As we first reported back in June, a mobile dentistry operation is being sued by an Arizona family. They allege their special needs son received unnecessary dental work at school.
Tonight, we revisit the Gagnons, to see how their son Isaac is doing, and update a case that may have already forced the state to make changes in the way dentists do business.
The first time we met the Gagnons, Isaac was kept from our cameras because they might scare him.
This time, we got a chance to watch Isaac color a picture for his friend's birthday party.
Isaac gets night terrors after what happened to him.
"He was diagnosed with post-traumatic stress disorder… he was a very fragile emotionally child in the first place," says mom Stacey Gagnon.
Fragile in the first place because Isaac was adopted after surviving severe shaken baby syndrome.
"He was horribly injured as an infant including five skull fractures."
But Isaac had come a long way with the Gagnons.
"We saw this little boy emerge who loved tractor trucks and run and play in the dirt."
That ended about a year ago.
"October 4th, Isaac was seen by a dentist at school," says dad Darren Gagnon.
A dentist from Big Smiles, a part of Reachout Healthcare America, treated Isaac inside his school's art room.
"He says you know the dentist man got me… we didn't know what had happened."
Reachout paperwork in Isaac's backpack showed the boy had been given two pulpotomies - or baby root canals - and 10 X-rays. Something his parents say they never approved. Isaac's mother called Reachout for an explanation.
"They told me it was a training error on their part," says Stacey.
Everything the Gagnons allege is part of this lawsuit they filed against Reachout, Big Smiles, and two dentists.
It alleges among other things, battery, fraud, intentional infliction of emotional distress and racketeering.
"We found out from the school they had actually held Isaac down for somewhere in the neighborhood of 40 to 45 minutes, that they physically restrained him to do the work on him because obviously he was in a lot of pain," says Darren.
The two dentists named in the lawsuit include Doctor Ralph Green who works at Reachout Corporate offices in north Phoenix -- and Doctor Alvin J. Coon, who performed the work on Isaac.
Doctor Coon, along with Reachout Healthcare America, filed for dismissal of two of the claims. But last week, a superior court judge denied the defendant's motion to drop fraud and racketeering charges.
"We felt like we needed to try to do something to draw some attention to this company," says Darren.
Since Isaac Gagnon received his dental work at school, the law in Arizona concerning parental permission has changed.
"There is a specific requirement in the law now that informed consent must be given and it must be related to the specific procedure proposed being provided to that child," says Kevin Earle, director of the Arizona Dental Association.
"The new consent requirements have to tie that consent to the specific procedure that is being proposed for that child."
Now, according to Earle, dentists have to get permission for each specific treatment before any dental work is performed -- permission on paper or over the phone.
"If it is done over the phone it has to be recorded and maintained as part of the patient record."
This is the latest parental permission form from Reachout Healthcare America. It lists several procedures in a single paragraph - the parent signs below. But is this enough to satisfy the new law? According to Earle it does not.
"This would be considered an improper consent form based upon the requirements of the new law."
When asked for comment, Reachout attorneys said their form does comply with Arizona law.
They also gave us this statement: "More than 16 million children in the united states go without even the most basic dental care. Reachout Healthcare America is working to address this crisis by connecting underserved children with independent dental practitioners who provide comprehensive care in a school environment."
Recently, we watched as Reachout dentists visited two Phoenix inner city schools. First, Dunbar Elementary, part of the Phoenix Elementary District.
We watched from a distance as dental assistants wheeled their equipment into the school
Then it was Glenn L Downs Elementary on 47th Avenue, part of the Cartwright School District. More dental assistants heading in to see children.
Some of the kids, waited their turn, on the playground.
"Part of our concern about some mobile dentistry providers is they target schools where there is a significant Medicaid population," says Earle.
Why would some mobile dentists target schools with low income families? The parents pay nothing - Reachout bills AHCCCS - Arizona's indigent health care system. Taxpayers foot the bill.
As for the rest...
"There's a significant amount of children who do not qualify for AHCCCS and they don't get seen."
The Arizona Attorney General's Office says it is investigating one dentist associated with Reachout Healthcare America -- and that it is also assisting AHCCCS while it investigates Reachout itself. They declined to say more.
Reachout insists its dentists do not work "for" the company, that Reachout only schedules school visits, and takes care of the paperwork including Medicare billing. Reachout says the dentists are paid by Medicaid.
"This is about trusting doctors and dentists with your kids," says Stacey.
In the meantime, Isaac Gagnon's night terrors continue.
"He was medicated with anti-anxiety and anti-depression medication to try and help him because he didn't want to go to sleep at night."
The Gagnons wait for their lawsuit to be heard.
"What happened to Isaac was unconscionable," says Darren.
Kevin Earle says the Arizona Dental Association is working with the State Dental Board and state legislators to make further improvements in the parental consent law.
He says the intent is still to make sure each specific procedure being offered is communicated to and approved by the parent.
Follow this story: Dentists performing unnecessary work on kids to cheat Medicaid