Report of the California Board of Dental Examiners:

State of California vs. Tony Protopoppas

Editor's Note: about December 31, 1980, respondent was issued
The following statement is a verbatim report by the General Anesthesia Permit No. G-473.
Board of Dental Examiners of the State of California. 3. Business and Professions Code section 1670*
It is reprinted here in its entirety because of the wide- provides, in pertinent part, that the board may dis-
spread interest by the lay press and radio-television cipline any of its licenses for unprofessional conduct,
coverage the accused dentist received. Allegations and incompetence, gross negligence, repeated acts of
misstatements by the medial create erroneous impres- negligence in his profession, or for any other cause
sions about the practice of anesthesiology by dentists. applicable to the licentiate provided in the Dental
This document provides factual information concern- Practice Act (section 1600 et. seq.).
ing the 3 incidents that led the State Board to revoke 4. Section 1680(p) provides that unprofessional
the dental certificate and the general anesthesia per- conduct includes clearly excessive administering of
mit previously issued to this dentist. Further legal drugs or treatment as determined by the customary
action is proceeding. practice and standards of the dental profession.
JOHN K. VAN DE KAMP, Attorney General of the 5. Section 725 provides, in pertinent part, that
State of California repeated acts of clearly excessive administering of
ALAN A. MANGELS drugs or treatment as determined by the standard of
WILLIAM L. MARCUS the local community of licensees is unprofessional
Deputy Attorneys General conduct for a dentist.
3580 Wilshire Boulevard 6. Respondent is subject to disciplinary action
Los Angeles, California 90010 pursuant to sections 1670, 1680(p), and 725 as follows:
Telephone: (213) 736-2026
736-2074 KIM ANDREASSEN
Attorneys for Complainant A. On or about September 30, 1982, respondent
placed Andreassen, then 23 years old, under general
BEFORE THE anesthesia for the purpose of filling three teeth and
BOARD OF DENTAL EXAMINERS performing a root canal.
DEPARTMENT OF CONSUMER AFFAIRS B. Andreassen suffered from chronic renal failure
STATE OF CALIFORNIA secondary to systemic lupus erythematosis and had
In the Matter of the Accusation Against: been undergoing hemodialysis three times per week
TONY PROTOPAPPAS, D. D. S. since 1974. Andreassen also has a seizure disorder,
534 West 19th Street hypertension, anemia and multiple problems with
Costa Mesa, California vascular access infections.
Dental Certificate No. DT 22270 C. Respondent knew, before he treated her, that
General Anesthesia Permit Andreassen had heart trouble, high blood pressure,
No. G-473, Respondent. kidney disease and underwent chronic dialysis.
NO. AGN 1982-14. D. Respondent administered or provided the
following drugs to Andreassen:
ACCUSATION 1. 100 mg. of Demerol and 100 mg. of Nembutal
and .4 mg. Atropine as oral premedication.
Complainant alleges that: 2. Intravenously, as part of general anesthesia,
1. He is Rodney M. Stine, Executive Secretary of 2 cc atropine (.4 mg/cc), 2 cc Valium (5 mg/cc),
the Board of Dental Examiners of the State of Cal- 2 cc Innovar, 2 cc Sublimaze, 1 cc Demerol (50
ifornia (hereinafter "the Board") and makes and files mg/cc) and 2 cc Benadryl (50 mg/cc).
this accusation solely in his official capacity. 3. 7 carpules of Xylocaine, 1:50,000 epinephrine,
2. On or about June 29, 1971, Tony Protopappas as a local anesthetic.
D.D.S. (hereinafter "respondent") was issued Cer- 4. 6 cc Narcan.
tificate No. DT-22270 to practice dentistry. On or 5. For arrhythmia, 10 carpules of Lidocaine,
1:50,000 epinephrine.
*Hereinafter all statutory references are to the Business and E. While respondent worked on Andreassen's
Professions Code. teeth or within 15 minutes after, while Andreassen
96 ANESTHESIA PROGRESS
was still in respondent's treatment room, Andreassen
suffered cardiac arrest and shortly thereafter died.
