Monty D Tolman DDS

Complaint: [redacted] I am rejecting this response because: ***Please view attached document***Sincerely, [redacted] Attention: [redacted] , Revdex.com Resolutions Consultant I received yesterday the response given to me through your office from Dr T***Informed consent for this procedure was not obtained by Dr T [redacted] at my initial consultationInstead it was obtained on the day of my procedure after the ingestion of four Halcion tablets given for sedationThe basis for my complaint is not addressed in his response

Dear Sirs: I would firstly like to make the observation that in nearly years of clinical practice in the specialty of Periodontics, at the same location in Olympia, Wa., this is the first time that any patient has ever filed a complaint against me with your organizationThis patient has made
multiple complaints with *** ***, with *** *** and *** *** and with ***, In an attempt to receive refunds for rendered periodontal services provided by this therapist Contrary to the first paragraph of her complaint, both insurance providers were indeed billed for those services and *** made payment*** *** and *** *** dropped the complaint*** elected to not rescind payment to my practice, in spite of this patient's vociferous complaints( It is my understanding that credit card companies seldom find in favor of the provider against the interests of their credit card clientsBut the evidence was so unequivocally clear In this instance, they dismissed her complaint and rejected this former patient's request for a refund)It was incumbent upon me to also provide a complete explanation of the events surrounding this complaint and to provide detailed documentationIt is important to verify, then, that all three companies listed above dismissed this complaint after their independent analysisThere is a unanimity then, in refuting the many and erroneous statements made by this disgruntled patientRegarding the several instances of complaints flied against me in the past, what relevance does that really have in this specific case? I believe it unfair and unreasonable that I should need to justify my entire career in regards to one isolated failed procedure for one patientIt should also be noted that I have been in practice for nearly years, and I estimate that I have treated over 20,patients over my long careerThe few disgruntled patients who have filed a complaint constitute a very, very small percentage (.00025%)In the total of seven cases, two were immediately dismissed without meritIn the other five cases, no disciplinary action was ever taken against me and no wrongful treatment was ever assignedAdditionally, I have never been suedOver this long span of time in a very busy practice, routinely treating very complex and advanced cases, I am very proud of my record, fully realizing that some treatments are not always successful, no matter how experienced or how accomplished the therapist might beIn defense of my reputation, since 1997, I have each and every year been voted as one of America's Best Dentists, an honor bestowed by my peersI also formed the South Sound Dental Study Club In 1998, the largest study club In the South Sound area with members, and the primary source for continuing education in Thurston and Mason CountiesI have also been a speaker at the Washington State Dental ConventionContrary to this patient's insinuation, I am a respected periodontist in my fieldAs regards my career, the only one blowing smoke, is this patientAt this point, I believe the patient is approaching a very negative place, continuing to slander me with the malevolent intent to harm my practice and to intentionally tarnish my reputation without just causeShe is on a vindictive witch huntI would hope that this former patient would find a more productive avenue to express herselfI sincerely regret that I was unable to meet this patient's expectationsI strongly feel, however, that I performed accepted surgical protocols and rendered treatment within the standard or careAdditionally, although having no obligation to do so, I offered to retreat this site at no additional fee, being committed to taking this case to a successful completionI did not abandon this patientOf her own volition, this patient sought treatment in another officeI would sincerely request that you dismiss this patient's complaint, a complaint that has been proven to be unfounded and without meritAlthough I have tried to provide a complete answer, If you should have any additional questions or concerns, please notify me

Thank you for sending Dr T*** responseIn my judgment his "clarification" for the reason he failed to obtain my signature on the informed consent at the initial consultation has turned into an attack on my personalityFrom the beginning, he has refused to accept any responsibility for his actions preferring to place the blame on me as a way to deflect from the real issueI have submitted the required documentation of his failure reflecting fact; not excusesDr T*** failed to follow protocol and the medical standards of practiceFrom the beginning he has attempted to use manipulation and control to manage his failureMy questions are/have been simple and require professionalism and ethical behaviorThe signed from provides the I00% certainty neededThe date reflects when the from was signed, the fact there is no witness signature to the form reflects his lack of attention to the form, and the fact that I was sedated was corroborated by everyone in his officeWhat is not corroborated is the