Major changes could be coming to dentist offices across North Carolina.
Currently, if a patient needs anesthesia to have a tooth pulled or for oral surgery, a dentist can administer sedation or general anesthesia and perform the procedure at the same time.
Channel 9 learned that some patients have died in the dental chair and now, some families are calling for changes.
RELATED: State board looks at anesthesia rules in dentist offices after 6 deaths since 2014
“He came and saw me graduate and that meant more to me than anything in my life,” said Kaitlyn Mobley about her father, Roman Mobley.
Her brother, Thomas, told Channel 9, “The only thing I have left of him is his car.”
In March 2019, 43-year-old Mobley needed two teeth pulled and was referred to Dr. Din Lam in Indian Trail.
Mobley answered health history paperwork at Dr. Lam’s office that showed Mobley was asked, “Is there any condition concerning your health that the doctor should be told about?”
Mobley wrote,“Heart transplant — 2002.”
Records from the North Carolina Board of Dental Examiners state Dr. Lam failed “to seek a medical consultation or request medical clearance for patient Roman M. and document any clinically sufficient reason(s) or justification(s) before administrating deep sedation or general anesthesia.”
ALSO READ: 9 Investigates: Why state dental board took action against well-known Charlotte dentist
“Within a couple of minutes of being administered anesthesia, his heart rate slowed down and his pulse slowed,” said attorney Curtis Osborne, who represents the Mobley family.
Osborne said Lam’s efforts to revive Mobley were futile.
“I lost it and had a whole meltdown,” said Mobley’s daughter. “My mom had to come pick me up off the floor.”
The North Carolina Board of Dental Examiners revoked Lam’s license to practice dentistry and his general anesthesia permit in December 2020.
Six months later, Lam signed a consent agreement with the North Carolina Medical Board that allows him to practice under the condition that he “shall not administer general anesthesia or sedation or supervise the administration of general anesthesia or sedation.”
Channel 9′s Allison Latos went to Lam’s current practice.
Because he’s involved in a civil lawsuit, Lam wouldn’t comment about his treatment of Mobley, but said he has taken steps to increase safety.
“It is a constant reminder for me that we have to improve our care every day to provide the best care we can to our patients,” said Lam.
During every procedure Lam performs now, an anesthesiologist administers drugs and monitors a patient’s vital signs. That is not required of all North Carolina dentists.
Possible major changes to dentist offices
For 32 years, the North Carolina Board of Dental Examiners’ rules have allowed dentists to sedate patients and perform procedures at the same time.
There have been eight anesthesia-related deaths — six in the past four years — and now the board is considering changes.
Some changes include requiring an anesthesiologist or certified registered nurse anesthetist to be present during deep sedation, a rule for dentists to track adverse events, and deadlines for how quickly they notify dental board officials.
Shital Patel believes those changes could have prevented her husband’s death.
In July 2020, Henry Patel, a well-known Wilmington cardiologist, went to Dr. Mark Austin for a dental implant.
While under anesthesia, the 53-year-old’s heart rate and oxygen levels dropped to life-threatening levels.
“Literally, I just slipped to the floor when all of this was going on,” said his wife.
Patel died four days later in the hospital.
The North Carolina Board of Dental Examiners contended Austin violated the standard of care in Patel’s treatment, which Dr. Austin disputes.
The board separately found that Austin had “diverted controlled substances, including fentanyl, from his dental practice for personal use and used them with at least one other employee.”
Channel 9 reached out to Austin. He wouldn’t address the allegations about drug use but sent a lengthy statement about his training and treatment of Patel, which he said had included a prior successful surgery.
His statement said, in part, “I think about this tragedy every night that I try and sleep and every morning that I wake up.”
Austin also wrote, “The accusations that I didn’t attempt to save his life in every way that I could are completely false.”
Austin agreed to permanently surrender his license in August 2021, which he said he regrets.
ALSO READ: UnitedHealthcare patients caught in middle of anesthesiology fight
“We just decided as a family, we can’t let this go,” said Patel’s wife.
She is pushing for statewide sedation and anesthesia rule changes.
“If that’s all I can do in my lifetime is to save another life, that’s what I’m going to do,” said Patel.
Dentists push back against proposed changes
Dr. Alec Parker of the North Carolina Dental Society told Channel 9: “The NC Dental Society (NCDS) respects and agrees with the NC State Board of Dental Examiners (NCSBDE) commitment to ensuring patient safety. At this time, the NCDS does not support requiring a separate dental anesthesia provider. There is no scientific evidence to support that a separate provider would enhance patient safety or decrease adverse events occurring in the administering of sedation for dental care. There would also be increased costs of a separate dental anesthesia provider and the supply of medical and dental anesthesiologists and CRNA’s is not sufficient to meet the need in North Carolina, particularly in rural areas. In addition, North Carolina would be the only state in the country to require a separate anesthesia provider.”
