1st Sun City Dental, PLLC
Added on -, by Reviewer8480273
I have reviewed the response made by the business in reference to complaint ID [redacted], and have determined that this proposed action would not resolve my complaint. For your reference, details of the offer I reviewed appear below.
RE: Complaint ID # [redacted]
To Whom it May Concern:
The following text includes: a message from [redacted]'s dental office and within that message my responses which are put forth as supplementary narrative and a citation from [redacted] website.
[redacted] responses, and other statements originating from [redacted]'s office are shown in red italics, citations quoted from the [redacted] website are shown in bold black, and [redacted]'s rebuttals and supplementary narrative are presented in the form of bullet points, and are written in 12 point black print.
MESSAGE FROM BUSINESS:
This letter was written in response to complaint ID#: [redacted]. Specifically, [redacted] reported:
" She was pressured to consent to additional dental treatment while "under heavy sedation."
Patient openly expressed anxiety surround dental work and was provided with a typical low dose prescription (Valium 5mg, take l tab before bed and 1tab one hour prior to appointment) from [redacted] to help with her anxiety. This is in no means a heavy sedation and cannot affect the mental statusof a patient. Doctor went over all necessary treatment at time of visit.
• • According to the [redacted] website (the manufacturer of Valium), both doses of Valium were 250% of the amount recommended for elderly patients (the first dose - prescribed and taken by her - on the evening prior to the dental work which likely did not have time to clear her system; and the next dose which was administered one hour prior to the appointment), and I quote:
"Use in the Elderly
There have been reports of falls and fractures in benzodiazepine users. The risk is increased in those taking concomitant sedatives (including alcoholic beverages) and in the elderly.
Elderly or debilitated patients may be particularly susceptible to the sedative effects of benzodiazepines and associatedgiddiness, ataxia and confusion, which may increase the risk of a fall.
Lower doses should be used for elderly and debilitated patients
DOSAGE AND ADMINISTRATION- Oral
For maximal beneficial effect, the dosage should be carefully individualised (sic). Dosage may need to be reduced in patients with hepatic or renal disease as the elimination half-life may be prolonged in this sub-group.
Elderly patients should be given a reduced dose. These patients should be checked regularly at the start of treatment in order to minimise (sic) the dosage and/or frequency of administration to prevent overdose due to accumulation.
Usual Adult Dosage: 5-40 mg daily.
Average dosage for ambulatory patients: 2 mg three times daily or 5 mg in the evening and 2 mg once or twice during the day.
Elderly or debilitated patients: 2 mg twice daily or half the usual adult dose.
Ability to **ive and Use Machines
Sedation, amnesia, impaired concentration and impaired muscle function may adversely affect the ability to **ive or operate machinery.
As with all patients taking CNS depressant medications, patients receiving VALIUM should be warned not to operate dangerous machinery or motor vehicles until it is known that they do not become **owsy or dizzy from VALIUM therapy. Abilities may be impaired on the day following use. "
• • Additionally, the dentist required [redacted] to have a [redacted] her both to and from the dental appointment as it is illegal to **ive under the influence of any substance that impairs one's ability to operate a motor vehicle which would be a potential liability for the dental office as well. Clearly, the dental office recognized that [redacted] would have had impaired mental abilities as a result of this sedative they prescribed, or they would not have required that she have a **iver for her appointment. This chauffer requirement, along with the information from the **ug manufacturer's website, is in direct conflict with the statement made by [redacted], office manager, that:
• "This is in no means a heavy sedation and cannot affect the mental status of a patient."
• Multiple visits to office due to pain factors that were not resolved
Upon researching the patient's clinical account, I have created a timeline of her care at our office since the dental work in questioning was started:
1/14/13: Patient had no complaints. 2/11/13: Patient feeling satisfied.
7/16/J 3: Patient left reporting "feel much better." 9/24/13: Patient left stating. "feels much better."
