Another dental death (MN)

[wiscoAA]

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Minnesota man dies after routine dental cleaning in Hopkins, police investigating

A family wants to know why their loved one died while undergoing a routine dental cleaning.

www.cbsnews.com

Relaxation/ Sedation Dentistry in Hopkins in Hopkins, MN | Gendler Dental Center

Relaxation/ Sedation Dentistry in Hopkins -

dentistmn.com

“WHAT SETS GENDLER DENTAL CARE APART AS SEDATION DENTAL CARE PROVIDERS?​

Your safety is ensured by the presence of an anesthesiologist or nurse anesthetist, who constantly monitors your well-being during your dental treatment. Because of this, the dentist can fully focus on delivering excellent dental results.”


What’s wild to me is that this office had a cardiac arrest only 2 weeks prior to this unfortunate catastrophic event. Really unfortunate how these errors are seemingly happening more and more.

 

[cittykat]

New anesthesiologist or CRNA?

 

[NPJR]

MN is teeming with CRNAs and it's an opt-out state so it is not beyond the realm of possibility that it was a CRNA. Awaiting updates..

 

[caligas]

It’s always seems contradictory to me; dental anesthesia is often challenging in regards to patient cooperation and airway management and yet it’s done by non anesthesiologists in isolated locations.

 

[aneftp]

MN is teeming with CRNAs and it's an opt-out state so it is not beyond the realm of possibility that it was a CRNA. Awaiting updates..

And if it’s an MD only? What will be the excuse? Just like Joan Rivers gi death was MD only.

We docs are better than this ideology.

I’m not gonna to do the crna or md blame game here.

Outpatient dental places need to screen patients undergoing anesthesia

Anyone who is developmentally challenge should automatically be axed from the center patient list.

One of the piss poor ASA mission planning is never to structure their arguments anesthesia safety is not just about what goes on in the procedure or or room. It goes well before that. With appropriate patient screening before procedures.

This is many crna only Achilles heel in terms of patient selection.

Crnas the independent ones know this game. Many are not trained for the medical knowledge of patient selection especially in the outpatient settings.

That’s why when I offered crna $400/hr to staff ep center solo. They balk at it. And yes that’s the real rate. Ep doc who is personal friend of mind wants to pay crna that but they gotta be good. Because he knows he can push the crna around. He’s willing to pay top dollar. But he wants to push the crna around to the limit what patients he can bring to his strip mall ep standalone center to do ablations

 

[NPJR]

So every developmentally challenged patient has to be done at a hospital ? That is your solution?
How 'bout dont do dumb stuff so patients die.
This was 100 percent an airway catastrophe by trying to deep extubate, using too much opioid medications, including dexmedatomidine in the mix or ketamine and tryna extubate in a cute manner rather than extubating wide awake however ugly that looks.

 

[VA Hopeful Dr]

So every developmentally challenged patient has to be done at a hospital ?

Yes? That's what our kids' dentist does. Anything beyond nitrous or a single benzo gets done in the hospital. But this seems to be something that only the pediatric dentists do in my area.

 

[NPJR]

Yes? That's what our kids' dentist does. Anything beyond nitrous or a single benzo gets done in the hospital. But this seems to be something that only the pediatric dentists do in my area.

You do realize that these dentists dont go to the hospital. So if you mandate that they wont get the service.

 

[aneftp]

You do realize that these dentists dont go to the hospital. So if you mandate that they wont get the service.

That’s their choice.
The patients don’t get anesthesia with crna or anesthesiologist

The dentist can do their own local/light sedation assume all the risk/reward.

The safest choice is local by the dentist.

The safest gi sedation is actually very little sedation. It’s been proven over and over again. And not propofol anesthesia

The Netherlands women only get epidurals 20-30% of the time. So it’s a cultural situation why USA women demand (70-75%) are taught to get unnecessary and more risky epidurals when most can do without any epidurals.

We have become such an entitled society in the USA.

The dentist can choose not to go to the hospital and do his own local anesthesia or give light sedation on his own. There is nothing wrong with that.

