Thursday, October 23, 2008

Fred Quarnstrom - How NOT to Resign from a State Dental Board - The Reponse


Fred Quarnstrom, Seattle dentist, Las Vegas ADA Convention, October 2006. Photo by Flap

Remember the FLAP?

Flap gets the following via e-mail:


For some reason, I do not understand, you seem to be on a vendetta aimed at me. I was alerted to your site by someone who suggested it is probably slanderous.

You obviously can publish anything that is public record. I certainly gave you enough references in my response that you can take out of context and make me look good or bad.

As to my being reappointed or not reappointed. We will never know for sure.
You are welcome to your speculation. However, if I had stayed knowing about the cover-up of the deaths, I would be part of the problem. Once I knew; I felt obligated to do something. I left so I could expose what was going on.

Because of my two media exposures, one three years ago and one this year, of the problems of anesthesia the DQAC is about to pass, I was told in November, new anesthesia regulations to update the ones I helped formulate
15 years ago after the first death. I worked for 4 years on these new

You may feel all dentists suffer under an oath of silence. However, dental ethics has advanced beyond that.

Being a lifelong Democrat, it hurt me to go public, as it did reflect on our Democratic Governor who had been alerted by me to the problems.

Because of my public stance, I have had an oral surgeon tell a patient who needed an implant, "If he is so God Damned smart, why does he not do the implant. I want you to leave my office. I will not treat you." She had found him on her own. He was already to do the implant until he told her I will put all this information in a letter to your general dentist. At this point he picked up her chart and realized I was her general dentist.

I am honored that you find me worthy of this much of your time.

Fred Quarnstrom DDS
Diplomate, American Board of Dental Anesthesiology Diplomate, National Board of Dental Anesthesiology Certified, American Association of Dental Consultants

Author - Open Wider: Your Wallet Not Your Mouth, A consumer's guide to dentistry.
Before somebody alerted Fred Quarnsrom about an alleged vendetta Flap received this e-mail.

The second Fred Quarnstrom e-mail:


While Ms. King bungled trying to have me removed. I would hate to have this lead to her being removed, she depends on her job.

DQAC was not a positive income stream for me. I did not expect it would be.
Financially, leaving the Commission was in my best interests. The attorney of the dentist who had two people die, filed ethics charges against me with the state in an attempt to have me removed. It was determined that I had not violated any state regulation and that is was not if violation of any ethical principles. It did cost me more than I got paid by the state in legal fees.

Would you put the following patients under general anesthesia or conduct the case in these ways ?
[1] This was the case of a woman about 50 years old. She was middle management at Boeing. She had mild hypertension, high blood pressure, that was controlled by a diuretic, water pill, and a beta-blocker.

She had one preoperative blood pressure taken. She was given 3 large doses of several medications including Versed, midazolam, a benzodiazepine; a potent narcotic and several other drugs that would depress here Central Nervous System and thus her respiration, both depth and rate of breathing.

The surgery to place implants was started and over several hour the 2nd and 3rd dose of medication was given. No monitoring was done other than having an assistant who was to hold her head and have a finger on her carotid artery and feel her pulse. At the time, it was standard to use a pulse oximeter to monitor level of oxygen in the blood stream and measure pulse rate. I had been standard to take a blood pressure no less than every 15 minutes for many years.

Eventually it was determined that the patients heart had stopped. The surgeon did not start the chest compression of Basic Life Support.
Paramedics were called and they managed to get the patient¹s heart restarted. She died several days later.

Dr. Ted Jastak, DMD, PhD and Dr. John Yageala DDS, PhD both national and international experts in Dental Anesthesiology testified they this was not adequate monitoring. However, a local oral Surgeon stated that if she had a ³bounding pulse² it was not necessary to monitor the patient further.

[2] . Same surgeon as case 1, A patient in their 50s stated that she had surgery to replace her hip joint. She was put to sleep under general anesthesia but the MD anesthesiologist was not able to breath for her so they woke her up and had a tracheotomy preformed, placing a tube through her neck into her trachea. They then put her to sleep breathing for you using this tube. He hip replacement surgery was successful. She told all this to the surgeon who put her to sleep. He was unable to intubate her or breath for her. 911 was called and the paramedics were unable to breath for her.
She died in the office.

If the Anesthesiologist was unable to open her airway, it is doubtful that an oral surgeon would be able. An expert witness was contacted and asked to review the attempted resuscitation. He stated it was well done. He later stated in a newspaper article that case selection was the problem but he had
not been asked about patient selection. This case was closed as within
standard of care.

I filed a request to reopen this case to look at the issue of case selection. The DOH attorney stated they would not reopen it.

[3] A Certified Nurse Anesthetist, CRNA, was used to give general anesthesia for an Oral Surgeon who did a cosmetic procedure to a patient in his 40s to his nose, and neck. After the surgery was done and the patient was awake his neck started swelling due to blood in the tissue. The surgeon told the CRNA he would finish in a minute. She stated she was unable to breath for the patient and needed help. His response to tell her he would just be a minute. Eventually 911was called but they were unable to resuscitate the
patient. DQAC did fine this dentist $3,000.

