Utah Reinstates Nicholas LaFeber’s Dental License Regardless of “Alarming” Care Document — ProPublica

The sufferers saved coming to the Utah oral surgeon’s workplace — one after one other, yr after yr — with dental work that the surgeon mentioned had gone improper. He later recounted in a letter to state licensors that he had seen dental implants that had been the improper measurement, sufferers with power sinus infections and one particular person whose implant had develop into misplaced inside their sinus cavity. These sufferers, he mentioned, had all been labored on by the identical dentist: Dr. Nicholas LaFeber.

The surgeon, a 30-year veteran, wrote the letter in November 2022 after Utah’s licensing division requested for his opinion of labor executed by LaFeber, whose license was on probation after the company decided he had offered substandard care to greater than a dozen sufferers. His warning was blunt: He believed LaFeber wouldn’t enhance as a dentist and shouldn’t be performing dental implant procedures. He had seen LaFeber make the identical errors in sufferers for years, he wrote, inflicting “extreme” and generally life-changing problems.

“I consider that he’s not competent to put implants,” the oral surgeon, Dr. Creed Haymond, concluded. “I give this opinion with soberness and unhappiness, however I really feel I’ve an obligation to assist the board in defending the general public from what seems to be an incompetent practitioner.”

His evaluation of LaFeber’s abilities in restorative dentistry was additionally talked about in a February 2023 order concerning company motion on LaFeber’s license. Haymond didn’t reply to interview requests.

This was the second letter that Utah’s Division of Skilled Licensing had acquired recommending that LaFeber be stopped or restricted from working towards after greater than a decade of dentistry in Utah, in line with information obtained by The Salt Lake Tribune and ProPublica. The company licenses Utah dentists and different professionals and investigates allegations of misconduct.

Two years prior, one other dentist who had thought-about shopping for one in every of LaFeber’s practices really helpful LaFeber’s license be revoked after trying by affected person information: “As I began going by charts, in addition to seeing the earlier work, I started to comprehend how poor he handled these people,” wrote Dr. Brandon McKee. “Sufferers with failed implants are placed on antibiotics and instructed to attend whereas the implant is constant to heal. A few of these are for 9 months.”

This letter was mentioned in a September 2020 public dentistry board assembly. McKee didn’t reply to interview requests.

The licensing division’s dentistry board — whose members are largely dentists and hygienists — really helpful to Utah licensing director Mark Steinagel in December 2022 that LaFeber’s license be revoked after reviewing further proof suggesting his abilities had not improved.

However regardless of this advice and the letters of warning from his colleagues, Steinagel reinstated LaFeber’s license in Could 2023 after the dentist accomplished three years of probation, which included taking remedial courses.

Since LaFeber’s license was reinstated, new sufferers say they’ve been damage. The Tribune and ProPublica spoke with two sufferers who say they noticed the dentist throughout the final yr for what they believed can be routine cavity fillings. As an alternative, they are saying they left in ache that turned extended and finally required the procedures to be redone by different dentists. Neither knew after they sought dental care that LaFeber had almost misplaced his license after regulators decided his work fell under the usual of care.

“I had by no means had this executed earlier than, so I didn’t know what’s regular,” mentioned one affected person, Michelle Lipsey. “I used to be identical to, ‘He’s an grownup, male dentist. He in all probability is aware of what he’s doing.’”

Lipsey filed a grievance towards LaFeber with licensors in July detailing her expertise, however the company closed the case a month later and took no disciplinary motion.

LaFeber mentioned he wouldn’t focus on particular person sufferers as a result of they didn’t grant him permission to take action. He instructed The Tribune and ProPublica that he has all the time tried to maintain his sufferers’ finest pursuits in thoughts. “I had a number of outcomes from dental work that had problems and wanted additional therapy,” he wrote in an electronic mail in response to questions.

“I assume each dentist encounters some share of destructive affected person outcomes and I’ve no motive to consider that my observe had a better share than others.”