timing of events*** *** timing of my signing is different than Dr T*** timingI cannot attest to what is true or accurate since I have no recollection of signing at allWhy was the informed consent not signed at the time of the initial consultation in evidence of his report that I was fully informed of the procedureThat is the purpose of obtaining informed consentI was notHad I been I would have sought a second opinionTo say I refused to sign the form at the initial consultation is simply not true I was not asked and nor did I refuseBut if I had refused, as he alleges; why would he tell his staff to schedule the procedure appointment??? Especially since his instructions were that I would arrive at his office sedatedHis story of my refusal was never stated to *** or to *** *** in his replies to their questionsHad he given them this information (accurate or not) they would have challenged his decision to schedule a medical procedure under those circumstancesThe hostile environment he has created was not and, is not conducive to problem solving and, from the beginning Dr T*** has been unwilling to answer questions asked of himThis is the precise reason I have chosen to enlist your helpSimply put, I was a patient who advocated on my own behalfFrom the beginning, my questions seemed to challenge his perceived authority as "Doctor." Because discussion was impossibleI wrote him a letter only to have it returned to me unopened and unreadFurthermore, if what his receptionist says is true and the staff discussed referring me to another periodontist, why was that not done???? In their statements a referral to another periodontist was considered on two occasionsThat's the beauty of being in private practiceIf statements are true, my question, why was that not done? I have no hidden agenda but simply to advocate for myself for improved careIts clear to me Dr T*** and his staff know the protocol but it is also clear they failed to follow the protocolTherein lies the crux of the issuePlease note: Dr T*** has been paid in fullIn closing, I would like to say the pressure to make statements by the entire staff is reflected by their conflicting storiesI do not fault the office staff for acquiescing to his request knowing that keeping a job is importantRespectfully submitted

Dear Ms***: I will attempt to specifically address all the issues noted in the second declaration provided by Ms*** ***Most of her discussion, however, is just a recapitulation of previous topics, presented from a somewhat different perspectiveIt has definitely been documented that the informed consent form was indeed reviewed with Ms*** at the initial consultation appointmentThis is one fact that this former patient intentionally, conveniently and consistently fails to mention in any of her declarationsShe was not sedated at the initial consultation appointment and has no legitimate excuse to not recall itIt has been conclusively documented that Ms*** proceeded to schedule her surgical appointment immediately after this initial consultation appointmentAs previously stated, the time for the patient to take exception to the consent form would have been at that time, not after the surgical therapy had been deliveredContrary to her assertion, at the day of that consultation appointment, I was unaware as to whether Ms*** scheduled her surgical appointment or notI was not monitoring her interaction at the insurance coordinator's station; but rather, was rendering patient care in another operatory, far removed from the reception areaHer decision to schedule her surgical appointment that day was made on her independent judgment, based on the information provided at the consultation appointment, an acknowledgment that she was satisfied with the explanation and satisfied with the documentation providedAs previously stated, by any criteria, this patient was assertive and demandingIs it remotely credible that she would immediately proceed to schedule her surgical therapy without reviewing the consent form, without having her questions thoroughly answered and without feeling comfortable with my explanations? Is it credible that she just spontaneously scheduled a surgical appointment; while at the same time, contending that it was all my idea that she schedule it? Additionally, as a part of my routine protocol at the consultation appointment, I would most often mention to the patient that the informed consent form would need to be signed prior to undertaking the surgical therapyWhen the patient was taken to the reception area, my financial coordinator would usually also offer the patient the opportunity to sign the consent formHowever, as a self described health care professional, is it credible that Ms*** was completely unaware of the need to sign the consent form prior to proceeding with the surgical therapy? Depending on whether or not it benefits her argument, Ms*** is at times acutely aware of medical protocols, while at other times, totally obliviousIt seems disingenuous on the part of Ms*** to want to have it both waysIn fact, it is not a stretch for most patients, even those untrained in health care occupations to, all on their own, be readily familiar with the necessity of signing consent forms prior to any surgical interventionI believe that Ms***'s definition of informed consent is also incorrect and that she is greatly stretching the intent of informed consent in an attempt to give some credence to her argumentIt is not mandatory that the informed consent form be signed at the initial consultation