My experience with a malpractice suit

[Molar Whisperer]

This will sound strange but this is one of the most valuable experiences to happen to me. No dentist wants to get sued. I hope to bring awareness since I was so complacent prior to this event.

I saw meth mouth patient denying taking any drugs. It was my fault for not spending more time and caution with her since I was seeing way too many patients at my previous DMO. She was an intense dental phobic, nightmare patient and I wanted to punt her to someone else. She would always be in tooth pain and I had a hard time juggling her case with other patients...which was a recipe for disaster. There's always hind-site. Could I have treatment planned her case differently? I should have told her I couldn't restore her teeth the way she wants...end of nightmare.

Fortunately, my opposing attorney had no dental experience. After the law suit notification, I looked up everything I could find on this lady and exposed 2 Meth related arrests. We brought down the original damages of $995k pain & suffering to start negotiating settlement at $30k. Why not just dismiss the case? The main question was did I follow "reasonable standard of care?" Her teeth started out marginally restorable. Caries were so rampant, I didn't know where to begin. Every visit the patient was in so much pain. I did mostly temp fillings and later root canals on her. I keep kicking myself for trying to restore her teeth because she didn't want any extractions. About 18 months later she switched dentists and began the legal process. Those temps fillings look pathetic. My chart write ups were also pathetic....lesson learned. Another detail I learned is that the defense attorney has no incentive to go heroics. He specializes in defending mostly dentists and some medical doctors. He has 4 other more pressing dental cases than the measly pain and suffering from a Meth abuser. There is no incentive for him to go to court. I believe he is on contracts with numerous malpractice carriers because he is on the phone with them to authorize specific settlements. He must have trusted me to mentioned that there is no money involved with defending malpractice cases. We finalized the settlement at $35k...under my prev company's name only.

How does this affect me? According to my attorney, really not much. This case will be on my national provider data base record and the state board will investigate it. About a year after the final settlement I haven't seen anything pop up on my state board disciplinary alerts. I applied to the new DMO company during that law suit, disclosed it fully, and received no concerns from them. My malpractice ins rates will go up...I don't know how much because my new DMO is covering it. Credentialing with various dental insurance benefits companies were not a problem although I needed to write a few narratives to explain the situation. I have a lot more awareness...once bitten twice shy. At the advice of my attorney, I took various risk mgt and record keeping courses. I've encounter a handful of similar phobic, noncompliant druggie cases and they ended up finding someone else because I'm not as accommodating to their unrealistic expectations. My advice is to follow "reasonable standard of care," never be complacent, take some risk mgt courses with serious intent, improve your chart notes and establish (communicate) clear expectations (when the patients are not in pain).

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[tooth-tastic]

This will sound strange but this is one of the most valuable experiences to happen to me. No dentist wants to get sued. I hope to bring awareness since I was so complacent prior to this event.

Thank you for sharing your experience!
What prompted the suit? Desire for money to finance the habit and/or personal animosity to you?

 

[Molar Whisperer]

A

Thank you for sharing your experience!
What prompted the suit? Desire for money to finance the habit and/or personal animosity to you?

Sorry this might go off tangent but she was more upset at my DMO company. She was upset that I didn't do crowns on her. At the time I worked for capitation. It is the company's best interest if I under-treat because doing a crown is losing money...think of a car insurance claim losing money for the company. She had the unrealistic expectation that all her rotting teeth will magically look like Hollywood's. We had to practice phase dentistry at that company and do crowns after all her disease is controlled. I couldn't get her out of phase 1 and had to fudge the metrics to get her to phase 2 for root canals. She was looking for full mouth implants after the law suit.

 

[tooth-tastic]

A


Sorry this might go off tangent but she was more upset at my DMO company. She was upset that I didn't do crowns on her. At the time I worked for capitation. It is the company's best interest if I under-treat because doing a crown is losing money...think of a car insurance claim losing money for the company. She had the unrealistic expectation that all her rotting teeth will magically look like Hollywood's. We had to practice phase dentistry at that company and do crowns after all her disease is controlled. I couldn't get her out of phase 1 and had to fudge the metrics to get her to phase 2 for root canals. She was looking for full mouth implants after the law suit.

Thanks for the response. Very unfortunate situation.

