A longtime Lewiston oral surgeon, Dr. Jan Kippax, has been reprimanded and placed on probation after state regulators cited incompetence and lack of professionalism in his care of a patient who came to him with a small bump on her lower lip.

The unnamed patient told the Maine Board of Dental Practice she expected to undergo a 15-minute procedure by the controversial dentist would take no more than four stitches.

Instead, she said, Kippax removed as much as a third of her lip, leaving her teeth visible with her mouth closed.

When she saw what happened, the patient said, she “broke down sobbing.”

An emergency room worker who looked at her later the same day said it looked like a dog had mauled the woman, according to the decision rendered by the dental panel.

After a 14-hour hearing that included testimony from experts and Kippax, the board found, on a 4-1 vote in March, that Kippax “engaged in unprofessional conduct by violating a standard of care” for dentists.

In addition, it unanimously ruled Kippax was “professionally incompetent for engaging in conduct” that showed “a lack of ability or fitness to perform the duties owed by a dentist to a patient” and “a lack of knowledge or inability to apply principles or skills to carry out the practice of dentistry.”

The panel’s reprimand included a provision that placed Kippax on probation through March 2025, mandated continuing education, required “a behavioral assessment by the Maine Medical Professionals Health Program” within 90 days and that he fork over up to $6,000 for hearing costs.

Kippax’s attorney, James Belleau of Auburn, said his client has appealed the board’s decision in Kennebec County Superior Court. He said Kippax did not violate any dental standards and accused regulators of being “irredeemably biased” in the wake of the panel’s previous dealings with Kippax.

Kippax, who was reprimanded and placed on probation in 2002, came under scrutiny again in 2017 when dental regulators, citing 18 patient complaints, suspended him from practicing.

At the time, the panel said, “If he is allowed to continue to practice in his reckless and harmful way, innocent patients are destined to continue to suffer dire consequences.”

But the state took so long to build its case that Kippax had already regained his license and reopened his Main Street office before the hearing to probe the incidents.

The Attorney General’s Office effort to prove Kippax should not have a license flopped badly when its own expert said state lawyers had not proven the oral surgeon did anything wrong.

By early 2018, having failed to make the case the dentist had done anything improper, the dental board threw out the remaining complaints, leaving Kippax to carry on his Main Street practice in Lewiston, The Implant Center at Androscoggin Oral & Maxillofacial Surgeons.

But, it turned out, that wasn’t the end of Kippax’s regulatory oversight.

PATIENT A

A woman described in the board’s decision as “Patient A, a board-certified doctor of audiology” sought help after she got hit in the face with a child’s stuffed toy, board records said.

That toy caused “a small bump on the right side of her bottom lip that was neither growing nor shrinking in size,” she testified.

Her primary care doctor referred her to Kippax, a dentist since 1985.

Six weeks after the injury, shortly before noon on July 1, 2016, the patient met with Kippax who confirmed she had a mucocele, a situation that occurs when a salivary gland’s output duct is damaged or pinched, causing it to swell a bit like a water balloon.

Kippax told the board that mucoceles are generally benign with about a 5% chance it could be “something else.” In any case, he said, the problem poses no harm.

Board records said that Kippax assured her the mucocele “would be very simple to remove with a small incision likely requiring no more than four sutures.” He also told her he would send it to pathology for analysis to make sure it posed no danger to her.

At that point, Patient A gave verbal consent for the surgery and Kippax administered local anesthesia.

A written consent document she signed agreed to “an extensional biopsy of the right lower lip,” but nothing about removing any tissue around it. Nor did the document say anything about possible disfigurement of the lip.

Kippax, she said, mentioned nothing about “possible negative cosmetic consequences” from what she thought would be a simple, quick surgery.

The patient declined to initial a section of the written consent form that said if the doctor finds a different condition than expected or feels more surgery should be done, she agreed to have it done. She said she wanted to be sure only a simple procedure would be done.

After the anesthesia, Kippax’s office informed the patient she had to pay before the dentist could proceed so she handed over her debit card.

SURGERY

Patient A thought it would take as little as 10 minutes and two stitches before she could be on her way.

Instead, she told the board, she recalled “the smell of burning skin” as Kippax cauterized the area and, as the procedure went on, Kippax mentioned that mucoceles “can grow large if unattended to,” adding that she’d “done the right thing to come” for his help.

The patient said she got the feeling Kippax’s conversation was artificial, “designed to make me feel better due to the long time” the surgery was taking.

Even so, she said, he said nothing about the size of the mucoceles being larger than he anticipated. Nor did he say anything about taking tissue away at its margins, the patient said.

Only when the procedure was over, she said, did Kippax mention it had been bigger than he thought and that as a result there would be “slight disfiguring.”

Patient A had already tried to count the number of stitches after the surgery. She said she lost count at 16 and began wondering what happened to the simple procedure she’d agreed to.

