This text was produced for ProPublica’s Native Reporting Community in partnership with The Salt Lake Tribune. Join Dispatches to get our tales in your inbox each week.
Reporting Highlights
- Warnings Ignored: Utah’s dentistry board urged the state to revoke Nicholas LaFeber’s license after stories of failed root canals and poor dental work. As a substitute, regulators reinstated it.
- New Hurt Alleged: Since LaFeber’s license was reinstated, two sufferers have stated routine fillings left them in extended ache they usually wanted to have the work redone by different dentists.
- Choosing Lighter Self-discipline: Regulators say they like probation and rehabilitation over license revocation as a result of it “ends a profession.” A former board member stated the general public “was not well-served.”
These highlights have been written by the reporters and editors who labored on this story.
The sufferers stored coming to the Utah oral surgeon’s workplace — one after one other, yr after yr — with dental work that the surgeon stated had gone mistaken. He later recounted in a letter to state licensors that he had seen dental implants that had been the mistaken measurement, sufferers with persistent sinus infections and one individual whose implant had turn out to be misplaced inside their sinus cavity. These sufferers, he stated, had all been labored on by the identical dentist: Dr. Nicholas LaFeber.
The surgeon, a 30-year veteran, wrote the letter in November 2022 after Utah’s licensing division requested for his opinion of labor performed by LaFeber, whose license was on probation after the company decided he had supplied substandard care to greater than a dozen sufferers. His warning was blunt: He believed LaFeber wouldn’t enhance as a dentist and shouldn’t be performing dental implant procedures. He had seen LaFeber make the identical errors in sufferers for years, he wrote, inflicting “extreme” and generally life-changing problems.
“I imagine that he’s not competent to put implants,” the oral surgeon, Dr. Creed Haymond, concluded. “I give this opinion with soberness and disappointment, however I really feel I’ve an obligation to assist the board in defending the general public from what seems to be an incompetent practitioner.”
His evaluation of LaFeber’s abilities in restorative dentistry was additionally talked about in a February 2023 order concerning company motion on LaFeber’s license. Haymond didn’t reply to interview requests.
This was the second letter that Utah’s Division of Skilled Licensing had acquired recommending that LaFeber be stopped or restricted from training after greater than a decade of dentistry in Utah, in keeping with information obtained by The Salt Lake Tribune and ProPublica. The company licenses Utah dentists and different professionals and investigates allegations of misconduct.
Two years prior, one other dentist who had thought-about shopping for certainly one of LaFeber’s practices really helpful LaFeber’s license be revoked after wanting via affected person recordsdata: “As I began going via charts, in addition to seeing the earlier work, I started to understand how poor he handled these people,” wrote Dr. Brandon McKee. “Sufferers with failed implants are placed on antibiotics and instructed to attend whereas the implant is continuous to heal. A few of these are for 9 months.”
This letter was mentioned in a September 2020 public dentistry board assembly. McKee didn’t reply to interview requests.
The licensing division’s dentistry board — whose members are largely dentists and hygienists — really helpful to Utah licensing director Mark Steinagel in December 2022 that LaFeber’s license be revoked after reviewing further proof suggesting his abilities had not improved.
However regardless of this suggestion and the letters of warning from his colleagues, Steinagel reinstated LaFeber’s license in Might 2023 after the dentist accomplished three years of probation, which included taking remedial lessons.
Credit score:
Rick Egan/The Salt Lake Tribune
Since LaFeber’s license was reinstated, new sufferers say they’ve been harm. The Tribune and ProPublica spoke with two sufferers who say they noticed the dentist inside the final yr for what they believed can be routine cavity fillings. As a substitute, they are saying they left in ache that grew to become extended and in the end required the procedures to be redone by different dentists. Neither knew after they sought dental care that LaFeber had almost misplaced his license after regulators decided his work fell beneath the usual of care.
“I had by no means had this performed earlier than, so I didn’t know what’s regular,” stated one affected person, Michelle Lipsey. “I used to be similar to, ‘He’s an grownup, male dentist. He in all probability is aware of what he’s doing.’”
Lipsey filed a criticism in opposition to LaFeber with licensors in July detailing her expertise, however the company closed the case a month later and took no disciplinary motion.
