AML is a life-threatening disease, and the failure to promptly diagnose or refer Ms. Taylor caused a delay in her chemotherapy treatment. This delay may have affected Ms. Taylor’s medication response and survival prospects. Although gingival enlargement is caused by multiple conditions, it may be an early sign in AML patients. Dentists need to be aware of this serious systemic condition and its oral sign. When there Dental malpractice charges Professional liability insurance companies have frequently claimed that errors or inadequacies in the patient record hinder their efforts to defend dentists against unsubstantiated accusations of malpractice effectively. The ADA Council on Members Insurance & Retirement Programs conducted a survey of 14 major insurance companies (referred to here as the 2005 ADA malpractice survey) to determine the frequency, severity, and causes of dental malpractice claims and identify the areas of record keeping needing the greatest improvements. Data from this survey were useful in providing details on the type and severity of medical/dental errors committed by dentists in the United States. The survey included 105,344 dentists insured by professional liability companies. The survey reviewed malpractice charges filed against 74,434 general practitioners and specialists General practitioner claims The majority of dental healthcare providers practicing in the United States are general practitioners (GPs); this group provides the majority of oral care to dental patients. When GPs are treating a large patient population, there is the possibility that an adverse event may occur simply because of the volume of patients treated and number of procedures performed. Data from the 2005 ADA malpractice survey indicated that of the 105,344 dentists who were insured, 82% were GPs. Based on this high percentage, it is easy to understand why the majority of malpractice claims filed by patients are against GPs. Claims paid by insurance companies involved: Dental specialties claims The 2005 ADA malpractice survey included the following specialties: ● Endodontics. Endodontists and orthodontists had the largest number of malpractice claims. The basis for claims against endodontists, ranging from highest to lowest incidence, included treatment failure (failure to meet the standard of care, resulting in an adverse treatment outcome), broken files, treatment of the wrong tooth, and inadequate precautions to prevent injury and paresthesia. The basis for claims against orthodontists, ranging Possible referral situations or conditions Although general practitioners may treat most dental conditions, they routinely refer patients to specialists. Most commonly, general practitioners refer their patients to specialists if they feel that they cannot perform a procedure at the level of the specialist. It is essential, when discussing reasons for referral, that the general practitioner clearly state the rationale for the referral, so that the patient does not suspect abandonment. According to the ADA Principles of Ethics and Code of Professional Conduct, which addresses the issue of patient abandonment in Section 2F, “once a dentist has undertaken a course of treatment, the dentist should not discontinue that treatment without giving the patient adequate notice and the opportunity to obtain the services of another dentist. Care should be taken that the patient’s oral health is not jeopardized in the process” (ADA, 2016). ● Oral and maxillofacial surgery. ● Oral and maxillofacial pathology. ● Oral and maxillofacial radiology. ● Orthodontics. ● Pediatric dentistry. ● Periodontics. ● Prosthodontics. ● Public health.
were no signs of improvement after the first three-month recall, and especially after the second three-month recall, Dr. S. should have reevaluated his diagnosis. It is easy to make errors in diagnosis. Dentists need to look at the patient’s overall health and medical history, not just at his or her presenting oral condition.
POSSIBLE LEGAL AND ETHICAL IMPLICATIONS OF MEDICAL/DENTAL ERRORS
in the United States over the five-year period from 1999 through 2003 (ADA, 2007). The survey asked the insurers to indicate the extent to which they identified specific problems with their insureds’ patient records. To quantify the responses to this subjective question, the survey assigned a value of 10 to any problem that the insurer deemed “very common,” a value of 5 for a problem deemed “fairly common,” and a value of 0 for a problem considered “not common” (ADA, 2007). Although the survey results were not analyzed statistically due to the qualitative nature of the data and reflect the opinions of the insurance companies involved, the findings are nonetheless informative. ● Restorative dental treatment, primarily failed root canals. ● Paresthesia or nerve injury. ● Swallowed objects. ● Failure to diagnose periodontal disease or oral cancer. ● Extraction of the wrong tooth/broken, fractured teeth. ● Adverse drug reactions. ● Implant failure. ● Infection control violations. ● Cuts, bruises, or burns (ADA, 2007). from highest to lowest incidence, included treatment failure, inappropriate procedure, dissatisfaction with the treatment outcome, misdiagnosis, compromised result, root resorption, and employee performance – referring to an act committed by an assistant or hygienist that causes an injury to the patient, such as dropping a sharp instrument and lacerating the patient. Other specialists and their primary violations included: ● Oral surgeons, for treatment of the wrong tooth. ● Pediatric dentists, for inappropriate procedures and inadequate precautions to prevent injury. ● Periodontists, for errors in placing implants. ● Prosthodontists, for problems with fixed partial dentures, including improper fit, occlusal discrepancies, or esthetic limitations. The ADA provides specific guidelines for GPs, outlining conditions that are acceptable and feasible for referring patients to specialists. A patient should never be referred based solely on his or her infectious disease status. Treatment decisions for patients with infectious diseases should be determined based on the same criteria as those used for other patients. Referral of patients who are HIV-positive or who have AIDS, based solely on their infectious disease status, would violate the Americans with Disabilities Act and would constitute patient discrimination (ADA, 2016). The dentist may make a patient referral if the dentist feels that there is a need for another practitioner’s skills, knowledge, equipment, or experience. Often a dental healthcare provider will refer a patient for a medical consultation with a physician. If, after consultation with the physician, the dentist feels that treatment in a GP’s office (for example, in the case of a
Page 24
Book Code: DHFL2624
EliteLearning.com/Dental
Powered by FlippingBook