Melanie Corridor, a spokesperson for Steinagel and the Division of Skilled Licensing, mentioned in response to questions that the division solely revokes somebody’s license when their conduct has been “particularly egregious” as a result of doing so “ends a profession.”

The company’s prime precedence, she mentioned, is protecting Utahns protected — however she added that it additionally desires to make sure that licensees have an opportunity at “skilled rehabilitation” and, when acceptable, can proceed to work and earn cash.

The state has revoked two dental licenses since June 2015, in line with a Tribune and ProPublica examination of a decade’s value of publicly obtainable licensing division information.

Corridor mentioned that LaFeber’s license was reinstated regardless of the dental board’s advice as a result of the dentist had completed the remedial programs that the board required him to take and his probationary interval was ending. She famous that no different sufferers filed a grievance throughout that three-year interval and that the dental board’s position was to solely make suggestions to Steinagel and his workers.

That call bothered a few of those that served on the dental board throughout that point. Two former board members instructed The Tribune and ProPublica that they have been annoyed state licensing division leaders didn’t take heed to them and that they felt LaFeber mustn’t observe dentistry given his report. Each spoke on the situation of anonymity due to potential skilled repercussions.

“You hate to take any person’s livelihood away from them after they’ve gone by years of dental college and had a observe,” one of many former board members mentioned. “However the board’s job is to guard the general public.”

In LaFeber’s case, the previous board member mentioned, “the general public was not well-served.”

LaFeber, with out realizing the identities of the board members, prompt that some may need been biased towards him.

“Each One in all These Circumstances Was Alarming”

LaFeber mentioned in public dentistry board conferences that he got here to the eye of the licensing division in late 2019 after one in every of his former workers filed a grievance. He mentioned the worker, who he mentioned he had beforehand fired, directed licensors to greater than a dozen instances by which he admitted throughout a board assembly that he had offered “poor affected person care.”

State licensing officers might have suspended or revoked LaFeber’s license, however as an alternative, in early 2020, they struck an settlement with LaFeber — a typical consequence in license self-discipline instances. In accordance with the settlement, investigators discovered that a few of the sufferers in these instances had had root canals that resulted in infections or wanted to be redone. Licensors additionally decided that LaFeber had improperly positioned everlasting alternative enamel in different sufferers, together with one whose implant prolonged into the sinus cavity, the doc mentioned.

LaFeber agreed to spend three years on skilled probation, throughout which he can be beneath the supervision of one other dentist whose time he was required to pay for. He was nonetheless allowed to carry out dental work throughout that interval, in line with the stipulation, however agreed to not do implant procedures or root canals.

He was not required to inform his present or future sufferers about this self-discipline. Like most different states, Utah has no legislation requiring affected person disclosure when a licensed skilled is disciplined, and a evaluate of greater than 3,200 filings from the licensing division’s web site reveals the state has hardly ever required disclosure of unprofessional conduct to sufferers.

The Utah regulators who self-discipline licensed professionals act solely when somebody information a grievance, like what occurred in LaFeber’s case. “We don’t have manpower or staffing for proactive investigations,” Larry Marx, the state’s well being care licensing bureau supervisor, defined to the dental board in a 2020 public assembly.

As soon as LaFeber was on probation, oversight of his progress moved to the dental board, an advisory group whose position it’s to interview probationers in quarterly public conferences and make suggestions to Steinagel about whether or not the professionals accomplished their probation and if they need to have their licenses reinstated.

In these interviews with the dental board, LaFeber admitted his errors. He blamed unhealthy outcomes on being burned out from proudly owning 4 dental clinics, and he mentioned he had executed procedures on mates and acquaintances who truly wanted extra specialised care however didn’t have the cash.

“A few of it I’ll simply admit was a poor, poor alternative on my half,” he instructed the board, in line with a recording of the assembly. “And I also can say for a few of them, they’re very pricey mates of mine, that I’ve both coached their children or helped them in Scouts or one thing else, single mothers, and making an attempt to assist them out.”