LaFeber stated he wouldn’t focus on particular person sufferers as a result of they didn’t grant him permission to take action. He instructed The Tribune and ProPublica that he has at all times tried to maintain his sufferers’ greatest pursuits in thoughts. “I had a couple of outcomes from dental work that had problems and wanted additional therapy,” he wrote in an electronic mail in response to questions.
“I assume each dentist encounters some share of destructive affected person outcomes and I’ve no cause to imagine that my follow had the next share than others.”
Melanie Corridor, a spokesperson for Steinagel and the Division of Skilled Licensing, stated in response to questions that the division solely revokes somebody’s license when their conduct has been “particularly egregious” as a result of doing so “ends a profession.”
The company’s high precedence, she stated, is protecting Utahns secure — however she added that it additionally needs to make sure that licensees have an opportunity at “skilled rehabilitation” and, when acceptable, can proceed to work and earn cash.
The state has revoked two dental licenses since June 2015, in keeping with a Tribune and ProPublica examination of a decade’s value of publicly accessible licensing division information.
Corridor stated that LaFeber’s license was reinstated regardless of the dental board’s suggestion as a result of the dentist had completed the remedial programs that the board required him to take and his probationary interval was ending. She famous that no different sufferers filed a criticism throughout that three-year interval and that the dental board’s position was to solely make suggestions to Steinagel and his workers.
That call bothered a few of those that served on the dental board throughout that point. Two former board members instructed The Tribune and ProPublica that they have been annoyed state licensing division leaders didn’t take heed to them and that they felt LaFeber mustn’t follow dentistry given his report. Each spoke on the situation of anonymity due to potential skilled repercussions.
“You hate to take any individual’s livelihood away from them after they’ve gone via years of dental college and had a follow,” one of many former board members stated. “However the board’s job is to guard the general public.”
In LaFeber’s case, the previous board member stated, “the general public was not well-served.”
LaFeber, with out understanding the identities of the board members, steered that some might need been biased in opposition to him.
“Each One in all These Circumstances Was Alarming”
LaFeber stated in public dentistry board conferences that he got here to the eye of the licensing division in late 2019 after certainly one of his former staff filed a criticism. He stated the worker, who he stated he had beforehand fired, directed licensors to greater than a dozen instances wherein he admitted throughout a board assembly that he had supplied “poor affected person care.”
State licensing officers might have suspended or revoked LaFeber’s license, however as a substitute, in early 2020, they struck an settlement with LaFeber — a typical consequence in license self-discipline instances. In line with the settlement, investigators discovered that a number of the sufferers in these instances had had root canals that resulted in infections or wanted to be redone. Licensors additionally decided that LaFeber had improperly positioned everlasting alternative tooth in different sufferers, together with one whose implant prolonged into the sinus cavity, the doc stated.
LaFeber agreed to spend three years on skilled probation, throughout which he can be beneath the supervision of one other dentist whose time he was required to pay for. He was nonetheless allowed to carry out dental work throughout that interval, in keeping with the stipulation, however agreed to not do implant procedures or root canals.
He was not required to inform his present or future sufferers about this self-discipline. Like most different states, Utah has no regulation requiring affected person disclosure when a licensed skilled is disciplined, and a evaluate of greater than 3,200 filings from the licensing division’s web site reveals the state has hardly ever required disclosure of unprofessional conduct to sufferers.
The Utah regulators who self-discipline licensed professionals act solely when somebody recordsdata a criticism, like what occurred in LaFeber’s case. “We don’t have manpower or staffing for proactive investigations,” Larry Marx, the state’s well being care licensing bureau supervisor, defined to the dental board in a 2020 public assembly.
As soon as LaFeber was on probation, oversight of his progress moved to the dental board, an advisory group whose position it’s to interview probationers in quarterly public conferences and make suggestions to Steinagel about whether or not the professionals accomplished their probation and if they need to have their licenses reinstated.
In these interviews with the dental board, LaFeber admitted his errors. He blamed unhealthy outcomes on being burned out from proudly owning 4 dental clinics, and he stated he had performed procedures on buddies and acquaintances who really wanted extra specialised care however didn’t have the cash.