12/2/13: Patient refused root canal due to fear of infection due to health issues and unable to take antibiotic. Patient expressed interest in extracting #14 andconcerning a partial.
• • The large number of visits following the crown placement indicate that there were problems, or there would have been no reason for [redacted] to continue for return appointments. With regard to the statement that [redacted] made that, " pain factors were resolved, " this in direct conflict with the following notes that **.[redacted] wrote:
"Your mom complained of having sensitivity in teeth #3 and 14 after receiving the crowns, an occlusal adjustment was done on them by me and **. [redacted].
The last time your mom was at our office was on December 2, 2013, a limited exam was done by **. [redacted]. Teeth #3 and 14 reacted to Endo- Ice test and were very sensitive." and that " root canals were recommended."
• • Clearly [redacted] was still in pain at each of these visits as [redacted] documented in his statement. Again, this is reaffirmed by his having recommended that root canals be performed.
• Office and **. [redacted] not responding to email and phones calls.
• On February 20, 2014, [redacted] and her daughter gave their first notice - in person - that they believed a full refund was warranted. After that meeting, numerous telephone calls were placed to [redacted], (who is represented on the website as an office manager), requesting that the refund be made. We requested an email from her acknowledging that we had made contact with her office, and that we were requesting a full refund. She refused to provide us with written confirmation of any of our contacts. We do have phone records establishing that we made these calls to her. After months of promises from her that the office manager would call us, [redacted] informed us that the office manager was not working due to family complications, and that she would have the dentist call us. Finally, on May 9th, the dentist - [redacted] - emailed us, and requested details regarding our request for a refund.
In fact, **. [redacted] has approximately 14 emails between himself. [redacted] (the daughter), and his office manager. All emails were focused oncommunicating and trying to understand and resolve the situation. To say, that as an office, we were not handling the matter, is fictitious.
"Your mother came first time to our office in July 27, 2012 and had X-rays done! saw her on July 30,2012 and did a comprehensive exam.Your mom was complaining during the exam that her upper molars were very sensitive to cold and hot and that is also what she checked on the dental history. The exam showed that teeth #3, 4, 5 and 14 have large amalgam fillings with recurrent decay, cracked and have facial abrasion.Tooth #1 0 has recurrent decay around an existing filling and tooth #32 has a deep cavity. The pt. was referred to an Endodontist to get a rootcanal done on tooth #32. On August 6th, 2012 your mom came and received a filling on tooth # 10. She declined to get tooth #32 treated by anEndodontist and insisted on getting it extracted; it was extracted on that day. On December 19, 2012, I prepared teeth# 3, 4. 5 and 14 forziriconia crowns, the recurrent decay in teeth #3 and 14 were very deep and the teeth were cracked, root canal therapy was an option at thatvisit. The crowns were cemented on June 14, 2013. Your morn complained of having sensitivity in teeth #3 and 14 after receiving the crowns, an occlusal adjustment was done on them by me and **. [redacted]."- [redacted]
The teeth were very sensitive to cold and hot temperatures before getting any treatment done. " Claiming open margins and decay due topoor workmanship
"The doctor checked the photos you sent, there is no sign of decay around the margin of the
crowns, however, there is a sign of (Xerostomia) **y mouth and plaque accumulation around the margins. There might be a little de-calcificationin tooth #3 above the margins of the crown but the margins of the crown looked very good in the pictures. **y mouth increases the risk for tooth decay. Saliva helps keep food from collecting around the teeth and neutralizes the acids
produced by plaque. Those acids damage the structure of the teeth. **. [redacted]and **. [redacted] both examined your mother's teeth, bothdocumented that the crowns were fine and no decay is detected around them. The x-rays taken in 12/2/ 2013 at our office show no signs ofdecay. If you provide us with other x-rays or pictures that show open margins or decay resulting from faulty crowns, I will be more than happy tocheck them out and give you my honest opinion. Thank you for your patience, and sorry about your mom's pain."- [redacted]
The doctor asked for x-rays from the other doctor to show any open margins or decay proving the need to redo the 2 crowns he replaced due todecay and open margins. Our office never received x-rays showing open margins and decay or a letter.
