A collaborative piece written by: Lorraine Perez, Nicole Cunha and Rebekah Adler
Date: April 13, 2012
The following information was provided by Rebekah Adler in multiple one-on-one interviews. These are her and her husband Jason’s personal accounts of what happened a year ago.
A parent’s natural instinct is to protect our children. To ensure that our children are safe from harm, are nurtured, taken care of and loved. Unfortunately, there may come a time when we are left helpless; when we battle between what our instincts tell us and what someone who is more educated recommends to us.
February 19, 2012 Rebekah Adler read an article in the Detroit Free Press (Painless, at what price? Risks of dental office sedation prompt calls for tighter regulation) about dental anesthesia and noticed the Raven Maria Blanco Foundation referred to as the “watchdog” group bringing attention to complications and deaths from sedation dentistry. As soon as Rebekah put down the article, she immediately emailed RMBF and told them Ashton’s story.
March 17, 2012 Rebekah and her son Ashton were on a plane headed to Virginia Beach, VA to tell their story of how poor management and neglect almost took Ashton’s little life and the life of his chronically ill little brother.
On April 13, 2011 six-year-old, Ashton Adler, was taken to the dentist for a routine dental procedure. Ashton needed a root canal and to have several cavities filled. Due to time constraints, the Adler’s family dentist suggested that Ashton be taken to a pediatric dentist to be sedated. Being sedated would allow for Ashton to receive all of the procedures needed in one sitting. This was a sigh of relief for the Adlers because their younger son, Gabriel was scheduled for brain surgery, making multiple trips to the dentist nearly impossible.
In the Dental Office | A Swinging Door
Ashton’s younger brother Gabriel suffers from life threatening anemia and multiple other conditions that require regular hospitalizations, so the Adlers are not new to sedation protocol and procedure. While Rebekah acknowledges that all cases are different, she believes she was pretty prepared for what to expect during Ashton’s sedation. However, what she found when she walked into the dentist’s office was far from what she has experienced for the past four years with her son Gabriel.
Prior to the visit, Rebekah had spoken to her family dentist about the pediatric office and she had their brochure, which outlined all of the doctor’s special skills. Rebekah felt confident bringing her son to the pediatric specialist because she trusted her family dentist and believed she received a solid referral.
When she walked into the office the first thing she noticed was that it was over-crowded and understaffed. Her instincts told her something was not right and she wondered how her son would be watched and handled properly with so many patients, however she patiently waited in the lobby. Rebekah waited…and waited and waited some more until finally the doctor approached her with what Rebekah describes as a “home bathroom style” scale. He then proceeds to place the scale in the middle of the waiting room to weigh Ashton. Another half hour passes when the doctor returns to the waiting room with the scale again to weigh Ashton. Rebekah is taken back by the chaos she is witnessing. She is watching the doctor bounce from room to room with no more than the front office receptionist and what she thought to be the dental assistant helping him. Rebekah became more and more uncomfortable as the day unfolded. Finally, Rebekah and Ashton are brought into a room and she is told to have Ashton drink two cups of medicine. At the time, Rebekah had no idea what medication she was administering to her son. Having no experience in the administration of a sedative, Rebekah reluctantly tries to get Ashton to drink the medicine by herself.
A Little Help Please? | “No – we can’t be with our patients from the beginning to the end of the sedation process”
When Ashton refused to drink the medicine Rebekah reached out to the dental assistant that she saw cleaning up a room across the way. She asked the woman for some help. Rebekah remembers being dumbfounded when she received a reply to the effect of “No – we can’t be with our patients from the start to finish of a sedation process. ” Rebekah then asked the woman if she was going to be able to handle Ashton after he took the medicine and the woman said she didn’t think so. Irritated and frustrated, Rebekah calls her husband Jason to tell him that she wanted to leave. Jason convinces her that she should stay due to Gabriel’s upcoming surgery and reminded her of the fact that Ashton had been fasting for around 19 hours at this point. As Rebekah puts it, “Jason was unaware of what was really going on in the office and based his push on that.” Rebekah told Jason if she was going to stay that he needed to come to the office to help her. Luckily he worked in the same city and was able to get to the dental office within a few minutes. Once he arrived he was able to get Ashton to drink the medicine.