 

[FiO2@21]

That’s their choice.
The patients don’t get anesthesia with crna or anesthesiologist

The dentist can do their own local/light sedation assume all the risk/reward.

The safest choice is local by the dentist.

The safest gi sedation is actually very little sedation. It’s been proven over and over again. And not propofol anesthesia

The Netherlands women only get epidurals 20-30% of the time. So it’s a cultural situation why USA women demand (70-75%) are taught to get unnecessary and more risky epidurals when most can do without any epidurals.

We have become such an entitled society in the USA.

The dentist can choose not to go to the hospital and do his own local anesthesia or give light sedation on his own. There is nothing wrong with that.

what are "unnecessary and more risky epidurals"?

 

[aneftp]

what are "unnecessary and more risky epidurals"?

The risk of doing no epidural is zero

The risk of doing an epidural is greater than zero.

It’s a very simple and logical explanation.

We perform way too many procedures in the USA compared to other countries.

Anytime you do a procedure there is a greater than zero percent risk.

 

[Hoya11]

That’s their choice.
The patients don’t get anesthesia with crna or anesthesiologist

The dentist can do their own local/light sedation assume all the risk/reward.

The safest choice is local by the dentist.

The safest gi sedation is actually very little sedation. It’s been proven over and over again. And not propofol anesthesia

The Netherlands women only get epidurals 20-30% of the time. So it’s a cultural situation why USA women demand (70-75%) are taught to get unnecessary and more risky epidurals when most can do without any epidurals.

We have become such an entitled society in the USA.

The dentist can choose not to go to the hospital and do his own local anesthesia or give light sedation on his own. There is nothing wrong with that.

we used to have this one severely autistic kid come to the hospital, his mom would open the car door, and you would ketamine him through the clothes in the car seat, and then take him out of the car by stretcher/o2 to the or for dental cleaning. his mom and the dentist insisted on cleanings every 6 months and any discussion as to the safety of what was going on or the necessity of the procedure was "depriving him of his right to health care"

 

[CopaceticOne]

we used to have this one severely autistic kid come to the hospital, his mom would open the car door, and you would ketamine him through the clothes in the car seat, and then take him out of the car by stretcher/o2 to the or for dental cleaning. his mom and the dentist insisted on cleanings every 6 months and any discussion as to the safety of what was going on or the necessity of the procedure was "depriving him of his right to health care"

That would be an absolute hard no for me. Full stop. Not open for discussion. No way I’m jumping on top of that ticking time-bomb.

Patient’s have a right to SAFE healthcare. And they don’t get to force me to do something I don’t think meets that low bar for an elective procedure.

 

[aneftp]

we used to have this one severely autistic kid come to the hospital, his mom would open the car door, and you would ketamine him through the clothes in the car seat, and then take him out of the car by stretcher/o2 to the or for dental cleaning. his mom and the dentist insisted on cleanings every 6 months and any discussion as to the safety of what was going on or the necessity of the procedure was "depriving him of his right to health care"

There are govt facility with tort law or soveign immunity they are welcome to go to. Many state dental schools tied to medical campus will do this dental sedation

Ain’t no way I’m risking it at a private institution

That’s what I mean by the entitlement

Dental care is important. But the dentist can find his own people to provide sedation.

 

[propadope]

The office website states that he is a GP dentist yet look at this website

Dr. Joseph Gendler, DDS - Oral and Maxillofacial Surgery - Hopkins, MN

Dr. Joseph Gendler, DDS, Oral and Maxillofacial Surgery specialist in Hopkins, MN. See credentials, services, locations & reviews.

www.myspecialtydentist.com

He’s advertised as specialist in OMFS but does not show credentials of being trained or board certified. Thats a red flag right there.

How did his practice not get shut down after the first cardiac arrest? I think the Minnesota Board of Dentistry should be liable for failing to protect public health and safety which is its mission

 

[NPJR]

Patient’s have a right to SAFE healthcare. And they don’t get to force me to do something I don’t think meets that low bar for an elective procedure.

They'll find somebody else. That is where we are with this.
Like joan rivers. There is NO way I would work in a GI center w/o the ability to use Anectine; But they somehow find people. I was working the circuit of GI centers at the time of MS Rivers death. Not that one. Solo GI. I had a circuit of about 5 GI centers I rotated through.

