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CHICAGO - An assistant to the Chicago dentist whose 5-year-old patient died after a routine procedure testified Monday that the dentist gave the child a third dose of valium because she would not calm down.

It was that third dose that put Diamond Brownridge in deep sedation and caused her to stop breathing on Sept. 23, prosecutors say.

"She was telling her mom not to leave. I remember her mom petting her," said Maribel Robles, who was assisting the dentist during the six-tooth operation to fill cavities and place caps. "She was still crying - moving around and kicking. I remember Dr. (Hicham) Riba said he'd have to give her more if she didn't stop."

The kindergartner slipped into a coma and died four days later. The Cook County medical examiner's office ruled she was killed by a lack of oxygen caused by anesthesia.

Robles testified at a state licensing hearing where an administrative judge for the Illinois Department of Financial and Professional Regulation will determine whether Dr. Hicham K. Riba can return to his practice.

More details have emerged of what occurred at Little Angel Dental through testimony from Riba, two dental assistants present during the operation, an anesthesia expert and the state investigator.

Defense lawyers have said that Brownridge could have had a medical condition that contributed to her death, and that Riba may have made a mathematical error when he administered the sedatives.

Dr. William Flick, an anesthesia specialist, testified Monday that the amount of Valium the girl received was too much for someone weighing 35 pounds and that her vital signs were not properly monitored.

Riba recorded in an anesthesia report that he gave Brownridge 17 mg of Diazepam, or Valium, both in pill form and intravenously, between 9 a.m. and 10:05 a.m. A patient of Brownridge's size should not receive more than 5 mg of the drug, Flick said.

The Illinois Dental Practice Act mandates that a patient's blood pressure, pulse, respiration and level of oxygen in the bloodstream be monitored and recorded before, during and after sedation.

Riba and his two dental assistants said the girl's blood pressure was not taken at any point and her pulse and respiration were observed but not recorded on treatment reports. The level of oxygen in her blood was recorded during the procedure, but the machine that displays the reading was removed from Brownridge's finger after the operation.

Brownridge, still unconscious, was then left alone with a dental assistant who was instructed to pinch the girl's neck every few minutes to try to wake her, the witnesses testified. When the dentist returned 10 minutes later and pinched the girl, her body did not respond. Riba then performed CPR and asked staff to call 911.

Flick, an oral surgeon and assistant professor at the University of Chicago, on Friday said that Riba's actions during Brownridge's operation were "gross negligence" and "a danger to the public."

The day of Brownridge's operation, Sept. 23, was Maribel Robles' third day at the dental clinic, she said. Robles, a certified nurse assistant, said she had never used a pulse oximeter, which measures a patient's pulse and oxygen level in the blood, before and did not know how to measure a patient's breathing.

The second dental assistant, Zoila Ocampo, who could not identify a stethoscope during the hearing Friday, had no formal medical training beyond a Red Cross CPR class at the clinic. Ocampo testified that she did not take the girl's pulse or check her breathing while the two were alone in the operating room after the procedure.

State investigator Pete Vasiliades said an autopsy report has not been released, but it's expected in the next week. The dentist's actions are still being investigated, he said.

The hearing will continue Wednesday morning. A decision is not expected for several weeks.

Distributed by McClatchy-Tribune Information Services.

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