No criminal charges will be filed, and the St. Johns County Sheriff’s Office has closed its case following the death of a patient who died during a dental implant procedure at a Ponte Vedra clinic.
The decision comes after the medical examiner classified Roy Estes III’s death as an accident and released a 25-page report five months after he died.
For months, his loved ones waited for answers. Now they have the results of his autopsy, which lists his cause of death as “combined toxicity of mitragynine, fluoxetine, diphenhydramine and bupivacaine.”
The medical examiner noted in the report, “Should additional information become available, these conclusions may be subject to reevaluation.”
Forensic pathologist Dr. Dan Schultz, who is the founder of Final Diagnosis, a Tampa lab that provides independent autopsy services, said the case was first brought to his attention by Estes’ family.
“When I heard about the case, I said, ‘well, I think we need to let the medical examiner in that jurisdiction know,’ so we referred to them,” Schultz said.
After reviewing the final autopsy report, Schultz said he agrees with its findings.
“Dr. [Iana] Lesnikova completed the report, very well done. I agree with her overall synopsis and that this is a multiple drug intoxication. It’s a combined toxicity from a variety of medications. I think the thing that’s most remarkable about this is the majority of these things, almost all of these things are agents that are typically self-administered,” he said.
The report states an unlabeled glass container with capsules appearing to be over-the-counter kratom was brought amongst the belongings.
“Yeah, he takes kratom instead of pain medicine and stuff because we were in a car accident back in 2023. So, he didn’t like to take pain pills, so he had chose to take like more of a natural type thing, or so he thought, I guess,” Amy Rowell, Estes’ fiancé, said.
She said Estes was very transparent, and she heard him tell Dr. Francesco Sebastiani what he was taking.
“He had asked him all the medicines he’s taken, and he gave him the list of the stuff prior to even coming there. And then also that morning, we had discussed some of it too. And then, like I’d even asked him, you know, about if he realized that he had sleep apnea and if he had all the precautions and procedures in place to, you know, if he stopped breathing,” Rowell said.
Sebastiani’s attorney, Rick Ramsey, says the dentist disputes that Estes told him everything he was taking. In a statement to First Coast News, Ramsey stated:
“The medical examiner concluded the very unfortunate passing of the patient was accidental due to his ingestion of several substances and medications before the procedure that led to his death. It is essential that patients always tell their physicians about all medications they might be taking and provide a complete medical history before undergoing any procedure. Such conversations between patients and their physicians help assure procedures can be completed safely. Dr. Sebastiani is deeply saddened by this tragic loss. Dr. Sebastiani’s thoughts and prayers remain with Mr. Estes’ family and loved ones.”
The medical examiner determined Estes died from a combination of substances, including a compound found in kratom, an antidepressant, a medicine commonly known as Benadryl, along with a numbing medication used in dental procedures. The report states all were present at levels within reported toxic ranges.
“Given the lack of complete procedural documentation regarding anesthetic dosing, route, and timing, definitive attribution to a single agent is not possible. Nonetheless, the totality of evidence supports death due to combined mitragynine-associated cardiotoxicity potentiated by bupivacaine, fluoxetine, and diphenhydramine exposure,” the medical examiner’s report states.
Rowell says she was saddened to learn the St. Johns County Sheriff’s Office investigation would not result in charges.
“The detective called and said that they would be closing the case as an accidental overdose and there would be no criminal charges filed against Dr. Sebastiani,” she said. “It was disheartening. And sad and angry and like all the emotions all over again. … It was like a hit in the stomach, you know. My heart dropped and I was just like, OK, well, I guess that’s it. There’s nothing nobody’s gonna do.”
A spokesperson for the Sheriff’s Office said the case was closed based on the medical examiner’s report and findings.
State records show Sebastiani’s license remains active with no disciplinary action. However, he is facing two administrative complaints filed by the Florida Department of Health seeking discipline that could include revoking his license.
The most recent complaint filed in March 2026 alleges he violated a Florida statute related to fraudulent, false, deceptive or misleading advertising on his website.
The second complaint is tied to the death of another patient, Colleen Krause Straw, who died days after complications from a dental implant procedure in 2023. That complaint alleges Sebastiani fell below the minimum standard of care, including failing to properly monitor and record vital signs and respiration.
Schultz said questions about the standard of care fall outside the role of a medical examiner.
“Standard of care in terms of how he’s treated and handled, that’s outside the scope of what a medical examiner or forensic pathologist like myself says. We just know why they died,” he said.
Sebastiani has requested an administrative hearing in the case involving Straw. A three-day hearing could begin as soon as April 22, 2026, in Jacksonville. The March administrative complaint has not been referred to the Division of Administrative Hearings. According to another attorney for Sebastiani, Jon Pellett, the Health Department has 45 days from March 24, 2025, to send the case to DOAH for a hearing.
Even with the sheriff’s office investigation closed, Estes’ loved ones don’t feel that justice has been served and say the pain of his loss remains.
“I miss being able to talk to him,” Rowell said. “He was my partner and my best friend. So, I’ve lost that. He was a mentor to my sons…There is definitely a big hole with everybody that knew him because he cared deeply about people and helping them.”
This story was first reported by Times-Union news parnter First Coast News.
This article originally appeared on Florida Times-Union: No criminal charges to be filed in Ponte Vedra dental patient’s death
Reporting by Heather Crawford, First Coast News / Florida Times-Union
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