The bosses of a California children’s dental clinic were warned of infections among their patients in July 2016, more than two months before the clinic began telling their young patients’ parents they were at risk.
The warning came as Children’s Dental Group in Anaheim saw a spike in kids who needed their recently worked-on teeth extracted. And it came two months after managers got another signal of ineffective sterilization when the clinic failed a spore test, the first in what would be a string of 13 failures that year.
The revelations are embedded in a new filing in the case brought by the families of more than 150 children and alleging overtreatment by Children’s Dental Group. Dozens of the children were sickened in a 2016 outbreak of a superbug called mycobacterium centered on the Children’s Dental Group clinic in Anaheim. Represented by the Law Offices of James R. Moriarty, the plaintiffs argue the information is evidence of recklessness and fraud by Children’s Dental Group and have sought to add a claim for punitive damages against the dentist defendants.
On July 1, 2016, a staffer at Children’s Dental Group sent an email to the top dentist at CDG, Dr. Jerry Minsky, with subject line “MISC !!!” and marked with high importance:
“In the last couple of weeks we have seen a handful of patients that had contracted infection from a treatment of (baby root canals and stainless steel caps) that was done at least 1 month ago. The odd part is that even when the doctor extracted the tooth that was in question the patients seem to not get rid of the infection. …”
The staffer describes follow-up tooth extractions dating back to June 8 and adds that another dentist says the problem could be instruments that haven’t been properly sterilized.
Three weeks later, the same staffer sent another email, pointing out that two more patients have come down with infections.
“There’s definitely something wrong here,” another staffer replies to a group that includes Minsky.
But Children’s Dental Group would wait more than seven weeks to notify its patients, beginning with letters on Sep. 13 and 15. The clinic had no choice at that point, as media covered the hospitalization of sickened children.
The staffer’s email wasn’t the only sign of trouble.
The clinic saw a spike in extractions for patients whose teeth had just been worked on beginning around May and June 2016. Among the child plaintiffs, there had been fewer than two such cases a month stretching back to January 2015. In May 2016, the number jumped to seven, then doubled to 14 in June, the plaintiffs’ medical records show.
Plaintiffs argue that Children’s Dental Group knew or should have known about the problems much earlier than their September notice to the public. But as more patients were getting sick, plaintiffs allege the clinic managers remained focused on profits.
Children’s Dental Group had come under new management in 2015, when Sam Gruenbaum, a lawyer-executive who had run the largest corporate dental chain in California, took over as CEO. Gruenbaum was fond of metrics and motivational emails punctuated with exclamation marks, like one dated March 2016 with subject line “Production levels -- message from Sam G: need to excel!!!”
Gruenbaum implemented “daily dashboard” reports to track productivity for each of the chain’s 10 clinics and per-dentist, as well as “average production per visit,” plaintiffs say in their June motion to add a claim for punitive damages. Gruenbaum put in place monthly reviews of productivity and said the dentists would receive standards for “reasonable levels of production.”
In June 2016, as the Anaheim clinic was seeing unexplained infections among patients, Children’s Dental Group implemented a new bonus system for dentists, according to the plaintiffs’ motion. The more the dentists produced, the more they got paid.
In the push for more revenue, Children’s Dental Group not only rewarded the top performers but sought to bring laggards in line.
On June 24, a #2 manager at CDG sent an email to Minsky and Gruenbaum, pointing out two dentists who showed “consistently low productivity” and musing they may not be “the right fit for CDG.”
The first trial in the overall case brought by the patients’ families is set for January in Orange County Superior Court. That trial, known as a bellwether, is meant to serve as a litmus test for the overall case.