When you go to the doctor’s office, you know that you may be placing your life in the hands of your physician.
But what about the hands of your physician’s builder?
In Lawrence and a handful of other area cities, that may be particularly true.
After allegations that an improperly installed medical gas system was to blame for a March 30 Lawrence dental office accident that left a Tonganoxie teen seriously injured, the Journal-World conducted a review of how other area cities inspect medical gas systems.
The review found that several cities do significantly more than Lawrence to ensure that the medical gas systems, which deliver oxygen and nitrous oxide, are properly tested before they can be used on patients. But the review also found that Lawrence is not alone in having a policy that essentially places all the burden of ensuring the safety of the system on private builders.
That finding was a surprise to the state’s chief dental regulator.
“I had no idea,” said Betty Wright, executive director of the Kansas Dental Board. “What happened to that young man is a nightmare scenario. I think this is the kind of thing that will cause people to ask whether we need to legislate some sort of final check for these systems.
“We’ll certainly be asking those questions.”
No verification
On March 30, Tonganoxie High School senior Austin Stone went to the dental office operated by Dr. S. Kirk Vincent at 4811 Bob Billings Parkway to have his wisdom teeth removed. After being sedated with medical gas, complications occurred, according to a Web site created by Stone’s family. Stone was taken to Lawrence Memorial Hospital after he stopped breathing, and later was taken to Kansas University Hospital.
Family members have been guarded in discussing the condition of Stone, and further medical updates have not been made available.
Lawrence building inspection leaders last week confirmed that they have no record of whether a required third-party inspection of the medical gas system was ever conducted at the dental surgery center. The International Plumbing Code adopted by the city requires a certified inspector — often a privately owned inspection company — to test the medical gas system.
But the city’s director of planning and development services said he believes the law does not require the city to ensure that the test actually has been done.
Instead, that responsibility is left solely in the hands of private builders and contractors.
“Events like this highlight the importance of contractors knowing and understanding the code and fulfilling its own requirements,” said Scott McCullough, the city’s director of planning and development services.
An attorney for Lawrence-based Action Plumbing — which is listed on the building permit as the company that installed the system — said he did not know whether a third-party inspection had been done on the medical gas system. A representative for the general contractor — Lawrence-based Design Build Collaborative — declined to comment.
Vincent has said he did not receive a certificate of inspection from the contractors, and he was unaware that he was supposed to receive a certificate showing the system had been tested.
Wright said she believes many other dentists likely aren’t aware of how the system works, either.
“This is the kind of thing that when they go to dental school, I don’t believe they learn about this,” Wright said.
A paper trail
Of the five other cities checked by the Journal-World — Manhattan, Olathe, Overland Park, Shawnee and Topeka — Olathe was the only other city that followed the same policy as Lawrence.
Herb Warren, chief building official for Olathe, said his city expects contractors to ensure that the proper medical gas system tests are done.
But Warren said hearing of the incident in Lawrence has caused him to consider requiring that contractors provide written verification that the test has been completed.
“This certainly raises a caution flag,” Warren said. “When you hear of a horrific instance like this, you ask yourself whether there is something more that can be done. We’ll certainly review our current policy.”
McCullough said Lawrence also will review its policy.
“I agree that it is a good practice, even if the code doesn’t require it,” McCullough said. “I think that is where we are headed with any type of code amendment.”
The other cities contacted by the Journal-World all currently have a system in place for verifying that the testing has been done. Although the systems vary, the end result is that a city building inspector is responsible for making sure that a document is in the project’s file showing that the inspection has been completed. Without verification that a medical gas inspection has been completed, the city won’t issue the final permit allowing the building to be occupied.
In Manhattan, any private inspection company that is doing a mandated inspection is required to send a copy of the inspection report to the city’s building inspections department.
“When we get to that final end stage, we want documentation that either our inspector or the right private inspector has inspected everything that needs to be inspected,” said Brad Claussen, the chief building inspector for the city of Manhattan.
Broader issue
Building inspection officials in other cities stopped short of saying whether they agreed with Lawrence’s contention that the city is not legally obligated to verify whether the inspections took place.
But there was general agreement that receiving documentation to verify the inspections took place is a recognized best practice in the industry.
“Following up with a paper trail is about the only way that you can safeguard that it has been completed,” said Tina Rakes, who is the code administrator for Baldwin City and is the past president of the Heart of America Chapter of the International Codes Council.
Building inspectors also stressed that medical gas installations aren’t the only instances where private inspection companies are required to do inspections. Installations of elevators, certain types of welded joints, and specialty types of concrete work are other examples of when private inspectors are called upon to ensure the quality of work.
McCullough said the city’s policy varies on whether all of those inspections are verified by city building inspectors. He said the code specifically calls for the city to receive copies of some reports. In those cases, the city has a system in place for ensuring those reports are received before a building is allowed to be occupied. But in other cases — like the medical gas instance — the code does not specifically state the city is to be provided a copy of the inspection report.
“I agree that requiring submission of inspection is a moderately simple thing to do to ensure that the inspection has been performed,” McCullough said. “The other side of that is that we would have to comb through literally thousands of pages of code to make sure we have received every inspection that the code requires.