When the doctor poked his head in the room to check on things he asked if Ashton had spit any of the medicine out. The doctor then noticed that there was medication on Ashton’s bib and brought in another cup explaining that it was more medicine for Ashton to drink due to the liquid he spit out. Rebekah recalls wondering how the dentist knew how much to administer based solely on what was on Ashton’s bib. After Ashton took the third cup of medicine, the Adlers were instructed to return to the waiting room where Ashton sat on his father’s lap. It was during this time when things took a turn for the worse.
After Being Sedated | “It’s like drinking a beer and taking a shot!”
Within a few minutes of reaching the waiting room – “Ashton began flailing his arms and became incoherent.” In the video you can see where Ashton is clearly starting to feel the effects of what his parents later discovered was Chloral Hydrate and Hydroxyzine. Jason asked the front desk receptionist if Ashton’s behavior was a normal reaction to which she replied, barely looking at him, “yes, it’s like drinking a beer and taking a shot” she then suggested they take Ashton outside to ease his fears about going to see the dentist. Rebekah found this strange because Ashton wasn’t afraid to go to the dentist. She didn’t understand how taking him to the car was going to help the situation, however, the Adlers decided to comply, again trusting what was suggested to them. When they arrived at the car Ashton became uncontrollable and this forced Jason to strap him into a car seat because he was fearful that Ashton was going to hurt himself. Jason then proceeded to rub Ashton’s head until Ashton falls asleep. As you will see in the video this happens rather swiftly. Within a few minutes of Ashton “falling asleep” they brought him back inside of the dental office to start the procedure.
The Procedure | “No, we can’t leave him like this”
When Ashton arrived in the procedure room he was limp and not moving at all. As previously mentioned, he had already received Chloral Hydrate and Hydroxyzine. Even though the little boy wasn’t moving a muscle, he was strapped into a papoose board (restraints) by the dentist. The Adlers were told not to be afraid if they heard Ashton fighting, screaming or crying because it was normal. To which Jason responded, “he seems pretty out to me.” The doctor replied “you would be surprised” and “I’m not a magician” implying that he couldn’t ensure Ashton wasn’t going to move, despite his clear state of unconsciousness from the medications already consumed. Nitrous Oxide was also administered throughout the entire procedure.
Being that Jason was at the office, Rebekah decided to go home in order to care for her other children: Gabriel (4), Joshua (2), and their new baby Samuel.
Once started the actual procedure only took the dentist a half hour to complete. When finished the dentist told his assistant to follow him to another patient. Being that nitrous oxide was still being administered to Ashton the assistant replied, “no, we can’t leave him like this” and she stayed back while the doctor proceeded to the other room. When the dentist returned he suddenly begins to tell Jason that Ashton required additional work, which was never indicated by their family dentist. Jason, already upset at what has transpired, declined the additional treatment. The dentist immediately gave Jason the green light to go home and instructed him to put Ashton to bed. The dentist did not try and wake Ashton, nor did he indicate that there was anything to be concerned about.
Jason left with Ashton’s chart, the bill and the x-rays.
There was nothing hand written by the dentist in Ashton’s chart and his vitals were not checked prior to leaving the office while he was still unconscious.
After the Procedure | A Strange Sound Alerted Dad that Ashton was in Trouble
After Jason left the dental office he heard Ashton making a funny sound that he describes as “gagging” and he quickly pulled over. As a volunteer Firefighter Jason’s instincts kicked in and he removed his shirt and positioned his son’s head to keep his airway open. At this moment, he knew Ashton was in trouble. Panicked he called Rebekah and told her what happened. He rushed home so Rebekah could see Ashton. She immediately attempted to wake Ashton and could not. At that point they realized their son was in danger and knew they needed to get to the emergency room as soon as possible. She told Jason to drive Ashton to the hospital and said that she would collect her things and follow behind.
During the entire ride to the hospital Rebekah continuously thought of two things:
- Ashton is going to die.
- Gabriel is going to die.
Ashton is Gabriel’s perfect bone marrow stem cell match. If something happened to Ashton and Gabriel indeed required a transplant, it would become difficult to find such a perfect match – meaning Gabriel’s chances of survival were minimal.
In the Hospital | “The Dentist Left Him This Way”
The emergency room personnel took one look at Jason carrying a limp child and panicked! They asked what happened and Jason replied “a dentist left him this way”, they immediately sent him STAT to a room to work on him. Regardless of everything they did the doctors could not wake Ashton up. Even rolling their knuckles on Ashton’s sternum produced minimum results. It became a waiting game. Jason was told the drugs could not be reversed and all they could do was monitor him. Rebekah remembers watching Ashton and thinking he was going to die. She went so far as contacting her church community to pray and let them know to start preparing.