Along with the issues that the previous worker initially reported to the state licensing division, one dental board member, Dr. Ruedi Tillmann, checked out greater than a dozen different information of LaFeber’s throughout the first few months of his probation and located different instances by which Tillmann noticed indications that sufferers had poor outcomes, in line with a December 2020 board assembly.

Tillmann, a dentist, mentioned throughout the on-line assembly that he noticed “quite a few instances” the place LaFeber did 4 or 5 implants on a single affected person and none of them correctly built-in into the affected person’s jawbone. “Poor margins, open margins, implant crowns not sitting on implants appropriately,” he mentioned about affected person information he reviewed. “I’m sorry to be harsh. It’s simply that each one of those instances was alarming to me.”

Dr. Daniel Poulson, one other dentist on the board, questioned why LaFeber would do substandard work on his sufferers, together with folks he mentioned he knew and cared about.

“With 30 instances, what that communicates to me is you didn’t be taught. You simply saved doing it,” Poulson mentioned throughout the identical assembly. “And guilty that on being burdened or overworked — we’re all burdened. Dentistry is an extremely annoying career. However that shouldn’t, in my thoughts, make an excuse for ill-treating a affected person. Utilizing a variety of antibiotics to cowl infections that final years is simply out of bounds.”

LaFeber instructed the board throughout this assembly that he was assured he might enhance his dentistry by taking persevering with training programs and by being extra selective about sufferers and referring them extra typically to specialists as an alternative of making an attempt to do the work himself.

He additionally downsized to only one clinic, Sandy Middle Dental, a wood-trimmed workplace suite in a big, tan stucco constructing positioned in a Salt Lake Metropolis suburb on the base of the Wasatch Mountains.

“They Have been So Disgusted With All of the Issues”

LaFeber met with the dental board 11 occasions throughout his probation in public conferences that have been typically performed on video calls due to the coronavirus pandemic. He was cheerful and agreeable throughout conferences, even at occasions when board members requested him pointed, crucial questions on his work.

His well mannered nature was famous a number of occasions in information reviewed by The Tribune and ProPublica. For instance, McKee, the dentist who had thought-about shopping for LaFeber’s observe, wrote in his letter to the board that LaFeber got here throughout as a “humble,” “very good man” who sufferers trusted. A dentist who leads a dental examination company wrote in his abstract of an examination that LaFeber took that he was “overly nice to the acute.”

Members of the dental board remarked throughout public conferences about how “distinctive” LaFeber’s case was, they usually questioned what the proper metric can be to find out whether or not his dentistry had improved and he was protected to work with sufferers.

Utah licensors hardly ever self-discipline dentists over whether or not they’re competent to do their jobs, an evaluation by The Tribune and ProPublica discovered. A evaluate of disciplinary information from the final decade reveals dentists most frequently getting in hassle for drug or alcohol use or for overprescribing or diverting prescriptions.

Corridor, the licensing division spokesperson, mentioned the company doesn’t observe what number of standard-of-care complaints it receives, however acknowledged that proving these sorts of instances tends to be troublesome.

“Because of this, they’re much less prone to result in disciplinary actions in comparison with instances involving drug use, illegal conduct, or working towards exterior one’s scope of observe,” she mentioned.

However stress was rising between LaFeber and the dental board: Whereas LaFeber had taken a number of on-line, self-paced programs, board members felt he wanted extra intensive, hands-on courses to enhance.

A breaking level between LaFeber and the board occurred close to the top of LaFeber’s probation. On the December 2022 dental board assembly, LaFeber peppered members with questions concerning the board’s position governing probationers and implied {that a} board member had acted improperly by soliciting complaints about him.

The board appeared equally annoyed; LaFeber nonetheless hadn’t enrolled within the hands-on programs they’d required him to take, packages that would have price as much as $50,000. LaFeber had as an alternative taken a licensure examination and failed a number of sections, in line with a duplicate of the examination outcomes obtained by The Tribune and ProPublica, which was additionally referenced within the 2023 company order.

LaFeber didn’t reply on the report to questions on these check outcomes.