“A few of it I’ll simply admit was a poor, poor alternative on my half,” he instructed the board, in keeping with a recording of the assembly. “And I may also say for a few of them, they’re very pricey buddies of mine, that I’ve both coached their youngsters or helped them in Scouts or one thing else, single mothers, and making an attempt to assist them out.”
Credit score:
Screenshot by ProPublica
Along with the issues that the previous worker initially reported to the state licensing division, one dental board member, Dr. Ruedi Tillmann, checked out greater than a dozen different recordsdata of LaFeber’s throughout the first few months of his probation and located different instances wherein Tillmann noticed indications that sufferers had poor outcomes, in keeping with a December 2020 board assembly.
Tillmann, a dentist, stated throughout the on-line assembly that he noticed “quite a lot of instances” the place LaFeber did 4 or 5 implants on a single affected person and none of them correctly built-in into the affected person’s jawbone. “Poor margins, open margins, implant crowns not sitting on implants accurately,” he stated about affected person recordsdata he reviewed. “I’m sorry to be harsh. It’s simply that each one of those instances was alarming to me.”
Dr. Daniel Poulson, one other dentist on the board, questioned why LaFeber would do substandard work on his sufferers, together with folks he stated he knew and cared about.
“With 30 instances, what that communicates to me is you didn’t study. You simply stored doing it,” Poulson stated throughout the identical assembly. “And guilty that on being careworn or overworked — we’re all careworn. Dentistry is an extremely irritating career. However that shouldn’t, in my thoughts, make an excuse for ill-treating a affected person. Utilizing quite a lot of antibiotics to cowl infections that final years is simply out of bounds.”
LaFeber instructed the board throughout this assembly that he was assured he might enhance his dentistry by taking persevering with schooling programs and by being extra selective about sufferers and referring them extra usually to specialists as a substitute of making an attempt to do the work himself.
He additionally downsized to only one clinic, Sandy Middle Dental, a wood-trimmed workplace suite in a big, tan stucco constructing situated in a Salt Lake Metropolis suburb on the base of the Wasatch Mountains.
“They Have been So Disgusted With All of the Issues”
LaFeber met with the dental board 11 occasions throughout his probation in public conferences that have been usually performed on video calls due to the coronavirus pandemic. He was cheerful and agreeable throughout conferences, even at occasions when board members requested him pointed, vital questions on his work.
His well mannered nature was famous a number of occasions in information reviewed by The Tribune and ProPublica. For instance, McKee, the dentist who had thought-about shopping for LaFeber’s follow, wrote in his letter to the board that LaFeber got here throughout as a “humble,” “very good man” who sufferers trusted. A dentist who leads a dental examination company wrote in his abstract of an examination that LaFeber took that he was “overly nice to the intense.”
Members of the dental board remarked throughout public conferences about how “distinctive” LaFeber’s case was, they usually questioned what the precise metric can be to find out whether or not his dentistry had improved and he was secure to work with sufferers.
Utah licensors hardly ever self-discipline dentists over whether or not they’re competent to do their jobs, an evaluation by The Tribune and ProPublica discovered. A evaluate of disciplinary information from the final decade reveals dentists most frequently getting in hassle for drug or alcohol use or for overprescribing or diverting prescriptions.
Corridor, the licensing division spokesperson, stated the company doesn’t monitor what number of standard-of-care complaints it receives, however acknowledged that proving these sorts of instances tends to be tough.
“In consequence, they’re much less prone to result in disciplinary actions in comparison with instances involving drug use, illegal conduct, or training exterior one’s scope of follow,” she stated.
However stress was rising between LaFeber and the dental board: Whereas LaFeber had taken a couple of on-line, self-paced programs, board members felt he wanted extra intensive, hands-on lessons to enhance.
A breaking level between LaFeber and the board occurred close to the tip of LaFeber’s probation. On the December 2022 dental board assembly, LaFeber peppered members with questions in regards to the board’s position governing probationers and implied {that a} board member had acted improperly by soliciting complaints about him.
