Tribunal bans Pilbara dentist Ananda Krishnan from practising after giving boy excessive sedation

A tribunal has banned a Western Australian dentist from practising for four years after he gave too much of an oral sedative to a young boy, which carried a risk he could have stopped breathing.

A statement of agreed facts before the State Administrative Tribunal (SAT) said dentist Ananda Krishnan compromised the health and safety of a five-year-old boy by giving him 10 milligrams of midazolam before dental treatment.

The medication is used for sedation and to ease anxiety, but the dose was greater than what was needed in the circumstances.

In the statement of agreed facts, the SAT was told that in December 2019, the young boy, known as Master LW, attended the Pilbara Dental Centre clinic in South Hedland with his mother after experiencing pain in his mouth.

Dr Krishnan examined Master LW’s mouth in the clinic’s reception area but could not undertake a thorough assessment as the child was unwilling to open his mouth.

The now 66-year-old dentist scheduled an appointment for the boy to undergo dental treatment the following day and at that appointment, Master LW’s mother — known as NW — verbally told Dr Krishnan her son’s approximate weight.

Before starting the treatment, Dr Krishnan administered 10 milligrams of midazolam to ease Master LW’s anxiety, but the tribunal said the dose was greater than what was needed.

According to the statement of facts, the dose given carried a risk the five-year-old could have stopped “breathing with potentially fatal consequences” and the dosage should only have been given in a hospital setting.

After the treatment, the boy’s parents were concerned about the five-year-old’s condition as he appeared to be semi-conscious and was still affected by the sedative the next day.

Health and safety compromised

The Dental Board of Australia referred the incident to the SAT, which heard Dr Krishnan compromised the “health and safety” of Master LW, as he did not have the “knowledge, skill [and] judgement” to administer 10mg of midazolam.

The medication is a cardiac and respiratory suppressant, but its safety and effectiveness has not been established in children under the age of eight years.

“The use of midazolam in a five-year-old is considered off label,” the statement of facts said.

“Alternative and safer treatment options were available to manage Master LW’s anxiety.”

Port and South Hedland are remote towns in WA’s Pilbara region.(Supplied: Pilbara Ports Authority)

It was agreed Dr Krishnan failed to provide adequate pre-operative clinical care as he did not weigh Master LW or undertake a comprehensive physical examination and he failed to obtain a detailed medical history.

He failed to adequately monitor the child’s heart and respiration rate, blood pressure and blood-oxygen levels during the treatment.

The tribunal noted that before Dr Krishnan discharged Master LW, who had not met the discharge criteria, he left the boy in the care of a general dental therapist who was not qualified or trained to handle a serious emergency that could have stemmed from the overdose.

Dentist remorseful for conduct

The 66-year-old has been disqualified from applying for registration for four years and ordered to pay $6,000 of the Dental Board of Australia’s court costs.

The Tribunal made its orders based on the settlement made between the Dental Board of Australia and Dr Krishnan.

Dr Krishnan has expressed remorse for his conduct and admitted to his wrongdoing.

The tribunal said he cooperated with the disciplinary process by admitting to the incident, understanding its seriousness and showing insight into his conduct.

NW said the incident had a significant impact on her.

She said she becomes anxious when going to the dentist or taking her children to the dentist.

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