A mom says her pediatric dental office is threatening to report her for parental neglect because of a dispute over an appointment.
On Friday, Trey Hoyumpa, a mother in Stroudsburg, Pa., posted a letter she received from Smiles 4 Keeps, a pediatric dental office in Bartonsville, after her children, ages 12 and 9, were diagnosed with a total of seven cavities.
“Got this letter in the mail today. Smiles4Keeps bullies the parents, controls the care behind closed doors, and turns parents into villains…and I will not stand for it anymore!!!” Hoyumpa wrote in a Facebook post that received 228 comments, almost 800 shares, and more than 400 likes.
In the letter, a photo of which was also shared, the dental office states, “According to law, failure to bring your child for dental care is considered neglect. Pennsylvania Act 31 (Child Abuse Reporting and Recognition Requirements) states that health care providers must report your failure to bring your child to the dentist for evaluation and care. … To keep your child as healthy as possible and avoid a report to state authorities, please call Smiles 4 Keeps immediately to schedule a treatment appointment within the next 30 days.”
The mom’s post has sparked much debate. One commenter wrote that she visited Smiles 4 Keeps as a child and “hated it,” then had a similar experience there with her own child. Others slammed the mom for publicly complaining and defended the office policy. And many encouraged Hoyumpa to keep sharing her story.
“In November, Smiles 4 Keeps said that my kids had seven cavities between them, which sounded outrageous,” Hoyumpa tells Yahoo Lifestyle. She added that the practice does not allow parents inside examination rooms and that she was not shown X-rays to prove that her children have cavities.
“I asked the receptionist to schedule both kids’ appointments on the same day so I wouldn’t have to take off work twice, and she refused,” says Hoyumpa. “I got really angry because it showed that they didn’t care about their patients.”
Admitting that she got into a confrontation with the front office — “I was screaming” — Hoyumpa informed the desk that she would seek dental care elsewhere. Three months later, she received the letter in the mail.
A representative from Smiles 4 Keeps sent Yahoo Lifestyle the following statement: “We make multiple attempts to reach the parent or guardian of children who have outstanding dental treatment that may pose a threat to the child’s overall health. This letter is a last resort to give parents 30 days to either bring the child in to use for care or seek care from another provider. If the parent or guardian chooses another provider, we ask the name of the provider so we can close out the patient record in our office and send medical records (if requested and authorized by the parent or guardian). This is our legal responsibility, and we take it seriously. These laws are intended to protect children.”
The rep further clarified that despite social media claims to the contrary, “Outstanding dental treatment differs from cleanings. We have not and would not report anyone for changing dentists or missing a cleaning appointment” and “It would be ludicrous to report a parent or caregiver for missing a dental cleaning.”
On Wednesday, the office also addressed the controversy on its Facebook page, writing in part, “Letters that refer to dentists’ mandate to report failure to seek necessary treatment are sent under specific conditions. Letters are intended to remind parents and caregivers of the need for dental treatment for the child in question, and the letters are not sent unless attempts at multiple communications with the parents or guardians are unsuccessful or messages from our office remain unanswered. Letters are not sent after one missed treatment appointment.”
The practice clarified that it tries to accommodate families with multiple children, and if a parent wishes to change practices, it asks for the name of the new provider to update and transfer dental records.
Smiles 4 Keeps is suggesting that Hoyumpa’s failure to schedule her children’s fillings falls under “dental neglect” as outlined under the American Academy of Pediatric Dentistry’s “Guideline on oral and dental aspects of child abuse and Neglect.”
The AAPD doesn’t clarify a timeline in which parents are required to respond to treatment, stating only that “The point at which to consider a parent negligent … occurs after the parent has been properly alerted by a health care professional about the nature and extent of the child’s condition, the specific treatment needed, and the mechanism of accessing that treatment. … If, despite these efforts, the parents fail to obtain therapy, the case should be reported to the appropriate child protective services agency.”
Hoyumpa is in the process of seeking a new dentist — and a second opinion — and has no intention of keeping Smiles 4 Keeps informed of her family’s whereabouts. “I understand that dentists are mandated reporters, but this is bullying,” she says, adding that local low-income families that depend on state insurance may not have flexible options for alternative dental care.
Yahoo Lifestyle did not hear back from the Pennsylvania Dental Association or the Pennsylvania Department of State for comment.
John Rutkauskas, the CEO of the American Academy of Pediatric Dentistry, sent the following statement to Yahoo Lifestyle: “Dental care providers are required to report injuries that are concerning for abuse or neglect to child protective services in accordance with local or state legal requirements. In terms of dental neglect in particular, the AAPD defines it as ‘willful failure of parent or guardian, despite adequate access to care, to seek and follow through with treatment necessary to ensure a level of oral health essential for adequate function and freedom from pain and infection.’ To the best of his or her ability, the pediatric dentist should be certain that the caregiver understands the explanation of the disease and its implications and, when barriers to the needed care exist, attempt to assist the family in finding financial aid, transportation, or public facilities for needed services. If, despite these efforts, the parent fails to obtain therapy, the case should be reported to the appropriate child protective services agency.”
Rutkauskas also noted that dentists have the “ethical obligation” to provide dental records to a new provider, and “if the dentist believes the informed refusal violates proper standards of care, he/she should recommend the patient seek another opinion and/or dismiss the patient from the practice.”
He also noted, “Dentists must inform the patient/parent about the consequences of not accepting the proposed treatment and obtain a signed informed refusal. An informed refusal, however, does not release the dentist from the responsibility of providing a standard of care. If the dentist suspects dental neglect, appropriate authorities should be informed.”
On Monday, local news station WNEP reported that a Smiles 4 Keeps spokesperson admitted in an email, “It’s been a tough week,” suggesting that the letter was “grossly misinterpreted” and that its dentists have been “threatened” over the letter. The rep also confirmed that the practice had reported 17 cases of neglect in 2017 and plans to revise the letter due to the backlash, a sentiment the office confirmed in a Facebook comment. A major complaint has been that the letter suggests that parents will be found neglectful if they don’t visit Smiles 4 Keeps versus another provider.
“I’m being accused of abuse without foundation,” says Hoyumpa. “I wasn’t in the exam room, no one showed me any cavities, and I haven’t seen X-rays. Yet they have the gall to send me this letter.”
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