Dentistry Uncensored with Howard Farran

How to perform dentistry faster, easier, higher in quality and lower in cost. Subscribe to the podcast: https://podcasts.apple.com/us/podcast/dentistry-uncensored-with-howard-farran/id916907356

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Howard: it's just a huge honor for me today to be podcast interviewing double  Dr. Becky Bye DDS and JD she is both a licensed attorney and a licensed dentist and practices in the area of medical malpractice law including dental malpractice law as well as other areas of personal injury law my god I feel sorry for your husband your kid when mom when mom's a lawyer a doctor a dentist the ER your husband and kid don't have a chance Becky practiced law for a large law firm and in the government before choosing to use her previous background in science and her passion for health care to attend dental school while Becky was in dental school she maintained an interest in law and continued to use her legal background for the benefit of patients during your time in dental school she was elected president of the Colorado chapter of the American Student Dental Association and was also elected to serve on the board for her student chapter of Alpha Omega after graduating dental school I'm practicing general dentistry in the Denver metropolitan area dr. Bai emerged her passion for law and the Health Sciences as a practicing attorney at Thomason Hillyard and klore dr. Byas remained active in the legal community throughout her legal career she has served on the University of Denver Stern College of Law Alumni council the Denver Bar Association docket committee and previously chaired the Colorado Bar Association young lawyers division she's a member and president of the Judge William e Doyle in of court in 2011 was elected as one of two lawyers in the country to work with barristers in the United Kingdom for the in of Courts prestigious Pegasus scholarship program Becky by received her Bachelor of Arts degree with high distinction in liberal arts core curriculum from Colgate University with a double major in chemistry and religion that means you are very cerebral she received her law degree from the University of Denver's Thom and her doctor' dental surgery from the University of Colorado School of Dental Medicine where my teacher Nancy Kassebaum is now the Dean and she was my radiology instructor when I was in dental school in the 80s dr. Biden met her husband through their mutual involvement in the legal community she is a proud mom of a young son and two cats in her free time she enjoys traveling the world watching British costume dramas and anything that involves her undergraduate alma mater Colgate University please just note I'm not giving legal advice and this is not establish any sir sort of attorney-client relationship with your listeners or people who contact me I'm just talking about the law in general and if they have any specific questions related areas she advised them to seek counsel Becky thank you so much for coming on this show there's a million attorneys but there's not few that have a double Doctorate and dentistry in law and I don't know what to think of them dental malpractice because I have auto insurance I mean I don't want to get in a car wreck because I don't want to die I don't care who has to pay for it I have State Farm same thing in my four boys each one of them luckily each one of them only stack their car twice each and but you know they weren't hurt no one else was hurt that's all that matters I think I can't look at dental mile practices every dentist is gonna get sued and if anybody should worry about it should be my dental malpractice dil because I'm convinced that people are batshit crazy and eventually a crazy person you're gonna meet a crazy person and it's just gonna happen is that a bad attitude or should I be more fearful of getting sued 

Dr. Becky Bye: I would say if you do you're if you practice dentistry the way you should accidents do happen people have bad days dentists have bad days I think many  people call law firms like our law firm and other law firms and most of the cases or the potential cases that people call us about we don't take because it's often the person's irritated with the dentist the dentist did something or said something that they didn't like and they want to sue them and maybe they have some financial problems and so they this is my easy way out and most cases don't have merits but I do think that many of the cases that lawyers take on do have merit if it reaches that point the reason why you shouldn't just say oh my insurance carrier is going to worry about it is multiple reasons even if you settle a case at least in the state of Colorado and I think this is the case for other states you have to report it to your dental board when you renew your license that you settle the case and then it's going to be on your dental license for the rest of your life that you settle it 

Howard: but what is that subtle in private or public I mean I mean can't we I mean I just assume that lawyers that the business people then when they settle something it could be private or does it have to be public er

Dr. Becky Bye:  no so even if the settlement terms are private so you we most settlements are private they say you cannot tell anybody how what happened how much we settled for the terms of the settlement but the fact that you settled a case you still have to report it to our dental board if you settle a case that exceeds the amount that the patient paid you you have to report it even though you don't have to report the dollar amounts it's either one dollar more or a million dollars more that's not what the Dental Board wants to know it's the fact that you actually settle the case so in Colorado like other states doctors do have an incentive to not settle cases because they have to report that on their license and they say you know what I'm paying my insurance company for representation anyway and if I have to report it on my license might as well take it to court where I might have slightly better odds than just settling a case and many times they'll take it to court and the jury will find in favor of the doctor so they get to walk lock away and the insurance company pays the bill for the attorneys fees and they never have to report anything on their license 

Howard: so game theory you know Milton Friedman always talked about how government has the best intentions pass a law and then it blows up in their face you never know game theory do you think looking back now that that was smart a Colorado to say if you settle a case for a dollar more than the patient paid you you have to tell the board was that a good idea or a bad idea looking back

Dr. Becky Bye:  I think I think I understand what the idea is meant to do I think I think it alerts future patients who maybe do extensive due diligence about their health care providers and look at their license that yes maybe there are some unhappy patients or unfortunate outcomes in the past and it disincentivizes the doctor to settle the I'm glad you brought that up because there is a law that just got passed in Colorado that is based on an Iowa law and it started going effect into effect of July 1st of last year so it's very very new it's called the candor Act and it basically incentivizes health care providers to settle or to provide compensation to a patient for an adverse health health outcome so essentially you know a bad incident or negligence and if they follow a certain process they don't have to report it up on their license so I think this might be a game changer it's it's so new that I haven't seen really the effects of it yet but we're starting to take cases and trying to work it under that law so that way the doctor can the doctor and their insurance can settle the case and not have to report it on their license and 