The board appeared equally annoyed; LaFeber nonetheless hadn’t enrolled within the hands-on programs that they had required him to take, applications that might have value as much as $50,000. LaFeber had as a substitute taken a licensure examination and failed a number of sections, in keeping with a duplicate of the examination outcomes obtained by The Tribune and ProPublica, which was additionally referenced within the 2023 company order.
LaFeber didn’t reply on the report to questions on these check outcomes.
Given the check outcomes, Poulson, who had turn out to be board chair, stated within the public assembly that he apprehensive whether or not LaFeber would be capable of follow dentistry safely by the next February, when his probation interval would finish.
“I’ve two docs that after tried to purchase your follow. They gave it again as a result of they have been so disgusted with all the issues they have been having with sufferers,” Tillmann, one of many board members, stated in that very same assembly, recalling earlier conversations he had.
Credit score:
Francisco Kjolseth/The Salt Lake Tribune
Poulson steered that the group make a movement recommending that the state licensing division both revoke or droop LaFeber’s license, saying that the motion can be “defending the general public from inferior care.” The board unanimously voted to advocate revocation.
Just a few months later, Marx issued the company order stating that LaFeber’s license needs to be suspended till he might display he might follow dentistry “with affordable ability and security.”
LaFeber, although, had yet one more probability to reply earlier than the suspension would take impact. Quickly after the company order, LaFeber enrolled in and accomplished his remedial coaching. He additionally employed an lawyer who signaled his intent to struggle the company’s motion, in keeping with public information.
In response, Marx requested that the company’s transfer to droop LaFeber’s license be dismissed, noting that LaFeber stated he had delayed complying with the dental board’s requirement that he full additional coaching due to “monetary limitations.” Then, Steinagel reinstated LaFeber’s license.
By this level, Steinagel’s company knew not solely in regards to the stories of sufferers with improper tooth implants and the failed root canals that led to LaFeber’s probation, it additionally knew the state dental board had really helpful that LaFeber’s license be revoked.
As well as, the company was conscious LaFeber had been sued 3 times for medical malpractice — together with by a affected person who alleged he had implants positioned in his sinuses, which precipitated sepsis, and one other affected person who stated in her lawsuit that, after months of painful infections, she went to a different dentist who discovered a damaged dental instrument lodged in her gums. (LaFeber instructed The Tribune and ProPublica these lawsuits have been settled by his medical malpractice insurance coverage service and there was by no means any dedication made that his therapy fell beneath the usual of care.)
LaFeber stated in response to questions that he was not conscious of any suggestion from the board to revoke his license — although in keeping with recordings and minutes of the general public dentistry board conferences, he was current when the dentistry board took its vote. The board’s revocation suggestion can also be referenced within the company order he acquired, which The Tribune and ProPublica obtained via a public information request.
The dentist stated he felt he was handled pretty by licensors and most members of the dentistry board, however added that he felt one board member didn’t disclose a battle of curiosity and had a “private vendetta” in opposition to him. LaFeber didn’t reply on the report to follow-up questions asking for additional particulars. He stated he complied with each request by licensors and its dentistry board and “even went above and past” by taking further persevering with schooling. He famous that he handed the remediation programs and associated exams that the board had requested.
“I additionally labored with a supervising dentist, at important expense, who reviewed my work and supplied mentoring for 3 years between 2020 and 2023,” LaFeber wrote.
After taking these programs, he stated, he has been capable of incorporate new expertise in his practices that has improved affected person outcomes. “Dentistry is an space that’s continually evolving with a lot new expertise,” he stated, “and I welcome all info sources that may assist me enhance my follow.”
The Tribune and ProPublica requested the 2 former board members who spoke to the information organizations whether or not their vote to advocate LaFeber’s license be revoked would have modified if that they had the chance to weigh in once more after he had accomplished his remedial coaching.
One former board member stated they didn’t suppose the coaching accomplished to fulfill the state was sufficient to beat years of poor dentistry. One other stated that nothing appears to have modified given new affected person complaints. Three board members who have been concerned in LaFeber’s case declined to remark for this story, and 4 others couldn’t be reached.
New Sufferers Say They Have been Harmed
Together with his license restored, LaFeber began to as soon as once more develop his enterprise. Public information present he nonetheless owns Sandy Middle Dental, and in July 2024 he bought a enterprise license for a second clinic about 10 miles to the west. (An internet advert this summer season indicated LaFeber was making an attempt to promote his second follow.)