 

[CopaceticOne]

They'll find somebody else. That is where we are with this.
Like joan rivers. There is NO way I would work in a GI center w/o the ability to use Anectine; But they somehow find people. I was working the circuit of GI centers at the time of MS Rivers death. Not that one. Solo GI. I had a circuit of about 5 GI centers I rotated through.

True, there is always some schmuck willing to take it up the rear for $$.

Thankfully, that ain’t me.

 

[CopaceticOne]

The office website states that he is a GP dentist yet look at this website

Dr. Joseph Gendler, DDS - Oral and Maxillofacial Surgery - Hopkins, MN

Dr. Joseph Gendler, DDS, Oral and Maxillofacial Surgery specialist in Hopkins, MN. See credentials, services, locations & reviews.

www.myspecialtydentist.com

He’s advertised as specialist in OMFS but does not show credentials of being trained or board certified. Thats a red flag right there.

How did his practice not get shut down after the first cardiac arrest? I think the Minnesota Board of Dentistry should be liable for failing to protect public health and safety which is its mission

That’s some auto generated / AI crap website based on public databases. Did you miss the whole “enrich your profile further”?

There is one of these types of sites that lists me as a surgeon accepting new patients.

 

[aneftp]

True, there is always some schmuck willing to take it up the rear for $$.

Thankfully, that ain’t me.

It’s $4000/6 hr minimum is the standard dental oral max rate for crna only.

Anything cheaper no one will do it in Florida area. Crnas know they can sit around and do easy or cases with breaks and still get $2400-2600 for 12 hr in Florida. Why risk it.

Most dental practices will not want to pay that.

But like you said. Maybe they find a sucker. But most professional independents know better. I talk to a lot of guy simply because they know who I am. They balk at the price of anesthesia.

 

[propadope]

That’s some auto generated / AI crap website based on public databases. Did you miss the whole “enrich your profile further”?

View attachment 425820

There is one of these types of sites that lists me as a surgeon accepting new patients.

Yes missed that. My bad. Well it’s still sketchy and doing the public a disservice by having inaccurate information on these websites. These websites should not exist but thats another story…

There’s obviously a lot of details missing in both cases but supposedly a mobile anesthesia group was used in at least 1 of the 2 cases. We don’t know which group was involved and who the provider of anesthesia was.

 

[FiO2@21]

The risk of doing no epidural is zero

The risk of doing an epidural is greater than zero.

It’s a very simple and logical explanation.

We perform way too many procedures in the USA compared to other countries.

Anytime you do a procedure there is a greater than zero percent risk.

Right but which labor epidurals are we labelling unnecessary? How much pain or discomfort is worthy of an epidural?

 

[aneftp]

Right but which labor epidurals are we labelling unnecessary? How much pain or discomfort is worthy of an epidural?

It’s cultural.

What explains 1/3 of Holland women get epidurals for labor and 75% of USA women get labor epidurals ?

And maternal death rate is BETTER IN HOLLAND. Than in the USA.

The USA is full of entitled people expecting vip service for their healthcare

Sometimes less is better.

Just like 90% of gi docs can’t do their own sedation these days. It was never about patient satisfaction. It was always about the $$$ with propofol sedation and gi anesthesia. Let’s not kid ourselves here. They can do all the studies they want on patient satisfaction.

 

[spike7585]

It’s cultural.

What explains 1/3 of Holland women get epidurals for labor and 75% of USA women get labor epidurals ?

And maternal death rate is BETTER IN HOLLAND. Than in the USA.

The USA is full of entitled people expecting vip service for their healthcare

Sometimes less is better.

Just like 90% of gi docs can’t do their own sedation these days. It was never about patient satisfaction. It was always about the $$$ with propofol sedation and gi anesthesia. Let’s not kid ourselves here. They can do all the studies they want on patient satisfaction.

You doing your own colonoscopy no sedation?

 

[UscGhost]

It’s cultural.

What explains 1/3 of Holland women get epidurals for labor and 75% of USA women get labor epidurals ?

