Dentists Called Negligent in Death of Boy

Four-year-old Javier Villa, who died in a dentist’s chair after having his teeth drilled, was treated by dentists “who were incompetent and grossly negligent in sedating or monitoring the boy,” according to a dental expert cited in court documents.

Dr. Miguel Garcia, who supervised the dental clinic, also destroyed the child’s dental chart, altered records, withheld evidence and concealed the amount of drugs given the boy, according to witnesses quoted in a search warrant affidavit filed in Municipal Court.

Separately, the state attorney general’s Bureau of Medi-Cal fraud said Thursday it is investigating the Megdal Dental Care chain for possible criminal fraud, but would not provide details.

“We cannot comment on an ongoing investigation,” supervising Deputy Atty. Gen. Hardy Gold said in a statement.

The Board of Dental Examiners also is investigating a possible licensing violation by the Megdal clinics. State law requires that a dentist who owns two or more offices must be in each office at least 50% of the time.

Dr. Philip Megdal owns nine clinics in Southern California, said Jeff Wall, chief of enforcement for the dental board. Given the nearly full-time hours these offices keep, “I can’t imagine” how he can be in compliance, Wall said.

An attorney for Garcia denied wrongdoing on his client’s part, as did an attorney for Dr. Gabriella Pham, the second dentist involved.

Javier, who stopped breathing in a dentist’s chair and died at a hospital a few hours later on Aug. 4, had been taken to the Megdal Dental Care office in Santa Ana to have six cavities filled. He was given an oral sedative and an injection of painkiller.

Dr. Richard Mungo, the expert witness retained by the state board to evaluate the case, said “Javier was not properly sedated or monitored” by Garcia, who prescribed the oral sedative chloral hydrate, or by Pham, who did the dental work.

Mungo also said improper positioning of the child on a patient restraint board could have been a major factor in his death and that numerous routine safety procedures were not followed.

Javier was strapped to a papoose board, used to immobilize young patients, according to the court documents. Mungo said it was vital that the heavily sedated patient’s airway remain open. That could have been done simply by placing a rolled towel or pillow under the patient’s neck and shoulders, he said.

That was not done, according to statements made to investigators. Nor was the patient’s blood pressure, pulse or breathing monitored with standard equipment, according to the affidavit.

“My concern is the monitoring and positioning of the child,” Mungo said. “That is a factor we really have to look at. The papoose board is fine, but you need to know how to use it.”

Mungo and other pediatric specialists said it is crucial to give the proper dosage, based on the child’s weight, and to have constant mechanical monitoring of the child’s heart rate and amount of oxygen in his blood.

The case highlights a problem involving the sedation of dental patients, said several experts. Although the state requires that dentists intravenously administering general anesthesia or conscious sedation drugs undergo special training and licensing and have equipment in their office to handle emergencies, no such rules apply to dentists who sedate patients with oral doses.

Dr. Ray Stewart, president of the California Society of Pediatric Dentists, said Javier’s death might force overdue requirements for administering oral sedation.

“There’s been resistance on some people’s part to have any more governance, but it’s just exactly situations like this here that force the governing bodies to say, ‘ OK, something has to be done,’ ” Stewart said.

Neither Garcia nor Pham had been issued general anesthesia or conscious sedation permits, said officials at the state dental board.

Javier was administered chloral hydrate at Garcia’s direction by a dental assistant, according to the affidavit, and Lidocaine to deaden pain in his mouth. But the affidavit shows a sharp disagreement about how much of the drug the boy received and alleges that Garcia tried to conceal what happened.

According to the affidavit, both Pham and dental assistant Alejandra Juarez told investigators that Garcia ordered Juarez to destroy the child’s dental chart, which included the notation that the boy had received 16 cubic centimeters of chloral hydrate. Garcia also began a new chart, the affidavit says, showing that the boy received 6 ccs.

“That is the story,” Garcia said to Pham and Juarez when they met shortly after paramedics took Javier to the hospital, according to the affidavit.

Garcia told investigators that he ordered a 6-cc dose of chloral hydrate and “does not recall” if he was in the room when Juarez administered it, according to the affidavit.

The manufacturer’s maximum suggested dose for a child of Javier’s size is 9 ccs, according to the affidavit.

Garcia declined to discuss the allegations Thursday in a brief interview at the dental clinic. “I wasn’t the treating dentist,” he said. “Even I don’t know all the things that went on.”