BUFFALO, N.Y. (WKBW) — It was September, 2023 when Patricia Pachetti was seen by her dentist, Dr. Richard Charlap, on South Park Avenue in Lackawanna. She was in tremendous pain.
“Tooth pain is the worst kind of pain anyone could feel,” said Pachetti. “I would rather give birth three more times than have a toothache.”
At seven weeks pregnant, Pachetti needed medical clearance from her doctor to pursue treatment. But her doctor made it clear with a note, including special instructions, that the dentist should "refrain from prescribing...epinephrine.”
As far as Pachetti knew Charlap did as he was told when using a local anesthetic. “I was believing I was getting a safe medicine for my child and myself,” added Pachetti.
That was until December, when she received a phone call from a woman named "Carrie," the dentist's now former medical assistant. She informed Pachetti that the dentist gave her exactly what her doctor said she should not have had.
“My worst fear was I was going to call her and she was going to tell me, God forbid, she miscarried or something. But thank God she did not,” Carrie told the I-Team. “But I want to make sure this doesn't happen to anybody else.”
That’s why Carrie said she came forward as a whistle-blower. She was let go from Charlap’s practice in December, after three years of employment. Her time at the practice was coming to an end. The writing on the wall, she said, believing the dentist knew she was on to him.
“We got really into it bad when I realized and confronted him on the fact that he had used -- purposely used -- the wrong anesthesia on a pregnant woman,” said Carrie.
Recording shows dentist admits to using drug against doctor's orders
That confrontation, in part about Pachetti, was something Carrie secretly recorded and shared exclusively with the I-Team.
Carrie: Dr. Charlap, we had a seven-week pregnant woman who had a letter from her OBGYN that we were not supposed to use epinephrine on her and you switched the carpules.
Charlap: No I didn't.
Carrie: Oh you most certainly did.
Charlap: Oh I know exactly what I did Carrie. I know exactly what I did and I know why I did it.
Carrie: So you’re saying I’m stupid.
Charlap: No, you’re right.
Charlap admitted he switched the carpules, little glass tubes, that are put in the injector – giving Pachetti the wrong anesthesia. The audio recording was made three months before Carrie was let go, but Charlap had more to say.
Charlap: Yes I know what I did. Okay? I know what I did, I know why I did it. Do you know why I did it?
Carrie: Why you used epinephrine when the paper said not to? No.
Charlap: Why I used Septocaine instead of Carbocaine, even though you had Carbocaine out?
Carrie: You used Orabloc.
Charlap: That's Septocaine, Articaine.
Carrie: ‘Cause you always taught me with a pregnant person to put the other ones out.
Charlap: Right. That is correct.
Septocaine contains epinephrine. Septocaine's own website explains the product “should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.”
Remember, Pachetti’s doctor said no epinephrine.
Charlap: What I did isn't allowed. Okay?
Carrie: I know.
Charlap: Why?
Carrie: Because the note said no epinephrine.
Charlap: Why?
Carrie: Because she's in her first trimester.
Charlap: Bingo.
Carrie: Right.
Charlap: Okay? But is it going to do anything to the fetus? The answer is no. Okay? They just don't want us taking chances.
Carrie: Right.
Charlap: I used it because it gives a very profound anesthesia which I needed to have or I wasn't going to get the tooth out.
Carrie: Right?
Charlap: Okay. So that's what I used, off the record. On the record, I have no idea what you're talking about.
Documentation troubles
“I was betrayed,” said Pachetti.
But there's another problem. Pachetti requested her medical records after receiving that phone call from Carrie, only to learn the dentist documented using Carbocaine with no epinephrine. But on the tape obtained by the I-Team, he admits to using Septocaine, with epinephrine, contradicting those notes.
Dr. Jay Grossman is a practicing dentist and adjunct professor of dental medicine at NYU. Grossman has testified in more than 1,000 malpractice cases. He has no connection to this story but raises concern about the use of Septocaine with epinephrine.
“If there was a note from the physician, let's say the OBGYN that said ‘patients pregnant, do not use epinephrine’ and he used it, I would say there's a huge chance that there's a breach of the standard of care there,” Grossman said.
“The dentist does not have the knowledge, understanding and expertise of the specialists of the OBGYN,” added Grossman. “So there may be another reason that the gynecologist did not want that patient to have epinephrine.”
I-Team Investigator Ed Drantch: I wanted to give you an opportunity to have your voice heard in this story.
Charlap: No comment, sir.
Drantch: Do you want to talk about Patricia Pachetti?
Charlap: No comment, sir.
Charlap wouldn't sit down with the 7 News I-Team for an interview about the swap in anesthetics, the violation of the doctor's order, nor his documentation. So the 7 News I-Team found him one morning as he was walking into work.
