NEWS_ARTICLE.RttP{4yr old gets 16 root canals in one visit to dentist}

CHARLOTTE - Christy Dillbeck holds the stainless steel caps and teeth of her son Brandon. Brandon at the age of 4 had 16 teeth drilled out and capped with stainless steel in a scam by local dentists.
Nine dentists have been disciplined in connection with a Medicaid fraud case alleging they performed or billed for unnecessary dental work on poor children in North Carolina.

Patients as young as 4 years old had multiple teeth pulled and root canals performed during single appointments at Medicaid Dental Center clinics in Charlotte, Winston-Salem, Asheville and Raleigh, according to state documents.

At least two children received 16 pulpotomies, also known as "baby root canals," and 16 steel crowns during the same visit.

"It was a very traumatic experience for the children and their parents," said attorney Darren Dawson of Greenville, N.C., who represents some of the families involved.

"These were children who were 4, 5 and 6 who were told by their moms and dads that they were going to visit with trusted professionals. Suddenly, they're in there for three hours and coming out with a mouth full of steel."

In a settlement announced Wednesday, Medicaid Dental Center, a privately owned chain of N.C. dental clinics, agreed to pay $10 million to the government to resolve allegations that it performed and billed for unnecessary dental work on kids.

Clinic owners and dentists Letitia Ballance of the Charlotte area and Michael DeRose of Pueblo, Colo., are also serving three years' probation, starting in 2005, by the N.C. Board of Dental Examiners.

The seven other dentists who worked for the clinics received written reprimands in 2005 that will remain permanently in their N.C. files and with the National Practitioner Data Bank.

"It's something that will follow them in any state where they try to practice," said Bobby White, executive director of the dental board.

White said the seven dentists received lighter discipline than the clinic owners because they were inexperienced and essentially following orders. Ballance and DeRose "were the bosses, making decisions and sending it down the line -- \'You will do things this way,' " White said. "The board saw that as a mitigating factor."

The seven include three from Charlotte -- Drs. John Lyons, Jeffrey Zieziula and Erron Brady. Others are Drs. Lori Petree and Christopher Ballinger of Winston-Salem, Dr. Heather Berkheimer of Southern Pines and Dr. Michelle Wilkerson of Raleigh, according to the dental board.

None of the seven could be reached for comment Thursday. Several continue to work for Medicaid Dental Center, in the Charlotte office, now called Smile Starters, and elsewhere. Ballinger and Brady now work in private practice.

According to the board's reprimands, Lyons and Ballinger saw patients initially and developed diagnosis and treatment plans. The remaining five dentists performed the treatment. The board accused all seven of doing their work "without adequate diagnostic documentation."

The dental work was done between 2001 and 2003 and involved the children's baby teeth.

Since 2005, the dental board has made unannounced inspections of Medicaid Dental Center, and found the clinics substantially in compliance with its standards.

Spokeswomen for the U.S. attorney in Charlotte and the N.C. attorney general on Thursday would not disclose how many children they allege received unnecessary dental work, how many dentists were involved, or why the government settled for $10 million instead of bringing criminal charges.

Federal and state laws do not explicitly make it illegal for dentists to perform unnecessary work. Such claims are typically left to malpractice lawsuits in civil court. There are laws making it a crime to commit Medicaid and health care fraud in billings.

The settlement agreement doesn't prohibit prosecutors from bringing criminal charges. But when civil settlements are reached, sources said, it suggests prosecutors are not planning to pursue criminal charges.

One of the children treated in Charlotte was Brandon Dillbeck, then 4.His mother, Christy Dillbeck of Charlotte, said her son had 16 "baby root canals," and 16 stainless steel crowns placed on his teeth during one visit.

"He has nightmares to this day of people holding him down," the 24-year-old mother said. "He had blood all over his shirt. He was covered with sweat. He looked like he was in a trance. He was crying."

Dillbeck said she had taken her son to the dentist to have his teeth cleaned. She was 19 at the time and unemployed, and she took Brandon to Medicaid Dental Center because the office accepted Medicaid.

Dillbeck said she didn't give the dentist permission to perform the baby root canals or place the crowns on her son's teeth.

"What mother in her right mind would give permission to do that to their child all at one time?" she said. "A mother would have to be crazy to let someone do that to their child.

"He had beautiful teeth before. He came out of there, and they were all metal. He was embarrassed for years about how he looked. He wouldn't smile."

Brandon, now 9, has lost his baby teeth and the steel crowns, but his mom worries he may still suffer long-term problems.

Dawson, the Greenville lawyer, said Thursday he represents the families of five children, including Brandon, who received the questionable dental work. Four were patients at a Charlotte clinic, he said.

Dawson and his colleague Harry Albritton are in preliminary negotiations with attorneys for Medicaid Dental Center and the dentists, seeking to reach a monetary settlement rather than go to court.

The Medicaid Dental Center case gives a "black eye" to the profession, said Dr. Alec Parker, who heads the N.C. Dental Society, the state's professional organization for dentists.

"It's really just hard to understand how (dentists) could justify that," Parker said. "We put our trust in our health care providers, and we expect them to do what's best for the patient."

Part of the problem, Parker said, is that private dentists don't accept many Medicaid patients because the state-federal insurance program for the poor and disabled doesn't provide adequate reimbursement. Dentists also shun Medicaid because it means extra paperwork and frequently missed appointments because patients don't have transportation.

That leaves patients few choices for dental care and pushes dentists who do accept Medicaid to treat large numbers of patients. "When reimbursement rates are as low as they are, it makes it difficult to make ends meet," Parker said. "They feel like they have to overbill and overtreat to make a go of it."

Still, Parker said, if the Medicaid Dental Center dentists knew that what they were doing was wrong, and did it repeatedly, they should be facing "more than just a reprimand."

"People who are trying to take advantage of the system need to know that somebody's watching."