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Dental patient’s sudden death raises questions

SAN DIEGO – An oral surgeon and his procedure involving anesthetics were questioned Tuesday after a San Diego man allegedly died when he went to get his wisdom teeth extracted.

Fox 5 looked into the background of Dr. Steven Paul, the oral surgeon who administered the Mark Lapinski’s wisdom teeth procedure.  Dr. Steven Paul, dentist office

The state of Nevada shows Dr. Paul as a registered oral surgeon and has a permit to practice general anesthesia. He is in good standing with the state and has no formal complaints against him.

Fox 5 made second attempt to contact Dr. Paul Tuesday, after being told on Monday he was not available.

Marek LapinskiHis lawyer issued the following statement:

“Dr. Paul provides patients with state of the art services and monitoring for his patients…No surgical procedure is without risk… the circumstances regarding Mr. Lapinski’s complications are not completely understood.  What is understood is Mr. Lapinski’s complications occurred despite the fact there were no apparent contraindications for his oral surgery.”

Dr. Milder has practiced oral surgeries in San Diego for the past 20 years.  Milder could not comment on Marek Lapinski’s case, but said wisdom teeth extraction procedures are safe.

“In any surgery in any anesthesia there are risks involved,” said Dr. Milder. “In most cases with a young healthy patient, it’s a safe procedure.”

It was a procedure on March 21 that killed 25-year-old Lapinski, who was vice president and part-owner of Tactical 3D Dimension in San Diego.

The Lapinski family has raised questions over the dosage of Propofol administered during surgery.

Medical charts show Dr. Paul gave 43 milligrams to Lapinski when he began to cough.

Dr. Milder told Fox 5 when it comes to Propofol, there is no recommended dose.

“There’s not a specific dose that’s given that’s individualized per patient,” Dr. Milder said.

The family also claimed Marek was never properly monitored.  Records show he may have gone 10 minutes without oxygen.

Dr. Milder said surgeons must follow strict state and professional guidelines in monitoring patients.

“That would include a pulse-oxygenation to monitor the oxygenation, an EKG and also us in the room watching the patient visually,” Milder said, adding as with any procedure each patient is carefully evaluated for surgery. “We need to evaluate their medical history and make sure there aren’t any known risks.”

The results of Lapinski’s autopsy are pending.

30 comments

  • Anonymous

    No recommended dose? In a dog the dose for Propofol is 2-4mg/kg titrated to effect after pre-oxiginating the patient. Potential problems are transient apnea and hypotension. My condolences to his family. I am disturbed that I'm a retired Veterinary Technician and I brought more info than the human-side doctor. I do hope that even though they were recording his vital signs every 5 minutes they were watching them constantly. Anesthesia is not a joke.

    • guest

      According to your post they gave this guy as much anesthesia as you would have given to a 25 pound dog. That seems to automatically rule out any type of neglegence. The patient looks like he's easily 200 pounds.

      • Anonymous

        What's good for a dog may not be good for a human, hence the "dog" dosage…if humans don't have a set dosage for a drug than they shouldn't use it!

      • Prayers4Marek

        he was given more than 40mg, the article states he was given 40g after he started coughing. he had already had anesthesia in his system prior to this.

      • Anonymous

        It has to do with that if dogs have a set dosage for Propofol, humans do too. You don't fill up a syringe and just push it. I don't know how this poor man died and that is not the point of the comment. Lying about a drug to people who read this and don't know any better is ridiculous.

        • Dr. Hibert

          You can't seriously infer anything about human medicine from animal medicine. Honestly, anyone talking about anesthesia who is not a medical doctor of HUMANS is absolutely talking out of their a**. That's not to say that doctors are omnipotent, but only their peers are qualified to scrutinize their work

          • Anonymous

            Well if that's how it is I definitely won't be asking for the services of you, dr. Bombay or dr. Liar…and won't be watching Fox News, they apparently don't fact check.

          • Anonymous

            It's funny that you say I'm talking out of my a** when I knew there was an ACTUAL dosage…you're incredibly arrogant and just because you treat humans doesn't make you any better than anyone else.

          • Dr. Dre

            Hmmm…. I seriously question these posters' "medical" expertise and/or reading comprehension. Did you stop to think that

            “There’s not a specific dose that’s given that’s individualized per patient,”

            Means that there is no set amount written in a book, that the dosage during the procedure varies based on constantly changing parameters, such as blood pressure, oxygen saturation,, respiration, etc, etc not just fixed variables such as age and weight. Obviously he was not saying that the doctor just guesses and throws however much in he feels like as you all seem to think he was implying by this statement
            Maybe when when performing surgery on a cocker spaniel a set dose is standardized, but I'm sure those years and years of high level training and school have something to do with the job of an anesthesiologist more than just reading a number and pressing a button.

  • guest

    It's about time some credible reporting was done on this story, versus the sensational misinformation that came out initially just to make headlines at the expense of people's lives. We need to remember that real individuals are involved.