LaFeber is referenced as the only dentist on web sites for each of those companies. In his response to The Tribune and ProPublica, he stated he owns and operates a single workplace, Sandy Middle Dental, the place he works 4 days every week. A Sept. 23 search of public enterprise information present he’s nonetheless listed because the registered agent and principal for each practices. LaFeber stated he helped begin the second workplace, Parkway Smile Middle, however stated it’s now “solely owned and managed by one other dentist.” The brand new proprietor couldn’t be reached for remark.
Within the almost two years since LaFeber’s full return to follow, not less than two extra sufferers have publicly complained they have been harmed beneath his care, each of whom The Tribune and ProPublica contacted after they left destructive on-line evaluations.
Michelle Lipsey had been a affected person at Sandy Middle Dental for almost eight years, however she stated in an interview that she hadn’t been to the dentist for a pair years after her second youngster was born. She stated LaFeber instructed her throughout an October 2024 appointment that she wanted 5 cavities stuffed. She returned every week later for the procedures.
For weeks after, Lipsey was in ache, and he or she returned to Sandy Middle Dental later that month, complaining that she couldn’t sleep and was solely capable of eat tender meals, in keeping with her medical information. LaFeber redid a number of the fillings, medical information present, however Lipsey stated the ache continued. She stated a second dentist instructed her that LaFeber hadn’t correctly sealed the fillings and had drilled far deeper than he wanted to.
LaFeber famous in her medical information that he tried to name and textual content Lipsey after she left a destructive evaluate on-line. “Keep in mind affected person was very nervous,” her affected person file reads. “We tried our greatest to assist calm however at no level had the appointment gone as she described within the publish.”
Haley Stafford described the same expertise earlier this yr. She stated that, primarily based on what LeFeber instructed her, she was anticipating to have two cavities stuffed throughout a March appointment; as a substitute, he put fillings in seven tooth. She recalled in an interview that his arms shook when he gave her numbing photographs. (The testing examination outcomes reviewed by The Tribune and ProPublica additionally famous LaFeber’s unsteady arms.)
“That was the primary time he really did work on me,” she stated. “And it was utterly botched.”
She’s been in near-daily ache since, she stated, and has wanted extra dental work on her affected tooth, together with two root canals. Stafford discovered a brand new dentist, however the restore work has value her hundreds of {dollars}.
Each Stafford and Lipsey stated LaFeber contacted them about refunding their cash.
LaFeber stated he doesn’t recall refunding cash to any sufferers after a criticism. He stated he couldn’t touch upon particular instances to guard affected person privateness, however stated that sensitivity and ache can occur after a therapy.
“We attempt to do all we are able to to attenuate it,” he stated. “The presence of ache doesn’t display therapy that fell beneath the usual of care.”
Lipsey filed a criticism with licensors in late July and stated she was interviewed by an investigator and shared X-rays from earlier than and after LaFeber stuffed her cavities.
Licensors despatched Lipsey an electronic mail in late August saying that they have been closing the case and that “acceptable motion was taken,” in keeping with a screenshot of the e-mail Lipsey shared with The Tribune and ProPublica. They might not inform her what that motion was, saying the investigative report was thought-about personal beneath Utah regulation. Licensing officers declined to touch upon the end result of Lipsey’s criticism.
If licensors had disciplined LaFeber, it might be thought-about a public report. The company has the choice to deal with a criticism informally by giving a verbal warning to a licensed skilled or writing a letter of concern. These measures usually usually are not disclosed to the general public.
LaFeber instructed The Tribune and ProPublica that Lipsey’s criticism was dismissed and he didn’t obtain any warnings or a letter of concern. Licensors “investigated it totally and located it to be meritless,” he stated.
LaFeber’s license stays in good standing, in keeping with the state’s licensing database in September.
Stafford hasn’t filed a criticism with the state and stated she had no concept LaFeber had almost misplaced his license till a reporter reached out to her.
How does a dentist almost “lose their license and get it again,” she requested, “and sufferers usually are not conscious of that?”
