State records show dentists have called for emergency services dozens of times in the past five years after patients received anesthesia during dental work and experienced medical complications.
One of those was 77-year-old Sharlon Stemmons, a retired grocery store cashier.
“I miss her cooking. No more holidays together. That hurts,” said her daughter, Teresa Rushing. She brought her mother to the dentist in October 2019 to get her teeth extracted for dentures.
“I hugged her, kissed her, said a prayer with her,” she said.
What happened next is detailed in an ABC15 interview with Rushing and in a civil lawsuit alleging medical negligence filed in 2021.
As she sat in the waiting room, Rushing saw an ambulance pull up. That’s when she knew something was wrong.
Her mother’s blood pressure dropped shortly after being given anesthesia, according to a lawsuit Rushing filed in 2021 alleging medical negligence.
“She coded in the dental chair, was taken to the hospital, and died 10 days later,” said Lincoln Combs, an attorney who represents Rushing.
She is suing the dentist, Dr. Ehsan Pourshirazi, and the nurse anesthetist, Tory Richmond. They deny liability.
In court records, the dentist says he met the duty of care “at all times.” The nurse anesthetist says he met the standard of care “in all respects” and caused no harm to Stemmons.
An investigation by the Arizona State Board of Dental Examiners said the procedure should never have taken place because the dentist lacked the proper permit for anesthesia.
Pourshirazi told the board he was unaware he needed one. He also did not conduct a pre-anesthesia medical exam on the patient, according to the board’s report.
What happened to Stemmons was not an isolated case.
How often do problems happen?
Sedation and general anesthesia are used with more complicated dental procedures such as multiple extractions or oral surgery. Medical complications are rare. But there’s no state or national tracking of the total number of dental procedures involving anesthesia vs. the number of medical complications.
“That's the problem. We don't have any rates,” said Dr. Helen Lee, a pediatric anesthesiologist at the University of Illinois Chicago, who has researched pediatric deaths based on media reports.
The Arizona Dental Board does track “adverse occurrences,” which are reports dentists are required to file with the board when a patient dies or when emergency medical services are called during the administration or recovery from anesthesia and sedation.
The ABC15 Investigators found 50 cases where Arizona dentists were called for emergency medical services for patients under anesthesia since 2018, according to records from the dental board.
In a statement, the dental board said there were “only 12” adverse occurrence cases last year. This equates to about 2% of the cases the dental board reviewed last year.
“The vast majority of procedures done in the dental office are safe,” said Dr. Anthony Caputo, an Arizona dentist who specializes in anesthesiology and chairs the board’s investigative committee.
Of the 50 cases since 2018:
- Most of the cases, 32, were dismissed by the board, meaning there were no findings that dentists broke state laws governing conduct and standard of care.
- Seven patients, including Stemmons, died. None of the dentists had their licenses revoked even when the board found deviations from the standard of care or unprofessional conduct.
- Stemmons’ dentist, Pourshirazi, had his dental license suspended for six months and was ordered to take 11 hours of classes. He has an active dental license in Arizona. Records indicate he is working in California where he is also licensed.
- Six dentists had some lesser form of discipline than Pourshirazi. In 3 other cases involving deaths -- where the board found the dentists deviated from the standard of care and/or committed unprofessional conduct – anesthesia permits were suspended for six months or a year. Two other dentists, whose patients survived, were required to take continuing education.
- A handful of cases are still pending.
Attorney says discipline is lax
Scott Eldredge, a medical malpractice attorney who has handled cases involving deaths after dental anesthesia, said the Arizona Dental Board is lax when it comes to disciplining dentists.
“Sometimes they get a slap on the hand or a private reprimand,” he said.
But Caputo, who chairs the dental board’s investigative committee, said the board takes discipline seriously. “The board is doing a good job. And not just a good job, but a better job than previous boards did,” he said.
Dentists in Arizona need a permit from the state board to offer general anesthesia or deep sedation services in their offices.
Some dentists also contract out for the services by hiring nurse anesthetists or anesthesiologists. That’s what happened in the case of Stemmons. Pourshirazi was the dentist. His office contracted with a company that employed Richmond as a certified registered nurse anesthetist.
Along with the dental board, the Arizona Nursing Board also reviewed Stemmons’ death because nurse anesthetists are licensed through that board.
The nursing board found no unprofessional conduct, but instead issued a non-disciplinary letter of concern, saying Richmond did not sign the anesthesia consent form.
Peter Wittekind, an attorney who represents Richmond, told ABC15 the dentist and the nurse anesthetist were unaware Stemmons had previously had an adverse reaction to anesthesia during a prior dental procedure.
“It’s a tragic outcome,” he said.
According to the dental board’s investigation, this information was not disclosed by the patient on her intake paperwork. But Rushing’s lawsuit says “prior to” her mother’s October 2019 procedure, Stemmons disclosed her health history and difficulties with sedation during a previous dental procedure.
The civil lawsuit is ongoing in Maricopa County Superior Court.
The dental board is in the process of changing its rules on anesthesia and sedation in a move to enhance patient safety. Many of the more substantive changes deal with pediatric anesthesia, which ABC15 has previously reported on in depth.
Questions to ask before dental anesthesia and sedation
While the dental board says anesthesia-related complications are rare, here are some things to do and questions to ask to make sure the procedure is as safe as possible:
- Be forthcoming about health and medical conditions.
- Disclose any medications or drugs you are taking.
- Find out who will do the anesthesia. Is the dentist doing the anesthesia or contracting out for services?
- What are the qualifications of the person providing the anesthesia?
- Has the dentist ever experienced problems with a patient during or after sedation or anesthesia? If so, what happened?
- How many times has the dentist performed this type of procedure with anesthesia? How recently?
- How is the office set up to handle a medical emergency?
- Who will monitor your recovery and discharge?
- Ask whether the dentist has ever had to file an Adverse Occurrence Report with the dental board. Arizona dentists are required to file such a report if a patient dies or the dentist has to call for emergency medical services during the administration or recovery from anesthesia. If a report was filed, ask about the circumstances and the outcome.
- Get the name of the medical provider who will perform the anesthesia and check the person’s licensing discipline history through the appropriate state licensing board. Dentists can be checked through the Arizona Dental Board. Nurse anesthetists can be checked through the Arizona Nursing Board. Physician anesthesiologists can be checked through the Arizona Medical Board.
- Ask whether the office setting is the right place for the procedure. If you’re uncomfortable with the response, explore options for having the procedure done in a surgery center or hospital.
Sources: Institute for Safety in Office-Based Surgery; Dr. Anthony Caputo, dentist who specializes in anesthesia; Scott Eldredge, medical malpractice attorney.
Email ABC15 Investigator Anne Ryman at anne.ryman@abc15.com, call her at 602-685-6345, or connect on X, formerly known as Twitter, and Facebook.
