NEWSLETTER
problem. The patient may deny that you told them about the
problem but it is more difficult for them to make that argument if
the records clearly delineate the problem.
VOLUME 28, NO. 3
July-August 2013
Now, how is the patient going to feel after you started a procedure
and charged out a fee, only to have them be sent to a specialist who
will also have to charge them? Often, the best way to solve such a
fee issue is for the referring dentist to cancel his/her fee and have
the patient simply pay the endodontist one time for the procedure.
It helps if you have established a prior excellent relationship with
the endodontist as he/she may then be more willing to help calm
the patient down if they are upset over having to be referred as they
expect to have to pay more money for the procedure. The patient
may also wonder why they were not referred in the first place so
the referring dentist may have to be prepared to answer that
question. If the endodontist has to perform an apicoectomy or an
extra procedure that would not have been required had the patient
been referred to begin with, it may be necessary to add that into any
refund that may have to be made.
Over 30 years of serving the profession
pie@pieutah.org
www.pieutah.org
ONLINE EDITION
A PLAINTIFFS’ LAWYER SPEAKS!
PROBLEMS ENCOUNTERED
Recently I had a conversation with a lawyer who is willing to
represent plaintiffs who have problems with prior dental treatment.
The scary part of the conversation was when he told me he gets
over twenty calls a week from potential clients. The good news
was that only a small percentage of the situations he hears about are
cases he is willing to pursue. At least this lawyer has better
judgment than many!
We deal with this very scenario several times a month and have
Release forms ready to send whether a refund is made to the patient
or fees are paid directly to a specialist, etc. Remember to call us
for advice if you encounter this problem. Getting back to the
lawyer, he explained that he often tells patients that their problem
with the broken instrument is not substantial enough to get a lawyer
involved. Instead, he tells the patient to go back to the treating
dentist to see if a small settlement in the form of a refund, etc. can
be arranged.
There were two areas he described that generated the most
telephone calls. The first had to do with broken root canal files
where the patient was not notified of the problem. The second had
to do with cases where no antibiotics were prescribed even though
there was evidence of infection.
You may ask, “Doesn’t the informed consent form spell out a
broken or separated instrument as a known risk? Doesn’t this
excuse me from any liability or obligation to the patient?” The
informed consent form clarifies the risks but does not excuse the
treating dentist from negligence. If the tooth in question is curved
or calcified it could be argued that the treating dentist should have
referred the case to a specialist and was negligent for taking on a
difficult case that should have been treated with the microscope,
etc. Were the files used new or overused? How experienced was
the general dentist at treating molars, especially upper first molars
with an MB2 canal? Was the tooth a lower molar with a tricky Cshaped canal? These issues come up when broken files are part of
the problem, and increased risks must be considered by the treating
dentist before the case is started.
We have mentioned the reasons for the importance of disclosure of
broken instruments before, but whether you use the term “broken”
or “separated” or whatever applies, you must tell the patient
anytime you have such a procedural occurrence, even if you end up
incorporating the instrument portion as part of your final fill. In
many cases the instrument separation will not have an adverse
effect on the outcome of the case as the canal space is effectively
obturated. Nevertheless, the instrument will show up on a
subsequent x-ray and some dentist somewhere sometime will
notice it and question the patient. If the root canal is failing,
whether the instrument is the culprit or not, it will usually be
implicated.
So, how do you handle the situation with the patient? Of course
you should have them sign an informed consent form ahead of
time so they understand that separated or broken instruments are a
known risk of the procedure. Then, if it happens you can explain
that a portion of the root canal file lodged in the canal but you are
confident that it will simply act as part of the fill and should not
cause a problem. If, on the other hand, a significant portion of the
canal space is either unfilled or un-instrumented, then you are
probably committed to referring the patient to an endodontist so the
problem can be resolved immediately to better ensure success.
Now, what about the second area described earlier which involves
the use of antibiotics? Of course, we have all read articles in the
literature and attended lectures where the subject of overuse of
antibiotics is covered. However, at PIE we have seen far fewer
cases where antibiotics caused an allergy or untoward reaction
when used as compared to cases where antibiotics were not
prescribed and the patient ended up in the emergency room and
received IV antibiotics along with drains necessary to treat serious
infections which developed. One note we see in hospital records
frequently is where the physician asked the patient why the treating
dentist did not put them on antibiotics. The attorneys also note in
their allegations that even though evidence or signs of infection
were present, the dentist did not prescribe antibiotics.