F. Respondent was grossly negligent and incom-
petent in his treatment of Andreassen, as follows:
1. In placing Andreassen under general anesthesia
against the advice of her treating physician and
with knowledge of Andreassen's medical con-
dition and despite his own belief Andreassen
might well die in respondent's dental chair.
2. In administering, in combination, the De-
merol, Nembutal, Valium, Innovar, Subli-
maze, Benadryl and Xylocaine as described
hereinabove and in further administering the 7
carpules of Xylocaine, 1:50,000 epinephrine as
described above.
3. In failing to monitoring Andreassen with an
electrocardiograph or other monitoring and
emergency equipment.
4. In administering Lidocaine with epinephrine to
Andreassen for arrhythmia, where only Lido-
caine without epinephrine is indicated.
5. In failing to take or record vital signs before,
during or after treatment of Andreassen.
6. In failing to use or have on hand positive pres-
sure oxygen equipment or other emergency
equipment.
7. In failing to contact paramedics for approxi-
mately 20 minutes after Andreassen suffered a
cardiac arrest.
PATRICIA CRAVEN
G. On or about February 8, 1983, respondent
placed Craven, 13 years old, in good health, under
general anesthesia for the purpose of filling 10 teeth,
preparing 3 crowns and having 4 wisdom teeth pulled.
H. Respondent administered the following drugs
to Craven:
1. Intravenously, in lactated ringer's solution,
1 cc atropine, 2 cc Valium, 3 cc Innovar, 2 cc
Sublimaze, 2¼/4 cc Demerol, 14 cc Nembutal,
52 cc Brevital and 18 cc Benadryl.
2. 40 carpules of Xylocaine (1440 mg.), 1:50,000
epinephrine, as a local anesthetic.
3. 4 cc Decadron, orally, and 4 cc Narcan,
intravenously.
I. Craven was under general anesthesia from ap-
proximately 10:30 a.m. to 5 p.m. While under treat-
ment by respondent or shortly after respondent re-
moved Craven's wisdom teeth, Craven suffered
respiratory and or cardiac distress. Craven was re-
leased to her mother at about 6:30 p.m. in an un-
conscious, unresponsive state and was taken home.
Craven thereafter went into full cardiac arrest at or
before 7:15 p.m. on February 8, 1983, was revived,
and placed on life support system but died on
February 19, 1983.
J. Respondent was grossly negligent and incom-
petent in his treatment of Craven as follows:
1. In administering 40 carpules of 2% Xvlocaine,
1:50,000 epinephrine.
MAY/JUNE 1983
2. In administering, in combination, the Valium,
Innovar, Sublimaze, Demerol, Nembutal,
Brevital, and Xylocaine, as described
hereinabove.
3. In releasing Craven in an unconscious and un-
responsive state.
4. In failing to take or record vital signs before,
during or after the treatment of Craven.
5. In failing to observe or monitor Craven
between at least 10:30 a.m. and 4 p.m.
6. In leaving Craven under general anesthesia
without personnel properly trained to moni-
tor her condition.
7. In refusing to come into the treatment room
and/or to advise the dentist filling Craven's teeth
what to do when Craven began waking, and
screaming, during treatment.
8. In failing to have or use positive pressure oxygen
equipment or other emergency equipment when
Craven suffered cardiac and/or respiratory
distress.
9. In using Brevital for a procedure substantially
in excess of 1 hour.
CATHYRIN JONES
K. On or about February 11, 1983, respondent
treated Cathyrn Jones, 31 years old, and in good
health, for extraction of all her teeth. Respondent
actually removed 10 teeth before the procedure was
halted.
L. Respondent administered the following med-
ications to Jones:
1. Intravenously, 1 cc atropine, 2 cc Valium, 2 cc
Innovar, 2 cc Sublimaze, 4 cc Demerol, 14 cc
Benadryl and 38 cc Brevital.
2. 36 carpules of 2% Xylocaine, 1:50,000 epineph-
rine as local anesthesia.
3. 4 cc Narcan.