 

[wannagiveup]

A


Sorry this might go off tangent but she was more upset at my DMO company. She was upset that I didn't do crowns on her. At the time I worked for capitation. It is the company's best interest if I under-treat because doing a crown is losing money...think of a car insurance claim losing money for the company. She had the unrealistic expectation that all her rotting teeth will magically look like Hollywood's. We had to practice phase dentistry at that company and do crowns after all her disease is controlled. I couldn't get her out of phase 1 and had to fudge the metrics to get her to phase 2 for root canals. She was looking for full mouth implants after the law suit.

Is it true that as a government healthcare employee (military, prison, IHS, and FQHC etc) , you cannot be sued for malpractice?

 

[Molar Whisperer]

You can still get sued but not as frivolous. I heard there was a military OBGyn sexually assaulting women...I know it was criminal but wasn't sure about the civil details.

 

[Utdarsenal]

Thank you for sharing this. Were there any signs beforehand that the patient was acting a little strange/potentially litigious? Or did it come out of the blue?

This is what worries me the most about working in a fast-paced mill. The potential for something going wrong or not giving a situation more attention than it needs, which is pretty common in these environments.

I do find it ridiculous that a patient would sue for 995k for "pain and suffering".. like really? Did your malpractice insurance pay the 30k? I find it strange that she even managed to get away with that amount (sorry, I don't mean to be offensive here) but I have trouble comprehending how she managed to get away with that. I can understand that amount if something went wrong with an expensive treatment, say an all-on-six/full mouth rehab.. but just from pushing back treatment? It was also her decision to stick around, she could've gone to another office if she wanted to. I don't get it..

I don't mean to downplay the situation in any matter, I also work at a fast paced office and am scared of something like this happening which is why I'm trying to dig into this.

 

[wannagiveup]

Were you formally notified that you are being investigated by the board? The patient sued and also filed a board complaint? Did they request for records and later notify you of their findings and actions, if any?

 

[Molar Whisperer]

Thank you for sharing this. Were there any signs beforehand that the patient was acting a little strange/potentially litigious? Or did it come out of the blue?

This is what worries me the most about working in a fast-paced mill. The potential for something going wrong or not giving a situation more attention than it needs, which is pretty common in these environments.

I do find it ridiculous that a patient would sue for 995k for "pain and suffering".. like really? Did your malpractice insurance pay the 30k? I find it strange that she even managed to get away with that amount (sorry, I don't mean to be offensive here) but I have trouble comprehending how she managed to get away with that. I can understand that amount if something went wrong with an expensive treatment, say an all-on-six/full mouth rehab.. but just from pushing back treatment? It was also her decision to stick around, she could've gone to another office if she wanted to. I don't get it..

I don't mean to downplay the situation in any matter, I also work at a fast paced office and am scared of something like this happening which is why I'm trying to dig into this.

She was constantly asking me to do crowns. She voiced her displeasure because her teeth were breaking Left & Right and said it was my fault and she will sue me. I did such a poor job charting...I did say her caries were out of control but it wasn't as effective as I like. Hopefully I spelled out the general reasons for settling above. If I was unclear, pls PM me. Surprisingly she liked me because I gave the least traumatic injections and I was able to manage her anxieties better than the other docs...I wished I could have punted her away.

How do you protect yourself? I'm not qualified to give legal advice BTW.
1. Practice "reasonable standard of care." To the jury, my temp fillings look like sh__. Juries aren't dentists and believes what they see on x-rays.
2. If you have to put temp fillings, explain the reasons why and provide followup plan
3. Chart efficiently. Not all novels are effective. "Explained to the patient her deteriorating teeth due to uncontrolled caries and lack of compliance. If compliance is not followed, the patient was advised of the need to extract."
4. Try to take more risk mgt and record keeping courses...

 

[Molar Whisperer]

Were you formally notified that you are being investigated by the board? The patient sued and also filed a board complaint? Did they request for records and later notify you of their findings and actions, if any?

I was never investigated by the board for this case although at the same time this was happening, I had a board complaint of another case...I know you guys think I'm a loser. I worked at a franchise dental chain briefly and the hygienist tends to probe ~2 mm deeper to get her SRP production. The patient happened to be a lawyer and went elsewhere and they told him he had healthy gums. He complained about me and not her. I will start another thread about this chain sometime. Unfortunately the paper charting had numerous missing or undocumented information. With the advice of my attorney, I send the Board numerous certificates of my risk mgt training and promised to take better chart notes and they slapped me with a "Letter of Concern." A side note...I had a colleague working with me at the DMO where the law suit happened and he is a member of my state Board. Ironically he left that DMO and is practicing at my new company.