• • X-rays, and the other doctor's note were furnished by us to [redacted]'s office on many occasions including May 12 which is when we re-sent the earlier email to [redacted] that contained x-rays and photos (which we faxed to her as well at that time). We re-sent these to her on June 3, and again on June 20th.
• Wanting full refund $2,683.00
Three of the four crowns were placed when [redacted] did not have the capacity to enter into a legal agreement. The visit prior, when she was not sedated and the treatment plan was discussed, she refused everything that was proposed, with the exception of the one crown she. She only agreed to having the other three placed after she was under heavy sedation.
(Again, displaying continued communicate with daughter in regards to dental issue)
"I have not received any X-ray from you or the dentist I have X-rays showing that the crowns we placed have no decay or problems. The pictures yousent me do not show any cavity due to faulty crowns. I have not received any credit card dispute as well. We stand behind our work.
lf you provide us with a letter from the other dentist stating that the crowns we placed are faulty and needed to be replaced, supported with x-rays andpictures the shows the problem I will be more than happy to give you a partial or full refund. My reputation is excellent, if you go to the [redacted] website, you will see that l never had any complaint or action against me. I have been practicing in Arizona for 15 years. Sorry, again aboutyour mother's pain. Sincerely [redacted]"
[redacted] was very fair by offering to refund the payment price of the single crown that had initially given the patient problems.
• • The new dentist found that all four crowns had recurrent decay, open margins, and needed to be replaced. Therefore, the offer to refund one crown is not a satisfactory resolution to us. While a refund of all of the money paid for the four crowns could not compensate for the pain and suffering [redacted] endured over the year following the placement of those crowns, it is a resolution that we would be satisfied with. Additionally, [redacted] returned for consequent appointments many times over the course of the year following the crown placements; allowing ample time for [redacted] to alleviate her suffering.
• • Repeatedly, [redacted] was of the opinion that [redacted] needed to have at least one root canal in order to relieve her pain. Contrary to his recommendation, she has had two of the crowns he initially placed replaced by [redacted] (her new dentist), and does not have any pain. This outcome suggests that [redacted]'s recommendation for root canals was not the indicated course of treatment. .
• **. [redacted] notes stated all four crowns need to be replaced due to decay and open margins
"'Please ask the doctor to provide us with a letter stating that the decay was due to faulty crowns supported with x-rays to show it and I will be morethan happy to give your mother a partial or full refund. Again the x-rays we took at our office do not show recurrent decay around the margins.However, people who have **y mouth have the tendency to develop decay much faster than other people. Your mother chose to go to another officeand we are sorry to lose her. Should she come back to our office after the second opinion from the other office; we could've re-done the crowns for herfor no-charge if they needed to be replaced because we stand behind our
• • At that time [redacted] had already returned to the dentist at least five times, and had been in pain for nearly one year. The remedy being proposed by [redacted] was to do root canals. Clearly, at this point [redacted] had little or no faith in his dentist's ability to get her pain alleviated.
Thank you again. Sincerely yours **.[redacted]••
Our office asked repeatedly for X-rays to display faulty crowns. The pictures provided displayed only plaque accumulation around the crowns. We alsorequested a letter from the doctor saying that the work needed to be re-done due to faulty crowns. Our office has never received a note from **.[redacted] stating the cro"'11 margins and recent decay is due to faulty crowns or poor workmanship.
• • The x-rays that [redacted] took show the open margins around, and recurrent decay under the four crowns. These were furnished to [redacted] along with the doctor's note from [redacted] expressing his opinion that all four crowns needed to be replaced.
Sincerely Yours, [redacted] Office Manager
1st Sun City Dental
I hope that the information provided here is of help to you in making your appraisal of this situation. If any clarification, or additional information, would be helpful please don't hesitate to contact me.