M. Respondent placed Jones under general anes-
thesia at approximately 11 a.m. At approximately
12:30, while under treatment, Jones suffered full car-
diac arrest. Jones was transported to a hospital by
paramedics and died on February 13, 1983.
N. Respondent was grossly negligent and incom-
petent in his treatment of Jones, as follows:
1. In administering 36 carpules or 1296 mg. of 2%
Xylocaine, 1:50,000 epinephrine.
2. In administering the equivalent of 350 mg. of
Demerol in approximately 1/2 hours.
3. In administering, in combination, the Valium,
Innovar, Sublimaze, Demerol, Benadryl, Brev-
ital and Xylocaine, as described hereinabove.
4. In failing to contact paramedics for approxi-
mately 15 to 20 minutes after Jones suffered a
cardiac arrest.
5. In failing to take or record vital signs before
or during the treatment of Jones.
6. In failing to have or use positive pressure oxygen
equipment or other emergency equipment when
Jones suffered a cardiac arrest.
97
 IN GENERAL
0. Respondent administration of drugs as de-
scribed hereinabove constituted, as to each patient,
clearly excessive treatment and administration of
drugs according to Southern California community
standards for the administration of general and local
anesthesia by dentists and, as to all three patients
together, constituted repeated acts of clearly exces-
sive treatment and administration of drugs according
to said Southern California communitv standards.
P. Respondent's conduct as described herein-
above constituted negligent acts as to each patient
and repeated negligent acts as to all three patients
together.
Q. Respondent's conduct as described herein-
above was the direct cause or a substantial factor in
the deaths of Andreassen, Craven and Jones.
7. Respondent is further subject to disciplinary
action pursuant to section 1670 as follows:
A. Complainant incorporates paragraph 6 by ref-
erence herein as though fully set forth at this point.
B. Respondent failed to record blood pressure
or pulse or full and accurate descriptions of drugs
and amounts administered or the length of the pro-
cedure or to accurately record the complications of
anesthesia, as to Andreassen, Craven or Jones.
C. Respondent's conduct as described herein-
above constituted unprofessional conduct.
8. Section 1680(s) provides unprofessional con-
duct includes the alteration of patients records with
intent to deceive.
9. Respondent is further subject to disciplinary
action pursuant to section 1680(s) as follows:
A. Complainant incorporates paragraph 6G
through 6J by reference herein as though fullv set
forth at this point.
B. Respondent falsely caused to be recorded on
Craven's records with intent to deceive that she had
only slight difficulty when released, was in good con-
dition, responsive to external body stimulation and
SCIENTIA OMNEM
DOLOOtEM VINCIT
98
to her name and chose to be wheeled out to her
mother's car instead of walking, when, as respondent
well knew, Craven was unconscious and unrespon-
sive to verbal or physical stimulation.
10. Section 1680(u) provides unprofessional
conduct includes the abandonment of a patient bv a
licentiate before completion of a phase of treatment,
as such phase of treatment is defined by the custom-
ary practice and standards of the dental profession.
11. Respondent is further subject to disciplinary
action pursuant to section 1680(u), as follows:
A. Complainant incorporates paragraph 6G
through 6J, inclusive, by reference herein as though
fully set forth at this point.
B. Respondent released Craven in an uncon-
scious and unresponsive state to a non-professional
while Craven was still under the effects of general
and local anesthesia where customary practice would
be to retain the patient through recovery or arrange
transport to a hospital by paramedics.
WHEREFORE, complainant prays a hearing be
held on the matters alleged herein and, following
said hearing, the board issue a decision:
1. Revoking Dental Certificate No. DT 22270
heretofore issued to Tonv Protopappas, D. D. S.;
2. Revoking General Anesthesia Permit G-473
heretofore issued to Tony Protopappas, D.D.S.;
and
3. Taking such other and further action as the
Board may deem proper.
Dated: March 25, 1983.
Rodney Stein
Alan A. Mangels per direction
RODNEY STINE
Executive Secretarv
Board of Dental Examiners
Department of Consumer Affairs
State of California
Complaint
ANESTHESIA PROGRESS