“And maybe that is what we need to do, but I also think it is appropriate to remember that contractors are required to meet the code. We spot check them to make sure they meet the code.”
Comments
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458casul (anonymous) says…
thats not the only office that got done by a plumber without a licence
sheila56 (anonymous) says…
Dr. Vincent is a great dentist who is very professional and caring. He extracted my son's wisdom teeth without any incident. Whatever happened with the gas was a result of an installation issue and the person(s)/company responsible for the faulty installation should step forward and accept responsibility.
cj123 (anonymous) says…
i am sure both companies are stressing right now! i am sure it was an accident.
jafs (anonymous) says…
An accident is one description.
Negligence is another one.
Of course, they didn't mean for someone to get injured, but that doesn't erase their responsibility here.
jafs (anonymous) says…
And, sheila, I wouldn't hold my breath waiting for that to happen.
I'll bet that the GC and Action Plumbing will point the finger at each other and lawyer up.
pm59e (anonymous) says…
The doctor has to go to 4 years of additional training to become an Oral and maxillofacial Surgeon and is licensed thru this organization. These doctors receive advanced training and continuing education in the administration of anesthesia, and should be educated in the laws and codes of the actually connection, maintenance and permits for the equipment/gases that they have advanced training in. The Medical Gas equipment and tanks were connected and hooked up by whom? Did the Doctor hire a Medical Gas Equipment Supplier to advise him on the requirements NPFA 99 which states that Medical Gas equipment has to not only be installed by a 3rd party installer, but serviced by a qualified person. He had an existing practice, was this equipment not maintained by a qualified person or tested annually? When tanks were changed or filled at his existing facility, was the system tested at that time and in compliance with the standards of NFPA 99 as required on existing facilities?
Did the doctor hire the General Contractor to provide Medical Gas equipment and testing as part of the project scope or was the doctor’s Medical Gas equipment supplier/contractor going to perform this work for the owner directly, which is typical, similar to the owner of a restaurant hiring a food service equipment supplier and contacting the Health department prior to opening the doors for inspection.
NPFA clearly states that Administrative authorities of health care organizations shall provide policies and procedures for safe practices which includes maintenance programs per manufacturer’s recommendations, use and transport of equipment, proper marking of the cylinders, and testing required successfully prior to the use of any medical gas piping system for patient care.
Typically the General contractor turns over building/facility after the Authority having Jurisdiction provides occupancy to the owner of the building. At that time, the Doctor would have moved in his equipment, furniture and Medical Gas cylinders and equipment. The Medical Gas Equipment supplier/contractor hired by the owner should have provided and tested the Medical Gas Equipment connection to the piping provided by the plumbing contractor once all of the owner’s equipment was moved in and installed. The testing contractor should have then provided a testing certificate to the doctor. This information is all under the Gas Equipment in NFPA which would have been provided by the doctor/ Medical Gas equipment supplier, not the plumbing contractor or GC.
pm59e (anonymous) says…
The process does need to change, the doctor’s are the specialist in this field, and they should know that testing and installation of the equipment was required by the proper testing authority. A doctor’s office being given occupancy on a building by the City and/or GC is for the purpose of moving in the equipment, furniture and personal for training, not a go ahead and start practicing medicine/surgery. How would the city or the GC know if a doctor or other specialist is licensed, has the continuing education required, current board certification or the credentials required to see patients in this practice? This is the responsibility of the Doctor, not the City or GC. The Medical Licensing board should have requirements not only on the doctors, but also on their facilities.
Proper installation of the medical gas equipment is one of the issues; Testing of the equipment is the other issue that would have changed this outcome. NFPA required a 3rd parting testing agency, which if hired by the GC would make it a conflict of interest, which is why the owner typically hires the testing agency along with the medical gas equipment supplier.
A lot of good people including the doctor, the city, the GC and the Plumbing contractor are involved in this along with the family. This is a terrible accident that I am sure no one wanted to see happen. Everyone should be Praying for the young man to make a full recovery, for the family and everyone involved to get thru this remarkably hard time.
hg123 (anonymous) says…
I am writing to defend Dr. Vincent in this terrible tragedy. When Dr. Vincent hired a contractor to build his new office, he relied on the expertise and knowledge of that professional and that of the subcontractors to build it properly and abide by all codes. It was not Dr. Vincent's responsibility to inspect the plumbing lines; he is not trained to do so and he hired a professional to make sure it was properly done. When you have a house built, do you personally inspect all electrical wiring and connections, or do you trust the electricians to do the job correctly? After all, this is a critical and important phase of construction: if the wiring is done improperly it could jeopardize your family's lives and that of your property. This is why professions exist; they have the skills, knowledge, and experience that others don't so that they may accomplish the jobs for which they were hired.
It is easy to point fingers in situations like this, and obviously with 20-20 hindsight much should have happened in the construction and inspection process that either weren't required or simply not done. Hopefully, this will be a catalyst for change in the municipal codes so it will not happen again. Why the appropriate codes and requirements were not already in place in a progressive city like Lawrence is baffling to me, and they should have to answer to it.
cletus26 (anonymous) says…
i hope the problem gets solved
snap_pop_no_crackle (anonymous) says…
Relax and have a popsicle, bronze. It's a cool and fruity treat on a spring day.