The state Department of Commerce and Consumer Affairs has begun an investigation of Kailua dentist Dr. Lilly Geyer after a 3-year-old girl fell into a coma while she was in the dentist’s chair and later died.
Finley Puleo Boyle, the only child of Ashley and Evan Boyle of Kailua, never awoke after losing consciousness and suffering massive brain damage following heavy sedation at the dentist’s office Dec. 3, her mother said. She died Friday night at Hospice Hawaii’s Kailua house.
An autopsy will be performed, according to the Boyles’ attorney, L. Richard "Rick" Fried Jr., who filed a negligence lawsuit and now plans to file a wrongful death suit.
The state’s investigation of Geyer is being handled by the Regulated Industries Complaints Office, which enforces dental licensing regulations, according to Brent Suyama, communications officer for the department. It could lead to findings of no violation, fines, or license suspension or revocation.
Meanwhile, new details emerged that call into question what the child’s mother said was Geyer’s initial diagnosis of extensive dental decay. The information also further calls into question the level of sedatives given the child, who weighed 38 pounds.
Her mother, a registered nurse, said she was shocked when Geyer told her after an initial visit that her daughter had 10 cavities and needed four pulpectomies, also known as "baby root canals." But she said she trusted the dentist’s professional judgment.
A later examination by another dentist that was conducted while the girl was comatose showed only a few cavities, according to Fried.
"The problem with the X-rays that Dr. Geyer did is that they were of such poor quality that the dentist I had review them said they were essentially nondiagnostic," Fried told the Honolulu Star-Advertiser on Tuesday.
"There were not 10 cavities," Fried said. "Probably two teeth needed work, as best as we can tell preliminarily."
Geyer’s practice, Island Dentistry for Children, has shut down. Her attorney, John Nishimoto, told the Star-Advertiser in an email, "As this matter is now the subject of a pending lawsuit, it would be inappropriate for me or my client to comment on any of the unproven allegations that have been reported to the media."
Fried contends that Finley was given the maximum doses of Demerol and Hydroxyzine and 40 percent more than the maximum of chloral hydrate for a child her size — if just one of those drugs were being administered.
"The Physicians’ Desk Reference says clearly if you’re combining Demerol, which is a Class Two drug, with other central nervous system depressants, you must reduce it by at least 25 percent and more likely 50 percent if there is one other drug," Fried said. "And here there were two other drugs."
During a 26-minute gap in monitoring Finley’s vital signs, records from Island Dentistry show, Finley’s oxygen saturation level plummeted from normal to 65 percent or less, Fried said. Pediatric dentistry guidelines recommend checking oxygen levels every five minutes during sedation.
The dentist’s office summoned a pediatrician, Dr. Brit Reis, whose practice is down the hall, for help. Fried said Reis’ notes say Finley Boyle was sitting upright, unresponsive and not breathing, with no audible heartbeat when the doctor arrived. No effort had been made to assemble a resuscitator bag, and no reversal agent had been given to counteract the sedatives, Fried said.
"That happened after Reis got there," Fried said. A receptionist for Reis Pediatrics told the Star-Advertiser the doctor has no comment.