Given the check outcomes, Poulson, who had develop into board chair, mentioned within the public assembly that he apprehensive whether or not LaFeber would have the ability to observe dentistry safely by the next February, when his probation interval would finish.

“I’ve two medical doctors that after tried to purchase your observe. They gave it again as a result of they have been so disgusted with all the issues they have been having with sufferers,” Tillmann, one of many board members, mentioned in that very same assembly, recalling earlier conversations he had.

Poulson prompt that the group make a movement recommending that the state licensing division both revoke or droop LaFeber’s license, saying that the motion can be “defending the general public from inferior care.” The board unanimously voted to suggest revocation.

A number of months later, Marx issued the company order stating that LaFeber’s license ought to be suspended till he might show he might observe dentistry “with affordable ability and security.”

LaFeber, although, had yet one more likelihood to reply earlier than the suspension would take impact. Quickly after the company order, LaFeber enrolled in and accomplished his remedial coaching. He additionally employed an lawyer who signaled his intent to combat the company’s motion, in line with public information.

In response, Marx requested that the company’s transfer to droop LaFeber’s license be dismissed, noting that LaFeber mentioned he had delayed complying with the dental board’s requirement that he full additional coaching due to “monetary limitations.” Then, Steinagel reinstated LaFeber’s license.

By this level, Steinagel’s company knew not solely concerning the stories of sufferers with improper tooth implants and the failed root canals that led to LaFeber’s probation, it additionally knew the state dental board had really helpful that LaFeber’s license be revoked.

As well as, the company was conscious LaFeber had been sued 3 times for medical malpractice — together with by a affected person who alleged he had implants positioned in his sinuses, which brought on sepsis, and one other affected person who mentioned in her lawsuit that, after months of painful infections, she went to a different dentist who discovered a damaged dental instrument lodged in her gums. (LaFeber instructed The Tribune and ProPublica these lawsuits have been settled by his medical malpractice insurance coverage provider and there was by no means any willpower made that his therapy fell under the usual of care.)

LaFeber mentioned in response to questions that he was not conscious of any advice from the board to revoke his license — although in line with recordings and minutes of the general public dentistry board conferences, he was current when the dentistry board took its vote. The board’s revocation advice can also be referenced within the company order he acquired, which The Tribune and ProPublica obtained by a public information request.

The dentist mentioned he felt he was handled pretty by licensors and most members of the dentistry board, however added that he felt one board member didn’t disclose a battle of curiosity and had a “private vendetta” towards him. LaFeber didn’t reply on the report to follow-up questions asking for additional particulars. He mentioned he complied with each request by licensors and its dentistry board and “even went above and past” by taking further persevering with training. He famous that he handed the remediation programs and associated exams that the board had requested.

“I additionally labored with a supervising dentist, at vital expense, who reviewed my work and offered mentoring for 3 years between 2020 and 2023,” LaFeber wrote.

After taking these programs, he mentioned, he has been in a position to incorporate new know-how in his practices that has improved affected person outcomes. “Dentistry is an space that’s continuously evolving with a lot new know-how,” he mentioned, “and I welcome all info sources that may assist me enhance my observe.”

The Tribune and ProPublica requested the 2 former board members who spoke to the information organizations whether or not their vote to suggest LaFeber’s license be revoked would have modified if they’d the chance to weigh in once more after he had accomplished his remedial coaching.

One former board member mentioned they didn’t suppose the coaching accomplished to fulfill the state was sufficient to beat years of poor dentistry. One other mentioned that nothing appears to have modified given new affected person complaints. Three board members who have been concerned in LaFeber’s case declined to remark for this story, and 4 others couldn’t be reached.

New Sufferers Say They Have been Harmed

Along with his license restored, LaFeber began to as soon as once more develop his enterprise. Public information present he nonetheless owns Sandy Middle Dental, and in July 2024 he received a enterprise license for a second clinic about 10 miles to the west. (A web-based advert this summer time indicated LaFeber was making an attempt to promote his second observe.)