Are there legal advantages to disclosing such a problem to the
patient? Yes, because there is a two-year statute of limitations
provision in the rules governing malpractice claims which specifies
that a patient has two years from the time that they discover or
know about a problem to take legal action. Of course you must
document in your records that you informed the patient of the
So, our recommendation is: when in doubt, put the patient on
proper antibiotics, particularly if the tooth in question is a lower
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tooth! The patient’s age and any conditions which may
compromise their immune system should be considerations as well.
a case goes to trial, within the policy limit. PIE has also never
charged a deductible, something that many other companies do.
In summary, we hope the discussion I had with the plaintiffs’
lawyer prompts some contemplation on your part. Hopefully, one
of your former patients will not be one of those angry enough to
want to call him or another lawyer. There are certainly plenty of
lawyers out there eager to have more business. Many will not have
the same degree of judgment that precludes them from taking the
types of cases described in this article.
--RCE
6. Locum Tenens Coverage up to 120 days/year. Under your
PIE policy, whether you are locum tenens (temporary) or not, there
are no limits to the time frames or parameters for working in any
particular office, as long as it is in the borders of the state of Utah.
You are not limited to the address on your Declarations Page or
proof of insurance page.
7. Free Tail Coverage at Retirement. As you know, with a
claims-made policy such as the one offered by PIE, which is
industry standard, you must generally purchase extended reporting
or tail coverage at the time you cancel the policy, whether you
move, retire, are disabled or die. However, with PIE’s policy if you
are tenured, meaning you are insured for at least five years, you do
not have to purchase the tail coverage when you retire. If you die
during the coverage period, the five year tenure rule also applies.
The tenure minimum is only three years if you have to terminate
your policy due to disability. Unfortunately, the tail premium is not
waived when a dentist moves away from the state to practice
elsewhere.
IS PIE STAYING AHEAD OF THE CURVE?
WHAT OPTIONS MAKE PIE BETTER?
Many of you get advertisements periodically from our competitors
touting their options, etc. and encouraging you to consider
switching. We thought it would be worthwhile for us to list these
options and discuss how they are either built into your policy or
why they are not a good idea.
1. Practice-Based Pricing, where the company determines the
premium based on procedures performed and the complexity of the
procedures. PIE already does this. For example, if you perform
I.V. Sedation you pay a slightly higher premium. The same goes
for oral sedation. PIE does not charge a higher premium for
dentists who perform surgical procedures or implants, however, so
we do not penalize practitioners who enjoy doing such procedures.
8. Part-time Coverage Discounts. This is a benefit that PIE does
not offer. Why? The answer is that some of our worst claims have
resulted from practitioners who work part-time. Therefore, we
have determined that these dentists may have a higher risk of claims
potential based on hours worked so we feel that we owe it to our
self-insured pool to charge an appropriate premium which is the
same as the regular premium.
2. Flexible Coverage Limits. PIE sees no need to have various
liability limits as $1 million per claim and $3 million aggregate
limit are more than adequate for the state of Utah. For many years
we were able to keep the policy limits at $100,000 per claim which
lessened the target available to lawyers and greedy plaintiffs. The
main reason we raised the limits in 1999 was that hospitals were
starting to set $1 million as their requirement for dentists desiring
privileges. Since the higher limits have been in place, we have not
had any payout even close to $1 million and we feel it would be
foolish and unnecessary to arbitrarily raise the limits for everyone
or to offer different limits.
Most companies do not describe their protocols for handling
insured who sustain claims in their brochures because their solution
to this situation is often harsh – non renewal of the policy. PIE tries
to handle this unfortunate situation in a more equitable fashion
while still looking after the needs of our entire pool of insured.
When PIE pays a settlement for any of our insured, the PIE
Advisory Committee reviews the circumstances of the claim and
makes a determination as to whether or not the claim was
meritorious. In other words, did the dentist make a mistake that
was avoidable? If the Committee determines that the claim was
meritorious, the dentist is surcharged up to 10% of the total
settlement paid each year for four years, over and above the regular
premium. The purpose of the surcharge is not to recoup PIE’s loss
but to remind the dentist to be more careful in the future. Currently
about a half-dozen insured are paying surcharges since they wished
to remain insured with PIE. However, if a dentist has a second
meritorious claim as determined by the Advisory Committee, then
they are not renewed. Non-meritorious claims may also be subject
to smaller surcharges if an insured has more than one of these types
of claims.
