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.”