When Kippax handed her a mirror, she said, he remarked that “plastics can do magic now.”

Looking at herself in the glass, Patient A saw immediately that a quarter to a third of her lip was missing, with the pink part in the area of the mucoceles “almost all gone,” leaving her teeth visible through closed lips.

The woman told regulators she “broke down sobbing” and kept crying for 15 or 20 minutes at the sight.

Then she was given a pain prescription and an antibiotic, told to keep the area clean, and escorted out the back door.

She called her husband to come meet her in the parking lot and drive to the pharmacy so she wouldn’t have to go out in public.

EMERGENCY ROOM

When the swelling from the procedure seemed out of hand that afternoon, the patient and her husband took her to a hospital emergency room, records show.

“Her appearance prompted an emergency room worker to ask if a dog had attacked her,” the board’s decision said.

A physician there referred Patient A to a Falmouth plastic surgeon, Dr. Sarah Holland, whom she saw on July 5, four days after the surgery in Kippax’s office.

By August, the patient had “a pretty thick scar” on her right lower lip and other disfigurements.

Holland’s treatment notes indicated that tissue loss was “through and through” and that the patient’s lower teeth were visible through “a large divot” in her lips.

In December 2017, Holland operated on Patient A to perform a “complex repair” on her lip that included muscle, skin and more.

The patient filed her complaint with dental overseers, Belleau said, after seeing “negative news coverage” of the last round of cases pursued against Kippax.

KIPPAX’S TAKE ON IT

Kippax told regulators he did not recall his conversation with Patient A or the particulars of the surgery. He said he had no memory of discussing the possible impact of the procedure on her appearance.

He said, though, that a large defect was a realistic possibility given the size of the mucocele. Plus, he added, “You don’t know the size until you get into it.”

Shown a photograph of the patient taken at her home later that day, Kippax said, “I don’t remember seeing anything like this.”

Nor did he remember handing her a mirror or that she was especially upset.

“I would have remembered and documented it” in the records if she’d sobbed for 15 minutes, Kippax said.

He insisted the surgery was “well done” and that his work on Patient A was solid.

If he had the chance to do it again, he said, he would follow the same procedure.

EXPERTS WEIGH IN

Reviewing the records of the case, Dr. Killan MacCarthy of South Portland said that “an ordinary and prudent oral surgeon would have immediately recognized a significant defect” after the surgery.

A surgeon since 2007, with a dental degree from the University of Connecticut and a medical degree from Harvard University, MacCarthy said he has never seen a patient need to undergo the type of reconstructive surgery after a mucocele removal that Patient A experienced.

He said the removal of that much tissue is typically reserved for patients with a malignant growth.

MacCarthy said an oral surgeon in Maine ought to be able to remove a mucocele without creating the need for reconstructive surgery.

Another expert, Dr. Stuart Lieblich of Avon, Connecticut, said it is tough to know the size of a mucocele before surgery, but agreed the outcome of Patient A’s case was unexpected and “very unusual.”

He told the board that in the 300 to 400 similar procedures he’s performed over the years, he’s never had a patient whose lip was so disfigured.

However, Lieblich said, a bad result doesn’t necessarily mean Kippax deviated from the standard of care required by law. He said it did not show professional incompetence.

THE DENTAL BOARD DECIDES

After weighing the evidence, the board agreed that Kippax had violated the standard of care for Maine dentists in his treatment of Patient A.

It reprimanded him and put him on probation.

It also mandated that he take a course on patient communication and courses on oral pathology within 12 months, and to continue taking them every other year as a requirement of keeping his dental license.

Belleau said all of it resulted from a “single-minded focus on prosecuting and tarnishing Dr. Kippax’s reputation” by the board and its executive director.

Kippax’s lawyer also said that a number of board members had “ongoing referral relationships with the state’s expert witness,” MacCarthy, “who also happened to be the business partner of the board member who was serving as the complaint officer for the state.”

The complaint officer, Dr. Mark Zajkowski, helped investigate the initial complaint and assisted the state Attorney General’s Office in its preparations for the hearing. He did not participate in the vote about whether Kippax violated state standards in his treatment of Patient A.

The two board members who sometimes referred patients to MacCarthy, Dr. Stephen Morse and Dr. Todd Ray, who did vote, said they had no financial arrangements with the expert witness and received no payments from him. Each said their referrals had no impact on their ability to be impartial.

But Belleau said that by their own admission, “they make these referrals because they defer to the oral surgery expertise” that MacCarthy possesses, an indication perhaps of their willingness to believe his testimony over someone else’s.

Given the overall picture, Belleau said, it should “come as little surprise” that one unnamed board member “acknowledged that they were disciplining Dr. Kippax because of the previous complaints, ‘whether they were dismissed or not.’”

Now it’s up to a state court to determine who’s right.

Belleau said he’s likely filing his brief in the Kennebec court this week laying out Kippax’s case to appeal the board’s decision.

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