3. Protection for Entire Office. Some carriers advertise that they
consider all insured to include all employees including outside,
independent contractor hygienists. PIE has provided such coverage
for many years. No carrier will cover any employee dentists under
another dentist’s policy, however. Each dentist in a practice must
carry an individual policy, no matter which carrier is utilized.
4. No Dental Specialty Procedures Excluded. Although our
reinsurer does not allow PIE to insure Oral and Maxillofacial
Surgeons, who are in a different classification due to the
orthognathic and other surgical procedures they perform in
hospitals, we do cover all other specialists. We do not exclude any
specialty procedures performed by general dentists, however, such
as endodontics, third molar extactions, etc. We do expect our
insured to use their good judgment, however, in selecting those
procedures and patients that are best suited to their abilities.
One other thing PIE does not do is charge a “give-away” premium
for the first year of insurance. Although new graduates are often
tight for money due to loan repayments, etc., PIE cannot justify
insuring them for peanuts, although they do start out at a lower
rate. PIE’s rates slowly step up to a maximum amount at the fifth
year. What other companies do is step up their rates higher than
PIE does so the mature rate is several hundred dollars more than
PIE’s but then charge an expensive tail premium to discourage
5. Defense Costs Paid in Addition to Policy Limits. PIE has
never included defense costs, which can be substantial especially if
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2. Who is Paying the Bill for an 18 or 19-year- old
who Still Lives at Home?
I have had a number of telephone calls recently where dentists are
running into problems with patients over 18 who can authorize
work to be done but are not paying the bill since they live at home
and are covered by their parents’ insurance, etc. A problem will
arise when the young adult makes the appointment and drives
themselves to the office, fills out the paperwork, signs the informed
consent, but then indicates that their parents are going to pay the
bill. If the treatment plan turns out to be substantial, will the parents
be willing to pay for it without being consulted?
them from switching over to PIE. We cannot assume liability for
prior years paid to another carrier without charging a premium for
prior acts coverage if a prospective insured wants to avoid paying
the tail to that prior carrier, yet does not want to be devoid of
coverage for that period. So, the best thing to do as far as
encouraging young colleagues to switch coverage to PIE is to talk
to them when they are first in practice so they can keep their tail
payment as low as possible!
Other features that PIE has that the competitors cannot offer
include:
1. Ownership by insured. Since PIE is a self-insured
organization, all dentists who pay a premium are owners!
2. Management by and for dentists. PIE does not have
any corporate overlords masterminding our activities or depleting
our assets. Our Advisory Committee and management team are all
experienced dentists.
3. On-site local dental consultant. Dr. Engar is available
to answer your questions and handle your claims locally. He
practiced in Utah, maintains his dental license and is still involved
in clinical dentistry through his faculty position with the University
of Utah. He is aware of local issues and understands the settlement
trends, etc. where applicable.
Another problem occurs if one of these young adults is scheduled
for a filling but has caries so deep that the problem turns into a root
canal and crown situation. The patient can authorize the treatment
and sign the informed consent, but are the parents now willing and
able to sink nearly $2,000 into one tooth, especially if they do not
have dental insurance?
In these situations the parents must be consulted before dental work
can commence. It would be wise for the office manager or financial
coordinator to schedule a face-to-face meeting with the parent to
explain the treatment plan or alternative treatment plans and obtain
a signed authorization to perform the dentistry in conjunction with
a financial agreement. In cases where a filling turns into a root
canal/crown, rather than simply proceeding with the procedure with
no authorization from the parent paying the bill, you should do an
“emergency” open and broach procedure or simply temporize the
tooth and tell the patient you must discuss the expenditure with the
parent who is paying the bill before you can proceed. Otherwise it
will be easy for you to be burned as the parent will often refuse to
pay the fee if they are not notified in advance of the change in plans.
--RCE
In summary, if you look at all of the plusses PIE offers and compare
to what the non-Utah based competitors can’t or don’t provide, it is
a no-brainer to see which alternative is best. And we have certainly
appreciated the support we have enjoyed from our Utah colleagues
since September 1978 when PIE was formed.
