Lang v. Dental Quality Assurance Commission

156 P.3d 919, 138 Wash. App. 235
CourtCourt of Appeals of Washington
DecidedApril 26, 2007
DocketNo. 24473-3-III
StatusPublished
Cited by8 cases

This text of 156 P.3d 919 (Lang v. Dental Quality Assurance Commission) is published on Counsel Stack Legal Research, covering Court of Appeals of Washington primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Lang v. Dental Quality Assurance Commission, 156 P.3d 919, 138 Wash. App. 235 (Wash. Ct. App. 2007).

Opinion

¶1 Dr. Melanie Lang and Dr. Mark Paxton own a surgical practice and perform cosmetic and dental surgeries that require patients to be under general anesthesia. Dr. Lang is both a licensed medical doctor and a licensed dentist. Dr. Paxton is a licensed dentist. Following a complaint to the Department of Health (Department), the Dental Quality Assurance Commission (Dental Commission) and the Medical Quality Assurance Commission (Medical Commission) each charged the doctors with allowing unlicensed employees to start intravenous (TV) lines and administer general anesthetic in violation of RCW 18.130.180(7) and (10). After a contested hearing, the Commissions’ presiding officer found by clear and convincing evidence that Drs. Lang and Paxton violated the statutes, imposed sanctions of a $5,000 fine, and issued orders to cease and desist. The superior court affirmed the Commissions’ final orders.

Kulik, J.

¶2 On appeal, Drs. Lang and Paxton assert the Commissions’ presiding officer erred by (1) concluding that the doctors allowed unlicensed assistants to start IVs and administer general anesthetic in violation of RCW 18.130.180(7) and (10); and (2) by imposing sanctions for the violations. The doctors also assert a number of procedural errors.

[240]*240¶3 We conclude that the Commissions’ presiding officer did not err by concluding that the doctors violated the statute by allowing unlicensed employees to start IVs and administer general anesthetic. We further conclude that the sanctions imposed were not arbitrary or capricious. We affirm.

FACTS

¶4 Dr. Mark C. Paxton is licensed to practice dentistry in Washington. Dr. Melanie Lang holds a dental license and a medical license in Washington. Both doctors are subject to RCW 18.130.180 of the Uniform Disciplinary Act. At the time of the complaint and investigation, Dr. Paxton served as a member of the Dental Commission.

¶5 Dr. Lang and Dr. Paxton own Spokane Oral and Maxillofacial Surgery Associates, an office-based surgical practice in Spokane. Drs. Lang and Paxton perform surgeries, including cosmetic and dental surgery, that require the patients to be under general anesthesia.

¶6 In February 2003, a former employee of Drs. Lang and Paxton filed a complaint with the Department alleging that Drs. Lang and Paxton allowed unlicensed employees to start IV lines and administer anesthetic both in and out of the doctors’ presence. During the investigation of the complaint, both Dr. Lang and Dr. Paxton admitted that they employed unlicensed assistants to start IVs and give anesthetic during surgery.

¶7 The Dental Commission and Medical Commission each filed a statement of charges against Dr. Lang. The Dental Commission also filed charges against Dr. Paxton. The matters were consolidated for hearing.

¶8 The Commissions delegated final decision-making authority to a presiding officer. During the administrative hearing, Drs. Lang and Paxton again admitted that they employed individuals, who were unlicensed by the State of Washington, to start IV lines and give anesthetic. The doctors referred to these employees as “surgical assistants.” Administrative Record (AR) at 1892.

[241]*241¶9 The surgical assistants’ duties included administering anesthetic, including Propofol and Versed. The surgical assistants put the IV catheter into the patient’s arm, drew the anesthetic out of a vial into a syringe with a needle attached, inserted the needle into the patient’s IV port, and then pushed the anesthetic into the IV.

¶10 Patricia Rathbun-Gibson was a surgical assistant for Drs. Lang and Paxton. She attended a dental-assisting program at Apollo College. Ms. Rathbun-Gibson explained that after getting the patient hooked up to monitors, the surgical assistants started the TV before the doctors came into the room. She testified that the surgical assistants put the IV catheter into the patient’s arm and would hook up the IV bags. Ms. Rathbun-Gibson was not licensed.

¶11 Ms. Rathbun-Gibson had given patients Propofol at the direction of a doctor. Ms. Rathbun-Gibson gave the medication by putting it into the IV line. On 5 to 10 occasions, Ms. Rathbun-Gibson gave Propofol when the doctor was not in the room.

¶12 Kim Colt stated that she worked as a surgical assistant for both doctors. When she started the IV or administered a general anesthetic, a doctor would usually be in the room, but not always. Ms. Colt explained that, when there was a long surgical case, the doctor might leave the room to see other patients. The doctor would then ask the surgical assistants to continue administering the general anesthetic until the doctor returned. Danielle Cain, another surgical assistant, stated that she drew up a general anesthetic and pushed it in the IV port under the supervision of a doctor. Neither Ms. Colt nor Ms. Cain was licensed.

¶13 Katrina Soliday is a registered nurse who was employed at Spokane Oral and Maxillofacial Surgery Associates for several months. During that time, she assisted both doctors and observed over 100 surgeries where she saw unlicensed surgical assistants draw up general anesthetics from vials and push them through the patients’ IV ports. Ms. Soliday testified that on one occasion she heard [242]*242Dr. Lang ask the surgical assistant to give “2.5 of Versed.” AR at 2052. The assistant drew up 2.5 cubic centimeters of Versed, five times more than the intended dose of 2.5 milligrams. Dr. Lang noticed the error and the surgical assistant did not put the excessive dose into the IV port.

¶14 Ms. Cain prepared an office policy statement for an Occupational Safety and Health Administration review, which stated:

On a normal surgery day, we see approximately 10-14 general anesthetic patients. Us [sic] as surgical assistants need to make sure the drugs are getting administered correctly to the patients. During a general anesthetic procedure we already use fentanyl, versed, decadron and propofol. Any time we administer any of these drugs we must always check with the doctor on how much to give the patient, and the doctor must always be present. Patients vary and if you give too much to the wrong patient it could end up bad.

AR at 2329 (italics added).

¶15 The Commissions’ presiding officer found that Drs. Lang and Paxton violated RCW 18.130.180(7) by violating WAC 246-817-540(4). This regulation prohibits dentists from allowing unlicensed persons to conduct any administration of general anesthetic in connection with a dental operation. The Commissions’ presiding officer also determined that Dr. Paxton and Dr. Lang violated RCW 18-.130.180(10) by allowing their assistants to start IV lines and administer anesthetics. The Commissions’ presiding officer imposed sanctions of $5,000 against each doctor and entered a cease and desist order on January 13, 2005.

¶16 Dr. Paxton and Dr. Lang appealed the Commissions’ presiding officer’s orders.

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Cite This Page — Counsel Stack

Bluebook (online)
156 P.3d 919, 138 Wash. App. 235, Counsel Stack Legal Research, https://law.counselstack.com/opinion/lang-v-dental-quality-assurance-commission-washctapp-2007.