Posted by: Kate | November 4, 2009

Formal Complaint

November 4, 2009

Dr. Jeffrey M. Casiglia, DMD DMSc
Essex Street Dental Medicine
398 Essex Street
Salem, Massachusetts 01970

Dr. Casiglia:

I am writing to express my complete disappointment and extreme frustration following the interaction I had with your office manager, Lucy Poulin, and yourself, on the evening of Tuesday, November 3, 2009. I cannot consider any aspect of that evening to be a success, and the problems I had fall into three categories: poor communication, personal insensitivity and disrespect, and blatant violation of medical and personal privacy.

I will enclose, as an attachment, a recounting of my recollection of the evening’s events, so that you can have a reminder of your own actions and a debriefing on what occurred when you were not in the room. I am not interested in engaging in a debate as to your refusal to provide medical treatment to me, because I am no longer willing to be a patient under your care. Therefore, the intent of this letter is not to beg you to reconsider; it is to clarify the egregious errors and blatant disrespect displayed by yourself and your office manager.

First, there were many instances of poor communication. During my initial telephone call to the office, I spoke to Ms. Lenka French, and was clear and explicit in my explanation that I suffer from a severe dental phobia and have intense difficulty attending any part of the normal dental office routine. She acknowledged this statement, and my subsequent description of my typical follow-up care, which involves general anesthesia with a certified practitioner of both anesthesia and dental medicine in Hampton Beach, New Hampshire. Clearly, you and Ms. Poulin knew about this conversation, as it was the stated basis for your decision to decline care for me and to initiate the confrontation on Tuesday evening. However, you both changed our stance repeatedly, at times making reference to “your dental phobia” and at other times denying any knowledge thereof. I also found it impossible to complete more than one sentence at a time, because I would immediately be interrupted. Even before Tuesday’s face-to-face encounters, my husband and I found the telephone communication from your office to be confusing and ineffective, with multiple appointment-confirmation calls and conflicting responses around times and policies.

Second, a shocking level of personal insensitivity and disrespect was displayed by both yourself and Ms. Poulin. I was clearly in a heightened state of agitation and dismay, and yet you each continued to talk at me and defend yourselves. I had to physically leave the building, twice, because my efforts to ask for some time and space to calm myself inside were unsuccessful. I am several months pregnant, had informed you of this fact both in writing and during the initial telephone call, but apparently my physical condition and emotional state were not sufficient reason for you to volunteer to get my husband to come help me. In fact, you both attempted to refuse my direct requests that his exam be cut short, and I had to walk back and notify him myself, causing him an undue level of concern for my physical well-being.

Third, and most pertinent to your professional practice, my privacy rights under HIPAA were blatantly, repeatedly violated. Conversations regarding my private medical and emotional history were initiated by Ms. Poulin in the public waiting area, and my initial request for privacy was declined. After a second request on my part, she agreed to take me to a different part of the building to talk, and chose a room that was inhabited by another patient at the time. References were made to my psychological history, to my planned dental care, and to my present state of mind, all in the hearing of at least two patients or patient family members and my own children.

I understand and accept that you have the right to refuse to provide care if you do not agree with the method of treatment that I am requesting. This is not, and never was, the basis for my disappointment with your office. I am providing feedback about the first two categories of problem, above, because I feel the actions were outrageous and that I deserve to express my response to them, something I was unable to do at the time. I am providing feedback on the third because I have extensive familiarity with the HIPAA laws and have already initiated a formal complaint regarding the invasion of my privacy.

I am not yet able to assess the extent to which your treatment of me, yesterday evening, damaged the hard work I have done and the progress I have made toward upholding a more traditional regimen of dental health care. I also cannot yet determine the level of harm that was done to my children, to see their mother in such an unpleasant and uncontrolled state. Up to now, I had worked hard to shelter them from my fears, and I was proud of the fact that they are comfortable visiting their own dentist.

At the moment, I can only be sure that I am deeply hurt and upset by the events of the evening.

Katherine W.

cc: Better Business Bureau, OCR Region I

At 6:15 p.m. on the evening of Tuesday, November 3, 2009, my husband Willem was in your office to attend his initial examination. My children and I arrived shortly after he did, and planned to remain in the waiting room during his appointment. Upon our entry, Ms. Poulin arose and began speaking to me from behind the counter. She did not identify herself or make any attempt to lower her voice or move the conversation to a more private area. When I acknowledged my name, she walked into the room and asked if it was true that I planned to have any fillings or more extensive work performed by a different dentist. I said that this was, tentatively, the plan, but that I couldn’t know the full plan until I had seen the dentist for an initial consultation.


She stated that I could only be seen in your office if I was prepared to allow you to perform any and all necessary procedures. I was surprised, and explained that while my circumstances were out of the ordinary, I had never had a problem with this at any prior dental offices. We had a brief interaction in which she demanded to know why I was seeking this unusual approach to dental care, and she interrupted me several times. At least twice, she made reference to “your phobia,” but then later stated, “We didn’t know you had a problem.” She carried on this discussion in full view and hearing of my two young children and another woman in the waiting room.

When I was able to intervene, I requested that we move the conversation elsewhere. She stated that there was nowhere more private that we could go, but then led me through a door and into an examination room containing two dentist chairs. One was occupied by another patient, and the other was unused. She then attempted to repeat the previous discussion, despite the fact that there was no more privacy or discretion there than in the waiting room. It was at this point that I was overcome by a complete panic attack, including hyperventilation, nausea and incoherence. I left the building as quickly as possible and spent several minutes outside.  No one made any effort to check on my well-being during this time.

