AK: Dentist who rode hoverboard while pulling tooth faces patient in court

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  • Alamo

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    https://arstechnica.com/science/201...-while-pulling-tooth-faces-patients-in-court/

    He had himself video'd doing this:

    The footage—
    played in court last week and broadcast by Anchorage’s KTUU-TV
    —shows Lookhart standing over a sedated patient, swaying slightly on his hoverboard while extracting a tooth. Once done, he rolls out of the room, strips off his gloves, tosses them, and triumphantly throws both hands in the air as he zooms away down a hallway.

    He's also in trouble for some other minor issues like unnecessarily sedating patients so he could inflate billing to Medicaid and stealing $250K from his partners.

    [video=youtube;XVTt1DJGChw]https://www.youtube.com/watch?v=XVTt1DJGChw[/video]


    Amazingly this is in Alaska, not Florida.

    HoosierDoc, you MDs have been one-upped (one-downed?) by the DDS community. Eagerly awaiting your response.
     

    HoughMade

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    I know nothing about the billing or partnership issues, but I don't see anything negligent about the extraction.

    It's a dumb thing to do, but I don't see a reason to hand out money over this.
     

    SmileDocHill

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    I haven't seen the details of this case at all but my initial thoughts:
    -Hover board, meh, I don't need a stable platform to safely perform most all extractions. Bad idea, yes, malpractice, I'm not seeing it.
    -Any time you see Medicaid or Medicare fraud PLEASE take it with a grain of salt! It is an interesting dynamic. YES there are Dr.'s/practices that are gaming the system for everything it is worth so policies are made to be strict and harsh to try and prevent it. But, it is a Gov. agency that cannot make logical decisions but rather has to make rules and then hires the otherwise unhireable to manage the entire thing. It is SCARY what can totally look like fraud due to extremely strange rules, constantly changing, and require a full time staff to keep on top of. You simply cannot practice with a good ethical conscious and assume you are not doing something that will be fraud to some auditor 5 years later.
    -The stealing $250K from his partners: WOW, most likely something to that. :dunno:
     

    Alamo

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    The State of Alaska does not agree that hoverboarding while pulling a tooth isn't negligent, plus there's the issue of videoing and sedated patient without her permission:

    COUNT XI That in the Third Judicial District, State of Alaska, on or about July 14, 2016, at or near Anchorage, SETH LOOKHART, engaged in the performance of patient care, regardless of whether actual injury to the patient occurred, that did not conform to minimum professional standards of dentistry; to wit: Seth Lookhart performed a dental extraction procedure on a sedated patient while riding a hoverboard and filmed the procedure and distributed the film to persons outside his dental practice. All of which is punishable as a Misdemeanor Class B offense under 08.36.340 and being contrary to and in violation of 08.36.315(6) and against the peace and dignity of the State of Alaska.

    This is one of his lesser legal woes, but if the vid makes it in front of a jury in either a criminal or civil case I would not expect the verdict to go well for him. Maybe from practical standpoint this is one of his lesser sins, but it doesn't make him look like he has the best judgement.

    ETA: The State is charging him with felonies and misdemeanors for billing for IV sedation for procedures that normally don't require sedation, performing sedations before he became licensed/certified to do sedations and billing it as an oral anesthetic, allowing his office manager/dental assistant to perform tooth extractions, among other things. He was a new dentist in financial difficulties when his officer manager suggested that if he added IV sedation to his practice he could bill more.

    A former employee contacted the State alleging that he was pushing IV sedation to pump up his billing, and other ex-employees contacted by the State said the same thing, noting that he would use IV sedation for Medicaid patients but not for private insured patients for the same procedure, and that sometimes he would extend the sedation period for Medicaid patients beyond what was needed so he could bill additional increments (Medicaid paid for sedation in 15 minute increments). Although under the rules IV sedation was supposed to be used only for emergent care or patients uncontrollable by the usual anesthetic, ex-employees said once Medicaid patients reached their annual limit for non-emergency care, he would tell them they could have it paid for anyway if they agreed to IV sedation, and then he billed for routine care as emergent care.

    All remaining to be proven of course, but the State is claiming this is more than a bookkeeping error.

    The information filed against him: http://law.alaska.gov/pdf/criminal/MedFraud/2017/041717-LookhartInfo.pdf
     
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    Thor

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    My last tooth extraction sans hoverboard was a lot more aggressive than that. If they could have pulled it out in one piece and not had to resort to a knee on my chest I would have thought the hoverboard a unique feature.

    He got the tooth out...what more did he expect?
     

    HoughMade

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    A licensing board can take action on something that is unprofessional, but not civil negligence.

    My short primer on malpractice law after 21 years of practicing malpractice defense.

    Hoverboard:
    Duty- Yes.
    Breach of duty- I'll give you that.
    Causation of damages- No.

    No damages, no actionable malpractice, end of analysis.

    As for the video, I have not seen a consent form in mordern times that does not reference pictures and video, granted, if the video is for a "proper purpose", but for entertainment purposes, then we probably can't say she consented to that.

    Video:
    Duty- Yes
    Breach of duty- Yes.
    Causation of damages- Was this ever publicly released? Who saw it? I still don't see the damages, but with more facts, maybe.
     

    Alamo

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    A licensing board can take action on something that is unprofessional, but not civil negligence.

    My short primer on malpractice law after 21 years of practicing malpractice defense.