appointment, as she asserts; but rather, that the informed consent form be signed prior toinitiating the prescribed surgical therapyIt has been conclusively shown that the consent form was signed by Ms*** prior to the start of the gingival surgery(A number of patients do not elect to sign the consent form at the consultation appointment, wanting more time to further consider and to further reflect, prior to electing the surgical therapy.) This does not preclude them from ever scheduling the prescribed surgical therapy at a later dateWe also do not routinely dictate that these patients return to the office for the sole purpose of signing the consent form prior to scheduling their surgery, out of a consideration for their time and their schedules, not with the intent of diminishing the validity of the informed consent, especially in light of the fact that the consent form has always been completely reviewed with each and every patient, with ample time allotted to answer any and all questionsThe one part of her declaration that is true is that she signed both the patient and witness signature linesIn my thirty-seven years of practice, having treated approximately 20,patients, I can not recollect another time when this has happenedTo say the least, this is not a common situation that we are routinely anticipating or routinely monitoringI delegate the disposition of the informed consent form to my surgical assistants, fully realizing that it is still ultimately my singular responsibilityThis was a clear oversight on our part and I accept the sole responsibility for our failure to note that discrepancyHowever, the standard of care does not dictate perfection or demand a flawless, errorless protocolIt is clear that we attempted to provide, in good faith, a reasonable level of the standard of careThe fact remains that the patient signed the consent form prior to the initiation of the surgical appointmentI would believe that Ms*** would agree that this is her signature; and of this, there is no doubtIf we had failed to procure her signature on the consent form, this could pose a more serious problem, and might be considered a breach or departure from the accepted standard of careMy surgical assistant wrongly assumed that the patient's friend would sign as a witness to her signature; and clearly, this didn't happen
The patient has repeatedly stated that she was heavily sedated and that she was completely amnesic, having no memory of any events surrounding the day of surgeryAs previously related, if she was so profoundly sedated when entering the office, why was it necessary for her to double the sedative dose to achieve a higher level of sedation? Again, she selectively remembered some events surrounding the day of her surgery, but selectively forgot others, depending on what facts supported her argumentAdditionally, no one coerced or forced Ms*** to sign the consent form or to make the agreed paymentIf she was uncomfortable with our office protocols, she could have cancelled her appointment, rescheduled her appointment, or sought treatment elsewhereShe also had a designated driver to serve as her advocate and to assist herIt would seem that, if she was so heavily sedated, she could have requested some guidance from himIt seems, however, that his sole function and purpose was to substantiate Ms***'s declarationIt would have been more appropriate for him to have voiced objection at the time of the surgical appointment as an advocate for Ms***, not waiting weeks later, at the beckoning of his friendHis agreement with Ms***'s declaration and offering his objection, at this late date, serves little effective purposeI would also like to more completely address Ms***'s claim that she was heavily sedated and amnesic upon entering our office on the day of her surgery"Everyone in my office collaborated" the fact that Ms*** was lightly sedatedMs*** was cogent enough to express her discontent both in regards to having to make payment and in regards to having to sign the consent form, in spite of the fact that she was previously informed of the exact amount of her co-payment due at the time of her surgical appointmentAdditionally, she proved completely capable, all on her own, of making payment and in signing the consent formThere was no hint of depressed motor function in her hand writingHer speech was not slurred and her expressive language skills were normalShe was fully ambulatory, requiring no assistance in walking back to the surgical operatoryThese signs are not ones consistent with someone being heavily sedatedAs previously mentioned, she doubled the dose of sedative at her own initiation after arriving to the office in an attempt to achieve a more profound level of sedationIn conclusion, there was no credible evidence that Ms*** was even marginally impairedHer sedative effect seemed particularly light, even in her own estimation, at least on the day of her surgical appointment, as she doubled the first conservative doseAdditionally, in this regard, the standard of care does not mandate perfection or dictate flawless decision making by me or my office personnelA reasonable judgment was made that this patient was not visibly impaired, and we rightly proceeded accordinglyI am sorry that this former patient feels that I am personally attacking herFrom any objective observation, however, it is this patient that is maligning me and slandering me, taking her case to two insurance companies, to her credit card company, to the Washington State Dental Disciplinary Board and to you, the