Upon my return to the office, I approached Ms. Poulin, and stated, “I think you’re right. This office is not interested in my business. Please return our paperwork and let my husband know that it is time to leave.” She relinquished my forms, but stated that she could not return my husband’s forms to me and that she would not inform him of what was happening, because he was in the middle of an exam. I felt that my extreme emotional dysregulation was adequate reason to interrupt, and began walking toward the back of the building. She accompanied me, stopping to talk to a man in an adjoining room. I learned from your website that it was you, but you were never introduced or identified to me. Neither of you spoke to me, and so I said my husband’s name once and told him I needed to leave. He was able to join me immediately, because the x-ray machine was malfunctioning and thus he was not actually in the middle of an exam. After an extremely uncomfortable and ineffective exchange at the desk, in which you repeated many of the things Ms. Poulin had stated earlier – again, all in clear earshot of my children and of at least two strangers and another staff member – and had to be reminded by me that I was in no shape to be carrying on a conversation at that time.

We left the building, and I returned to our vehicle with the children. My husband returned, in an effort to gain clarity into your decisions, both regarding my care and regarding my treatment by yourself and your office manager. He was unsuccessful in this effort, instead finding you to be defensive and uncommunicative. At one point, you made a dismissive reference to my mental health, suggesting that my phobia was probably related to something in my childhood, and later stated that whomever I subsequently tried to see, I should ask for an initial consultation before an intake examination. Apparently this is not a service you were willing to provide, yourself, despite the fact that I had been clear about my extreme dental phobia from the first phone call.

You continued to refuse to return my husband’s paperwork, stating that he was considered a patient now and you couldn’t relinquish his medical records. You did concede that charging him for his appointment would be inappropriate, and he left the building for the last time at approximately 6:45 p.m.



  1. Wow. Just, wow. I hate that you had to go through this but I am SO incredibly proud of you for standing up for your rights.

  2. Holy crap. What kind of an office is that? They actually have other patients?? Good for you to carry through with your complaint – I’ll be anxious to hear how they try to resolve it, or if they do!

    Big hugs & deep breaths!!

  3. Oh my gosh. I am glad you’re pursuing all avenues of complaint; what they did wasn’t just insensitive and unprofessional, it was also ILLEGAL, and I hope they’re held accountable. Big hugs to you – what a terrible thing to have to endure.

  4. I am just stunned. My neighbor says her new mantra is “What is wrong with people?” and I’m beginning to chant it, too. What is wrong with people.

    You would think that a reputable dentist’s office would be sensitive to the needs of a patient with fear of the dentist. You can’t be the only one they’ve ever seen who has it. Sheesh.

  5. When I was pg with M, something vaguely similar happened (though not nearly as awful). I was 8 or 10 wks along, early enough that not many people knew, including our families, since we were waiting until the 1st trimester was over. At the dentist’s office, I told them b/c I didn’t want x-rays. A few days later, my FIL was in the office and the hygienist said something to him about my being pg! Imagine finding out your son is expecting his 1st baby from the DENTAL HYGIENIST. Argh.

    I know it was an honest mistake, but still. And what really pissed me off was that a week later, when I was back to have a cavity filled, she was dancing around the subject, as if she was trying to figure out if I knew she’d spilled the beans or not. I never pursued it as a HIPAA violation, though I felt sure it was one, and I’ve regretted not doing so ever since. At the very least, I should have complained to the dentist and encouraged him to give his employees a refresher course in HIPAA policy and how violations look in the everyday world. Now I’m mad about it again! 🙂

  6. I am so very sorry. Acceptance of psychological problems is spreading through “regular” medical circles, but sometimes, there’s a complete failure of procedure. I don’t think they understood the extent of your dental phobia (not something that can be overcome with half a valium), but I also think that the way they handled the situation when the extent became clear was acceptable in any way.
    Hug your children. Take care of yourself. Keep looking for a great dentist — they are out there.

  7. I thought we own our own records. They would’nt release your husbands paperwork? Why would they want it. What dinosaurs.
    Is this the dentist your last dentist recommended?
    How will you find someone with modern techniques?
    I wish we all could write letters heaping coals upon this office of medieval torture.
    I scrape sand over them and wish them root canals.

  8. Most excellent letter in re: a HORRIBLE situation. Sending you warm energies!!

  9. Outrageous and beyond nightmarish! Please spread the notice far and wide so that they receive some consequences for their actions!

  10. Please tell me you are filing a formal complaint with whoever regulates HIPPA compliance in your area, and with the Dental Society. Creeps like this don’t stop without a blow from a symbolic 2×4.

  11. Dude, just….. get em’, will ya?

  12. So sorry you and the whole family had to go through that! What a bunch of jerks!

  13. Oh please get them for me! We had a similar horrible experience for my 10 year old son.

  14. Yikes. Hugs.

  15. I am so sorry, what a horrendous experience. Completely unprofessional behavior on their part.

  16. Good grief, they sound like total shits. HIPAA aside, just basic decent common sense should have told that woman that you don’t discuss people’s private affairs with an audience. Geez.

    Great letter, I bet you will get some results.

  17. Once again I am stunned by how well you convey an experience with your writing. It leaves me speechless. And envious. Incredible letter about a horrendous confrontation…..too bad dummy dentist won’t get the subtlties.


  18. Wow. Sounds like someone’s practice needs an intensive HIPAA review.

  19. I. Hate. Dentists. ❤ ((Kate))

  20. ugh. I’m sorry that happened to you. Communication skills are in a sad state in the medical community. I’m still in a bad state emotionally from my own experience with my Ob’s office and from my hospital stay. Good for you for making a formal complaint.

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