years and never had a problem. I told him he was very lucky.
There were two assistants, and we split them up because we wanted to get the absolute truth out of them. One wasn't as forthright with her information as the other. They told us they had always done things in the manner they described to us since they started working at the practice, and they truly might not have known that it was wrong. However, ignorance of the law is no excuse. You can pick up the phone and call someone to ask. You can send an e-mail. It's your practice. As the state board, we want people to tell us what they want to do in their practice. We can then make some recommendations and help them. Please ask questions. Please read the law.
KH: What was your reaction after you left the practice that day?
SR: We left and went to lunch. We knew what was getting ready to happen. On the drive back from Tulsa, I called my board members, and I honestly didn't even know where to start explaining what I had just seen. There was so much that was so wrong. I knew a letter had to go out to patients, but I also knew his practice was over once that letter went out. Dentists can come back from losing their license, but they don't come back from something like this. There's no recovery.
KH: What will be the fallout from this, in Oklahoma and around the nation?
SR: There are people who say we need cheaper treatment and intermediary workers. No we don't! It's not supposed to work that way. You want someone who is trained to perform a procedure actually performing that procedure, unlike the dental assistants at this practice. I think we'll be doing more of a lockdown on dental assistants who are in the operatory area. You may see dental assistants coming to get permits before they can be in the operatory.