Howard: so basically it seems like you either believe in transparency or you don't so it sounds like the first round of this laws hey we just want transparency we just want you to report it and now you're saying that the Colorado candor ACK is establishes a voluntary framework for healthcare providers and facilities to offer compassion honest timely and throw our responses to patients who experienced an adverse care incidents so how is this gonna be different 

Dr. Becky Bye: so if they they choose to provide some type of compensation to patients under this law and there's certain procedures that you have to follow as the doctor in order for this law to apply they can quickly resolve it without having to report it on their license hi and

Howard: you're sure you'd rather do this than do a root canal yeah that is a hot yeah I could not be a dentist's lawyer because if you told me I could never pull four wisdom teeth again I know I would absolutely cry so so you know a fourth of my viewers are still in dental school and and the rest are under 30 and when they look at you when they think of getting sued by a lawyer that they just immediately just want to cry I mean it just looks like you're meaning you would be their worst nightmare why don't why is this so scary and why do old guys like me I mean I got five grandchildren I mean I just look at it's the cost of doing business you know I treat other people like I want to be treated I think one of the reasons I never got in legal trouble is because if grandma wanted her money back I give it back because I don't want grandma living three blocks away for 40 years telling everybody that my denture is horrible and every time I've refunded the money usually the spouse comes in and wants to shake my hand and say thanks for taking care of this or whatever there what so why do these kids get in trouble how can they not get in trouble you know

Dr. Becky Bye:  I'm glad you brought it up I would say that side manner is a huge component of it and people like you even if they know you did something that was a bad outcome maybe it was your fault maybe it was just a bad complication if they like you they are very very reluctant to pursue it any further because they don't want to hurt your feelings essentially and it's usually people with that manor or someone who if you just say I'm sorry let me let me try to fix this let me help you out that alone will deter someone from pursuing a lawsuit so I would say that's the main thing is just making a mistake and being unlikable at the same time is the recipe for someone to call me up and say I want to see my dentist something I find there are some converse other does the dentist's usually know he has bedside manner or is he a loofah how he makes people Phil I think the people that have the banner have no idea or maybe they don't know how to fix it so it does you know the great thing for your dental student viewers or listeners this is the time to work on your bedside manner while you're in dental school really try to make it a very positive patient experience call them after the procedure even if it's a pro fee just to see how they're doing and start working on the way you interact with patients right 

Howard: yeah III read one study I I don't know how long ago was but this one medical malpractice did a survey on their own claims and they figured they found out it was the same people getting sued over and over and over and was like you know it was like two person you know two percent of their people were six percent of their claims or something and that's what they they narrowed it down to that that you're just you're just not a nice person and people don't like you and so they spanked you with an attorney 

Dr. Becky Bye: no we and we get calls there are certain people that pop into my mind that we get constant phone calls about well you're an attorney you could say their name this is dentistry uncensored who's that most who's the most famous person in Colorado that's always getting people to call you the most I'm just kidding I knew a double another a double doctor wouldn't take the base so you're saying the first thing is I I said refund the money right and your response was just be nice be likable have a nice III cede all times it's like a broken endo file well that lady knows that a car's eventually break down until they throw them into a junk pile but they didn't tell him that the file break but when you get a flat tire the mechanic tells ya hey your alternator went out he doesn't cousin say I'm not going to show you under the hood you know yeah so they just they won't admit the file break they won't say they're sorry they won't show the human side and when you break that file I mean it happened a lot more in the 80s I'm in once I broke a file and I thought I was gonna throw up yeah I was so sad and the guys like patting me on the back telling me you know come on let's finish this tooth you know so it's like not only did I bring a file but not only did not lawsuit he was the one patting me on the back telling me to go with it well

Dr. Becky Bye:  no the final example is perfect because we get phone calls every once in a while about broken files and all the phone calls I've taken they've called and said my dentist or endodontist was your root canal and they told me that the file broke and they took x-rays and they referred me to somebody else and this and this this do I have a case and I often tell them they did the right thing we're not gonna take this case I don't think it's negligence this is something that happens unfortunately occasionally because these files are very delicate and their approach to breaking it would be a whole different thing if the they saw on the radiograph that there was a broken file and they covered it up and pretended nothing happened and didn't tell the patient about it and they find out a year later that would be a whole different ballgame yeah 

Howard: and you know this is a horrible example but I should say it just because I think it pit amaizing behavior it was like when Clinton had his deal when he got impeached if he just would have said you know hey why don't you go be married to Hillary for 30 years you know I'm sorry you know if he just would have met it and walked away everybody just would have gave him a pass but he lied exactly it's like in a in a Christian in a judeo-christian country they hate the sin they love the center all they had to do is say man I fell down I'm sorry it's it's hard being married to Hillary and it had been over but he lied played you as a not like okay I'm not gonna tell you I broke a file I'm a doctor you're not and then you find out at the next dentist five years later there's a broken file in your tooth and now you're mad and you want to go get a lawyer and sue me right

Dr. Becky Bye:  I always tell people before they're under oath taking deposition or in trial the the worst piece of truth is better than any lie you know tell you know tell the truth even if it makes you look bad it because it is better than any type of cover-up or a lie you couldn't ever do and it's that's the truth with dentistry 

Howard: especially since the media has a long-term memory about that what six seconds I mean it they it's tight between a gerbil a goldfish and and the the news cycle I mean so just get it all out there I love that you said would you say the little bit of truth is better than the than a lie

Dr. Becky Bye:  the worst the worst possible truth is better than even the smallest lie yeah this is better than a lie so um are there 

Dr. Becky Bye: any procedures like like young kids are coming out of dental school and they don't know if they should do the soft and pretty fluffier out of bleaching bonding veneers Invisalign or do they want to get where the real money is and the real need is get bloody extractions wisdom teeth implants is