Drantch: Can I play the tape for you where you're recorded saying you switched?
Charlap: I have to go to my office, sir.
Drantch: Do you feel sorry at all for her?
Charlap: No comment at this time.
WATCH: Lawmakers respond to history of legal problems and mistreatment
A history of legal problems, settlements
Charlap’s record-keeping has been called into question in the past. The 7 News I-Team discovered Charlap has been disciplined twice by the New York State Office of Professions. He received a stayed suspension once in 2019, "charged with practicing with negligence on more than one occasion" over inappropriate documentation when he failed to use a dental dam and failed to inform a patient of a perforation.
In 2021, he received a stayed suspension again after admitting to failing to complete "continuing education coursework" in documentation and risk management.
In 2022, Medicaid excluded Charlap from the program as a result of the state's action. "When a provider's unethical behavior warrants their removal from the program they are placed on the exclusion list," the Office of the Medicaid Inspector General wrote – damaging both Charlap’s finances and reputation – considering almost 40% of New York residents are on Medicaid.
“Medicaid is, you know, a government run program, and they have criteria. And one of their criteria is that they don't want to suspend the license,” said Grossman.
But the documentation problems don't stop there. Carrie's son was one of Charlap's patients.
“My son has two bad root canals from him, that he left broken files in. Both teeth need to be extracted,” said Carrie.
You can see the broken file in x-rays included in her son's file. But Grossman said notes of the broken file do not appear in the medical file.
“If this happened in my hands or if this happened in the hands of an ordinary and competent dentist, and the file broke, the protocol is to chart it... is to say to the patient, ‘the file broke.’ It is one of the risks of the procedure, as you know, because we discussed that in consent,” added Grossman. “And we're going to watch the tooth and see what happens. That is something that I did not see in the chart notes.
“So if this was a malpractice case, I would be critical of this dentist for not charting the broken file, because it is evident in the x-ray. So that would be the breach of the standard of care, which is the legal technical term for malpractice that when you see something that is abnormal, you must note it,” said Grossman.
In addition to the state’s disciplinary action against Charlap, he has been named in two malpractice lawsuits in the past ten years. In 2014, he was accused of failing to use reasonable care and precautions in examining, diagnosing and treating a patient. That case was settled.
In a 2019 lawsuit, Charlap is accused of, "negligently and carelessly break, crack, or otherwise damage one of [the patient's] wisdom teeth" without telling the patient "of an attempted but unsuccessful wisdom tooth extraction"-- but billed the patient's insurance for dental work, according to the suit – causing the patient "to expend additional costs relative to his subsequent dental care by other treating dentists and dental offices, and resulting in denial of benefits from his insurance carrier."
The patient, according to the lawsuit, was painfully and seriously hurt. That case was also settled. Despite all of this, Charlap is still seeing patients.
Hope for state investigation and action
“I want him investigated. I want his records gone over. I want him inspected,” said Carrie.
Carrie said she's submitted complaints to multiple oversight agencies, including the Office of the Medicaid Inspector General and the state education department about Pachetti’s care.
“What he did to Patricia was the final straw because it's just horrible that a human being could do that to another human being and care nothing about a life, about a fetus, about a life, about this girl that tried so hard to get pregnant and he didn't even care,” added Carrie.
Charlap: But is it going to do anything to the fetus? The answer is no. They just don't want us taking chances.
“As a trusted healthcare provider, you're not supposed to do anything to cause harm to a patient. Why would you do that,” questioned Pachetti. “I feel like his license needs to be stripped away from him because if he's done it to me, he's done it to other people.”
Pachetti said her pregnancy is going well and she’s looking forward to her son having a sibling. But if not for Carrie recording that conversation with Charlap, she feels he would not have been exposed for treating her against doctor’s orders.
“I just can't thank her enough for reaching out to me, being honest and giving me everything I'm aware of now and walking down this hard road with me,” said Pachetti. “It's scary and I'm glad I don't have to do it alone.”
New York State keeps complaints against licensed professionals secret until there is action taken by the Board of Regents. So there's no way to find out how many other complaints there have been against Charlap, that did not result in disciplinary action.
The I-Team also contacted the education department to understand why Charlap was given "a stayed suspension" – allowing him to continue practicing rather than suspending him altogether. They did not return our repeated requests for a statement.
Finally, the I-Team also learned the New York State Attorney General’s “Medicaid Fraud Unit" knows about Charlap, settling with him over a billing issue with a patient. That settlement was for almost 30-thousand dollars.
It remains unclear if the state will investigate this latest incident.
Ed Drantch is an Investigative Reporter for WKBW.
Have a tip for the I-Team? Email them at iteam@wkbw.com