And maternal death rate is BETTER IN HOLLAND. Than in the USA.

The USA is full of entitled people expecting vip service for their healthcare

Sometimes less is better.

Just like 90% of gi docs can’t do their own sedation these days. It was never about patient satisfaction. It was always about the $$$ with propofol sedation and gi anesthesia. Let’s not kid ourselves here. They can do all the studies they want on patient satisfaction.

What do epidurals have to do with maternal mortality?

 

[cittykat]

You doing your own colonoscopy no sedation?

My friend requested no sedation. Had 2 shots of tequila in the parking lot before walking in for his. He said it was fine. But he’s also a Vietnamese refugee orphaned at age 5 so he’s not your typical patient. I had propofol for my own.

 

[aneftp]

You doing your own colonoscopy no sedation?

No. Holland uses 10% propofol only for colonoscopy. The rest is just conscious sedation

The USA uses 60% propofol sedation for colonoscopy.

We over consume healthcare like anesthesia in the USA.

That’s one of the reasons that likely led to the dental death

 

[aneftp]

What do epidurals have to do with maternal mortality?

We all know the standard answers that maternal mortality is “multi-factorial”

Just need to start eliminating potential factors and we can get to the root cause of mortality.

 

[coffeebythelake]

No. Holland uses 10% propofol only for colonoscopy. The rest is just conscious sedation

The USA uses 60% propofol sedation for colonoscopy.

We over consume healthcare like anesthesia in the USA.

That’s one of the reasons that likely led to the dental death

Any sort of deep sedation anesthesia or general anesthesia for routine dental extractions or cleaning is almost certainly unnecessary.

 

[Gern Blansten]

That’s some auto generated / AI crap website based on public databases. Did you miss the whole “enrich your profile further”?

View attachment 425820

There is one of these types of sites that lists me as a surgeon accepting new patients.

Well then, this appears to be a clear cut case of Gendler dysphoria.

 

[Gern Blansten]

No. Holland uses 10% propofol only for colonoscopy. The rest is just conscious sedation

The USA uses 60% propofol sedation for colonoscopy.

We over consume healthcare like anesthesia in the USA.

That’s one of the reasons that likely led to the dental death

We use 1% propofol, as pictured:

 

[VA Hopeful Dr]

Any sort of deep sedation anesthesia or general anesthesia for routine dental extractions or cleaning is almost certainly unnecessary.

Ehhh, for super special needs kids it's either that or no dental care.

 

[aneftp]

Ehhh, for super special needs kids it's either that or no dental care.

It’s patient selection as well.

No one isn’t saying don’t get them dental care. (When necessary)

but the kids I did had really bad teeth and I was at govt institution. Not some stand alone dental clinic. I doubt this was even at a AAAHC (or similar) outpatient facility either

 

[propadope]

Any sort of deep sedation anesthesia or general anesthesia for routine dental extractions or cleaning is almost certainly unnecessary.

Lots of phobic patients out there, precooperative children, uncooperative children, special needs, bad gaggers etc…
In those cases, minimal or moderate sedation is likely going to fail. I guess it depends on what you consider routine.

 

[aneftp]

Lots of phobic patients out there, precooperative children, uncooperative children, special needs, bad gaggers etc…
In those cases, minimal or moderate sedation is likely going to fail. I guess it depends on what you consider routine.

It all comes down to risk and reward.

Dentist rather be in their clinic and if they are having to waste 2 hr of their time running to asc or hospital to do the procedure. They are losing money.

As we all know. Time is money.

We try to be holistic and say it’s for the patients. But let’s be honest. It’s ALWAYS ABOUT THE MONEY.

Now the dentist can try to group all the trainwrecks to one half day of procedures and bring them to an asc or hospital to do it. But it takes a lot of coordination. Many won’t do it.

We have so many docs from other specialties unwilling to go to the hospital these days. And certainly dentist’s hardly ever go to the hospital. Even the oral max docs. At trauma centers. We gotta wait for them to 5-7pm to do their oral max cases at hospital. They aren’t taking half their more lucrative clinics to run to the hospital during normal business hospitals to do a hospital case. The vast majority of mandibles cases can be done at stand alone centers on outpatient basis. But oral max docs aren’t that dumb to risk it.