--RCE
SOME SHORT SUBJECTS
1. Missionary Examination Forms
Since the LDS Church lowered the age to 18 for males and 19 for
females to serve missions, there has been a lot of activity on the
part of dentists performing the necessary pre-mission screenings.
Once the information is filled out by the dentist, which consists of
yes and no questions pertaining to dental problems pending or
resolved, the status of third molars, the status of orthodontic
treatment, etc. the missionary turns the written copy in to the
Bishop who must then provide the paperwork to a Stake Clerk who
must input the data electronically before the Stake President can
complete the final process of submitting a recommendation
following an interview, etc. I happen to be one who has to review
these written documents and I have to admit that too often I have
to struggle to interpret the name and address of the attending dentist
due to poor handwriting or an incomplete address. I have often had
to go online to obtain the necessary information which delays the
submission of the application.
PHONY ALLEGATIONS: CASE REPORT
Have you ever had a post-surgical complication where a patient has
complained of paresthesia but was vague or inconsistent on how
the symptoms were reported? Or, have you ever had a patient
report persistent numbness following a mandibular injection which
did not make sense? Recently we dealt with an interesting claim
where a very experienced practitioner took out a third molar tooth
only to have the patient claim that he was numb following the
procedure. The extent of the claimed numbness did not make
anatomic sense, however, but the patient still obtained the services
of a lawyer and sued our insured dentist for malpractice. The
extraction was not necessarily easy and we had the claim reviewed
by a potential expert witness who had some interesting
commentary. Nevertheless, the claim had a positive end result for
PIE. Following is a description of the procedure, the patient’s
complaints, and the course of the claim:
My purpose in writing this brief is to encourage all of you who
handle these forms, which is probably every general dentist in the
state, to write legibly and make sure the address is complete. The
form also has a space for a telephone number and e-mail address
which should also be included. I know how pharmacists feel
sometimes when they must decipher a prescription and I am sure I
am not the only one who has had trouble interpreting the
information on the forms. So, please, help your patient by being
sure that the form is complete and legible!
A 45-year old male had been a patient of the subject dentist for 2.5
years and had several procedures performed, including crowns,
root canals and preventive care. In August 2010 he presented for
several procedures including the extraction of tooth #32, the lower
right third molar. The patient complained later of continuing
numbness when he thought the anesthetic should have worn off and
the subject dentist prescribed a Medrol dose pack. He requested
that the patient return for a follow-up evaluation and also discussed
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The oral surgeon who disputed the patient’s claims of numbness
reported to PIE’s lawyer who handled the claim that too many
dentist’s just take a patient’s word for the location or extent of their
numbness or do just a single examination. Taking this approach
simply gives patients trying to make a fraudulent or trumped-up
claim the opportunity to memorialize their false claims in an
official dental record that they can use later as evidence to support
their claim. The oral surgeon had the following technique to assess
any patient’s claims of numbness following dental injections or
other procedures:
the situation with the oral surgeon he normally referred patients to,
who speculated that the numbness could be a result of the injection.
The patient returned one week later and complained of numbness
on the right side of his tongue as well as his right cheek and gums
on the upper right. Clinical testing was done by the dentist who
logged his findings. These included numbness on the right side of
the tongue, right cheek opposite #31, upper right gingiva, buccal
gingiva from #25 to #31, and right lingual gingiva from 27-31.
Interestingly, no numbness of the lower lip was noted. The patient
was diagnosed as having a dry socket and this was treated with
medicated paste. The dentist noted that he had not made a lingual
incision, did not use Septocaine, and sectioned the tooth by
removing the distal aspect of the crown. He told the patient he
expected the numbness to ease off but also mentioned that the
feeling may never come back.
He would do an initial examination on the patient to map out the
extent of the claimed numbness using a visual chart to mark areas
of claimed numbness. He would use probes, etc. to delineate
borders where the numbness stopped and started. He would then
leave the patient in the chair and depart from the room for several
minutes to see another patient, etc. Then he would return and repeat
the examination but would use a new, blank chart to delineate areas
of claimed numbness. He would then leave the patient in the chair
again and return to his private office to compare the charts. If there
were no discrepancies the examination would be complete and the
numbness would be considered to be legitimate. If there were
discrepancies he would repeat the examination and charting a third
time and would then reassess for further discrepancies.
