Dr. Blake C. Wullbrandt

Dr. Blake C. Wullbrandt speaks with his lawyer, Cinde Warmington, at Friday's hearing before the N.H. Board of Dental Examiners in Concord.

CONCORD — The N.H. Board of Dental Examiners heard testimony Friday involving allegations of professional misconduct by a Keene pediatric dentist.

The allegations against Dr. Blake C. Wullbrandt include claims that he overused physical restraints, performed too much dental work in single appointments, kept deficient records and obtained insufficient informed consent for some procedures at his practice, Children’s Dental Care on Railroad Street.

The N.H. Board of Dental Examiners outlined the allegations in an August notice.

Friday’s day-long hearing was occupied entirely by the testimony of Dr. Nilfa Collins, a pediatric dentist and dental board member who recused herself last year to serve as an investigator in the case.

The board is determining whether Wullbrandt committed professional misconduct and, if so, what sanctions are warranted. The hearing will continue Dec. 2, when Wullbrandt and other witnesses are expected to testify on his behalf. Wullbrandt declined to comment on Friday’s testimony.

Wullbrandt’s New Hampshire license to practice dentistry was issued in 2001.

The dental board began its investigation after receiving a referral from the N.H. Attorney General’s Office’s Medicaid Fraud Control Unit in March 2018. The office was investigating possible “abuse/neglect” of patients at Wullbrandt’s practice, according to letters sent to parents in 2017, but closed its inquiry without criminal charges.

In conducting her investigation for the dental board, Collins testified that she had reviewed patient records, billing records, statements by parents and other materials.

She said she found deficiencies in Wullbrandt’s recordkeeping in multiple cases. She testified his clinical notes would mention that a papoose board — a type of physical restraint — was used, but not why or for how long. There were similar gaps in notes about the use of nitrous oxide, a mild sedative, and some records omitted x-rays that had been performed, according to Collins. The prevailing best practices call for those things to be recorded, she said.

Informed consent — parents’ understanding and agreeing to the procedures the dentist will use — was not always documented, she said.

Collins added that during a May 2019 visit to Wullbrandt’s office, she reviewed more recent records and found “a huge improvement.”

“The correct consents were obtained,” she said. “… It looked like he was doing what he was supposed to be.”

One of the allegations in the August notice is overuse of the papoose board. The American Academy of Pediatric Dentistry’s standards say dentists can use restraints, or “protective stabilization,” to keep a child from moving around too much during a procedure. Collins said when a papoose board is used, it should be only for a short time.

Janice K. Rundles, an attorney with the state’s administrative prosecutions unit, asked if Wullbrandt was restraining kids with the papoose board for too long.

“I can’t be a judge of that because he didn’t write down how long,” Collins said. But based on the amount of work performed on some patients, she said, she “can’t see that being a short amount of time.”

She said that, according one mother, a child ended up with “scrapes and broken skin” on her hands and wrists. In response, according to Collins’ testimony, Wullbrandt acknowledged that the papoose board can cause “rugburn-type injuries.”

Rundles asked about appointments with seven different patients between July 2014 and June 2017. Collins said she judged the amount of work Wullbrandt did during each of those appointments excessive, including a 2-year-old who received crowns on 12 teeth and four pulpotomies — a procedure that involves removing some tissue.

“Just the amount of restorative work just really blew my mind,” Collins said.

Though the current allegations involve incidents after 2013, the board had raised similar issues with Wullbrandt before, according to Collins’ testimony. She cited several “letters of concern” the board sent the dentist between 2006 and 2018 about topics including his use of restraints, recordkeeping and the amount of dentistry work he performed in one appointment.

Beginning after the lunch break, Wullbrandt’s attorney Cinde Warmington grilled Collins for more than two hours, challenging her interpretations of particular records and her conclusions about Wullbrandt’s treatment decisions.

“So that’s your treatment philosophy,” Warmington said at one point, referring to Collins’ contention that too much dental work was performed in some appointments. “And Dr. Wullbrandt’s treatment philosophy is to limit the difficult visits to one longer visit, than to have the child come back multiple times.”

In one appointment, for instance, Warmington said Wullbrandt’s clinical notes show the child got a little fussy but generally behaved well. Warmington pressed Collins on her conclusion that the work went on too long.

“There wasn’t any reason why Dr. Wullbrandt needed to stop,” the lawyer said. “This was — this child did fine.”

“Well, you know what, that’s subjective,” Collins said. “I wasn’t there. I didn’t see.”

Warmington said that in at least some cases, the parents signed off on the treatment plan outlining the procedures. She acknowledged the past issues with Wullbrandt’s recordkeeping but said he always talked to parents and got verbal consent, even where that wasn’t documented.

Warmington also said her client is often referred patients who have extreme dental needs or behavioral issues.

And she contended that parents’ complaints about Wullbrandt were sparked by the publicity around his “struggle with alcoholism,” which came to light in 2017 when the dental board publicly alleged he had practiced while impaired. Wullbrandt later agreed to a one-year suspension of his license to settle the allegations.

“Some parents even said that they are now concerned, now that they read about his alcoholism, they are now concerned about the care that their child had,” Warmington said.

At the outset of Friday’s hearing, Warmington argued that Collins had a conflict of interest because she plans to open a pediatric dentistry practice in Dublin early next year, potentially competing with Wullbrandt’s Keene business.

Collins, who previously practiced in Pelham, rejected the assertion. She said her business plans are unrelated to the Wullbrandt case.

Paul Cuno-Booth can be reached at 352-1234, extension 1409, or pbooth@keenesentinel.com. Follow him on Twitter at @PCunoBoothKS.