Dr. Becky Bye:  there is there more legal problems going soft and fluffy as opposed to getting bloody soft and fluffy stuff and a lot of it has to do with because there is it because they're not sued because they're really not real doctors lawsuits are very expensive it is thousands of dollars in court fees to get expert witnesses they charge thousands of dollars so most lawyers will not even take a case unless after the amount of money you have to pay or the client has to pay to even litigate if it's worthwhile at the end and the way the amount of money that you think of when you're trying to calculate oh how much money is this lawsuit gonna result in for the client is what are called damages and it's a combination of non-economic damages like pain and suffering and economic damages basically out of pocket money you've expended in the past or will have to expend in the future to make you whole so for the things that are kind of light and fluffy like getting a bat filling and getting a bad crown maybe drilling on the wrong tooth the damages are so small especially even if you have to redo the whole thing and the pain and suffering on the grand scheme of things is pretty insignificant the economics just don't justify pursuing that kind of case so it's usually not the kind of bloody stuff because it involves nerves and permanent nerve injuries and lifetime of maybe physical therapy or going to a neurologist taking something like lyrica or gabapentin so those are the things the kind of cases that you'll see in the dental malpractice realms and I will say and I'm glad you brought that up talking about trying to figure out what you're gonna do practicing especially as a general dentist one of the themes that I see is the overarching themes of cases that I see out there are usually general practitioners that are doing things like wisdom teeth extractions when they should have referred that out and I'm not saying any general every general practitioner should refer every wisdom tooth case out but there are cases where the piano showed that there might be ia involvement and the general practitioner failed to CBT or maybe fail to appreciate the significance of that on the piano and what ahead and did the surgery and completely severed the a nerve it's a very similar set of facts that multiple cases have severed the inferior alveolar nerve or the lingual nerve yes 

Howard: yeah by pulling wisdom teeth and you and so you're saying they have to have a seat if they don't have a CBC T is that the standard of care care is the CBC T but

Dr. Becky Bye:  I would I would argue and the standard of care is something that's established by an expert witness in a case there looks like there's an ia that is going through the tooth or the eye a nerve looks like it's deflected under the root or there's something that looks a little off without it then I would argue that they should order a c.b.c t of the next step 

Howard: so what would be the most weighted wisdom teeth lingual nerve was that number one yeah that would be say number one in terms of our variety of cases now and how much is that usually that case usually worth I mean I mean how much do they use will it usually go for when it's all settled and done 

Dr. Becky Bye: it's hard to say because it's a variety factors how how old is the client if the client is 85 years old and the life expectancy is maybe 88 years old it's worse it's not worth as much as a 25 year old who has to deal with dysesthesia paresthesia on one side of their tongue for the rest of their life so you know in the hundreds of thousands I would say but it just depends on so many factors whether it inhibits them from doing their job maybe they have let's say if their TV broadcaster and they're making $300,000 a year and they can't be on air as often or at all because they're slurring their speech so that calculates the damages versus someone that maybe had a dust job and it doesn't affect their future economic wages so all those factored into the total amount of damages

Howard: the thing that I just really don't recommend it all and I see it all the time is IV sedation I mean if you go into any hospital and uh we're were you born in Colorado I was born in New York okay born in New York uh since you were born in every hospital in America you can't do the bypass and the IV they broke those apart they said we want anesthesiologist just doing the anesthesia while you're doing the gallbladder and it's a total separation and the only place you see that happen ask Joan Rivers how it went you know she went to the private upscale Great Physician and she's dead and she you know and and I was when I was lecturing in London the UK had come to the same conclusion they were looking at all the data and they're saying you know what we don't like what why is this so much higher and they go because it's doctors who aren't anesthesiologist then they're like I thought we got rid of that and they go yeah it's the dentist it's only done in dentistry unless you're Joan Rivers and can get it private but I'm what would you say to young kid who says well I want to go to sign up for docs and I'm gonna be a weekend anesthesiologist

Dr. Becky Bye:  ya know that scares me too and I I wouldn't say to anyone hey anytime you choose to do something especially if it's a little risky make sure you are you know what you're doing and you're competent and speaking of anesthesia I don't personally have any cases about IV sedation or anesthesia I do know there's a big case right now in Arizona against kool Smiles I believe what a for wrongful death of a child and it's related to say anesthesia one of the firm's that's based in Denver with an Arizona office is handling so I am aware of it and that

Howard: that's a nightmare I mean that's just a nightmare I mean crazy I mean uh you know just uh but so I I don't do that I I tell people that if you because I know when you have babies I mean I have four babies and you go in there in the middle of the night and you say yeah I want an IV sedation and they push their little Motorola beeper and that guy would show up in like two minutes I'm like where were you and he goes I just said at the IHOP and eating a waffle and and Here I am so it's like if you can have an anesthesiologist delivered faster than Domino's Pizza why would you want to go learn that yourself right well again I think another theme that comes up with unfortunate outcomes dentistry is putting profits over patients and when you put profits over patients at any setting and this type of scenario could be part of that is I think that's when you start getting people what injuries or even death and so you have just take a step back and think what's in the best benefit of the patient or during this anesthesiologist or that can just show up or maybe go into a surgical center and doing something under more controlled conditions

Howard: yeah and again I don't know if it's because I'm old but I still like profit first I'd rather be a conductor I mean I do they have the anesthesiologist come and put him to sleep and sometimes they'll put him to sleep you'll have like to do like 4 molar endows on a guy well I don't worry you for back-to-back molar windows so you have ended on his command and have him do those 4 molars for 50/50 and then when he's done the paradox can come in and drop the implants and all you did is spend 3 hours surfing dental town while it was all done you don't I mean do you do you only do in dental malpractice is it mostly dentist patient cases or what would if it's a dentist who is associate violated his non-compete clause and you do that type of law 

