Archive for category Quality of care

Failures in protecting the public health

I haven’t blogged in a while… apparently it took a story like the one I saw this morning to get me started again.

According to the articles I’ve read (here, here, here and here, and there are numerous others out there), Wayne Scott Harrington operated a dental clinic in Tulsa, OK and failed to take even the most basic safety precautions to protect his patients from a host of health problems. Some of these basic safety precautions include, oh, using non-rusted equipment, sanitizing the equipment, using clean and previously unused needles and drug vials, maintaining infection-protection protocols, and regular upkeep for the sterilization machines. Basic things we’d all expect our health care professionals to do to keep themselves and us, their patients, safe. Harrington’s failure to do these things (his defense is that he left issues of cleanliness, sterilization, and drug procedures to his staff) is not just disgusting; it led to some currently unknown number of his patients contracting hepatitis B, hepatitis C, and/or HIV. Government officials are notifying some 7,000 current and former patients that they should be tested. Can you imagine getting a letter from the state health department saying that you might have HIV or hepatitis because your dentist couldn’t bother cleaning his equipment or getting new equipment when the old stuff rusted? Unreal. It’s just unreal.

Notably, all of the articles I’ve read place the blame entirely on Harrington. (I’ve purposely removed the title of “Dr.” because if the allegations are true, I don’t think he deserves that kind of respect.) They make him out to be the sole bad guy. The reports also indicate that he’s been in practice for 36 years, and state investigative officials have no idea how long these unsanitary, unsafe practices have been happening. Now, I’m surely not defending this kind of behavior, but the articles seem to be missing something. How is it possible that the state or local government entities didn’t pick up on it until now? The Oklahoma Board of Dentistry is charged with investigating and punishing dentists in the state who are “a menace to the public health by reasons of practicing dentistry in an unsafe or unsanitary manner or place.” Okla. Stat. tit. 59, s. 328.32(13). (By the way, the Board is comprised of 11 people, only two of whom are women, and neither of the women are dentists. But that is a separate discussion.) Presumably, the Board issued Harrington a license to practice dentistry and continued to reissue him the same license every year, either with no inspection about the cleanliness of his practice or with reckless disregard of the unsanitary conditions. Apparently, the only reason that any inspection occurred is because a patient tested positive for HIV when the patient had no risk factors, other than having dental work done around the time his doctors estimated he contracted the disease. The OK State Department of Health has no oversight responsibilities for dental offices because they do not require a state facility license to operate. The Tulsa Health Department is involved somehow, probably because Harrington treated a number of Medicaid patients (so yes, likely that means some number of un- or underinsured children are involved), and now offers free testing to the implicated patients. I suspect, though I don’t have time to research it, that certain safety inspections are required for Medicaid providers, meaning that whatever agency office was responsible from the Medicaid perspective also missed the boat for what appears to be at least 6 years.

My point is this. Isn’t it someone’s responsibility to keep tabs on the safety and cleanliness of private practitioners’ offices? In this case, it seems the Board of Dentistry was primarily responsible for this oversight. Either the Board failed to satisfy their duties to protect the public health, or their duties are not defined to include regular health and safety investigations. Both are poor options.

If the allegations are correct, the dentist was wrong. But so was the state. Let’s not ignore the dereliction of duty either on the part of the Board, in failing to timely and appropriately investigate before years of unsafe dental practice, or on the part of the legislature, in failing to assign that duty in the first place.


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