Findings, allegations in inspection of dental office

‘A menace to the public health’

An Oklahoma Board of Dentistry report1 on the findings and resulting allegations against the dental practice of Wayne Scott Harrington, DMD in Tulsa, included these key points summarized as follows:

“Board investigators requested to see where Dr. Harrington and staff’s dental and drug licenses were on display. The office manager [took] Dr. Harrington’s licenses out of a folder in the cabinet. Staff were asked where the dental assistants’ permits were and the office manager advised that she would have to check with Dr. Harrington. Upon her return she stated `we need you to educate us on that issue.’ No dental assistant permits were found except for [one with] an expanded duty permit for radiation safety.

“Board investigators requested to see Dr. Harrington’s drug logs and drug cabinet. The drug logs as kept listed only the amounts of drugs administered to each patient during procedures. There were no logs of inventory in and out of the drug cabinet that would show where each scheduled drug went after receiving it from the distributor. No daily count of scheduled drugs was conducted. The drug cabinet was found to be unlocked and unsupervised. Scheduled drugs and legend drugs were mixed and not in any specific order within the cabinet. Multiple drug vials both scheduled and legend were expired. One drug vial found had expired in 1993.

All of these are violations of Dental Board and the Oklahoma Bureau of Narcotics and Drug Enforcement Agency’s state and federal laws. Multiple bottles of hydrocodone syrup were found in the back of the cabinet and staff advised it was for ‘one-patient.’ According to the drug logs kept by the assistants, morphine had been used on patients intermittently throughout 2012. According to DEA records, Dr. Harrington has not received morphine from a distributor since 2009.

“Dr. Harrington and staff advised health department officials that they had a high population of known infectious disease carrier patients in the practice. Two separate sets of instruments were kept, one set for patients known to have infectious diseases and another set for persons unknown or not believed to have an infectious disease. Each set had a different cleaning method. The set of instruments used for the known infectious disease carriers was dipped in bleach in addition to other cleaning methods. During the investigation an inspection of each set of instruments in the lab area was conducted and the instruments used for the known infectious disease carriers had multiple tools that had no sheen and red-brown spots on the metal making the instruments appear to be rusted. The Centers for Disease Control has determined that rusted instruments are porous and cannot be properly sterilized.

“A plastic box identified as the ‘dry socket box’ had open vials of medication with dark brown contents and the box was light brown in color due to staining. The box also had gauze strips inside.

“The autoclave used to sterilize all the instruments was not being properly used. According to the manufacturer’s instructions, a monthly test is required to be performed and sent to a lab to determine that the autoclave is successfully sterilizing all instruments. No such test had ever been performed in the 6 years one dental assistant had been working at the office. No sterilization log was present or had been kept by staff. Bags are not used during the disinfecting process, instruments are wrapped in a cloth then by autoclave tape to determine that the instruments reach the recommended amount of heat to be disinfected. After instruments were cleaned they were placed in a tray under the cabinet with a bib covering the instruments.

“Each dental assistant had a ‘drug tray’ that was kept in the top of the drug cabinet with multiple opened and unopened vials of scheduled and legend drugs and needles. The drug trays were kept in the operatory rooms during multiple procedures. Other opened and unopened vials of medication were found in drawers in the operatory areas with needles. Needles used for the drugs to be injected into the port were being filled in the operatory room and if additional amounts of medication were needed, the needles would be reinserted into the vials then into the ports. All of these practices cause a great risk of cross-contamination. Multi-dose vials of controlled and legend drugs were used on multiple patients, not dedicated to individual patients.

Tweleve allegations

Counts I and II: Authorizing or aiding an unlicensed person to practice dentistry by allowing [two] dental assistants to perform acts that only a licensed dentist may perform, specifically IV sedation on patients.

Count III: Unauthorized personnel taking radiographs without an assistant expanded duty permit.

Count IV: Being a menace to the public health by reasons of practicing dentistry in an unsafe or unsanitary manner or place, specifically violations of Board Rule 195:35-1-3(c) sterilization equipment and its adequacy shall be tested and verified on a regular basis.

Counts V-XI: Being a menace to the public health by reasons of practicing dentistry in an unsafe or unsanitary manner or place, specifically violations of Board Rule 195:35-1-4(a) (1) failing to comply with universal precautions recommended for dentistry by the Centers for Disease Control and Prevention; by use of multi-dose medication vials used on multiple patients; use of multi-dose medication vials in the operatory area; use of multi-dose vials of medication without attaching the appropriate dates; having open vials of medication and absorbent materials in the “dry socket” box used on multiple patients; separation of instruments and different cleaning procedures for known infection carrier patients versus unknown or non-infection carrier patients; utilization of non-sterilized porous and rusty instruments;

Count XII: Committing gross negligence in the practice of dentistry specifically by deferring all decisions and supervision of cleaning, infection control and turning over all inventory and maintenance of scheduled and legend drugs to dental assistants.

Reference

1. Oklahoma Board of Dentistry. Statement of complaint against Wayne Scott Harrington, DMD. March 28, 2013. Available at: http://www.ok.gov/dentistry/