[4] An 89-y.o. Holocaust survivor, 98 lbs who had a transfusion a month earlier. The surgeon gave her general anesthesia drugs and 3.6 cc xylocaine 2% 1:100,000 epinephrine and 7.2 cc 3% Carbocaine plain. That is 72 mg Xylocaine and 216 mg Carbocaine. Total dose 285 mg of local. Max dose of a healthy 98 lb patient is 3 mg per pound, 294 mg. This was not a young healthy patient. In addition she got 50mcg of Fentanyl, 3 mg Versed and 45 mg bolus of Propofol and a drip of 100 mch/kg/min. She became apneic and
bradycardic 15 minutes after starting the anesthesia her heart stopped. At
89 and 98 lbs with a history of having a transfusion, this was a fragile patient with little reserve. This case was seen by a pro tem panel with one DQAC member. It was closed by this panel in secrecy. The rest of DQAC was not aware that the case had occurred. This surgeon was a member of DQAC at the time. However had only attended a few meetings.

I got the records from this case under the freedom of information act but only after having my request lost 4 times and paying to have the records copied. This cost me over $50 dollars

[5] . This is a patient that from videos appears to be in his 50s. He appears to be 50 or 60 lbs over weight and about 5¹8² in height, quite over weight. He has a pacemaker. Pacemakers are usually placed when a patients heart will not beat at a normal rate. This usually is due to a conduction problem of the nerves in the heart secondary to a MI, heart attack. In addition he had an implanted defibrillator. These are place when a patient has a history of going into Ventricular fibrillation or tachycardia. Both lead to death if the heart is not shocked so it can revert to normal rhythm.
He was also reported to be diabetic. He clearly was not a candidate for in office anesthesia. This case was closed in secrecy by a pro tem panel. I do not know who was on this panel. I learned of the case after a newspaper article was forwarded to me.

[6] A 70-y.o. patient had surgery to help with sleep apnea. This type of surgery is questionably effective. I have heard that if it helped, you probably did not need it. The patient when home and bled and aspirated, breathed, blood into his lungs. He was on a respirator in the hospital for a few days but died. This case was not reported to DQAC until the newspaper found it and that a lawsuit was in progress.

[7] . A 21 year old had orthognathic surgery and died 10 hours later of an allergic reaction to a medication. This case has just been reported The question is did the surgeon know the patient had this allergy. Did the patient receive adequate informed consent as to the risks of this type of surgery.

I am sure you can twist all these cases to make me look like a fool. I guess that is up to you.

Fred Quarnstrom DDS
Diplomate, American Board of Dental Anesthesiology Diplomate, National Board of Dental Anesthesiology Certified, American Association of Dental Consultants

Author - Open Wider: Your Wallet Not Your Mouth, A consumer's guide to dentistry.

Now, Flap is confused.

Did Fred Quarnstrom resign for a principled reason, forced out over a political dispute and by whom, or did Quarnstrom merely resign because he did not get his own way?

The first e-mail response from Fred Quarnstrom below.

The first Quarnstrom e-mail:

First I am honored to be featured on you blog site.

As to who on the DOH wanted me gone. I have no idea of how high the request came from. However it was higher than middle management.

I was requested to come to a DQAC meeting an hour early. I was escorted to a room where Ms. Joy King middle to upper management in the Department of Health and Dr. Mark Koday were waiting. They railed on for about 45 minutes and presented me with a letter of demands, either agree and sign this letter or leave the Commission.

I told them if they wanted me off the Commission there was a way and it would be in a public meeting. I would have legal representation and the media would be there. Their demands were, among other things, that I not speak to the legislature or the press, a gag order. I said I would verbally agree while I was on the board, but would not sign their letter. It they wanted me off they would have to get a majority of the commission to agree in public hearing and send they recommendations to the Gov.

When the media first exposed the mishandling of death cases, it got pretty ugly. "Who went to the press." "He should be removed from the Commission."
"Who released all the patients names." (I turned out it was the State had released them, under the freedom of information act.) My retort this Commission is charged by the legislature with protecting the citizens of the state. Covering up death cases was not doing that. You should be worried about why these people died and not how to keep me from reviewing death
cases. They decided to go on to new business.

As it turned out 3 years later we have 5 more deaths. 1 or 2 might have been avoidable.

I liked the photo you have, I have put on a little weight since then. Your photo will get me back on the ball. You had better hope Obama gets elected can you fathom Palin and Polosi as Pres and VP. That should curdle the blood of most R's.

Have a good day, you trouble maker.


Fred Quarnstrom DDS
Diplomate, American Board of Dental Anesthesiology Diplomate, National Board of Dental Anesthesiology Certified, American Association of Dental Consultants

Author - Open Wider: Your Wallet Not Your Mouth, A consumer's guide to dentistry.

Stay tuned........

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