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Editor's Note: The following statement is a verbatim report by the Board of Dental Examiners of the State of California. It is reprinted here in its entirety because of the widespread interest by the lay press and radio-television coverage the accused dentist received. Allegations and misstatements by the medial create erroneous impressions about the practice of anesthesiology by dentists. This document provides factual information concerning the 3 incidents that led the State Board to revoke the dental certificate and the general anesthesia permit previously issued to this dentist. Further legal action is proceeding. JOHN K. VAN DE KAMP, Attorney General of the State of California
ALAN A. MANGELS WILLIAM L. MARCUS Deputy Attorneys General 3580 Wilshire Boulevard Los Angeles, California 90010 Telephone: (213) 736-2026 736-2074
about December 31, 1980, respondent was issued General Anesthesia Permit No. G-473. 3. Business and Professions Code section 1670* provides, in pertinent part, that the board may discipline any of its licenses for unprofessional conduct, incompetence, gross negligence, repeated acts of negligence in his profession, or for any other cause applicable to the licentiate provided in the Dental Practice Act (section 1600 et. seq.). 4. Section 1680(p) provides that unprofessional conduct includes clearly excessive administering of drugs or treatment as determined by the customary practice and standards of the dental profession. 5. Section 725 provides, in pertinent part, that repeated acts of clearly excessive administering of drugs or treatment as determined by the standard of the local community of licensees is unprofessional conduct for a dentist. 6. Respondent is subject to disciplinary action pursuant to sections 1670, 1680(p), and 725 as follows:
KIM ANDREASSEN On or about September 30, 1982, respondent placed Andreassen, then 23 years old, under general anesthesia for the purpose of filling three teeth and performing a root canal. B. Andreassen suffered from chronic renal failure secondary to systemic lupus erythematosis and had been undergoing hemodialysis three times per week since 1974. Andreassen also has a seizure disorder, hypertension, anemia and multiple problems with vascular access infections. C. Respondent knew, before he treated her, that Andreassen had heart trouble, high blood pressure,
Attorneys for Complainant
BEFORE THE BOARD OF DENTAL EXAMINERS DEPARTMENT OF CONSUMER AFFAIRS STATE OF CALIFORNIA In the Matter of the Accusation Against: TONY PROTOPAPPAS, D. D. S. 534 West 19th Street Costa Mesa, California Dental Certificate No. DT 22270 General Anesthesia Permit
No. G-473, Respondent.
NO. AGN 1982-14.
Complainant alleges that: 1. He is Rodney M. Stine, Executive Secretary of the Board of Dental Examiners of the State of California (hereinafter "the Board") and makes and files this accusation solely in his official capacity. 2. On or about June 29, 1971, Tony Protopappas D.D.S. (hereinafter "respondent") was issued Certificate No. DT-22270 to practice dentistry. On or
*Hereinafter all statutory references are to the Business and Professions Code.
kidney disease and underwent chronic dialysis. D. Respondent administered or provided the following drugs to Andreassen: 1. 100 mg. of Demerol and 100 mg. of Nembutal and .4 mg. Atropine as oral premedication. 2. Intravenously, as part of general anesthesia, 2 cc atropine (.4 mg/cc), 2 cc Valium (5 mg/cc), 2 cc Innovar, 2 cc Sublimaze, 1 cc Demerol (50 mg/cc) and 2 cc Benadryl (50 mg/cc). 3. 7 carpules of Xylocaine, 1:50,000 epinephrine, as a local anesthetic.
4. 6 cc Narcan. 5. For arrhythmia, 10 carpules of Lidocaine, 1:50,000 epinephrine. E. While respondent worked on Andreassen's teeth or within 15 minutes after, while Andreassen
was still in respondent's treatment room, Andreassen suffered cardiac arrest and shortly thereafter died. F. Respondent was grossly negligent and incompetent in his treatment of Andreassen, as follows: 1. In placing Andreassen under general anesthesia against the advice of her treating physician and with knowledge of Andreassen's medical condition and despite his own belief Andreassen might well die in respondent's dental chair. 2. In administering, in combination, the Demerol, Nembutal, Valium, Innovar, Sublimaze, Benadryl and Xylocaine as described hereinabove and in further administering the 7 carpules of Xylocaine, 1:50,000 epinephrine as described above. 3. In failing to monitoring Andreassen with an electrocardiograph or other monitoring and emergency equipment. 4. In administering Lidocaine with epinephrine to Andreassen for arrhythmia, where only Lidocaine without epinephrine is indicated. 5. In failing to take or record vital signs before, during or after treatment of Andreassen. 6. In failing to use or have on hand positive pressure oxygen equipment or other emergency equipment. 7. In failing to contact paramedics for approximately 20 minutes after Andreassen suffered a cardiac arrest.
PATRICIA CRAVEN G. On or about February 8, 1983, respondent placed Craven, 13 years old, in good health, under general anesthesia for the purpose of filling 10 teeth, preparing 3 crowns and having 4 wisdom teeth pulled. H. Respondent administered the following drugs to Craven: 1. Intravenously, in lactated ringer's solution, 1 cc atropine, 2 cc Valium, 3 cc Innovar, 2 cc Sublimaze, 2¼/4 cc Demerol, 14 cc Nembutal, 52 cc Brevital and 18 cc Benadryl. 2. 40 carpules of Xylocaine (1440 mg.), 1:50,000 epinephrine, as a local anesthetic. 3. 4 cc Decadron, orally, and 4 cc Narcan,
2. In administering, in combination, the Valium,
Innovar, Sublimaze, Demerol, Nembutal, Brevital, and Xylocaine, as described hereinabove. In releasing Craven in an unconscious and unresponsive state. In failing to take or record vital signs before, during or after the treatment of Craven. In failing to observe or monitor Craven between at least 10:30 a.m. and 4 p.m. In leaving Craven under general anesthesia without personnel properly trained to monitor her condition. In refusing to come into the treatment room and/or to advise the dentist filling Craven's teeth what to do when Craven began waking, and screaming, during treatment. In failing to have or use positive pressure oxygen equipment or other emergency equipment when Craven suffered cardiac and/or respiratory distress. In using Brevital for a procedure substantially in excess of 1 hour.