Dr. Becky Bye: - I don't know there was a time so when I was practicing dentistry I so many of my classmates and other dentists I knew asked them to review their contracts including non-compete clauses and ask for legal advice so I decided to open my own law firm to do that kind of stuff and just very much very very very part-time just because I wanted to keep my hands in law and I just realized how much I love law which is why I got into it more full-time than before so my firm doesn't do that and I don't do that because I'm affiliated with a personal injury firm but there are people that call me up because they see me on the internet that I'm that just attorney with those kind of issues and I usually refer them to attorneys that do contract law business law employment law and falls under that realm um

Howard: you had a jury Creek dentist Colorado in the news on dental town right did you hear about that one there's a high-profile Cherry Creek dentist can no longer practice in Colorado after the state board suspend his license do those are those big ones do those big name cases um 

Dr. Becky Bye: I do yeah we sometimes so I and this is a good time to make a distinction between the board and the civil case I'm sure many of your viewers understand this but so the dental boards are given authority by the state legislature of their respective states to regulate dentists so if you want to practice dentistry in your state the board regulates you if you do something that violates the board rules as a dentist the board can go after your license or put certain conditions on your license maybe require you to take a certain class maybe put you on probation and then the legal system the civil legal system where you go after what patients might sue you essentially under the legal system that's a whole different tribunal it's a whole different process but many times we have patients that call us uh after either after their doctor their dentist was in the news for something and they say I was one of these patients and something like this happened to me or many times a patient will call us up and say I already submitted a board complaint and the board is investigating it but I also like to pursue a civil action against the dentist also so we do overlap sometimes and we definitely keep apprised of what's going on with the board it's public information as well you could go on to your board's website and type in someone's name and see what's going on if they're in proceedings or the result of some proceedings as well

Howard: well the point I want to make about that that case is um a lot of the what the press is covering isn't really what he did really  bad like I'll give you two examples like he left town for what may be very good reasons and everybody on dental town things say he it was all good but he didn't he didn't he left her patients without he abandoned patients and when the Lehman's day contraction in 2008 80 dentists and Phoenix  went bankrupt and some of them were so depressed that they just left town and went and cried with her mom for three months and they came back to a bigger nightmare than going bankrupt and all that kind of stuff because now the board has gone their license but I'll tell you that cats meow that I saw is um there was a case where the hygienists went and I'm deaf the pedo kid and they were doing four quadrants so she went any game for car pills the kid already had too much till well then the dentist came in and he didn't know the hygienist said number up so then he numbed it up and then the patient died okay that is a nightmare but you know what the real night where was he when he found out what happened he altered the chart he's dirty racing the church so it went from a civil year near stupid now the government's and they're saying no no this isn't a civil case you are a criminal lying and so um so yeah stuff has problems I mean my god yeah problems you go bankrupt whatever happens you can't abandon patients in the middle of treatment and no matter what happens I still love your quote but I didn't get it down all right the worst possible truth is better than the smallest lie or what did you say the smallest lie yeah and you know what you just you don't lie you just you know yeah I know give you a third example with the with the the DEA um sometimes they'll come into a dentist office because they know he's ordering and eating vicodin like Cheerios and when they walk in there if you just raise your hand say oh my god I'm I'm addicted I can't get off and you know I'm so sorry my god they they take you to the Betty Ford Center everybody everybody's your friend you're just gonna pee in a cup for five years and it's all great and you're gonna get treatment for your disease but once you tell the DEA oh no I'm smarter than you homie I ain't ever done this you're wrong I'm gonna go higher now you're gonna be in a cage so just it's so simple it's just so simple to do the right thing so what so you're not gonna so you don't do business law yeah and so within what other on what other advice would you give for these kids 

Dr. Becky Bye: so number one is if you ever even question your treatment with the patient or the patient's already starting to threaten to sue you or implying that something's going wrong never hesitate to call your insurance carrier and the reason why is your insurance carrier might help you with some form letters or something to interact with your patients but they also might already just put you in touch with their attorney in your state that might represent you and you might start getting legal advice it may be free may not not be free just depends on your insurance plan when in doubt contact your insurance or contact your own attorney never try to if you're concerned never go through it alone definitely get some kind of advice from an advisor I would also I mean it's also part of you have insurance at all times even though it is required under the state Dental Practice Act in Colorado and probably most states that you have insurance as a requirement for being a licensed dentist many dentists don't have insurance they don't think is what type of insurance dental network till malpractice insurance or their search what of several cases that where we someone whether it's our firm or another firm has pursued a doctor whether it's a DDS or an MD or some other health care professional and they find out that they don't have insurance so then your personal assets are at stake and it could be your future your family's future so it no matter how much your insurance cost it is always not only are you fighting your state's Dental Practice Act if you don't have it but for your own sake and for your family's sake you've got insurance so

Howard: so are all the states do all state require that you have to have dental malpractice 

Dr. Becky Bye: well I know Colorado does and I'm pretty sure it's a routine requirement for four states because it protects not just the doctors but the patients in case they do get injured and they need compensation for it yeah so

Howard: I know this might not be your core subject expertise but it's on everybody's mind the smiles direct club lawsuit where the old-school orthodontists say hey we want $6,500 and we want to be involved with this and technology innovators are saying $6,500 we can do this for twenty five hundred dollars through Teledyne Astari and then of course the lawyers you know so what's your take on this I mean if it was if it was with an iPhone and someone said every iPhone is sixty five hundred and Becky becomes Long says well I'm gonna make another one with less bills and features for 2500 everyone would love it but how do you how do you see this fight 

Dr. Becky Bye: so my I did about smile direct club months ago my take on it is it's different and I I phone is different than your mouth and your health and your well-being and I personally I've never used personally smile direct Club myself but we get calls about smile direct Club occasionally a saying people call us and say I use smile direct Club and now my bite is off and I'm gonna have to go through yours of orthodontia to fix what they did or I you smile direct Club but now they won't even be able to fix my bite because my roots are too short to get more orthodontia and so there it is causing permanent disfigurement for a lot of people and permanent injuries and perhaps it could have been prevented if a real-live orthodontist or dentist was walking through with them through their orthodontic procedure or maybe someone should have told them they weren't a candidate to begin with so i will say i don't know enough about smile direct club to make it a total conclusion but my initial thought is that health care should never be compromised even if it's a lot less expensive i