 

[Agast]

They'll find somebody else. That is where we are with this.
Like joan rivers. There is NO way I would work in a GI center w/o the ability to use Anectine; But they somehow find people. I was working the circuit of GI centers at the time of MS Rivers death. Not that one. Solo GI. I had a circuit of about 5 GI centers I rotated through.

Joan Rivers died in a GI suite because her ENT doctor decided she wanted to do a quick scope as well. It’s been years since I’ve practiced any sort of general anesthesia but I feel like the anesthetic conditions that work for upper endoscopy are not equivalent to laryngoscopy - should she have been intubated for the level of stimulation the ENT was going to perform? I think the anesthesiologist was too timid to push back.

 

[caligas]

Joan Rivers died in a GI suite because her ENT doctor decided she wanted to do a quick scope as well. It’s been years since I’ve practiced any sort of general anesthesia but I feel like the anesthetic conditions that work for upper endoscopy are not equivalent to laryngoscopy - should she have been intubated for the level of stimulation the ENT was going to perform? I think the anesthesiologist was too timid to push back.

It was the unplanned vocal cord biopsy that triggered laryngospasm that was insufficiently managed leading to her death. I would not do that biopsy without an ETT. You can do an endoscopic laryngoscopy with just IV sedation. We see the vocal cords on every EGD.

 

[cittykat]

It all comes down to risk and reward.

Dentist rather be in their clinic and if they are having to waste 2 hr of their time running to asc or hospital to do the procedure. They are losing money.

As we all know. Time is money.

We try to be holistic and say it’s for the patients. But let’s be honest. It’s ALWAYS ABOUT THE MONEY.

Now the dentist can try to group all the trainwrecks to one half day of procedures and bring them to an asc or hospital to do it. But it takes a lot of coordination. Many won’t do it.

We have so many docs from other specialties unwilling to go to the hospital these days. And certainly dentist’s hardly ever go to the hospital. Even the oral max docs. At trauma centers. We gotta wait for them to 5-7pm to do their oral max cases at hospital. They aren’t taking half their more lucrative clinics to run to the hospital during normal business hospitals to do a hospital case. The vast majority of mandibles cases can be done at stand alone centers on outpatient basis. But oral max docs aren’t that dumb to risk it.

Yep all our trauma OMFS cases go at 5.

 

[NPJR]

Joan Rivers died in a GI suite because her ENT doctor decided she wanted to do a quick scope as well. It’s been years since I’ve practiced any sort of general anesthesia but I feel like the anesthetic conditions that work for upper endoscopy are not equivalent to laryngoscopy - should she have been intubated for the level of stimulation the ENT was going to perform? I think the anesthesiologist was too timid to push back.

The point I was trying to make is that at the time that she died- I was doing fulltime Endo for good money- and certain centers I refused to go to because the would not allow you to use Anectine- which would have saved Joan Rivers life breaking the laryngospasm and allow for proper mask ventilation. My larger point was even if I refuse, someone else would be happy to take that risk. Not worth it tome. Not worth it to me to do Autistic dental in free standing centers with dentists who are pushy with their time. No thanks.

The reason why I suspect this was a CRNA is they are less apt to make that risk/cost calculation from what ive seen.

 

[UscGhost]

The point I was trying to make is that at the time that she died- I was doing fulltime Endo for good money- and certain centers I refused to go to because the would not allow you to use Anectine- which would have saved Joan Rivers life breaking the laryngospasm and allow for proper mask ventilation. My larger point was even if I refuse, someone else would be happy to take that risk. Not worth it tome. Not worth it to me to do Autistic dental in free standing centers with dentists who are pushy with their time. No thanks.

The reason why I suspect this was a CRNA is they are less apt to make that risk/cost calculation from what ive seen.

Why/how would they refuse to allow you to use it?

Its not expensive

 

[aneftp]

Why/how would they refuse to allow you to use it?

Its not expensive

Many amsurg facilities at gi stand a lone center were cost savings and didn’t want to pay $3000 for mh cart that needed to throw away expired mh drugs every 24 months.

