Dr. Wiggs, asks us:
Several years ago one of my patients called on the New Year Holiday weekend and said she just fractured tooth # 7 which was recently part of anterior restorations in Porcelain—-some full porcelain crowns and others porcelain laminates. My office was closed but I told her to come in–the remaining root structure could not be restored and I told her it would have to be extracted and could be replaced with a dental implant or a 3 unit fixed bridge.
She chose a dental implant without hesitation especially since she already
had a successful implant procedure in another quadrant. I called two
offices who now handle most of my dental implant procedures. Both were
closed. I called a third–a surgeon who I had worked with – and he was
open. Told us to come right over and proceeded to place a dental implant. The
patient left, pleased with what was apparently a successful procedure.
The patient called me the following week and said the area did not look
normal—the tissue around the dental implant had collapsed. We returned to
the surgeon who said he would repair the area with tissue taken from
the palate. I suggested that he have a periodontist perform the
procedure since it was in such an aesthetic-sensitive area but he
insisted he would do it. There was nothing in my past experience with
this dentist to mistrust him and so he proceeded.
Two weeks later the
area looked worse than ever and I sent her to see a periodontist who
said it would be a long and difficult series of operations to restore
the collapsed ridge—-if it could be restored. I called the surgeon
and explained what had occurred and told him about the cost and time
estimates the patient now faced. I told him that she indicated to me
that she intended to sue for damages if she did not get her money back
from him. He passed a vulgar remark about where she could go and hung
up. I explained to the patient that instead of suing she should try
peer review.
When she investigated peer review she discovered that he
did not belong to the New York Dental Society and therefore had no
obligation to participate. Apparently no lawyer would take her case
because she was not suing for enough money, so she personally took him to
court.
The bottom line is that the dental implant was not restorable, the
judge decided that the dental implant was placed into the bone within the
parameters of correct procedure despite the result and ruled in the
surgeon’s favor. There was no discussion about the aesthetic
restorability.
Where does the responsibility for a successful procedure restoration
lie when a one dentist inserts the dental implant and another dentist has to
restore it? And why is this surgeon permitted to get off free–his
insurance company offered to settle but he refused to permit that, as
his malpractice policy permitted?
Dear Dr. Wiggs, An acquaintance of mine had a similar complication from a dental implant leaving him in chronic pain. He, however, was able to have the case tried by a jury. I can tell you if she had a jury trial she would have won. She’d have my vote based on the events you describe leading to her injury. The arrogance of this lawyer is awful and would have been evident to the jurors. She may be able to have her case retried. Good luck. What a horrendous situation. At the very least report him.
It is often rude and dismissive behavior that gets people sued. The patient really was treated shabbily in this case, and it is too bad that you were put in an unfortunate postion as well.
Dear Dr. Wiggs, I meant to say “the arrogance of this surgeon is awful and would have been evident to the jurors”. Sorry for that but it’s been a long day. Again, good luck to you and your patient. Also, don’t spoil your reputation by referring any other patients to him.
Clinicians referring patients to other doctors should always bear in mind that there is some potential liability based on a tort theory of “negligent referral.” Before referring a patient to another doctor, the referring dentist should be 100% satisfied with the specialist’s credentials and importantly, his bedside manner. Further, the referring dentist should follow up on the procedure as if he/she had performed it personally. The comment about “rude and dismissive behavior gets people sued” is right on. People go to lawyers’ offices more frequently when they’re treated badly by a doctor and/or his staff than for any other reason. Importantly, referring doctors should remember that just like in this case, the patient always returns to the doctor hired in the first place. “I didn’t hire him (referred specialist), you did!” is usually said. To precisely answer Dr. Wiggs’ question, the liability for an unsuccessful procedure lies with the doctor actually doing the work. Conjoint liability (including the referring doctor) is applicable only if the referring doctor knows, or should have known, that the referred specialist was incompetent or was not qualified to do the procedure. An expert witness trained in the discipline would be required to bring in the referring doctor.
It is a lesson to learn. If the patient sues a dentist in small claims court without an expert witness of equal or greater expertise (ie. another dentist) the court assumes the dentist knows more about the situation than does the patient and the patient will loose.
Dr. Wiggs, You mention the incident took place several years ago. Are you still treating her as a patient and how did her situation turn out? I really feel for that poor woman.
A similar thing happened to me so I decided to take a comprehensive course in implant placement. I now place the implants I feel comfortable placing and have my network of specialists who I refer to for more difficult cases. One of them acts as my mentor and our implant cases have increased dramatically over the past several years because of this relationship.
I believe the lesson we can all learn from in this case is, don’t refer to anyone who hasn’t done this procedure for you in the past – the poor patients that must endure this sort of care are the only ones that lose.
If it’s not too late, she should hire a lawyer. The lawyer will hire expert dental professionals to work with this woman to help her repair the injuries she sustained. At the same time, these professionals will serve as expert witnesses in the trial. I am sure that she now will not refrain from suing this so called surgeon for the maximum. I am also certain there are many reputable attorneys out there who would be willing to take her case. Again, provided it is not too late. You, of course, could serve as a witness. My very best to you and your patient. PASS THIS SURGEON’S NAME AROUND. GET THE WORD OUT ON HIM. HE IS A DISGRACE TO THE DENTAL PROFESSION!!!!!!!!!
Dr. Wiggs, as per your original post, you indicated that you accompanied the patient to the surgeons office. Were you present during the surgical procedure? Was the residual root fragment removed atraumatically ie: periotomes?I agree that a periodontist is by far the pratictioner I would choose concerning esthetic soft tissue grafting procedures. I would like to remind everyone that not all procedures result in a successful outcome despite how well they are preformed. Additionally, we only have one side of the story with no records to review. The surgeon should stand behind his or her treatment. I would also steer clear of the genral practitioner who believes they are an impant specialist following the completion of a so-called impant mini residency, 6 weekends, please!
We as a dental profession, are sometimes very critical of one another. Be it a specialist or another GP. The bottom line is that complications happen to everyone. If someone out there states that they never get complications, then this person is either lying or simply hasn’t done enough of the given procedure. It’s how one deals with the complications that’s important. I agree that arrogance is never a good thing, yet we should not condemn the surgeon in his absence and without any records. The esthetic area is one of the most difficult areas to treat and sometimes the results that we achieve are not what the patient might have envisioned from the beginning.