Revdex.comShe is the one pushing this antagonistic agenda, not meBecause I am being attacked, I am only attempting to defend my good name and my good reputationIt is not difficult to ascertain what objective Ms*** has in making this complaintShe has stated that she is being "an advocate for myself for improved care" , "with no hidden agenda"I am uncertain as to how this complaint is in any way going to accomplish that stated goalAnd her agenda is, in reality, far from hidden; but rather, her goal is readily apparentHer agenda is to malign and slander me and pursue, on multiple fronts, an ongoing and relentless attackAdditionally in this regard, there would be no kind or gentle way for me, or anyone else for that matter, to point out that Ms*** is not telling the truth, is greatly distorting the record, while making many grossly inaccurate statements throughout her declarationAnd contrary to Ms***'s assertion, I feel that I have specifically and adequately addressed all the assertions made in her declarations, most of which I believe have been proven to be unfounded, without merit, and grossly exaggeratedI also continue to strongly support and to firmly stand behind the declarations made by me and made by my staffIf there is any discrepancy between our respective declarations, it was unintentionalMore specifically, on rereading the initial declarations of myself and my surgical assistant, Bobbi I***, I found only one discrepancyI actually made a typographical error in my declarationI incorrectly stated that "she was asked to sign the informed consent form immediately after being brought back to begin her appointment"It should have read "she was asked to sign the informed consent form immediately before being brought to the back to begin her appointment"Our long established protocol is to always have the consent form signed prior to going back to the surgical operatoryIt just makes common sense to proceed via that approachHowever, whether she signed the consent form before or after going back to the surgical operatory makes no material difference in the disposition of this caseMs*** also insinuates that there was "pressure to make statements by the entire staff"Obviously, there is no way for her to know this to be trueThis serves as yet another example of Ms*** making an outrageous statement that she knows nothing aboutSecondly, it was not necessary for the staff to "acquiesce" to support my declarationThere were equally insulted by the accusations made by this patient and resented the aggressive attitude of this patient, as her comments negatively reflected on the entire team, not just meThey were all self motivated to set the record straightI resent the implication that I would threaten my employees with loss of their employment if they failed to collaborate the facts surrounding this caseShe may view this as a and customary way to operate, but I view it as simply unethical and unacceptableI also resent the fact that she implies that my staff personnel have no integrity and would knowingly perjure themselvesAgain, Ms*** is making outrageous and insulting statements about people and issues that she knows nothing aboutI was particularly intrigued by Ms***'s statement that "DrT*** has been paid in full"This is an extremely misleading statement, implying that she was agreeable to her present "full payment" statusThe reality is opposite from Ms***'s implicationAs has been previously noted, Ms*** was opposed to making her co-payment at the day of her surgical appointment, in spite of the fact that she had been throughly informed of this, as a pre-condition for proceeding with her surgical procedureHad we not insisted on her payment at that time, I firmly believe that we would not have been now paidAdditionally, Ms*** has taken every conceivable step to rescind payment for the surgical services that I providedShe petitioned her credit card company to stop paymentHer request was denied(My understanding is that it is rare for credit card companies to not support their clients interests in payment disputes and to find in favor of the vendor.)She petitioned both of her insurance companies to disallow my fees for serviceBoth of these requests were also deniedDuring the time of these resolutions, I made my caseShe was fully involved and was given an equal opportunity to make her caseHer requests were denied, in my opinion, because her arguments were weak and her rendition of events was not compellingI have attempted to fully address all the complaints outlined by this disgruntled former patientContrary to the patient's opinion, I fully accept all responsibility for every and all actions relating to all aspects of her careI would kindly request that this case be dismissed on the merits of my arguments and on the merits of my explanation, acknowledging that we demonstrated a reasonable effort to provide accepted treatment protocols with an honest effort to apply accepted standards of practice, including the issue of informed consent

Complaint: [redacted]I am rejecting this response because: [redacted]Please view attached document[redacted]Sincerely,[redacted]
Attention: [redacted], Revdex.com Resolutions Consultant I received yesterday the response given to me through your office from Dr T[redacted]. Informed consent for this procedure was not obtained by Dr T[redacted] at my initial consultation. Instead it was obtained on the day of my procedure after the ingestion of four Halcion tablets given for sedation. The basis for my complaint is not addressed in his response.