CATHYRIN JONES K. On or about February 11, 1983, respondent treated Cathyrn Jones, 31 years old, and in good health, for extraction of all her teeth. Respondent actually removed 10 teeth before the procedure was
intravenously. I. Craven was under general anesthesia from approximately 10:30 a.m. to 5 p.m. While under treatment by respondent or shortly after respondent removed Craven's wisdom teeth, Craven suffered respiratory and or cardiac distress. Craven was released to her mother at about 6:30 p.m. in an unconscious, unresponsive state and was taken home. Craven thereafter went into full cardiac arrest at or before 7:15 p.m. on February 8, 1983, was revived, and placed on life support system but died on February 19, 1983. J. Respondent was grossly negligent and incompetent in his treatment of Craven as follows: 1. In administering 40 carpules of 2% Xvlocaine, 1:50,000 epinephrine.
halted. L. Respondent administered the following medications to Jones: 1. Intravenously, 1 cc atropine, 2 cc Valium, 2 cc Innovar, 2 cc Sublimaze, 4 cc Demerol, 14 cc Benadryl and 38 cc Brevital. 2. 36 carpules of 2% Xylocaine, 1:50,000 epinephrine as local anesthesia. 3. 4 cc Narcan. M. Respondent placed Jones under general anesthesia at approximately 11 a.m. At approximately 12:30, while under treatment, Jones suffered full cardiac arrest. Jones was transported to a hospital by paramedics and died on February 13, 1983. N. Respondent was grossly negligent and incompetent in his treatment of Jones, as follows: 1. In administering 36 carpules or 1296 mg. of 2% Xylocaine, 1:50,000 epinephrine. 2. In administering the equivalent of 350 mg. of Demerol in approximately 1/2 hours. 3. In administering, in combination, the Valium, Innovar, Sublimaze, Demerol, Benadryl, Brevital and Xylocaine, as described hereinabove. 4. In failing to contact paramedics for approximately 15 to 20 minutes after Jones suffered a cardiac arrest. 5. In failing to take or record vital signs before or during the treatment of Jones. 6. In failing to have or use positive pressure oxygen equipment or other emergency equipment when Jones suffered a cardiac arrest.
IN GENERAL 0. Respondent administration of drugs as described hereinabove constituted, as to each patient, clearly excessive treatment and administration of drugs according to Southern California community standards for the administration of general and local anesthesia by dentists and, as to all three patients together, constituted repeated acts of clearly excessive treatment and administration of drugs according to said Southern California communitv standards. P. Respondent's conduct as described hereinabove constituted negligent acts as to each patient and repeated negligent acts as to all three patients together. Q. Respondent's conduct as described hereinabove was the direct cause or a substantial factor in the deaths of Andreassen, Craven and Jones. 7. Respondent is further subject to disciplinary action pursuant to section 1670 as follows: A. Complainant incorporates paragraph 6 by reference herein as though fully set forth at this point. B. Respondent failed to record blood pressure or pulse or full and accurate descriptions of drugs and amounts administered or the length of the procedure or to accurately record the complications of anesthesia, as to Andreassen, Craven or Jones. C. Respondent's conduct as described hereinabove constituted unprofessional conduct. 8. Section 1680(s) provides unprofessional conduct includes the alteration of patients records with intent to deceive. 9. Respondent is further subject to disciplinary action pursuant to section 1680(s) as follows: A. Complainant incorporates paragraph 6G through 6J by reference herein as though fullv set forth at this point. B. Respondent falsely caused to be recorded on Craven's records with intent to deceive that she had only slight difficulty when released, was in good condition, responsive to external body stimulation and
to her name and chose to be wheeled out to her mother's car instead of walking, when, as respondent well knew, Craven was unconscious and unresponsive to verbal or physical stimulation. 10. Section 1680(u) provides unprofessional conduct includes the abandonment of a patient bv a licentiate before completion of a phase of treatment, as such phase of treatment is defined by the customary practice and standards of the dental profession. 11. Respondent is further subject to disciplinary action pursuant to section 1680(u), as follows: A. Complainant incorporates paragraph 6G through 6J, inclusive, by reference herein as though fully set forth at this point. B. Respondent released Craven in an unconscious and unresponsive state to a non-professional while Craven was still under the effects of general and local anesthesia where customary practice would be to retain the patient through recovery or arrange transport to a hospital by paramedics. WHEREFORE, complainant prays a hearing be held on the matters alleged herein and, following said hearing, the board issue a decision: 1. Revoking Dental Certificate No. DT 22270 heretofore issued to Tonv Protopappas, D. D. S.; 2. Revoking General Anesthesia Permit G-473 heretofore issued to Tony Protopappas, D.D.S.;
and 3. Taking such other and further action as the Board may deem proper. Dated: March 25, 1983. Rodney Stein Alan A. Mangels per direction RODNEY STINE Executive Secretarv Board of Dental Examiners Department of Consumer Affairs State of California Complaint
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