Implant replacement turned deadly. Now, consequences for a Broward dentist
The actions of a Broward dentist before the death of an implant replacement patient will cost him $16,000, the cash part of a punishment list approved by the State Board of Dentistry in its final order.
The Florida Department of Health accused Dr. Joel Berley, who works out of Plantation Oral Surgery’s Plantation and Hollywood offices, of not meeting the minimum standard of care “by failing to stop surgery and stabilize Patient J.S.’s medical condition after conditions of medical emergency arose” in 2022.
That’s from the administrative complaint filed Sept. 13, which starts the disciplinary process. Berley originally disputed some of the complaint’s statements and requested a hearing. Then, however, he entered the settlement agreement, which states that he neither admits nor denies the complaint’s allegations, but the agreement is “a fair, appropriate, and reasonable resolution to this pending matter.”
Berley didn’t return messages from the Miami Herald.
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Implant replacement and death
According to the complaint, Berley put implants in J.S.’s mouth in 2016. She returned to Plantation Oral Surgery’s Plantation office, 201 NW 70th Ave., on April 6, 2022, for extraction and replacement of those implants.
J.S., the complaint said, was a 75-year-old who had bypass surgery in 2015, hypertension, osteoporosis and one working kidney. She was on three different blood thinners. Berley, the complaint said, administered general anesthesia.
From 9:12 a.m. until 10:25 a.m., the complaint said, J.S. blood pressure rose and stayed between 173/77 and 194/83.10.
“Elevated blood pressure for an extended period during an anesthetic surgical procedure may lead to emergency conditions in a patient,” the complaint said. “In response, [Berley] administered a jaw thrust, chin lift, and rescue breaths.”
From 11 a.m. to 11:37 a.m., the complaint said, the patient’s oxygen saturation rate — “the amount of oxygen you have circulating in your blood,” the Cleveland Clinic explains — measured 68 to 74.13. From 11:54 a.m. to 12:11 p.m., that number got higher, but remained under 85.14.
“When a patient’s oxygen saturation remains lower than 85 for longer than five minutes, the patient is at risk of developing brain ischemia and/or brain damage, a medical emergency,” the complaint said.
For the next 50 minutes, the complaint said, no oxygen saturation was recorded. Also, not recorded was EtCO2, or end-tidal carbon dioxide. That’s how much carbon dioxide you release when exhaling, a measure that tells “how well a patient is oxygenated.”
What was measured was blood pressure, which had dropped to 93/40.2, considered low blood pressure.
“These conditions of elevated blood pressure, low or undetectable oxygen saturation, and undetectable EtCO2 solely and/or combined resulted in a medical emergency,” the complaint said. “[Berley] continued the surgical procedure on J.S. despite her high risk/emergent medical condition. [Berley] fell below the minimum standard of performance in diagnosis and treatment in the practice of dentistry when he failed to stop surgery and stabilize J.S.’s medical condition after conditions of medical emergency arose for J.S.”
The surgery finished at 12:44 p.m. Seven minutes later, the complaint said, “J.S. went into distress and became non-responsive with difficulty to no breathing, low saturation of oxygen, and continued sinus bradycardia (slow heart beat).”
The office called EMS at 12:56 p.m. J.S. died three days later, on April 9, 2022.
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Berley’s money, time and punishment
Here’s what’s demanded from Berley, who also received a reprimand against the Florida license he’s held since Oct. 13, 2010.
Money: Berley must pay $16,000 — a $10,000 fine and Department of Health case investigation and prosecution costs, which the state Board of Dentistry set at $6,000, the maximum the settlement agreement allows.
Time: Berley’s required to do continuing education courses in ethics (three semester hours); medical emergency, Level I (three to six hours); and anesthesia, Level III (over 13 hours). Also, he has to pass the American Association of Oral and Maxillofacial Surgeons Office-Based Emergency Airway Management course, a simulation designed to practice operating in office-based anesthesia situations; and the state’s dentistry Laws & Rules exam.
Restriction: The Board of Dentistry added to the settlement agreement a requirement about any Berley procedures using moderate or general sedation. For the next three years, that will require medical doctor or osteopathic physician anesthesiologist or certified registered nurse anesthetist to handle anesthesia.