Nearly six months later, in March 2011 the patient called and
complained about the ongoing paresthesia. He was invited to return
to the office for an evaluation but stated that he was not able to
come in. He was also offered a referral to a specific oral surgeon
but did not follow up. Soon after this telephone call, the subject
dentist contacted PIE and reported that he had a patient who
claimed a residual paresthesia following extraction of tooth #32 in
August 2010. The dentist reported that the patient’s description of
the numbness was strange considering the normal distribution of
the nerves he claimed were damaged. He wondered if the
numbness could be due to the injection of local anesthetic used as
the apex of the tooth was not near the inferior alveolar nerve canal.
The dentist was advised to secure the chart and provide any followup examinations, etc. that were indicated.
Such an examination was done in the case in question eight months
after the third molar was removed, in April 2011. When the patient
presented for treatment he claimed that he had residual numbness
from a root canal done in the upper left around the same time the
third molar was removed. So mapping of the numbness was
performed and due to discrepancies the procedure was done three
times. The first time the patient claimed numbness on the right
buccal mucosa from the gingiva of the lower right teeth all the way
to the buccal vestibule of the maxilla and inside of the upper lip
about halfway to the midline. During the second exam he claimed
that the numbness of the right buccal mucosa extended about 5mm
lower. The third time he claimed it was numb to about the plane of
occlusion and inside the lateral third of the upper lip. The three
examinations of the lower right lip area revealed similar
discrepancies. Likewise, the three examinations of the tongue
showed discrepancies, the most blatant being that during one of the
exams the patient claimed numbness crossing the midline in the
posterior tongue by about 1.5 centimeters. During the third exam
the claimed numbness extended past the midline to almost the left
border of the tongue. At this point the oral surgeon explained to
the patient that while reviewing the panoramic film he took he
could see that the outline of the extraction site showed that the roots
did not even reach the mandibular nerve canal and that the
extraction could not have caused the numbness he was claiming
there. He also explained that a root canal procedure on the upper
left side could not cause the numbness he was claiming on the other
side of his face. The surgeon offered to see the patient again in four
months to reassess the areas of claimed numbness and an
appointment was made but the patient did not show up for his
follow-up appointment. Following this examination the oral
surgeon actually called the dentist who removed the tooth and
reported only that he had examined the patient and that PIE will
want to see his records since they do not help the patient’s case.
In July 2011 the dentist received a request for records from an
attorney. PIE suggested that he send us a copy of everything that
he planned to send to the lawyer. He complied and had created a
typed transcript of his handwritten records which made it easy to
determine exactly what had transpired. One year went by until the
subject dentist was notified of the patient’s intention of suing in
September 2012. The dentists contacted PIE after the Notice of
Intent to Commence Legal Action was received and records were
reviewed. The dentist had the patient signed a detailed informed
consent form specific for oral surgery and dental extractions and a
review of the x-ray showed the tooth was a reasonable case for the
dentist in question to perform. Therefore, PIE took the position that
the claim was defensible. Therefore a Summons and Complaint
was served on November 28, 2012 and so now we were dealing
with an actual lawsuit.
PIE’s position did not change and our lawyers maintained a
defensive posture. Records of the oral surgeon with whom the
patient consulted in April 2011 were obtained and the patient’s
deposition was taken. Next the deposition of the oral surgeon was
taken in May 2013. He came out and stated that the patient was
“trying to pull off a fraud, that this was just downright obvious
fraud” as his claims of paresthesia were inconsistent and
anatomically impossible. This deposition had a very deleterious
effect on the patient’s claim and the attorney ultimately talked him
out of pursuing the claim any further and it was dismissed in July
2013 with no settlement being paid to the patient.
The expert witness that we had review the case had some
interesting comments as well that are worth repeating to help those
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of you that take out third molars to take a hard look at your own
protocols.
He had the following positive comments about the procedure:
1. The tooth was indicated for removal because it was in a position
which allowed for communication with oral fluids.
2. The pre-op x-ray was adequate (met the standard of care)
3. The apex was not too close to the mandibular canal.
4.
There was a signed consent form specific for oral
surgery/extractions.
5. The injury showed signs of improvement meaning the nerve had
largely recovered (which indicates bruising or stretching and not
cutting).
which established governing principles for five Midwestern states.
