Texas patient safety advocates hope the April death of a child who overdosed at a Fort Worth dental office will prompt state legislators to tighten medical laws, they told the Star-Telegram.
The child, 4-year-old Aithana Arriaga, died of a drug overdose at the office of pediatric dentist Chrishelle Hemphill, the Star-Telegram previously reported. Arriaga came to Hemphill’s practice for a routine procedure to alleviate a tongue tie.
In the autopsy, Arriaga’s blood was found to contain an amount of the opioid Demerol that would’ve been toxic even for an adult, investigators wrote in an affidavit supporting Hemphill’s arrest warrant.
Even though Arriaga died in April, it took until July for Hemphill to be arrested and charged with serious bodily injury to a child and her office, Cuddle Kids Dental Care, remained open to treat other patients. That delay is one of the first things about the case that concerns attorney Ware Wendell, who is the executive director of advocacy group Texas Watch.
“When there has been a tragedy like this where a little girl has died, you would think that regulators would swarm that office the next day, and here it seems that there were months of delay,” Wendell said.
The investigation of Arriaga’s death uncovered a series of errors at the practice that police believe contributed to that outcome, according to the affidavit.
Hemphill failed to recognize signs of respiratory distress in the child in addition to administering a fatal combination of drugs, police wrote. The Texas State Board of Dental Examiners later wrote that Hemphill failed to account for the way Demerol would interact with nitrous oxide gas and two other sedation drugs. The board suspended Hemphill’s license on July 15, the same day she was arrested.
Additionally, during attempts to revive the girl, Hemphill administered Flumazenil, which is a reversal drug intended for benzodiazepines, according to the warrant. Because Demerol is an opioid, the correct reversal agent would’ve been Narcan.
These errors are part of why Wendell says his group will push for laws expanding the required life-support training for dentists. Currently, dentists in the state are only required to be trained in basic life support, according to Texas law.
“For offices treating younger patients, this should be broadened to include BLS and Pediatric Advanced Life Support (PALS) training for support staff,” Wendell said. “This will help to ensure more sets of trained eyes can catch early signs of respiratory distress in our youngest and most vulnerable patients.”
PALS-trained healthcare providers know how to provide specialized life-support care to infants and children, according to the American Red Cross.
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Other fixes, Wendell said, could be as simple as requiring practices to post a notice on the door when a patient has recently died there, provided the relevant licensing agency allowed the practice to continue providing care.
“We place so much trust in our medical providers,” Wendell said. “It seems that the very least we could do is give people that information.”
Lisa McGiffert, a leader of the Patient Safety Action Network and a former director of the Consumers Union Safe Patient Project, said she believes Texas law doesn’t allow for enough transparency about provider history.
“For example, if the Board of Dental Examiners had received complaints against this dentist in the past, the law does not allow the public to know about them,” McGiffert said. “If the board had enough evidence that the dentist posed a danger and didn’t follow up, the public would never know. The system is set up to protect licensees and not the public.”
For parents, McGiffert recommends checking with the relevant licensing agency for complaints and actions before taking a child to see a provider. When in the dental office, McGiffert said, parents should not leave their children alone, and change dentists if the provider doesn’t allow the parent to stay with the child. In Arriaga’s case, Hemphill would not allow a parent in the room during the procedure, according to the affidavit.
“We need to make sure that dangerous medical providers are held accountable under the law,” Wendell said. “We need to make sure that these medical providers are caught early and not late, because that’s where you see people losing their lives.”
Hemphill’s defense attorney, Michael Heiskell, said in a statement to KXAS-TV, “This is a heartbreaking tragedy and our condolences are with the family. At the same time, allegations contained in an affidavit are not proof. As a reminder, Dr. Hemphill is presumed innocent and we intend to hold the government to its burden of proof as the facts are tested in the courtroom and not in the press. In the meantime, my team and I are in the midst of conducting a thorough review of the available evidence and will make any additional public comment as necessary when that process is completed.”