LaFeber is referenced as the only dentist on web sites for each of those companies. In his response to The Tribune and ProPublica, he mentioned he owns and operates a single workplace, Sandy Middle Dental, the place he works 4 days per week. A Sept. 23 search of public enterprise information present he’s nonetheless listed because the registered agent and principal for each practices. LaFeber mentioned he helped begin the second workplace, Parkway Smile Middle, however mentioned it’s now “solely owned and managed by one other dentist.” The brand new proprietor couldn’t be reached for remark.

Within the almost two years since LaFeber’s full return to observe, at the least two extra sufferers have publicly complained they have been harmed beneath his care, each of whom The Tribune and ProPublica contacted after they left destructive on-line evaluations.

Michelle Lipsey had been a affected person at Sandy Middle Dental for almost eight years, however she mentioned in an interview that she hadn’t been to the dentist for a pair years after her second baby was born. She mentioned LaFeber instructed her throughout an October 2024 appointment that she wanted 5 cavities crammed. She returned per week later for the procedures.

For weeks after, Lipsey was in ache, and she or he returned to Sandy Middle Dental later that month, complaining that she couldn’t sleep and was solely in a position to eat smooth meals, in line with her medical information. LaFeber redid a few of the fillings, medical information present, however Lipsey mentioned the ache endured. She mentioned a second dentist instructed her that LaFeber hadn’t correctly sealed the fillings and had drilled far deeper than he wanted to.

LaFeber famous in her medical information that he tried to name and textual content Lipsey after she left a destructive evaluate on-line. “Bear in mind affected person was very nervous,” her affected person file reads. “We tried our greatest to assist calm however at no level had the appointment gone as she described within the publish.”

Haley Stafford described an identical expertise earlier this yr. She mentioned that, based mostly on what LeFeber instructed her, she was anticipating to have two cavities crammed throughout a March appointment; as an alternative, he put fillings in seven enamel. She recalled in an interview that his arms shook when he gave her numbing pictures. (The testing examination outcomes reviewed by The Tribune and ProPublica additionally famous LaFeber’s unsteady arms.)

“That was the primary time he truly did work on me,” she mentioned. “And it was utterly botched.”

She’s been in near-daily ache since, she mentioned, and has wanted extra dental work on her affected enamel, together with two root canals. Stafford discovered a brand new dentist, however the restore work has price her 1000’s of {dollars}.

Each Stafford and Lipsey mentioned LaFeber contacted them about refunding their cash.

LaFeber mentioned he doesn’t recall refunding cash to any sufferers after a grievance. He mentioned he couldn’t touch upon particular instances to guard affected person privateness, however mentioned that sensitivity and ache can occur after a therapy.

“We attempt to do all we will to attenuate it,” he mentioned. “The presence of ache doesn’t show therapy that fell under the usual of care.”

Lipsey filed a grievance with licensors in late July and mentioned she was interviewed by an investigator and shared X-rays from earlier than and after LaFeber crammed her cavities.

Licensors despatched Lipsey an electronic mail in late August saying that they have been closing the case and that “acceptable motion was taken,” in line with a screenshot of the e-mail Lipsey shared with The Tribune and ProPublica. They’d not inform her what that motion was, saying the investigative report was thought-about non-public beneath Utah legislation. Licensing officers declined to touch upon the end result of Lipsey’s grievance.

If licensors had disciplined LaFeber, it might be thought-about a public report. The company has the choice to deal with a grievance informally by giving a verbal warning to a licensed skilled or writing a letter of concern. These measures usually should not disclosed to the general public.

LaFeber instructed The Tribune and ProPublica that Lipsey’s grievance was dismissed and he didn’t obtain any warnings or a letter of concern. Licensors “investigated it totally and located it to be meritless,” he mentioned.

LaFeber’s license stays in good standing, in line with the state’s licensing database in September.

Stafford hasn’t filed a grievance with the state and mentioned she had no thought LaFeber had almost misplaced his license till a reporter reached out to her.

How does a dentist almost “lose their license and get it again,” she requested, “and sufferers should not conscious of that?”