June 18, 2024

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The tragic case of San Antonio-area dentist Jerry Teague

Early last May, with temperatures in the Hill Country in the low 90s, Dr. Jerry Teague became “partly disoriented, partly confused” while taking a walk after work.

Shortly after 5 p.m., his wife reported him missing to the Marble Falls Police Department. She said he was having “cognitive issues,” according to a police report, that he’d recently been diagnosed with cancer and it was “affecting him mentally.” 

Less than 40 minutes later, Teague turned up at his residence in Horseshoe Bay after getting a ride from someone on a golf cart. Emergency personnel had arrived and wanted to transport him to an Austin hospital. But Teague, who later said he’d become dehydrated and lost his bearings, declined to go.

The next morning, the dental anesthesiologist was back at work in the office of Nunnally, Freeman & Owens in Marble Falls. His patient that day was Maria Elena Lugo Querales, who’d traveled from Miami for a dental procedure. 

Her meeting with Teague changed her life forever.

He failed to intubate her and administered excessive amounts of anesthesia drugs, her husband says in a lawsuit. She was overdosed, causing her heart to stop and her breathing to cease, the complaint says. She remained “unconscious and unventilated, without oxygen or heartbeat, for an extended period of time.”

Lugo suffered severe brain damage caused by a lack of oxygen, the lawsuit says, and now lives in a skilled nursing facility.

The episode has raised questions about whether it was appropriate for Teague to administer general anesthesia, given the events of the previous day and his illness. It also triggered a police investigation, but that abruptly ended with Teague’s death less than two weeks later on May 23. He was 70.

“It’s a tragedy all the way around,” said San Antonio lawyer Sean Lyons, who represents Lugo and her husband, Luis Espana.

‘Totally normal’

Espana, individually and as his wife’s guardian, filed a medical malpractice lawsuit against Nunnally, Freeman & Owens, the dental practice’s three principals and Teague’s estate March 28 in state District Court in San Antonio. The suit was filed here in part because Teague owned a Shavano Park home on which he claimed a homestead exemption. The suit doesn’t specify the amount of damages sought, but Lyons said it will be in the millions of dollars.

The suit alleges that Lugo was never told about what happened to Teague the day before her May 10 visit or the nature and extent of the deep sedation he provided. Neither Teague nor anyone else obtained informed consent from Lugo, the complaint says.

The office and its dentists also were negligent in allowing Teague to perform general anesthesia, the suit says.

In an interview with Marble Falls Police Detective Michael Tutor on May 12, Dr. Lane Freeman — who was scheduled to perform Lugo’s dental procedure — recalled her partner, Dr. Stuart Nunnally, telling her before the procedure that Teague “looked really good. He’s clear-headed. He’s totally normal.”

She found Teague to be “clean, dressed nice, hair fixed,” and her staff reported to her that there was nothing out of the ordinary when he interacted with Lugo.

“So I had no reason to think that he wasn’t on and completely able to do the sedation,” Freeman told the detective.

The dentists should have done more than simply observe Teague’s appearance, Lyons said.

“The doctor should be evaluated professionally before placing the patient under general anesthesia,” he said. “Just knowing he had been a missing person the afternoon before, because he had cognitive difficulties, yeah, I think that’s reason to say, ‘We’re not going to let you put our patients under general anesthesia.’ ”

Freeman and Nunnally separately told the detective that they’d been unaware of Teague’s cancer diagnosis before that morning. “He’s very private,” Freeman said.

In his own interview with Tutor, Teague revealed that he had pancreatic cancer and was told he had from six to nine months to live.

The dentists and their practice, as well as Teague’s estate, have issued general denials to the lawsuit’s allegations in court papers. In a text, Freeman said she and Nunnally declined to comment and referred questions to their attorney, who also would not comment. A lawyer for Teague’s estate didn’t respond to a request for comment.

The dentists have asserted various defenses, including that Lugo’s injuries are the result of a preexisting medical condition — though its nature is not specified in their answer. Lyons said he didn’t know what condition the pleading was referencing. 