The North Carolina Board of Dental Examiners hopes to decide on these changes at its September meeting.
(WATCH BELOW: 9 Investigates: Why state dental board took action against well-known Charlotte dentist)
Full statement from Dr. Mark Austin:
“I was asked to give a statement and answer questions regarding the incident that occurred in my office on July 30, 2020 concerning Dr. Henry Patel. I have agreed to make this statement because I believe that there has been misinformation circulated with regard to the care Dr. Patel received in my office. It seems to me that there has been an attempt by certain parties to portray my role in the incident as less than satisfactory, or that I didn’t play an active part in attempting to save Dr. Patel’s life, which could not be further from the truth. There was not a time during the incident that I was not by the patient’s side performing CPR (Cardiopulmonary Resuscitation) and ACLS (Advanced Cardiovascular Life Support). My staff members that were present would testify to this. Dr. Patel coded after his surgical procedure was complete. Immediately after this happened, I realized he wasn’t spontaneously breathing, and CPR was initiated on the patient. EMS was then called while CPR was being performed. I do not know what caused Dr. Patel to code. If I knew that then I probably wouldn’t be here giving this statement. I do know that he was not over-sedated during the procedure as some have speculated. I had done surgery on Dr. Patel previously with no issues. In fact, his first surgery was a longer, more complicated surgery and required a bit more sedation than his second surgery. With assistance from the Brunswick County EMS, continuous ACLS protocol was carried out, a sustained pulse was achieved and Dr. Patel was transferred to the hospital. Unfortunately he passed several days later. The medical examiner told me that my case had been reviewed and that proper protocol had been followed during the code. He also told me that when a patient codes in an outpatient facility, there is less than a 20% chance of survival. Those statements do not make this tragedy any easier to handle. There is not a day that goes by that this isn’t weighing on my mind. I think about this tragedy every night that I try and sleep and every morning that I wake up. I knew Dr. Patel from my time working at the hospital and had the utmost respect for him. He was a remarkable cardiologist and a remarkable man. I remember feeling proud that he chose to come to me for his surgeries because that’s how much I respected him. Losing this great man after the tragedy in my office has been heartbreaking for me and always will be. I cannot begin to understand the heartbreak that this has caused for the Patel family. And I will always keep them in my prayers.
“Prior to this incident with Dr. Patel, I had done approximately 7,000 sedations in my office with no significant complications. My training included four years of dental school, followed by six years of hospital based residency with almost one full year dedicated to anesthesia training. Starting in 2007, I worked for NHRMC for 7 years focusing on emergency facial trauma and reconstruction. During that time I performed many tracheotomies in the OR. I am well versed in that field. The NC State Dental Board brought up the fact that I did not attempt to perform an emergency cricothyrotomy on Dr. Patel. The fact is, a cricothyrotomy was not necessary in this case. During the code, a laryngeal mask airway was placed and successful ventilation could be carried out with that airway. If ventilation can be carried out with the placement of a laryngeal mask airway, then a cricothyrotomy is not necessary and would be the wrong choice of action.
“I trained my entire life to become an oral and maxillofacial surgeon. I love this specialty of surgery, it is my greatest passion in life. I loved my patients and loved being able to help them with their oral and maxillofacial surgery needs, and in many cases, greatly improve their quality of life. I can assure you that no one cared for their patients more than I cared for mine. I believe that if you asked my patients, my referrals, my colleagues and the people I worked with closely in the hospital; most would tell you that they respected me as a surgeon and they knew I would always do what was right for my patients. Many of my patients were people I worked with at the hospital and also family and friends of my referrals. They chose to come to me for a reason. Obviously that has all changed now as I am not allowed to practice oral surgery in my community or in NC anymore. Due to outside influences that I couldn’t control, I felt a strong pressure to surrender my license. It’s something I regret happening everyday. Oral surgery was my life’s work! There is nothing I wouldn’t do to be able to practice again someday. It’s all I’ve ever done since my training and all I’ve ever wanted to do. I miss it everyday and miss my patients everyday. I also think of Dr. Patel everyday and that will never change. But the accusations that I didn’t attempt to save his life in every way that I could are completely false. The efforts obviously didn’t lead to the outcome we all desire and that is something I have to live with for the rest of my life.”