More allegations surface against former Hudson dentist
A state agency was investigating multiple cases involving a former Hudson pediatric dentist until he surrendered his license to practice last month.
Documents obtained through a RiverTown Multimedia records request show Dr. Andy Mancini was being investigated in seven different cases by the state's Department of Safety and Professional Services. The allegations included multiple violations of unprofessional conduct under Wisconsin's administrative code.
The alleged violations included engaging in practices that constitute a substantial danger to patients and practicing in a way that "substantially departs from the standard of care ordinarily exercised by a dentist," according to records.
An attorney for Mancini previously told RiverTown he would not comment on legal matters involving his client, though Mancini denied all allegations in a state Dentistry Examining Board document outlining the permanent surrender of his license in Wisconsin.
Kirsten Reader, a DSPS assistant deputy secretary, said Mancini voluntarily surrendered his license April 10. She said that happened during the investigations — the outcomes of which could have led to revocation of his license by the DSPS board.
Reader said Friday that an additional complaint was received by DSPS after Mancini surrendered his license. That case, relating to "standard of care," will be investigated, she said.
The latest allegations didn't surprise former La Petite client Rebecca Viebrock. The Hudson mother of four said reports of unnecessary tooth extractions struck a familiar chord with her.
She said that after being initially impressed with La Petite's kid-friendly atmosphere, replete with decorative art depicting seaside settings, things took a turn once she found herself having to return over and over.
"I practically lived at that place," she said, describing how she was surprised by how often Mancini sought to pull her children's teeth.
While she grew skeptical, she said her children grew scared. But she said her questions about X-rays and cavities were met with defensiveness from Mancini and the distinct impression that "we're the doctors, you're not."
"Most parents have a right to ask questions like that without being snapped at," Viebrock said.
And now she's left wondering where to go next.
Viebrock said La Petite was one of the only dentists in the area that took state insurance. Without La Petite — where she also received dental care — Viebrock said she and her children are left without options in the area.
Reader said Mancini was ordered to notify his patients of La Petite's closure and to comply with state laws governing health care records. She said he has provided the department with an affidavit attesting that he has complied with the order.
Stillwater resident Ashley Foley said she's also in search of answers after learning about allegations of questionable care at La Petite. She said she took her children there for two years beginning in 2012 and never questioned the multiple tooth-pullings Mancini recommended.
Two of those involved her daughter's front baby teeth, which have sat empty since the child was about 2. Foley said the girl is now 5 years old and must wait at least two more years before her adult teeth come in. Meanwhile, Foley said her daughter is in speech therapy and covers her mouth in shame when she smiles.
"What if this didn't need to happen?" she said.
Cases investigated by DSPS resulted in criminal charges in St. Croix County Circuit Court and the civil suit brought by the state in Dane County for falsified Medicaid claims.
The other five investigations also involved complaint-based allegations.
Dozens of allegations
A 2016 DSPS memo alleged 37 separate complaints, including multiple reports of unnecessary tooth extractions, billing problems, children being held down, "aggressive procedures" and a threat to a child.
Among the allegations outlined against Mancini and the dentistry from those reports:
-- Patients were billed for treatments that weren't performed.
-- A parent wasn't consulted about her child's appointment
-- A child was held down while "kicking, pinching and clawing to get out of the seat during an extraction procedure," during an unnecessary extraction procedure that a parent was not allowed to sit in on.
-- Mancini threatened a 10-year-old child with "sharp tools" if the child refused to calm down during a treatment that was also deemed unnecessary.
In a November 2016 interview with investigators, Mancini denied performing unnecessary work, but admitted to the possibility of billing errors "due to the incompetence of previous staff."
He told investigators that being from outside the Hudson community created struggles, including with the local dentist community. The report states that "at times he believes they sabotage his business."
Mancini contended in the interview that he does allow parents in the room while he's performing exams, but that he discourages family from being there during procedures "because it can be distracting" and can lead to anxiety for patients.
In a portion of the report addressing patient files and consent forms, Mancini admitted to investigators that he "has not always obtained consent in writing but is working on changing this practice."
Mancini denied to interviewers that he lost his temper at the office or around children. He denied the allegation involving the "sharp tools" threat, telling investigators that particular child was a special-needs patient who was told to be careful when moving around "because he has sharp tools and does not want anyone to get hurt," the report states.
Laughing gas and X-rays
Records also revealed Mancini used nitrous oxide levels that exceeded generally accepted standards for children.
Standard care for "ideal sedation" in children limits nitrous oxide-to-oxygen concentrations at 30-40 percent, according to a board case adviser, and shouldn't routinely exceed 50 percent. Mancini said told investigators he believed 50 percent was the standard and that amounts shouldn't exceed 70 percent.
A dentist from the Department of Human Services Office of the Inspector General conducted an audit — generated by patient complaints — of 86 administrations of nitrous oxide at La Petite for 13 months beginning in January 2014.
DSPS investigators concluded Mancini administered nitrous concentrations of at least 50 percent in 94 percent of the cases audited. The report states administrations higher than medically necessary can result in nausea, vomiting, headache or disorientation.
After being informed that four of the 86 examples in the audit revealed a 70 percent concentration, "Dr. Mancini was not surprised by this number," the report states, which goes on to note that when he uses the 50-percent concentration, it doesn't stay at that amount for the entire administration of the gas.
The inspector general's audit included a review of patient files that turned up "substandard issues" including "grossly mislabeled" X-ray files. The audit noted that Mancini would take the same six X-rays each time he'd see a patient. Medicaid, the report notes, reimburses for up to six X-rays on any date of service.
Substandard issues listed in the audit also included a discovery that patients "as young as 3 years old would be hospitalized on two successive weeks for treatment."
Unnecessary dental work
A 2015 case alleged Mancini was performing dental work that wasn't medically necessary and was billing insurance companies for work that wasn't performed.
The unnamed complainant in that case reported Mancini failed to teach his staff how to take X-rays safely. He also didn't provide staff with necessary X-ray equipment, according to documents.
That complaint also alleges Mancini was "disrespectful to employees and patients."
State investigators interviewed Dr. Larry Bloom, a dentist who worked part-time at La Petite from 2012 to 2013 and for a one-week stint in 2015 while Mancini was on vacation.
Bloom told investigators that while Mancini was "very clinically competent," he didn't seem to have respect for his employees, according to a memo. The records state Bloom — who resigned over "differences of opinion with Dr. Mancini regarding patient treatment plans" — said the high turnover rate at La Petite was "very disturbing."
In an interview with investigators, Mancini denied the allegations, but said an OSHA inspection did generate a reminder for staff to wear gloves while handling X-ray machines.
A DSPS attorney had recommended that case to be closed for insufficient evidence, though it was still listed as pending until Mancini turned in his license.