A Florida periodontist who allegedly “failed to meet the minimum standard of performance” when he did not stop implant surgery when a patient drifted into deep sedation and who later died was disciplined by the state dental board.
Dr. Richard Aguila of Jacksonville Dental Specialists in Jacksonville, FL, is restricted from administering anesthesia for no less than 12 months. This restriction does not include local anesthesia, according to a final order dated December 5 from the Florida Board of Dentistry.
When a patient requires moderate or general anesthesia, Aguila must employ a medical doctor anesthesiologist, an osteopathic physician anesthesiologist, or a certified registered nurse anesthesiologist to administer it, according to the order.
Additionally, Aguila must take 60 didactic hours and complete 20 cases administering moderate sedation from an accredited program, as well as other courses. Furthermore, he must pay a $10,000 fine plus $5,300 in costs.
In November 2022, a 73-year-old man with a history of controlled high blood pressure, diabetes, and sleep apnea went to see Aguila for a bilateral sinus lift and implant surgery while under local anesthesia and IV sedation.
At about 8:50 a.m. on the day of the procedure, the patient was administered seven carpules of 2% lidocaine with 1/100,000 epinephrine. Between 8:31 a.m. and 9:18 a.m., 3 mg midazolam, 8 mg dexamethasone, 25 mg promethazine, 25 mcg fentanyl, and three additional units of 2 mg of midazolam were administered to the patient, according to the order.
After the sedation medications were administered, the patient’s oxygen saturation dropped. The dentist responded by tilting the man's head and lifting his chin to return his levels to normal. Though the sedation drugs moved the patient from moderate to deep sedation, the dentist reportedly did not attempt to return him to the lesser sedation level, according to the order.
At 9:18 a.m., Aguila started the surgery. Aguila purportedly failed to document whether the patient’s vital signs were continuously monitored as required when general or moderate sedation are used.
During the surgery, the patient’s oxygen saturation dropped below 85% multiple times, including as low as 38%. A patient is at risk of heart and brain function damage when the saturation level dips below 85% for more than five minutes, according to the state board.
The minimum standard of performance requires a practitioner to stop surgery and stabilize a patient when a medical emergency arises. Despite the patient’s emergent medical condition, Aguila continued with the surgery.
Since Aguila didn’t stop the procedure, Aguila “fell below the minimum standard of performance in diagnosis and treatment,” according to the state.
At 9:22 a.m., the patient stopped breathing, and Aguila responded by tilting his head and lifting his chin. Three minutes later, the patient’s blood pressure rose to 163 mmHg/112 mmHg.
Aguila administered sedation reversal agents and gave CPR with supplemental oxygen. Also, staff contacted emergency services, which arrived at 9:35 a.m., to take the patient to the hospital.
The patient died at about 10:37 a.m., according to the state board.
The state contended that Aguila violated Florida statutes by failing to return the patient to a moderate sedation level and failing to stop the surgery when his condition became an emergent medical emergency.