Howard: i thought the most profound book I ever wrote was the the 1984 Paul Stars the rise of the American healthcare system which got a Pulitzer Prize or whatever and I mean is but it's 17 percent of the economy every president out there has said you know the the health care is it's just so it's just so huge and and they launched that and their Invisalign correctly launched it to the orthodontist first and then slowly let people like me look at it I remember they did this with with M Lance when I remember when the oh my gosh what's the guy that invented the implant when he came over to the United States he only would teach it to oral surgeons he you couldn't even go to the class if it was a paradise and I felt that discrimination I remember in California dr. Gary Carr he'd only let endodontists go into the course so I snuck in with de Kola and we didn't get caught till like 3 o'clock and then he kicked us out and I thought you know it's so weird but his first move was to sue the ortho societies and I'm like dude or maybe I just like wow I mean I guess so so what do you what do you think do you think they'll shut them completely down or will they just what will be the future if of Smiles direct 

Dr. Becky Bye: you know I I don't know I know there are some lawsuits whether it's shareholder lawsuits or the class action that you had an attorney on your program talking about a class action to class actions one of orthodontists against alder I called one of patients of smile at Direct Club and I don't know what the outcome is gonna be I the reason why is health care is changing not just dentistry but all of healthcare and it's moving to a more high volume more hands-off approach and I think what are the big arguments that's a big selling point is it's more access to care and more economical access to care so I think there's a whole philosophical Asif II mindset that's changing about what healthcare should be and maybe style direct Club is the future of healthcare maybe it's going to be more regulated but it is it's maybe it's such a disrupter that local state boards don't even know how to regulate it so I don't know it's gonna go out of business but maybe there will be a different relationship with smile direct Club and dentists and and the ports in the future that's my prediction 

Howard: so did you see the hoverboard dentist in court did you see the hoverboard case the hoverboard - yeah yeah I I didn't think that the key was the hoverboard but where I'm trying to dispose yes I'm trying to transfer knowledge from the old guys like me you have five grandkids - the new kids coming out that never had their first kid and in that transfer I've always been against Medicaid and I don't know if you're if this is like in your court and your expertise or as business law but the reason I don't like Medicaid is because staff make mistakes humans make mistakes and when your lovely receptionist who might even be your spouse makes a bunch of Medicare Medicaid mistakes and then you find out about it ten years later you're gonna go sit in a cage and I know I know a guy who had to go spend the rest of his life in Mexico who just died after Christmas but he retired in Mexico because he would have sat in a cage because his amazing beautiful wife Barbara was not the best biller and I just tell people that you know if I do business with you and it goes wrong you're gonna sue me for money but you do you do something wrong with the government they kidnap you and put you in a cage or kill you and and I what if you say hey do you want to do business with the mob I mean if it goes bad they might shoot you and they go no I would never do that but I'll do business with the United States government dude that's like the biggest criminal mobster in town and this guy yeah he's on the hoverboard so the media is making a news out of it but it's Medicaid fraud and dude when you do Medicaid fraud or it's alleged when you do Medicaid fraud I mean what is their conviction rate like 93% 94% I mean I just I don't I wouldn't do business with the mob so why are you doing business with the government 

Dr. Becky Bye: yeah I mean once you start accepting Medicaid Medicare you are subject to really stringent requirements that if you violate any of those it could have some serious consequences for you not just financially but obviously what's your liberty and so

Howard: so they're there they're so young and dumb yeah will you review it for the mob - why should you not do business with mob in Denver no no it's a mafia I mean do you do I mean would you recommend that they they do dental contract with them the local mafia organization in Denver I mean I just don't get it I mean tell these young kids that they look and they said well you know I like I want to be a medicaid provider because I want to help the poor okay you have a big heart you're gonna you're gonna get in bed with a guy who kidnaps and kills for a living and and it's just if they wanted to make health care I mean if they want to do Medicaid reform the first thing I would do is say well we're trying to save people's teeth while you're still practicing kidnapping and putting people in a cage okay so if you want health care reform the first thing you do is that when I find out my surely has made 14,000 billing errors that it's a financial deal I mean you know sue me get the money back but the first thing they do is they put him in a cage and and look at that the only quote from the guy from the government if convicted he'll face ten years in prison you know I mean it's like so Medicaid's dead to me so um so do you if again I'm sorry to understand but like do you do if someone had a Medicare case like that do you who do you refer them to do you do that to or just this only clinical malpractice 

Dr. Becky Bye: so right now no it's something that I'm definitely looking into if we were going to expand the scope of the type of things we do because you can if you are if you know of fraud against the government there's something under it's called aqui tam action where you can file a case as a plaintiff on behalf of the government for damages to the government from some type of fraud and and then you get a percentage of whatever amount that you as the plaintiff get a percentage of whatever amount you recovered for the government and the Medicaid thing I'm glad you brought that up there was a case a couple years ago now where there was a dentist and I believe in the state of Indiana was working for one of the DSOs that accepted Medicaid and he was noticing that there was Medicaid fraud going on they were charging Medicaid for procedures that never happened or they were over diagnosing just to use up the Medicaid benefits and he filed one of these actions on behalf of the government and prevailed and the settlement was pretty substantial I believe well over a million dollars maybe a couple of million dollars and of course the government got most of it but he was able to get a fee and his attorneys got a percentage of what he recovered for the Medicaid fraud so it costs him two million dollars I believe so so some some amount i don't know offhand I just remember reading about the case that's 

