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A 2-year-old in Arizona died after getting what was allegedly a medically unnecessary dental procedure. Now his parents are suing.

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Zion Gastelum had been seen by the dentists at Kool Smiles only twice before they said that the 2-year-old needed multiple pulpotomies (baby root canals). The procedure, meant only for cases in which the nerve has been damaged, requires general anesthesia. Although it seemed drastic, Zion’s parents trusted that Kool Smiles — a privately held dental company operating in more than a dozen states — had his best interests in mind.

His mom, Veronica Gastelum, took him to get the procedure done.

According to a wrongful death lawsuit filed by Zion’s parents, Victoria was the first to notice something amiss. The complaint details how she arrived at the procedure room and found Zion hooked up to a heart rate monitor that was showing no pulse — which the staff reportedly shrugged off as a faulty machine. After noticing that his chest wasn’t rising, Veronica suggested that he wasn’t breathing. It wasn’t until then, she said, that nurses sprang into action and 911 was called.

Zion was rushed to an emergency room where he was pronounced dead shortly after arriving. His official cause of death was severe hypoxic-ischemic encephalopathy, or a lack of oxygen to the brain. According to the lawsuit, before his mother was sent in to see him at Kool Smiles, doctors had returned the toddler to a room — still unconscious — and left him alone, where he was hooked up to an oxygen tank that was either faulty or empty. Unable to breathe on his own, Zion likely died soon thereafter.

The Gastelums claim that their son’s death was the result of “gross medical negligence.” But although on the surface it may seem like a singular tragedy, earlier legal documents suggest earlier trouble. In January 2018, Kool Smiles, which specifically caters to low-income families, agreed to pay nearly $24 million to settle a false claims lawsuit brought by the U.S. Justice Department.

In the complaint, the Justice Department alleges that Kool Smiles “knowingly submitted false claims” to Medicaid for “medically unnecessary pulpotomies,” among other procedures. It goes on to claim that the company bribed doctors not only to perform many of these procedures, but also to do so quickly. “The United States alleges that Kool Smiles clinics routinely pressured and incentivized dentists to meet production goals through a system that disciplined ‘unproductive’ dentists and awarded ‘productive’ dentists with substantial cash bonuses based on the revenue generated by the procedures they performed,” it said.

The Gastelums’ lawsuit quotes U.S. Attorney John H. Durham for the District of Connecticut, who touched on the cruelty of Kool Smiles’s alleged tactics in the Justice Department complaint. “The allegations in these cases are particularly egregious because they involved medically unnecessary dental services performed on children,” said Durham. “Exploiting needy children for financial gain is inexcusable.”

In the lawsuit, the Gastelums’ attorneys write that there were “far less expensive” and “safer” methods to treat Zion’s cavities — including $25 silver diamine fluoride. But because they chose to put Zion at risk, his family is now fighting to make sure it doesn’t happen again. [The Gastelums] bring this action not only to hold Kool Smiles and its affiliates accountable … but also to prevent this type of senseless tragedy from ever happening to another family because of Kool Smiles’ abhorrent and chronic misconduct,” the lawsuit said. “No more children should die in order to prevent such reckless and greedy corruption.”

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