Nobody likes going to the dentist. However, imagine being a child who goes to the dentist only to be physically restrained during the whole dental procedure. This has happened to some children, and can happen to other children.
The American Academy of Pediatric Dentistry (AAPD) has outlined when physical restraint on children is acceptable in the dental setting. Acceptable uses of restraint include: patient diagnosis is of an emergent nature and the patient is not old enough or lacks the mental capacity to understand what must be done; dental staff, as well as the patient, would be at risk without the patient being physically restrained; or, a patient that has been sedated requires restraint to help prevent untoward movement.
The AAPD has also provided contraindications for use of physical restraint on children in the dental setting. These contraindications include: the non-sedative patient is being cooperative; the patient would be harmed due to a medical or physical condition if physically restrained; the patient has been previously traumatized, either mentally, physically, or both, from such physical restraint, unless there is no other means available.
One upstate New York dental chain, Small Smiles, was sued for a rash of unnecessary physical restraint on child patients. Claimants argued that the dental chain had no right to hurt children in order for that chain to meet its revenue production quota. Some examples of patient trauma experienced at Small Smiles include an 8-year old patient undergoing four tooth extractions, six root canals and crowns, and three fillings. The 8-year old had been physically restrained throughout the whole ordeal. Parents of these children were told by staff at these facilities that they were not allowed back with their child during the procedures because doing so would violate HIPPA regulations.
Small Smiles and its parent company, FORBA LLC, ended up in trouble with the United States Department of Justice. The end result was FORBA had to pay $24 million pertaining to allegations of fraud. From that settlement, $1 million went to New York. While the settlement paid back Medicaid for its fraudulent claims, none of the individual claimants who were subjected to trauma from Small Smiles received any settlement money.
It is alleged that FORBA LLC put its dentists under pressure in an attempt to increase the number of procedures done on patients. It is further alleged that the children who were physically restrained were done so simply to finish procedures quickly, and assuage FORBA.
These unnecessary procedures were done requested by FORBA of its staff because many of the patients were on Medicaid, and Medicaid would reimburse, and reimburse very well at that, for such procedures. FORBA would also reward dentists who performed these unnecessary procedures with hefty bonuses. FORBA made a game out of the whole scenario, getting all of its clinics to compete with one another and further rewarding participants with a trophy.
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