Howard: so much money my divorce was 3.8 million I know what half a divorce cost so that I share the pain this is another thing that always comes up on dental town if you go to the dental town I've got 50 categories root canals fillings crowns ones laws and ethics and they're always don't know what to do about a patient refund some people say well you give a patient refund they better sign something and release you and then other people say no dude you just you just signed a receipt admitting to what you did wrong what would what do you what do you say I mean I give them their money back but what's your thoughts on a patient refund

Dr. Becky Bye:  so again I think that's something that if you're concerned they should definitely talk to an attorney about but just in general circumstances is most patients that call us and I usually tell them if your case is maybe not economically viable you'd probably lose more money even if you prevailed by the expensive litigation and have you talked to this dentist about getting a refund would you be satisfied with the refund if they gave you a refund because by a refund you might be able to get more money than you would have have you gone through the litigation route after attorney fees and court fees and often time to call me back and say thank you for recommending that I got a full refund and I'm so happy and they move on with their life and the dentist moves on with their life so I think more people more dentists more doctors should should evaluate and see if a refund even if it's a significant refund maybe it's worth it to reduce the likelihood of them pursuing a case against them and maybe prevailing or just the headache of dealing with a case for one to two years so I think it's a great thing in general I don't believe just issuing them a refund would it be able to avoid having them maybe report something to the dental board because again that's a whole other process in the civil litigation process but most times patients are just so happy they got a big chunk of money back and they just move on with their lives well 

Howard: the one thing I've noticed and I had one of my mentors and role models got sued and it went to trial and the whole thing was a couple of years long he wound like two years of his life he never smiled he wasn't happy and you couldn't he wouldn't go out drinking I mean when you're Irish and you're not drinking something you should tell the doctor and you know it's like God for two years of that yeah I mean why it's refund the money you know that even if you're convinced that you did nothing wrong sometimes it's just so much better than til you sleep at night yeah so um

Howard: are you seeing I'm I'm hearing that the opioid is causing loss suits now and I'm starting to hear of people wanting you to pay for me to go to the Betty Ford Center or something like that what are you seeing it with opioids and I know that you're in Colorado so you're probably stoned right now and don't even care but uh what would you think of that marijuana being illegal and when are they gonna start advertising when our dentists can I'm still waiting for Dennis say hey you're afraid of the Dennis the Colorado smile dentistry and eat this little buttercup with THC and you're gonna have a happy time is that a corner 

Dr. Becky Bye: yeah I think you just gave people some ideas probably for new dental clinics but the opioid crisis has is definitely has hit Colorado as it has nationwide we do get some calls about wrongful deaths related to opioids usually not against DDS is the Morrigan's md's who see people for chronic pain long-term there are multiple as you probably know class-action lawsuits against the pharmaceutical companies themselves for it what we I have been seeing which is kind of interesting is people calling us up and saying I was in so much pain and they didn't give me opioids they didn't give me opioids even though I deserve to have them because I was in so much pain and they said it because of the opioid crisis and I would say number one do not let that deter you from choosing not to give opioids because again my legal opinion is that's not negligence  is injuring someone permanently or temporarily because you reach the standard of care withholding opioids from someone does not hurt them because it doesn't treat the problem it just treats the pain and there's other ways to deal with pain management but we get a lot of people just angry  at their dental provider or the health care provider for not giving them opioids right now which is kind of an interesting phenomenon

Howard: yeah and that's the way it was when I got out of school they bad guy was a doctor for poor grandmas got pain and your won't give her a drug cuz she's gonna get addicted when she's gonna die so then the pendulum swung the other way and they were giving it all out and now the pendulums going back to the other way and it doesn't make any sense cuz I mean I don't I don't see people dying of opioids I see people dying of addiction like Whitney Houston when when she died it wasn't one thing hell her bloodstream had all kinds of things in it had cocaine marijuana prescription drugs all that so I don't so the people that are overdosing on opioids well they're not doing a toxicology report and just finding opioids they're they're finding half the kitchen sink in their bloodstream because addiction was the problem not any specific brand but there's a I see other problems though in these states that are legalizing marijuana like your state from dental school faculty they say we don't know what to do because doctor good who is been at the dental school 20 years uses medical marijuana for chronic pain whatever and he totally believes it and he loves how it works but before school at lunch and after school he goes outside and smokes a joint and we're and I I've talked to deans and I said well what do you think they go well or you know I don't want to assume because what what if he what if he's right I don't I don't want to write his paycheck you know I so so they're just like so so my thought is when in the Supreme Court's supposed to weigh in eventually when the states are going to different ways don't they usually wait a minute

Dr. Becky Bye:  I'm sure that there will be some some kind of federal legislation which will help maybe normalize things among the states but I think the case that you're talking about if there's a provider that might be under the influence of marijuana I think it just goes into are they impaired is it is it the same as having one or two glasses of wine before working out a page is that impairment to the point where not only is it negligent from my perspective but from the board's perspective are they violating some type of dental board regulation and I think it's quite possible but I also think marijuana probably has a different effect on every single person just like half a glass of wine might have a different effect on different people I don't think you know personally if I was gonna practice law or dentistry I would never put anything in my body that might impair my judgment or my performance on working on a patient but and that kind of opens a can of worms is well is waking up and taking you know something for a heart condition will that impaired me my professional judgment or something so I mean I think it comes down to impairment yeah that's a good answer and

Howard: it's crazy time I'm back to the government HIPPA you know it's the same thing it's like it's like my god HIPAA OSHA Medicare and so do you see do you do HIPAA cases or do you see HIPAA cases or what's your thought on HIPAA

Dr. Becky Bye:  so I don't do hid the cases directly but HIPAA is a big part of my practice in many ways number one if a doctor committed a HIPAA violation and kind of just adds in to the whole set of facts that we do to show that they were negligent in some way if they violated HIPAA their state Dental Board might get involved or the federal government might get involved because HIPAA is a federal law also as an attorney as a representative for clients patients we have to go through the HIPAA process to certain to send certain documents that comply with HIPAA to get their medical records from their from their dentist and the other medical or dental providers so I have to be aware of HIPAA and know what hibbett is if there is a really bad violation often times we will recommend to the client to go through a certain route through the federal government to to report HIPAA violations and 

