Valium / Diazepam News Blog

Records taken from Riba's Little Angel Dental office indicate that the 35-pound girl was "alert and responsive" when she was discharged at 10:30 a.m. Sept. 23.

State investigators said in the report, however, that Diamond's mother found the girl in a comatose state at 10:45 a.m., lying on her side in the dentist's chair.

Diamond was on life support for four days before she died at Children's Memorial Hospital.

A seven-count complaint charges Riba with infractions ranging from unprofessional conduct and making false reports to gross malpractice and incompetence.

Over a 90-minute period on Sept. 23, Riba administered oral doses of Valium in addition to nitrous oxide, according to the state report.

Valium, atropine, Talwin, midazolam, and lidocaine with epinephrine were administered intravenously during the same period, investigators found.

The report did not suggest that the dosages were inappropriate for a 35-pound girl, and experts said the mix of drugs was not out of the ordinary.

Dr. Indru Punwani, head of the pediatric dentistry department at the University of Illinois at Chicago, said his familiarity with intravenous sedation was limited, and he would not comment on this incident.

But he said it was atypical for dentists to use IV sedation on small children for a routine procedure such as filling cavities and placing caps because there is little margin for error.

Diamond was taken to Riba's office in the Little Village neighborhood for a combination of six fillings and caps.

"In a very young child, finding a way to administer intravenous is somewhat challenging," Punwani said. "This is a very young, very lightweight baby. You have to be really skilled. A little bit can move the child from what you are targeting to be to a lower level or higher level."

It is more common to use oral sedatives when treating small children, or respiratory sedatives, such as nitrous oxide, which leave the child moderately sedated, Punwani said.

Using oral or respiratory sedatives lets doctors speak with young patients, and children can respond to prompts such as a pinch, he said.

It was too early to say what went wrong last weekend in Riba's office, however, and Punwani stressed that Riba may be very skilled in IV sedation.

Diamond had been sedated heavily for a broken arm in April with no ill effects, her mother told the Tribune in an interview last week.

State officials and medical experts stressed that parents should not be alarmed by the incident because such deaths are "highly, highly uncommon."

"Moderate sedation is a very routine procedure that is carried out in thousands of offices every day very safely," Punwani said.

State officials also stressed that the investigation is focusing on Riba's actions, not sedatives that are widely used by dentists nationwide.

"The investigation is twofold and we first determine if there was a violation of practice," said Sue Hofer, spokeswoman for the state Department of Financial and Professional Regulation. "... Beyond that we determine if the infraction poses an imminent threat to the public and if it does, we suspend the professional."

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