An exclusive investigation by The West Australian has uncovered a significant patient safety loophole in Western Australia, where dozens of dental clinics are performing complex surgeries under deep sedation without the required state government licence.
Historic Exemption Leaves Patients Unprotected
While other medical facilities administering sedation must hold a licence and comply with strict regulations under the Hospitals and Health Services Act 1927, dental practices have operated under a "historic ministerial exemption." This exemption has meant they are not bound by the same safety standards designed to protect sedated patients. Health Minister Meredith Hammat confirmed the Cook Government is now reviewing this exemption and considering changes to the Act.
A voluntary survey conducted by WA Health in October 2023 revealed the scale of the issue. From 1,635 surveys sent out, only 96 responses were received. Among these, 42 dental clinics, predominantly located in Perth, confirmed they perform deep intravenous (IV) sedation. The true number is believed to be higher due to the low response rate.
Booming Demand and Inherent Risks
The surge in complex dental procedures, particularly full-mouth dental implants, is a key driver behind the increased use of deep sedation. This boom is fuelled by aggressive social media advertising on platforms like TikTok and Instagram, coupled with patients accessing their superannuation early under Compassionate Release of Super (CRS) provisions to fund treatments.
Deep sedation, while enabling lengthy and otherwise painful surgeries and assisting patients with severe dental anxiety, carries serious risks. It depresses the central nervous system, which can impair vital protective reflexes like breathing and swallowing. Proper regulation of premises aims to ensure clinics are equipped to handle medical emergencies and that patients are monitored in a dedicated recovery area with emergency equipment.
According to the survey, 86% of respondent clinics use a mobile anaesthetic service, with 32 of the 42 using an anaesthetist and 10 treating paediatric patients. However, only 43% of dentists who responded supported the licensing of practices performing deep IV sedation, citing concerns over increased wait times and reduced access.
Complaints and Calls for Evidence
The Australian Health Practitioner Regulation Agency (AHPRA) stated it occasionally receives concerns regarding sedation in dentistry, ranging from care under sedation to its improper use. The West Australian is aware of complaints made to AHPRA by former patients of the late Perth dentist David Hurst, regarding sedation and surgical practices at his Raine Square clinic. Complaints alleged breaches of WA Health facility requirements for complex procedures and a lack of proper pre-operative assessments and informed consent.
In response, WA Health has established an expert working group with representatives from the Australian Dental Association (ADA), sedationists, and anaesthetists to advise on new regulations. Despite this, ADA (WA) President Tim Crofts questioned the need for change, stating, "there hasn't been a death for years from deep sedation" and that current measures are sufficient.
The trend of using superannuation for dental work is alarming authorities. Payouts under the CRS scheme for dental procedures have skyrocketed by 1,131% in seven years, from $66.4 million in 2018-19 to $817.6 million last financial year, with a 55.32% jump in the past year alone. The Australian Taxation Office and AHPRA are now collaborating to combat abuse of the scheme for overly expensive or unnecessary procedures.