Howard: explain to the young kids in dental school what that they may not even know what hip is explain it explain them what that is basically

Dr. Becky Bye:  it requires that you cannot divulge any personally identifying information for your patients in any way and there's a certain process in methodology for safe safeguarding patient information and it's very very serious if you breach hit but depending on the severity and they extend to what you breach it or how many times you've reached HIPPA for a specific patient or a set of patients you can be fined on significant amount of money and what is worst hepatitis or hepatitis you do not want to breach it but you do not want to commit a HIPAA violation make sure you listen in all your classes dental school that talked about HIPAA and make sure as a practicing doctor that you take C's on HIPAA as well because pimping is also like many federal laws it's evolving it changes or maybe there's new methods and ways to comply with it that come up so definitely keep up with the legal requirements on that so again you're a dentist and a lawyer 

Howard: so there's so many questions I want to ask you so if it's not your core deal sorry about that but I'm the other thing that makes dentists just go insane is online reviews and sometimes you're reading it's like you're fighting with with Karen on the Internet are you are you drinking and then I believe drinking has some do think is like on on all these social communities like like dental town it's a different behavior between 10:30 at night and 1 o'clock in the morning is measured by typos and telling they just go jump off a cliff you know whatever so I mean I I will I was we were all on dental town they were posting this Denis arguing with somebody and we're just like okay I guess I Meyer so I just assumed he was drunk I'm like nobody in their right mind would argue online but anyway so so why does this bother dentists so much why do they go ballistic because when I got high school when you went in there and he told the dentist he said I have 5,000 charts and then it could need pay consultant 30 grand it take him two weeks to say uh yeah but 3,000 of them have never come back and he just like scratch his head like 3,000 patients never came back he didn't blink but now he sees one lady online saying doctor and he just loses it

Dr. Becky Bye: well it's the same for attorneys that we we get online our views and in many ways we don't are not subject to HIPAA ourselves but we have an attorney-client privilege which is considered this very sacred privacy between an attorney and a client and if you breach it you can there's really great consequences between also getting sued and once you're our own regulatory about the body which is the Colorado Supreme Court for us so we're also sensitive to online reviews and I think doctors and attorneys and other professionals that have the same kind of confidential information it's hard because you can't go out there and tell your side of the story because you're you're you're violating HIPAA you're violating privilege and so I think that's what's what's frustrating about it I think unlike a restaurant I see restaurant reviews where there's bad reviews and then maybe a manager whether they're stepping out of bounds or not will say we remember you you're just upset because we were really busy and you didn't have a reservation and we didn't have a five-person table but we try to accommodate you by giving you three drinks or something to that extent and being professional that work you're subject to that kind of privacy you can't you can't defend yourself for online reviews 

Howard: so I think that is what's really frustrating about about that yeah but I what I don't understand is if you if you go up to anyone anyway I mean I've lectured 50 countries if you go to if you're having dinner with any dentist in any country and say just approximately what percent of all the people in your country are nuts and the lowest you're gonna hear is 20% and usually it's about they say like a quarter so it's usually 20 to 25 percent so somebody leaves you an online crazy review well I'm sorry are you new to earth is this the first time you found out that people were crazy and I I mean I had an online review and the guy mentioned like nine times in the review that he was a warehouse manager it's like I mean he just he started every point and it's like okay okay you know whatever so I just think they should lighten up but are they more you think you think dentists physicians lawyers are just their ego is so wrapped up into that I'm a doctor and you're not that to have someone review them in poor light is just just something they just never saw coming or all right

Dr. Becky Bye:  it's more of a permanent perspective I think lawyers and doctors they they work really hard and they have very stressful jobs and they they put a lot of time and money and effort into becoming those professionals to begin with so if someone is criticizing you for the whole world to see about what you did for them when you know you did your best I think that really kind of gets to your heart and I mean I can I can see it bothering me too 

Howard: you it the best joke about Hippias oh I can't tell you great compliance so um my gosh I can't believe this hour went so fast I'm so the biggest thing it you know a lot of people say well you know half the dentists don't do this and I would say god that's that's an amazing stat I'd love to see the stat but they never have a stat they never have a survey dental town when start a thread you can start a pole so I've been seeing my poles on this thing forever but when you line up dentist and you say what stresses you out the most what's owed so is a human it's either a human that's a patient or a human that's an employee we've been talking about all the lawsuits humans that are patients and and we talk to our but any advice on lawsuits with the human employees because all the dentists will tell you no it's not finding the mb2 that stressed me out it's my hygienist it's that lady's online it's people's what stresses them out in all fields but again of course since I'm an attorney 

Dr. Becky Bye: I'm a little biased and anytime you think you might have a serious problem with another employee it's always good to consult with an employment attorney or somebody but in terms of working with people something that I learned as a lawyer and even in dental school as a dentist taking different personality tests it's really important to identify the personality types of people even if you don't make them take a test in front of you and I don't frankly not employ a lawyer but that doesn't sound very illegal or there might be legal issues with that but understanding what makes people tick versus what makes people happy and happy to work with you and taking classes on leadership styles and personalities and finding a way to work with different people based on their personalities and it is a lifelong process to do that and you're not just born with it you have to work at it and it's something that you as doctor as the leader of this team you need to invest time and money into learning how to deal with personalities and if you take that education apply it it should be easier to work with people and I help them work with you