On top of everything they experienced with the dentist, the Adlers now faced controversy at the hospital. According to their account it seemed as though there were two teams battling against each other. One was for protecting Ashton and the other did everything they could to protect the medical professional. When asked why she felt this way, Rebekah explained that the people trying to help went out of their way to retrieve a pharmacist to answer questions regarding dosage amounts and as soon as he told the Adlers that he believed Ashton was given too much medication, he was suddenly whisked off on another “emergency” by a doctor. The Pharmacist then returned recanting his previous statement indicating that Ashton had been administered a level of chloral hydrate that was within the daily limits. He did however tell the Adlers that if they wanted to call him to discuss this at a later date, they were more than welcome to.
According to the dentist and his records, Ashton was given 1,700 mg of Chloral Hydrate. According to Drugs.com a child receiving chloral hydrate for sedation purposes should receive 25 to 50 mg/kg/day divided every 6 to 8 hours. Ashton weighed approximately 18kg, which at maximum daily allotment should have received only 900 mg of which should have been administered in multiple doses of 500 mg at a time.
Additionally, Ashton was given 50 mg of Hydroxyzine and according to Drugs.com the proper dose for a child receiving sedation is 0.6 mg/kg/dose. Being that Ashton weighed approximately 18 kg he should only have received 10.8 mg. According to the suggested dosing, clearly Ashton received too much medication.
Knowing these facts made both Jason and Rebekah wonder why Ashton was put in restraints and given Nitrous Oxide and Lidocaine in addition to the Chloral Hydrate and Hydroxyzine? The combination seems more than excessive to them. Rebekah posed this question to the State Dental Board and the Adlers are anxiously awaiting a response.
There were two physicians at the hospital obviously protecting the dentist. These doctors attempted to persuade the Adlers to meet with the dentist by repeatedly asking them to speak with him. It was even mentioned by a staff member that there was a discussion going on between the doctors and the dentist. The Adlers strongly believe this was a violation of their HIPAA rights. Finally a resident that was looking out for the best interest of Ashton escorted the dentist out of the hospital.
It is important to note that the hospital did not draw blood to confirm how much medicine was in his system, nor did they call poison control.
Thank Goodness | He woke up!
At 10:00 p.m., just as the Adler’s Church Pastor Beau McCarthy was praying over him, Ashton briefly awoke. At this point he had been sedated for nearly nine hours. Shortly after waking, Ashton was released from the hospital. He slept until about 1:00 p.m. the next afternoon and wasn’t feeling well or acting like himself for the next few days. While Rebekah and Jason were both relieved to have their son alive and well, Rebekah suffered from shock and had an emotional breakdown. They are doing better now, however this dramatic experience will leave the Adlers wounded forever. One of the hardest things they will have to face is the mandatory future sedation that is scheduled for Gabriel every 3-6 months which he may have to endure for the rest of his life. Just a few weeks ago, Gabriel was sedated for a bone marrow biopsy and Ashton was there to support his brother. As Gabriel fell asleep Ashton broke down in tears because he remembered how he, himself, almost died while he was under sedation and “he was afraid for his brother.”
With that said, Rebekah recognizes that there are others who have suffered the loss of a child due to dental negligence and she realizes how lucky her family is to have Ashton with them. It is because of that she feels that her experience carries a responsibility to share it with the public and she wanted to also share the following message:
“Trust your instincts. As a parent you should be able to ask questions. You are your child’s best advocate and if a medical professional makes you feel stupid or does not respect you and does not want to answer your questions then you should know that you CAN walk away! A good doctor will be humble and will try his best to make you feel comfortable”
The Raven Maria Blanco Foundation | RMBF Kids’ mission is to advocate for children like Ashton and their entire families. We would like to extend our humblest and deepest gratitude to families such as the Adlers who have come forward to share their stories and experiences for the rest of the world to hear and learn. Our mission is never to put down or degrade the dental community or professionals but rather to promote the necessity of Medical Emergency Preparedness. We hope by viewing the video of Ashton’s story dentists will come to understand that emergencies are never expected, however, they should be prepared for in ways that extend beyond simple CPR. We owe it to our communities to go above and beyond what is required. For more information about the Raven Maria Blanco Foundation | RMBF Kids, please visit our website at www.rmbfinc.org
