Dentists at San Quentin Say Their Pleas to Reduce Risk of COVID-19 Spread Were Ignored

In its report, Cal/OSHA wrote that San Quentin dental staff were being asked to perform “high-hazard” dental procedures that generated aerosols, or fine airborne particles, without the protection of specialized equipment, in locations that did not adequately limit the spread of airborne infections. (Justin Sullivan/Getty Images)

Dentists at the San Quentin State Prison clinic said they’d been pushing for crucial workplace safety improvements for months before state regulators intervened and shut down key operations.

Regulators with the California Division of Occupational Safety and Health (Cal/OSHA) had posted a red tag Wednesday at the clinic, declaring certain parts off limits and certain procedures as “dangerous.” Regulators said the hazardous work conditions “contributed to the spread of SARS-CoV-2 in the workplace.”

San Quentin has seen the largest coronavirus outbreak in the state prison system. More than 2,200 people incarcerated there have tested positive for COVID-19 and 26 have died from the virus. More than 270 staff have been infected and one has died, according to the California Department of Corrections and Rehabilitation (CDCR).

The dental clinic, which treats people incarcerated at the prison, employs six dentists, three of whom agreed to share their concerns with KQED on the condition that they not to be named, for fear of losing their jobs.

The dentists, who are members of a public policy committee for the Union of American Physicians and Dentists, said San Quentin officials had repeatedly failed to address their concerns about the risks of spreading COVID-19 through dental exams and procedures.

“I could not trust my job to keep me safe,” one of the dentists said Friday. “I was terrified of bringing it home.”

A few days after statewide shelter-in-place orders were imposed, the California Dental Association issued guidance that dentists should immediately suspend all non-essential, non-emergency procedures for the next 14 days.

At San Quentin, however, the dentists said their supervisor ordered them to continue routine screenings of inmates transferring in from county jails, a task that entailed putting dozens of men together in holding cages and checking each person for broken jaw bones or signs of infection. Adding to their concerns, the dentists said incoming inmates were not being quarantined upon arrival for 14 days at that time.

“Just looking in their mouths is putting us at risk,” one dentist said. “We were just told, ‘Do your job.’ ”

On March 23, all but one of the San Quentin dentists refused to do the screenings.

One day later, on March 24, the head of dentistry at CDCR adopted a new policy to end non-urgent dental screenings.

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Nonetheless, a month later, the dentists who had refused to do the screenings said they were “written up” for defying orders, a first step in a progressive disciplinary process that can lead to a cut in pay or termination.

Some of the dentists said they were also disciplined for questioning the prison’s COVID-19 safety guidelines.

“We have a saying down there [in dental],” one of them said. “You want to get a write up? Ask a question, especially one about safety.”

Some of the questions the dentists said they asked included, “We don’t know what the level of filtration is for the air in the dental unit. Can you evaluate these rooms? Do we have proper ventilation? What is our risk?”

One dentist said, “They tried to muzzle us!"

In an email last Friday, CDCR spokeswoman Dana Simas called the health and safety of employees the agency’s “top priority.”

Simas said prison officials will work closely with the Department of Industrial Relations, Cal/OSHA's parent agency, “to fully explain all of the actions San Quentin's Dental Program has taken during the COVID-19 pandemic and to directly address OSHA's concerns.”

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Many emergency or urgent dental procedures, such as tooth extraction, involve drilling and spraying water and air inside a patient’s mouth and can produce droplets that can spread and infect others.

All three dentists who spoke with KQED said their repeated requests for better safety equipment protections were ignored or refused.

The dentists said they asked for specialized masks called PAPRs that include respirators to purify air for the wearer, but were told to make do with N95s.

They also asked for an auxiliary air filtering device that suctions and disinfects exhaled air from a patient’s mouth.

And they asked for air scrubbers to clean the air inside the dental clinic and prevent potentially infectious particles from being recirculated to the rest of the prison.

None of those requests were honored, they said.

“We went through this whole crisis at San Quentin and they didn’t give us one damn additional piece of equipment,” said one dentist.

In August, a Cal/OSHA inspector arrived at the dental clinic and started asking questions.

In a report last week, Cal/OSHA wrote that dental staff were being asked to perform “high-hazard” dental procedures that generated aerosols, or fine airborne particles, without the protection of specialized equipment, in locations that did not adequately limit the spread of airborne infections.

Cal/OSHA issued an Order Prohibiting Use, directing the clinic to stop all dental work that generates aerosols from a patient’s mouth, including drilling, until the prison can meet a list of safety conditions.

CDCR immediately requested a hearing, but after meeting with Cal/OSHA representatives Friday, said it is now working with the agency on an agreement.

Cal/OSHA is expected to issue an updated order this week.