Howard: that was very well said and very profound because it's the my gosh it's in life it's not your doctorate or - it's not what you know it's what you know with you know and you know like you said don't lie though the worst truth is better than the small why don't give toxic people money I mean there's so many dentists I know and they're like well she's been here for this many years and when I bought the practice she was here dude you hate her you hate her you you absolutely hate her and you give her money every two weeks right this is never gonna end well I'm sitting with patients I had to fire my best friend because we have a deal we don't do talk civility comes in here he's the nicest guy with me and he's just law he's just unbelievable but once he searched doing his dental in church this the profanity starts flying and he's crazy crazy and I and we have a protocol and and they said it a morning one day they go yeah but if you wouldn't dogs friend we'd release them I go I didn't break protocol you did if that's the protocol calls but up and firearm but don't work with toxic people don't do things for you that you don't like to do for money it's just bad idea I'm but but you confuse me on the smiles direct Club or what's confusing me about the smiles direct Club is that here's a case where the orthodontist say no we're not gonna have save money low cost and you know we're not gonna do that and then the same people say oh but here's a dental therapist and so you you know if you don't want low-cost technology then how could you accept low-cost labor right I mean if you're not into low-cost then be consistent no smiles direct club no dental therapists they just can't pick and choose where you're gonna have high cost and low cost or Kenya where is that gonna end in Colorado

Dr. Becky Bye:  I think I mean I I think there is a movement to get mid-level providers into Colorado I know that in the last year - they are allowing dental hygienist to apply also high silver yeah the silver fillings and so and again I think it goes into that argument not just lower-cost dentistry but also excuse me access to care I think even though a smile direct Club is less I think a lot of people who use smile direct Club are more concerned about cosmetic care than actual necessity but there is a movement for the mid-level providers and other providers to provide more care expand their role overlap with dentistry in many ways for access to care and I think there are benefits and risks to that to the general public as well as to dentistry

Howard: so it's kind of funny when I got out of school in 87 and please don't tell me you weren't born in 1987 if you weren't just keep us here but it was you were always afraid of not diagnosing periodontal disease that was the scary thing and now that probably doesn't even make the top three you're saying nerve paresthesia lingual 

Dr. Becky Bye: nerve implants man another one we we get that is a case and again it involves the nerve is overfilling when you're doing a root canal of calcium hydroxide and it's often on routes that happen to be close to the i-80 canal and calcium hydroxide seeps in onto the nerve and then also causes really permanent devastating nerve injuries as well so we have a couple of those cases we either done or on our radar as well so those are the big ones because they're nerve injuries and so it has huge consequences for the patient long-term so

Howard: so what you're saying is I just know the worth of the risk are I mean you know when you're driving down a crazy I by the way you live in Denver Colorado right yeah that's that drive went to Breckenridge I mean you that that there's a lot of steep turns and a lot of a lot of crazy stuff and you slow down and obviously you know you be aware of that but I would be a nice guy and I would not have set the patience and and just just treat other people like you want to be treated and avoid the hazards is there anything anything that you wanted to talk about that I didn't bring up also say

Dr. Becky Bye:  disclose the risk to the patient and really emphasize what the risks are I know that many practices they just sign a sheet and that's it but if you have the time it's really worth talking through the risks of a procedure with the patient so you're setting their expectations to begin with if something happens if there's an outcome even if it's something as small as a crown and one of the risks is maybe their bites a little off or they might have to come back for adjustments or to get it redone let them know that in advance so if they come back there they already know that okay this happens and you know my dentist already warned me about this and it it's consistent what with what he or she told me anything else I think it's important when I was in dental school and obviously because of my legal background but it's very important to be involved in what's going on with your your state or your federal legislature see on how laws can affect you even if they're not a dental law directly a dental law it might be a law that applies to all of healthcare that might affect you as a dentist and I  would definitely recommend being involved in your local organized dentistry chapter and because they do pretty good they  have lobbyists and they have people who stay in prized of these laws and they can give you a lot of good education about how it might affect you so I think it's important even if you have no interest in the law whatsoever it does affect you and I think it's important to be involved as a citizen and as a professional and understand what's going on yeah and

Howard: I just want to say another thing about the a DA and um I have always been a member even as a student and a lot of people always tell me what they don't like about the ad a night what would you like to hear what your ex-wife doesn't like about you and how many times how many things have you told me you didn't like about your own mom and dad but let me tell you something bout the United States it's 1 million attorneys charging one trillion dollars in a 19 trillion dollar economy mediating between the business class and the people and the US government and they write all the laws and when I was little and I told my dad that I didn't like the lawyers and I thought it was crazy he said are you kidding me he said when I was your age they were shooting each other and I'd rather have him suing each other than shooting each other because it's tough for these people families tribes to all get along and my god if your whatever tribe you're in the dental tribe if you don't have your lawyers sitting down at the desk you know the insurance companies does you know HIPAA does OSHA does you know you know everybody who wants a piece of your hide does and they didn't say well I don't want to be a member well you know what it really means it means that three out of four dentists got to pay the bill because you're a tightwad Cheapskate and I I don't want to hear don't don't tell me you're not a member and to my face because I'm I'm paying for the right it doesn't mean I like it but does that Danny DeVito movie remember ones Danny DeVito movies suck I forgot the name of the movie and he was talking about somebody goes I bet a little all cities are they got their nuclear bomb missiles and I got mine in the color money do you remember that the color money but anyway it's just a part of doing business and and that's my number one complaint with the Arizona State Dental Association I was always telling Kevin Kevin I know all this stuff you're doing but I was out with these four guys last week none of them knew any of those that they got to market these state-by-state battles because otherwise it's just crazy and by the way and my last advice when you start doing things with Medicaid or Medicaid there remember that there was that Dennis in oh where was yet in Ohio where he hired former OJ attorney Alan Dershowitz hired to represent the former Metro help Dennis I'm convicted I mean I yeah I mean when you got to get when you got to get oh geez attorney maybe you should stop doing Medicaid and Medicare but anyway it was an honor to podcast you thank you so much for coming on the show today and it was just an honor to podcast you well thank you I've been a member of dental town for many years even since before I went to dental school and it's an honor to be on your show so thank you.