Small Smiles sued for alleged mistreatment of young patients

The U.S. dental clinic chain Small Smiles is facing more lawsuits over alleged mistreatment of young patients, including allegedly restraining children as young as 1 year old for procedures plaintiffs say were "unnecessary and excessive."

Two separate lawsuits were filed April 4 in New York State Supreme Court in Onondaga and Schenectady counties on behalf of 10 families in each county, as first reported by the Times Union. The suits seek damages for alleged "unnecessary, inappropriate, unsafe, and excessive dental procedures" performed on young children at various Small Smiles clinics in those counties between 2005 and 2009. Battery, false advertising, malpractice, negligence, and breach of fiduciary duty are also alleged.

Specific claims in the Schenectady lawsuit include:

• An 8-year-old girl underwent six root canals and crowns, four extractions, and three fillings during a single visit -- all while being restrained.
• A 1-year-old boy was restrained while the dentist began four root canals and four tooth extractions.
• A 4-year-old girl had eight fillings, four extractions, and two root canals during one visit while restrained.

Claims in the Onondaga suit include:

• A boy who, while between the ages of 3 and 5 years old, received fillings without any anesthesia on three occasions.
• A 2-year-old boy who received one or more fillings without any anesthesia on four occasions.
• An autistic girl who, during one session, received four fillings without anesthesia while restrained.

Small Smiles, which is owned and operated by Church Street Health Management (formerly Forba Holdings, also named in the suit) -- previously paid $24 million to settle allegations of Medicaid fraud brought by the U.S. Department of Justice. A total of $3.45 million of that went to New York state, where the company operates several clinics.

"The government proceedings have legitimacy," Patrick Higgins, a partner at Powers & Santola, the law firm representing the plaintiffs, told DrBicuspid.com. "This [lawsuit] is for the 20 children who were impacted, to compensate them for what they went through. What is important is that the parents or legal custodians have no claim whatsoever; the funds would go solely to the children."

The government payment did not compensate the children involved, who ranged in age from 1 to 8, Higgins noted. "That's not part of the government's role in investigating Medicaid fraud," he said.

In the current lawsuit, Small Smiles is accused of a policy of "converting" patients, whereby they encouraged parents to consent to additional procedures when the child was brought in for a cleaning. Dentists were systematically urged to perform additional procedures and the number of procedures performed was tracked.

The clinics "routinely restrained children under the age of 5 for the convenience of the clinic and not because restraints were medically necessary," one dentist quoted in the Schenectady lawsuit admitted. To increase production, the dentists were expected to reduce time spent with each child and consequently used restraints, presented as a safe alternative to sedation or general anesthesia, which was presented as risky, the complaint alleges.

In reality, the clinics were unequipped to administer general anesthesia, according to Higgins. "Work was done in some cases without anesthesia or without x-rays and was rushed to meet corporate income goals," he said.

In the Schenectady complaint, eight of the patients had received a root canal, restoration, or both without the aid of x-rays. In instances in which x-rays were taken, they revealed that the work performed was unnecessary, incomplete, or done improperly, according to the complaint.

The plaintiffs are seeking punitive damages "in an amount that is constitutionally permissible" within New York law. The state would supervise the money until the children are 18.

"The core of the complaint is that Small Smiles set up a profit scheme at the expense of these children," Higgins said.