20 Mar 2015

Air Jordan 11s Trouble at VA went beyond 1 dentist

DAYTON Problems at the Dayton VA Medical Center’s dental clinic went far beyond Dr. Dwight Pemberton, the dentist whose poor infection control practices may have exposed 535 patients to such diseases as hepatitis and HIV from January 1992 to July 2010.In sworn testimony given during a Veterans Affairs investigation, workers describe a poorly run, understaffed clinic, where supervisors tolerated inappropriate activities and cut corners, and workers were paralyzed by fear.According to a post investigation Air Jordan 11s report, another of the clinic’s eight dentists allegedly broke teeth during extractions and performed unnecessary procedures. Working with that dentist, whose name hasn’t been obtained by the Dayton Daily News, “was just like watching a child be abused,” one worker told investigators.Clinic dentists even took credit for being primary providers of dental work done by unlicensed students, who were permitted to practice without the required level of supervision, according to the report.A former patient of Pemberton’s said he received substandard care at the clinic during a visit five years ago. Thomas Woodson of Harrison Twp. told the Dayton Daily News Pemberton enthusiastically introduced him to his fellow dentists after Woodson told him he is a descendant of Thomas Jefferson and slave Sally Hemings. While Pemberton took keen interest in Woodson’s roots, Woodson went home with ill fitting dentures that he soon quit wearing.VA Secretary Eric Shinseki acknowledged a “failure of leadership” in Dayton during a federal budget hearing earlier this month, during which he was asked why VA Medical Center Director Guy Richardson had received an $11,874 bonus at the end of federal fiscal 2010.”I’m not going to try to describe why a bonus was sensible,” Shinseki said. “This went on for an extended period of time when it wasn’t brought to the attention of leadership, and I again fault that to a failure in leadership.”Soon after, Richardson was reassigned to a VA regional headquarters job in Cincinnati, described by VA officials as a “lateral move” without a change in pay. Richardson received $167,328 in fiscal 2010.The VA initially said nine veterans had tested newly positive in preliminary tests for hepatitis B or hepatitis C antibody, but on Friday cut that number to five.Members of Congress have been unimpressed by the VA’s response to the scandal so far. Rep. Mike Turner, R Centerville, said Thursday. Instead, he said, the agency “clearly appears to be in cover up mode.”Sen. Sherrod Brown, D Ohio, called the response “slow” but said transparency is improving.The VA has defended its response, pointing to a recent New England Journal of Medicine article that singles out the VA’s disclosure policy for adverse events to patients. The policy, according to the article, “endorses transparency.”VA officials didn’t defend Pemberton’s actions, but noted not all of the complaints about the second dentist Air Jordan 2010 were deemed valid. Dr. Bill Germann, the Dayton VA’s acting chief of staff, said that dentist will likely begin practicing again at the Dayton VA.Germann also said there was appropriate oversight of fourth year dental students, and dentists appropriately documented work done by those students.”Based on my knowledge, the comments in the (investigative) report were not totally appropriate,” Germann said.The dental clinic scandal Air Jordan 7s in Dayton calls into question how accountable people are Air Jordan 1s held throughout VA, said Ronald Hamowy, a fellow with the Cato Institute and Nike LeBron 11 the Independent Institute, both libertarian groups.Hamowy prefers the government stop providing medical care directly to veterans and instead contract for that care to be provided in civilian medical facilities under a Medicare type program.Though Medicare itself has been abused by clinicians, “there’s less opportunity for waste and corruption,” Hamowy said.But Brown said the dental clinic scandal reflects long standing issues specific to the Dayton VA that merit a hospital wide organizational review, not systemic issues across VA nationwide.”It’s a very good health care delivery system,” Brown said of the VA. “It’s a cultural issue in that VA (in Dayton). It doesn’t extend beyond that VA, but it’s been endemic there for some time.”Dental clinic workers told investigators the clinic was woefully understaffed. The director of the facility’s residency program said the ratio of dental assistants to dentists was too low to support four resident slots and put patients at risk.”We were critically short dental assistants, not only to run a residency, but to run a dental service,” he told investigators.One assistant was hired in response to his concerns, but the staffing levels remained unacceptably low, the director said.The shortage of dental assistants also may have had implications for infection control. Prior to 1992, investigators said Pemberton regularly had at his side a dental assistant, who would prod him to follow hygiene protocols. But in 1992, Pemberton began working alone, and the VA report concluded “it was when he worked alone that (he) presented a clear danger to patients since he would often fail to adhere to established infection control protocols.”Supervisors for years had been told about Pemberton’s failure to change gloves and sterilize dental instruments, but he was not disciplined and continued to receive raises up until dental clinic workers alerted an outside team of VA inspectors to the infection control issues in July.”I’ve seen him literally walk from his room with this patient’s denture in one hand, go across to another room, open this patient’s mouth with this denture of the opposite patient in his hand,” one dental assistant testified. “I’ve seen him use the same instruments, the same handpiece, the same burs all day long on every patient. I’ve seen him go out of the clinic and push the button on the elevators with dirty gloves on. I’ve seen him open lab doors with dirty gloves on; I’ve seen him go in the lunchroom and use the microwave with dirty gloves on.”

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