    • Prayers4Marek

      i think the reporter is doing a good job at presenting what little information is available at the time.

  • Anonymous

    My condolences go out out to everyone involved. It is difficult to “arm chair quarterback” such a tragedy and we should wait for results of investigation. I would like someone to question why it is legal for an oral surgeon in California to perform a surgical procedure and provide anesthesia at the same time. This happens in no other medical specialty. You can not concentrate on a surgery and seriously monitor a patient. How many more patients will we lose before this archaic law is changed? I can only recommend you have any procedure with anesthesia be performed in a setting that has either an Anesthesiologist or a Certified Registered Nurse Anesthetist on staff who NEVER leaves your side. I do pray for the family.

  • Guest

    The recommended induction dose is usually 2mg/kg for intubation. So 40mg isn't that much, unless he had other agents on board. This sounds like a lack of monitoring issue. The standard of care is the use of CO2 monitoring in the state that I practice. Not just sat and EKG monitoring. Also, the use of propofol is not usually indicated for wisdom teeth extraction. An anesthesia personnel should be the ONLY person that pushes propofol. I guess we make it look easy!!! So sorry for his family's loss.

    • Guest

      You may want to reference the ASA's position on the administration of propofol by non-anesthesiologists. There are exceptions, one of which is the oral and maxillofacial surgeon. Propofol is routinely used, with the utmost of caution, during wisdom teeth removal. No one wins when there is an anesthetic tragedy, and being judgemental of one's ability or inability certainly doesn't help alleviate the family's pain.

  • Dr. Smith

    Tragic. Just Tragic. Always, and I mean ALWAYS insist of having a PHYSICIAN ANESTHESIOLOGIST responsible for your anesthetic care. Accept no substitutes.

  • ENT MD

    And what happens when an anesthesiologist cannot intubate and insert an airway?? They call a surgeon to perform a surgical airway that they are not capable or trained to perform. So I guess if an anesthesiologist cannot deal with any possible complication, then he/she should not intubate anybody. This is the same assinine logic as the comment that only anesthesiologists should perform any form of anesthesia. MAC anesthetics or moderate sedation is performed daily by oral surgeons that have to constantly monitor their sedatied (not paralalyzed under general anesthetic) patients. Stop the holier than thou BS. I cannot count how many times I have witnessed an anesthesiologist or CRNA in the OR reading a freakin book or magazine during a case. Unless you stare at the monitor for every minute of every case then shut up. This guy has a general anesthesia permit, a DDS, and an MD just like you. It looks like he has remarkable training from a top dental and medical school. Attacking other medical professionals makes you look like an insecure fool Dr Smith. Where did you go to med school, the Carribean?

    • Dr. Smith

      Again, what a tragedy and my heartfelt sympathies go out to anyone affected by this.

      Did not mean to strike a nerve or inflame, ENTMD. I see these sort of cases too often. There are countless more "near misses" anesthetic misadventures that I review that never make the press, of which >90% involve anesthetics administered with an physician anesthesiologist on premises or supervising the anesthetic. Sadly, and hopefully (not knowing the full details of what actually happened), this shouldn't have been and can't intubate can't ventilate situation. (ASA 1 pt seeming young healthy and prob MP 1 or 2). BTW, for me, I am fully trained to handle an emergency cricothyrotomy, TTJV, etc as a surgical airway (although I pray I never have to). And I'm not questioning the training or credentials of the dentist, but propofol is a very dangerous agent. Unless you are routinely handling propofol related resp depression and airways, things can get out of hand very quickly. Just because he is credentialed in endotracheal intubation, doesn't necessarily mean he is Proficient in it. Light to moderate sedation is usually not too much to handle for non anesthesiologists. Deep sedation, however, is a whole new ball game. BTW, I don't stare at the monitor every minute: I watch my PATIENT every minute. Not attacking other professionals here..merely stating that you cannot replace the experience, safety, and expertise a board certified anesthesiologist brings to the table.

  • AnesRes

    ENT MD, you're clearly delusional. I am an anesthesiology resident and we are we are extensively trained in surgical airways. Next, you don't have to stare at the monitors. The pulse oximetry has alarm settings and variable tones depending on the patient's degree of saturation. Listening is key.

    What this tragic case highlights is the high degree of variability among individuals for sedation requirements. Proper continuous monitoring and experience using these agents is a must.

    Lastly, what surgeons consider MAC is often full on general anesthesia without a secured airway.

    And if you're wondering ENTMD, I'm Ivy educated. Thanks.

  • Guest

    AnesRes – Stay in school and keep studying! Yes Pulse Oximeters have alarms – but you're not supposed to trade reliance on an alarm for patient monitoring. I can't tell you how many times I've read treatment reports where the alarm was turned DOWN! or slipped off the finger!

  • Brian

    Sharon

    Has there been any updates on this lately? It seems like the story just stopped getting press a few months ago. I am interested in the autopsy results to see what actually happened.

Comments are closed.