I also learned of the school’s storied dental history and its
illustrious dean, Dr. G.V. Black. We studied his principles of
cavity preparation, saw pictures of him with his giant teeth and
various tooth preparations, and attended class in lecture halls
bearing his name. After graduation when I became acquainted with
doctors from other schools, I was usually met with, “ah,
Northwestern… GV Black, right?” However, I soon learned that
all schools have a Dr. Black, or a Dr. Woodbury, or a Dr. Ferrier.
A few years after graduation, I had the opportunity to go back to
Chicago to attend a meeting at ADA headquarters. As my wife had
worked at the ADA during the dental school years, we were excited
to take the offered tour of the headquarters building. As
Northwestern was in the process of closing, many of the library
materials and exhibits were being moved to the ADA building. On
our tour, there was a GV Black exhibit with all the inherent
reminders of dental school days, but it also included a display of
his histology slides, microscope and notebooks. Suddenly I saw a
side of him that I had not known. I was immediately taught the
significance of one of his favorite sayings: ”The professional man
has no greater responsibility than to be a continuous student.”
The expert had the following criticisms:
1. The patient was in his mid forties, specifically age 45, which is
enough reason right there for referral to an oral surgeon.
2. The tooth was tight against the second molar for its entire length,
which pre-disposes the second molar to injury and makes access
difficult. Fortunately there was no gouging or other trauma to #31,
but PIE has had to deal with cases where the adjacent teeth were
indeed damaged during third molar removal.
3, Although a Medrol Dose Pack was used, there was no indication
in the records that other steroids or high doses of ibuprofen were
recommended to help de-inflame the nerve.
4. It took about two hours to do the case, which is too long.
5. The patient did not see an oral surgeon for an assessment until
eight months had transpired. It is best to have the patient see an
oral surgeon at a three month period post-op at most when the
clinician first suspects that the injury could be permanent and might
be a candidate for microsurgery repair, which should be done
within four months of the procedure causing the injury.
6. Was the tooth sectioned sufficiently to allow for a more efficient
extraction?
7. Lingual nerve injuries are generally due to encroachment. In
one out of five people, the nerve is located “at or above the crest of
the lingual bone” in the soft tissue. The rest of the time it is just off
the lingual plate and could be injured there. Anyone doing
exodontia of third molars must understand anatomy and nerve
location.
During my senior year in dental school, Johnson & Johnson
developed a white filling material called Adaptic that became all
the rage for Class V fillings. We couldn’t use it fast enough. Then
Lee Pharmaceuticals came out with an “acid-etch” technique with
a white filling material, and the history books and operative
dentistry manuals changed forever. It didn’t matter that the etch
had to stay on for four minutes and you had to let the material set
in place for ten minutes, we were thrilled with the new possibilities
we could give our patients. Suddenly “toilet the prep” and
“extension for prevention” became snide remarks seemingly
doomed to the refuse pile of history. We didn’t need to ”cleanse
and shape” because now we could use ”acid-etch”.
My head swims as I think about the rapid development and
deployment of new materials and techniques. Implants, bonding
ortho brackets and obtaining space closure; dentin adhesion, the
disappearance of screws for primary retention, adhesive cements,
aesthetic pressed-porcelain crowns, interceptive orthodontic
appliances, medicaments that work; and I truly do not miss packing
gold foil in a Class III anterior prep!
Did this patient have a legitimate lingual nerve injury? Possibly,
although you would not have expected to see any residual
numbness of the cheek or buccal gingiva, anywhere. If he had not
tried to exaggerate the extent of the claimed numbness, he may not
have scared his lawyer away. If this were a TV case, during trial
someone would take a pin and want to stick it right through the
patient’s tongue in front of the jury to verify the fraud, but this is
the real world and we cannot do that! But, hopefully, this
experience will give you some tips in more accurately evaluating
claims of numbness, particularly if anything appears to be dubious.
--RCE
I think about the changes that have occurred in my short lifetime,
and only guess at what is coming next. But I feel the need to
remember some guiding principles that were once applied to gold
and amalgam restorations, but now should also be applied to the
materials we use today. Prep; cleanse and shape; finish and polish,
still an innate professional responsibility. I think Dr. Black would
be right up front using these new materials, and trying to find out
what would make them work in the best possible way. He would
expect us to be “always a continuous student”.
GUEST COMMENTARY
MAYBE GV BLACK WAS RIGHT AFTER
ALL…
I attended Northwestern University for dental school, and learned
that the university is named after the Northwest Ordinance of 1789,
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