They also said that if there was negligence in Lugo’s care and treatment, it was “an unavoidable accident in that it was not proximately caused by the culpable negligence of any party to this action.”

Social media influence

Maria Lugo Querales, 52, and her family left their native Venezuela for Miami about six years ago. They’re among more than 7 million people who have fled the country since 2015 because of the economy’s collapse.

As she did in her home country, Lugo provided elder care in Miami. She was taking classes to become further certified to provide home heath care. She has a daughter who lives in Florida and a son in Spain. Family members declined to be interviewed.

Until her dental procedure, Lugo also had a presence on Twitter. She primarily retweeted others’ Spanish-language posts — particularly those critical of the Venezuelan government and COVID-19 vaccines.

She learned of the Marble Falls dental practice from a social media influencer — Dr. Ludwig Johnson, Lyons said. Johnson is a medical school graduate from the Central University of Venezuela. He has a significant online presence, and one website describes him as “the creator of revolutionary protocols to reverse Type 2 Diabetes, Fatty Liver Disease … and Obesity, all based on a Paleo Diet.”

Johnson interviewed Freeman and Nunnally in a video that was posted to YouTube on May 9, the same day Teague was reported missing. Johnson also posted the video on Instagram.

A video on the dentists’ website says their practice has treated patients from 52 countries and all U.S. states. They offer treatments that include the removal of infected teeth and mercury fillings, periodontal therapies and cavitation cleanings.

With almost all surgical patients and most restorative patients, the dentists incorporate some type of sedation, Freeman says in the video. Most will receive IV conscious sedation, which is administered by the dentist performing the procedure. Occasionally, based on the amount of surgery needed or health issues, an anesthesiologist provides deeper sedation or general anesthesia, she says.

“This can be provided very safely and easily within our office because we have an anesthesiologist on staff,” Freeman says as Teague appears in the video.

Lyons said it’s not clear what treatment Lugo sought, but from the records he has it appears she was having a tooth extracted. A GoFundMe page that was set up for her says she went for a “surgical intervention.” Lyons has received her records from the dental practice but said they did not include Teague’s anesthesia record.

Teague’s history

The anesthesiologist grew up in Fort Worth and attended the University of Texas at Austin on a basketball scholarship, but an injury in his freshman year ended his hoops career, according to his obituary. He transferred to Abilene Christian University as a pre-med student, graduating in 1976. He attended Baylor School of Dentistry, earning his doctorate in dental surgery in 1979, then opened his own practice.

In his late 40s, Teague pursued post-doctoral training in general anesthesia at Loma Linda University Medical Center and Riverside County Regional Medical Center in California. He developed a specific expertise in out-of-hospital, office-based general anesthesia for special needs populations, the obituary added.

Over the next decade or so, Teague worked in various practices as an independent anesthesiologist — seeing some 25,000 patients.

But Teague had his share of difficulties during that time. 

His obituary states that he suffered a “tragic injury” that led him to take a 3½-year sabbatical beginning in 2015.

The next year,  an executive committee of the Texas State Board of Dental Examiners ordered a temporary suspension, records posted on the board’s website show.  His continued practice of dentistry “would constitute a clear, imminent or continuing threat to a person’s physical health and well-being,” the committee said.

In a petition for Teague’s temporary suspension, a board staff attorney cited Teague’s “noncompliance” with a contractual agreement he had with the Professional Recovery Network, an Austin-based program that assists dentists, pharmacists, veterinarians and others who have “potential impairment due to substance use or mental illness.” Teague was discharged from the program for noncompliance. There were no details on why he entered it.

He was under an “enforced suspension” that prevented him from practicing until he entered into a “monitoring agreement contract” with the recovery network. Once board staff received proof of the monitoring agreement, Teague would serve a two-year probated suspension — meaning he could resume practicing.

