Three-year-old Finley Puleo Boyle is nearing the end of her short life, in the arms of her mother at Hospice Hawaii’s facility in Kailua, after suffering massive, permanent brain damage a month ago, allegedly during a visit to the dentist.
"She will probably not be with us much longer," said her mother, Ashley, who has slept every night since Dec. 3 with her daughter, holding her in a position to ease her breathing. "We were all hoping. Even the doctors are in tears. We were all just waiting for her to wake up."
A mile away, the offices of Island Dentistry for Children on the fifth floor of a Kailua professional building stand empty, the waiting room devoid of furniture, the front door stripped of any identification. The only sign of the once-busy practice is a flower-shaped popsicle stick wedged below the door, with a child’s penciled inscription, "to my niceise dentist."
Finley’s parents, Ashley and Evan Boyle, filed a lawsuit Monday in First Circuit Court against Dr. Lilly Geyer, Island Dentistry for Children and unidentified staff members, alleging negligence and dangerous conduct in sedating Finley and failing to prepare for medical emergencies. The suit seeks general and special damages in amounts to be proved at trial.
Geyer, the dentist who oversaw Boyle’s care, and her staff have not responded to phone calls or email messages from the Star-Advertiser seeking their side of the story this week. All calls go straight to a voicemail advising callers to send an email.
Ashley Boyle, a registered nurse, brought her daughter to Island Dentistry for Finley’s first dental exam. She hadn’t complained of any pain, and was cheerful throughout the visit, Boyle said. Afterward, Geyer said the child had 10 cavities and needed four root canals. The Boyles’ attorney, L. Richard "Rick" Fried Jr., said it now appears that most of the work was unnecessary.
"As a parent, you are always watching your kid when in the pool … or a street; you don’t want them to crawl into a window," said Boyle, 30. "With a doctor or a dentist, you kind of let your guard down, and you trust."
She brought her only child back Dec. 3 and was told to stay in the waiting room while Finley was given oral sedatives and then propped in the dentist chair. A technician administered the drugs before the dentist arrived and began the procedure. Just two teeth were prepared for treatment before the situation spiralled downhill, according to Fried.
Boyle became aware of what was going on only when she saw emergency responders arrive on the other side of a glass door, and rushed to her daughter’s side. The staff had summoned a pediatrician down the hall for help and called 911, she said.
Dental records obtained by Fried show just three notations of Finley’s vital signs that morning. At 7:56 a.m. her pulse was 83 and her oxygen level at 100 percent, and two minutes later the readings were almost identical at 82 and 100. The next reading is 26 minutes later, at 8:24 a.m., when Finley’s pulse was racing at 143 beats per minute and her oxygen level had plunged below 65 percent.
"That’s a huge, huge drop," Boyle said. "We have patients when they get below 85 we put them on oxygen."
Guidelines by the American Academy of Pediatric Dentistry call for monitoring and documenting vital signs at least every five minutes for patients undergoing sedation. Noting that young children are "particularly vulnerable" to sedation’s effects, the guidelines also call for the presence of someone capable of providing advanced pediatric life support.
Fried said there is no evidence of such precautions. Finley received high doses of Demerol, hydroxyzine and chloral hydrate, all of which suppress the central nervous system, as well as nitrous oxide. Fried said dosages should be lower when such drugs are used in combination, and such heavy premedication was probably unnecessary.
Geyer was first issued a licence to practice dentistry in Hawaii in July 2005, and there were no records of complaints against her or Island Dentistry for Children on file with the state Department of Commerce and Consumer Affairs as of last month.
Ashley Boyle said that if simple precautions had been taken, her child would be healthy today.
"If something as simple as a $45 monitor that you can put on your finger that reads your oxygen level, something as simple as basic life support, had been initiated at the right time, she’d be walking out of the hospital, I think," Boyle said.
Instead, Finley has been unresponsive since Dec. 3 and has suffered "brain storms," seizurelike events. She was fading fast this week, her breathing more and more labored.
"We’re just trying to keep a positive vibe in the room for her," Boyle said Thursday afternoon. "We speak to her, sing to her, play music for her all day," she said. "She’s been getting reiki therapy, aromatherapy, acupuncture. We have had a lot of support from the community."
Boyle said she is speaking out in hopes of alerting other parents to be on guard and question even medical professionals, adding that "it doesn’t ever hurt to get a second opinion on anything." She also hopes eventually to campaign to help ensure better regulation of drugs given in dentists’ offices.
"They are not medical doctors," she said. "They didn’t go to medical school. They are allowed for some reason to administer these heavy, heavy, heavy medications, but they’re doing it not nearly as well prepared."
She closed with a message of aloha for other parents.
"Just love your kids every day," she said, her voice catching. "You just don’t know what’s going to happen. It could be running across the street — or just going to the dentist."