    Hoverboard:
    Duty- Yes.
    Breach of duty- I'll give you that.
    Causation of damages- No.

    No damages, no actionable malpractice, end of analysis.

    As for the video, I have not seen a consent form in mordern times that does not reference pictures and video, granted, if the video is for a "proper purpose", but for entertainment purposes, then we probably can't say she consented to that.

    Video:
    Duty- Yes
    Breach of duty- Yes.
    Causation of damages- Was this ever publicly released? Who saw it? I still don't see the damages, but with more facts, maybe.

    In reverse order: It does not appear that he submitted the video to a journal of dentistry as an advancement of the art. The information says the investigators discovered it on his phone and his assistant's phone, and it had been sent to "friends." Not sure how far it went after that. How many friends and friends of friends have to receive a copy before its "public?" Facebook? INGO? There's about a dozen copies of it on YouTube now, tho likely the result of the court actions and the news articles. (More damaging, they discovered videos and texts indicating that he permitted his assistant to perform procedures and prescribed controlled drugs that she apparently should not have been doing. Oops.)



    So per your analysis "malpractice" definitely fails because no causation of damages (and whether "breach" is arguable). I looked up the Alaska code that he's being charged under with respect to the video hoverboarding, and this seems to be the relevant part:

    The board may revoke or suspend the license of a dentist, or may reprimand, censure, or discipline a dentist, or both, if the board finds after a hearing that the dentist:

    ...snip snip snip…
    (6) engaged in the performance of patient care, or permitted the performance of patient care by persons under the dentist’s supervision, regardless of whether actual injury to the patient occurred,(A) that did not conform to minimum professional standards of dentistry;
    ...snip...

    So is standing on a hoverboard while you yank a took "not conform[ing] to minimum professional standards of dentistry" seems to be the question? So maybe no civil damages, but criminal liability? That section of code appear it provides both civl and criminal penalties.

    With all the other more substantial stuff they are going after this guy with I expect that the hoverboard issue will fall by the wayside as either plea-bargained away or just too much work to prosecute when they have all this other stuff to work with.

    btw I'm not necessarily advocating that the hoverboard stunt is or is not below minimum professional standards or whether he's guilty of the other stuff, I just like exploring the details, seeing how things work. But also, I would not go to this guy for my teeth. :)
     

    KokomoDave

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    Licensing? Criminal?? This is performance art...at least it's not a banana taped to a freaking wall selling for 6 figures. Sheesh!
     

    sparky32

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    This guy billed 1.8 million (suspected) and was majority medicaid fraud. His big problem here was he posted the video without patient consent big no no HIPPA violation. My wife is a DDS and practice owner and wonders what goes through some of these Docs minds. You loose your license from dumb crap like this you are toast.
     
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    hoosierdoc

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    My patients come to me on hoverboards, not the other way around

    my wife is a dentist. She has yet to sedate me and “work on me” :(

    to smiledochill’s point on medicaid fraud: medicaid itself is fraudulent. Automatic denials of payment, late payment, wrong payment, etc. ridiculous. Criminal IMO.
     

    HoughMade

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    I have been involved in cases with Medicare fraud allegations...and that involves the Dept. of Justice.....fun times.

    The rules are so convoluted and arcane that even when you do everything "right" and have no intentions of defrauding anyone, not filling out a form correctly or missing some hypertechnical something that doesn't affect anything will get the attention of an AUSA.

    I am working on a case now that is insane in this regard and centers around the fact that the post office insisted that the medical offices in a particular single building all have individual street addresses rather than one street address with suites A, B, C, etc. More than that I cannot say.

    What this dentist did or did not do...don't know, but allegations are not evidence...but get reported by the press like fact.
     

    SmileDocHill

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    My patients come to me on hoverboards, not the other way around

    my wife is a dentist. She has yet to sedate me and “work on me” :(

    to smiledochill’s point on medicaid fraud: medicaid itself is fraudulent. Automatic denials of payment, late payment, wrong payment, etc. ridiculous. Criminal IMO.

    I've had medicaid randomly, without any notice, automatically deduct money from my account. Reason: they apparently were going through records and changed their mind on approving a patients treatment... 2 YEARS LATER! To do a denture on a medicaid patient you have to have prior authorization. Even if you know it won't be covered, you have to have the denial before being able to LET the patient pay out of pocket for the procedure. So ALL dentures get pre-approved on Medi patients before hand. Got approval, made the denture, years later they change their mind and take the money back. This is why the Government has NO place in healthcare. If this was a totally private entity doing this it would be criminal.
     

    Alamo

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    Licensing issue for sure. Criminal? I would have to see the statute at issue.

    I have since closed the link And I am on a different device anyway, but IIRC The section of the Alaska code listing violations is followed by two separate paragraphs, one which lists civil penalties, and the other which list criminal penalties for violating that section. If you’re really interested follow the information link I posted earlier, and the paragraph about the hover boarding cites the criminal penalties section of the code, which refers back to the list of potential violations.
     

    chezuki

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    This guy billed 1.8 million (suspected) and was majority medicaid fraud. His big problem here was he posted the video without patient consent big no no HIPPA violation. My wife is a DDS and practice owner and wonders what goes through some of these Docs minds. You loose your license from dumb crap like this you are toast.

    What’s a “HIPPA”? Is that like a female Hippo?
     
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