In a lawsuit filed against him in 2018 in San Antonio over a business dispute related to the creation of a dentistry company, the plaintiffs alleged that Teague had said the allegations that led to his suspension were “all lies” and he was “hiring a ‘big time’ lawyer to clear it all up.”

“He said that he was going to sue the (board) for millions and that he was sure to win,” the lawsuit alleged. No such action against the board could be found. The lawsuit against Teague was dropped last summer after his death.

His probated suspension ended in November 2019 after he completed all requirements, including maintaining membership in the Professional Recovery Network. He had no further run-ins with the board. But that same year, the IRS hit him with federal tax liens totaling more than $660,000 on unpaid income taxes. No lien releases have been recorded.  

Also that year, he married Donna Tiemeyer and joined the Nunnally, Freeman & Owens practice. Tiemeyer, a licensed professional counselor, declined to comment.

‘Are you kidding me?’

By coincidence, one of the Marble Falls police officers who responded to a 911 call made at the dental practice May 10 was officer Scott Dulaney, who recognized Teague from the day before when the dentist was reported missing.

Dulaney whispered to another officer that Teague, the subject of the missing person report, was the doctor who administered the anesthesia.

“Are you kidding me?” the officer replied with a startled look captured by Dulaney’s body camera video. 

“Based on the totality of the situation and my prior knowledge,” Dulaney wrote in his report, he directed the officer to call the detective with the Marble Fall police’s on-call criminal investigation division to come to the scene.

Dulaney told another colleague that Teague was “very confused” when Dulaney arrived at the dental office. 

A short time later, Detective Tutor interviewed Teague. Tutor started by saying that it sounded like Lugo had been stabilized and that she was going to be all right.

The sedation got underway about an hour late as they waited on Freeman, Teague said.

“I would never have called 911,” he told the detective, according to a recording obtained from the Marble Falls police. “911 is way overused. Today was one of ’em. But you know, you could make a case either way. It’s not my office. So I must submit to, to what they want because I don’t own any of this office. The final decision is not mine. I submit to that.”

He recalled how “everyone was panicking” after Lugo’s heart rate and blood pressure decreased.

“I just realized it’s futile to just say, ‘You don’t need to do this — just give me a second and she’ll be fine,’” Teague said. “But I was now having trouble finding lines because they were everywhere. They were just coming out of — and I needed certain connectors and things that are normally there. But the late start became confusing because we were trying to induce her at a time when she’s already supposed to be asleep.”

When emergency medical technicians arrived in response to the 911 call, they performed CPR before taking Lugo to St. David’s Medical Center in Austin.

Though initial indications were that she would be OK, that was not the case. She suffered “anoxic encephalopathy,” or severe brain damage, caused by a lack of oxygen, the lawsuit says. She now lives in a specialized neurological skilled nursing facility.

‘Huge dose’

Tutor wrote in a report that Dulaney was “afraid (Teague) had made an error when administering the anesthesia” to Lugo. 

Teague described how he had a “little bit of a problem” getting Lugo intubated with a nasal tracheal tube. The induction drugs were not enough to lower her consciousness level so more drugs were required.

In all, Tutor’s report shows, Teague administered about 400 micrograms of fentanyl; 100 milligrams of lidocaine; 2 to 3 milligrams of midazolam, or Versed; 100 to 150 or “maybe” 200 milligrams of propofol; and 300 micrograms of remifentanil mixed with 400 milligrams of propofol.

“400 micrograms of fentanyl is a huge dose for somebody who is having a tooth extracted,” said Dr. Robert Ertner, an anesthesiologist based in Chico, Calif., who is not involved in Lugo’s case. “Now, we do live in a time where more and more people are requesting deeper and deeper levels of sedation for their procedures based on the fact that they don’t want to feel any pain.” 

Ertner has administered general anesthesia for office-based dental surgeries. 

“This may be a case where that tooth is what we call ‘impacted,’ and (Freeman) had to surgically go dig around and find it,” he said. “If that is the case, then general anesthesia would have been warranted and they probably would have put the patient to sleep at the beginning of the procedure. Still, I think 400 micrograms of fentanyl is a rather large dose considering even after the patient gets put to sleep, they’re going to go ahead and do local anesthesia along the gum line there so the patient won’t really feel a whole lot of stimulation during the procedure. So I would never have used that amount of medication.”

