Caleb Sears’ grandmother, Ann Bentley, was sitting at the front of a Capitol committee room, making sure legislators could see the framed photograph she held of the smiling boy, frozen in black and white, at age 6.
Caleb’s aunt and uncle, Annie and Sebastian Kaplan, were there, too. Caleb’s father, Tim Sears, would come to testify the following day. His mother, Eliza Sears, stayed behind at their East Bay home, caring for the infant daughter who would never come to know her brother.
“It has been education in how democracy works,” Annie Kaplan said.
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The family learned tragedy on March 13, 2015, when Michael Doucet, an oral surgeon, prepared to pull one of Caleb’s teeth that was coming in wrong. As was his practice and that of other oral surgeons, Doucet anesthetized Caleb with heavy drugs: propofol, ketamine, fentanyl, nitrous oxide, lidocaine, midazolam. It went terribly wrong.
The little boy stopped breathing before the surgery began. Doucet tried to insert a breathing tube down young Caleb’s throat. He failed. He called for the crash cart, but it lacked vital items. His assistants couldn’t find a particular drug that should have been within easy reach to ease intubation.
One of Doucet’s assistants called 911, too late. By the time the ambulance arrived, Caleb had no pulse. His body lived on for two days, but his brain had died.
Aunt Annie Kaplan, a physician who lives eight blocks from the Searses, set out to discover what went wrong. Educating herself about oral surgery, she was appalled that oral surgeons commonly operate and administer anesthesia, and that the law permitted the practice. Having been trained as a general surgeon, she would never attempt to do both. No physician would.
And so she came to Sacramento to get the law changed. Her idea was simple: Oral surgeons should perform surgery, and anesthesiologists should administer anesthesia. Surgeons should not do double duty. Nationally recognized experts have endorsed the concept, as has the California Dental Board. But no issue is black and white in Sacramento.
Oral surgeons, backed by dentists, argue that if they must hire anesthesiologists, or specially trained nurses, patients will be priced out of dental care. They say there aren’t enough anesthesiologists available to do such work. And oral surgeons in California adhere to widely accepted practice, they say.
Then there is the matter of the dentists’ clout. In the early 2000s, leaders of the California Dental Association set out to turn the organization into a player. Following the path of other organizations, they increased the levy on members for political action from $65 to $75 to $125 and now to $150 a year. Multiplied by roughly 20,000 members, that’s $3 million.
In the 2002 election, the California Dental Association spent more than any other single group in California, $1.5 million. In 2004, the dentists made the largest single independent expenditure, $408,000, to elect one of their own. They since used their money to help elect an oral surgeon and a dentist.
They spent almost $2.5 million on California campaigns in the 2015-16 cycle, and $1.3 million on lobbying. Oral surgeons, who contribute to the dentists’ PAC, chipped in another $105,000 on lobbying.
“That is the way politics works in Sacramento,” George Maranon, an Encino oral surgeon, told me. “It is really just an avenue to provide access.”
They clearly have gotten an audience.
On Tuesday, Maranon testified before the Senate Business and Professions Committee in favor of legislation by Sen. Steve Glazer, D-Orinda, to require further study to determine the wisdom of having anesthesiologists present when oral surgeons operate on young children. Oral surgeons are sponsoring the bill; the committee approved it.
Caleb’s aunt, grandmother and uncle testified against it, as did Dr. Paula Whiteman, a pediatrician who was representing the American Academy of Pediatrics, California, which has made the Sears’ family issue a top legislative priority.
The following day, Assemblyman Tony Thurmond, D-Richmond, appeared before the Assembly Business and Professions Committee to argue for his bill, which would require that oral surgeons have anesthesiologists or nurses trained in anesthesia present during surgery on young children. Caleb’s family and the pediatricians backed it, as did anesthesiologists.
“This seems like such an obvious thing. How can anybody be against it?” Tim Sears, Caleb’s father, said the other day. “But it has been a hard push. There is a lot of money involved.”
For a time, it appeared that the bill would pass. But as the hearing was ending, the chairman, Assemblyman Evan Low, D-Campbell, imposed an amendment that was just what the oral surgeons ordered. Essentially, it would allow them to conduct business as usual. The committee approved it, over Thurmond’s protest.
“We were so shocked,” Annie Kaplan said of Low’s manhandling of Thurmond’s bill.
She and the rest of Caleb’s family will keep coming back to Sacramento. “I’ve learned that money counts. But I also learned that if you keep coming and tell your story over and over again really loudly, that also counts in some way.”
Earlier this year, the California Dental Board disciplined Doucet, Caleb’s oral surgeon, adopting an administrative law judge’s recommendation that he serve five years probation, and forfeit his permit to administer anesthesia. Doucet is OK with that.
“Respondent no longer wishes to administer conscious sedation or general anesthesia to his patients,” the judge wrote. “He hires a dental anesthesiologist for surgeries that require conscious sedation or anesthesia.” Which is the point Caleb’s family has been trying to make, in the hope of saving someone else’s child.