Thats being cheap

Legally if they had any drugs or anesthesia gases that can trigger mh. They must by rules and regulations carry an mh cart

So the legal teams devise plans to have roc refrigerated as a backup for muscle relaxation in place of suc

Legally they can say they have a drug (roc) that can break a spams. Plus not have to waste $3000 on mh cart they likely will never use

This is the real reason why Joan rivers gi center didn’t have sux available.

So the anesthesiologist probably freaked out. Didn’t have sux available remember no reversal for roc at the time.

 

[coffeebythelake]

Lots of phobic patients out there, precooperative children, uncooperative children, special needs, bad gaggers etc…
In those cases, minimal or moderate sedation is likely going to fail. I guess it depends on what you consider routine.

The patient who died in this case fit in any of these categories?

 

[cittykat]

The patient who died in this case fit in any of these categories?

From OP

"Edan was autistic and so due to sensory issues they needed the sedation for him, but it was a procedure he had done a routine cleaning multiple time before," said Bruce.“

That said, some autists can handle dental work just fine.

 

[NPJR]

From OP

"Edan was autistic and so due to sensory issues they needed the sedation for him, but it was a procedure he had done a routine cleaning multiple time before," said Bruce.“

That said, some autists can handle dental work just fine.

Just because you survived one anesthetic doesnt mean you will survive the next. That was then, this is now.

 

[cittykat]

Just because you survived one anesthetic doesnt mean you will survive the next. That was then, this is now.

Most patients can survive a really bad anesthetic most of the time.

 

[propadope]

Yes, of course case selection is very important in office based anesthesia. All anesthetics come with risks and one must weigh risk vs benefit. It’s not reasonable to make a blanket statement that all special needs patients should be seen in a hospital setting. Special needs encompasses a whole host of conditions. Autism as you know is a spectrum. Surely there’s a difference between a patient with mild or moderate autism vs a patient with Trisomy 21 with congenital heart disease or a CP patient that is wheelchair bound, severely contracted and has a G tube or a syndromic patient with craniofacial deformities…. Hospitals and the health care system might be overtaxed and overburdened depending on the country, city, etc…. Where I am, very few hospitals have a dental department unless its a major teaching centre. Hospitals that do take on special needs or pediatric patients have months long waitlists and may only see patients they deem unsuitable for private practice.

 

[NPJR]

Most patients can survive a really bad anesthetic most of the time.

Enter C.R.N.A. stage left

 

[NPJR]

Yes, of course case selection is very important in office based anesthesia.

Patient selection is what? It is work for somebody, to sift through the notes call the parents or caregiver and make a decision. For each one right? It is unreimbursed work for the most part. So it's just easier to say " all intellectual challenged dental goes to the hospital" and I tend to agree with this sentiment. BUt i also understand that it is a massive inconvenience for the dental staff to come to the hospital and haul all their stuff there each time. If they even have an affiliation. All for Medicaid rates.

 

[dannyboy1]

Many amsurg facilities at gi stand a lone center were cost savings and didn’t want to pay $3000 for mh cart that needed to throw away expired mh drugs every 24 months.

Thats being cheap

Legally if they had any drugs or anesthesia gases that can trigger mh. They must by rules and regulations carry an mh cart

So the legal teams devise plans to have roc refrigerated as a backup for muscle relaxation in place of suc

Legally they can say they have a drug (roc) that can break a spams. Plus not have to waste $3000 on mh cart they likely will never use

This is the real reason why Joan rivers gi center didn’t have sux available.

So the anesthesiologist probably freaked out. Didn’t have sux available remember no reversal for roc at the time.

I always bring roc and suggamadex with me whenever I go to these centers. Prior to suggamadex I always carried sux.

 

[caligas]

I always bring roc and suggamadex with me whenever I go to these centers. Prior to suggamadex I always carried sux.

I think even without danteolene if I had a laryngospasm in an EGD I’d prefer a bit of sux.

 

[cittykat]

I always bring roc and suggamadex with me whenever I go to these centers. Prior to suggamadex I always carried sux.

Where do you get the roc and suga?