After reviewing the lawsuit and other information, Dr. Steve Yun, a dental anesthesiologist in Orange, Calif., expressed alarm over the “very high dose of fentanyl” given to Lugo. 

“For a typical woman, 50-100 mcg of fentanyl is given,” he wrote in an email. “This patient was given 4-8X the standard dose!!! As you know, fentanyl is an extremely potent narcotic and it is often abused by anesthesia professionals.”

Yun added that his “strong suspicion is that the anesthesiologist was diverting fentanyl for his own use. He may have been impaired during the case from fentanyl, which may explain the failure to rescue.”

No wrongdoing

In his report, prepared nine days after Teague’s death, Tutor wrote that a “question had been raised whether Teague’s cognitive abilities were dampened by his medical condition, affecting his ability to safely administer anesthesia. Teague died prior to the the conclusion of the investigation.”

Marble Falls Assistant Police Chief Trisha Ratliff said in an email that “no determination of criminal offense was pursued” as a result of Teague’s death.

Tutor also told Nunnally he didn’t see any wrongdoing.

“I know any time you’re doing anything medically or with sedation, there’s always risks,” the detective said.

Craig Klugman, a professor of bioethics at DePaul University in Chicago who previously worked at what’s now known as UT Health San Antonio, said Teague’s colleagues had no obligation to have him evaluated before Lugo’s procedure to ensure he was fine.

“If they did not suspect (he) was a risk to the patient, that’s kind of where it stops from an ethical standpoint,” Klugman said, adding that he is not an attorney. 

In addition, Klugman said Teague’s wife had no requirement to report his “cognitive issues” to his employer or the Texas State Board of Dental Examiners.

Teague “has as much right to medical privacy as any other person,” Klugman said. The practice’s principals “would only know what he chose to tell them. If he didn’t choose to share anything, and he appeared to be fine, then they would have no reason to suspect he was endangering patients.”

From an ethical standpoint, he added that no one has the right to know their doctor was out late the night before or was up all night because of a crying baby and didn’t get much sleep.  

As more of the physician population has gotten older, Klugman said, there becomes a “strong question of when people should stop practicing.”

“Is there a good way to know when it’s time for a doctor to step down?” he said. “We don’t have one, and I don’t know that there could be one. It’s sort of a self-realization that one has to come to.”

Denied coverage

Lugo spent six months at St. David’s Medical Center, racking up about $1 million in medical bills, Lyons said. Her health insurer has denied coverage because it didn’t approve her getting health care in Texas, he added.

“I’m not sure why that’s a basis for denial,” he said. “So we’re going to have challenge that at some point.”

Two decades ago, state lawmakers passed tort reform in medical malpractice cases. So the most Lyons’ clients can recover in noneconomic damages — which include pain and suffering — is $250,000, he said. Economic damages are not capped, so they will be seeking past and future expenses and lost wages, he added.

There may not be much of a recovery from Teague’s estate. An inventory filed in the Bexar County probate case March 31 — three days after Lugo’s lawsuit was filed — values the estate’s assets at $883,396. The Shavano Park house accounts for about $857,100 of the estate’s value. No claims on the estate were reported. Teague’s widow is the sole beneficiary. He had no children.

The odds of Lugo making a significant recovery from such a dramatic brain injury are “very low,” Lyons said, but the family is hopeful her condition will improve. Lugo requires mechanical ventilation through a tracheostomy tube and artificial feeding via a gastronomy tube. 

The family had her moved from St. David’s to a hospital in Jacksonville, Fla., in November. They started a GoFundMe page to help defray that cost, but raised only $7,255 of their $50,000 goal.

Lugo was returned home in December, but this month, the family moved her into a neurological skilled nursing facility in central Florida so she could receive better care.

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