 

[Svart Aske]

She was upset that I didn't do crowns on her. At the time I worked for capitation. It is the company's best interest if I under-treat because doing a crown is losing money...

DHMOs are such bull****.

 

[Molar Whisperer]

DHMOs are such bull****.

The trend is cutting costs of dentistry...the company ended up being named on the suit instead of me.

 

[tooth-tastic]

I know you guys think I'm a loser.

Not at all. Really appreciative that you're sharing your experience.

 

[nbde4dds]

This will sound strange but this is one of the most valuable experiences to happen to me. No dentist wants to get sued. I hope to bring awareness since I was so complacent prior to this event.

I saw meth mouth patient denying taking any drugs. It was my fault for not spending more time and caution with her since I was seeing way too many patients at my previous DMO. She was an intense dental phobic, nightmare patient and I wanted to punt her to someone else. She would always be in tooth pain and I had a hard time juggling her case with other patients...which was a recipe for disaster. There's always hind-site. Could I have treatment planned her case differently? I should have told her I couldn't restore her teeth the way she wants...end of nightmare.

Fortunately, my opposing attorney had no dental experience. After the law suit notification, I looked up everything I could find on this lady and exposed 2 Meth related arrests. We brought down the original damages of $995k pain & suffering to start negotiating settlement at $30k. Why not just dismiss the case? The main question was did I follow "reasonable standard of care?" Her teeth started out marginally restorable. Caries were so rampant, I didn't know where to begin. Every visit the patient was in so much pain. I did mostly temp fillings and later root canals on her. I keep kicking myself for trying to restore her teeth because she didn't want any extractions. About 18 months later she switched dentists and began the legal process. Those temps fillings look pathetic. My chart write ups were also pathetic....lesson learned. Another detail I learned is that the defense attorney has no incentive to go heroics. He specializes in defending mostly dentists and some medical doctors. He has 4 other more pressing dental cases than the measly pain and suffering from a Meth abuser. There is no incentive for him to go to court. I believe he is on contracts with numerous malpractice carriers because he is on the phone with them to authorize specific settlements. He must have trusted me to mentioned that there is no money involved with defending malpractice cases. We finalized the settlement at $35k...under my prev company's name only.

How does this affect me? According to my attorney, really not much. This case will be on my national provider data base record and the state board will investigate it. About a year after the final settlement I haven't seen anything pop up on my state board disciplinary alerts. I applied to the new DMO company during that law suit, disclosed it fully, and received no concerns from them. My malpractice ins rates will go up...I don't know how much because my new DMO is covering it. Credentialing with various dental insurance benefits companies were not a problem although I needed to write a few narratives to explain the situation. I have a lot more awareness...once bitten twice shy. At the advice of my attorney, I took various risk mgt and record keeping courses. I've encounter a handful of similar phobic, noncompliant druggie cases and they ended up finding someone else because I'm not as accommodating to their unrealistic expectations. My advice is to follow "reasonable standard of care," never be complacent, take some risk mgt courses with serious intent, improve your chart notes and establish (communicate) clear expectations (when the patients are not in pain).

Thanks a lot for sharing. I wish more of us can come forwards and share their experience, it teaches everyone. I applaud you for your courage coming forward and wish you all the best in life.

 

[nbde4dds]

Actually this reminds me about one of my patient's from dental school who was always in pain, no local anesthetic worked on her, all teeth carious, she was never happy and always complaining, I was scared to book appointments for her. Now I am thinking might be she was a case something similar to your pt, taking drugs etc.

 

[OMSDoc]

...She voiced her displeasure...and said it was my fault and she will sue me...

Any time a patient threatens to sue you, you can stop treating them, telling them, "It would be inappropriate for me to continue treating you if you are considering legal action." You want an assistant present who can write their own note about it.

2. If you have to put temp fillings, explain the reasons why and provide followup plan
3. Chart efficiently. Not all novels are effective. "Explained to the patient her deteriorating teeth due to uncontrolled caries and lack of compliance. If compliance is not followed, the patient was advised of the need to extract."
4. Try to take more risk mgt and record keeping courses...

To me this is the main advantage of electronic records. You can have templates of your consultations and treatment notes, and just fill in the blanks, and the computer will generate a nice looking note. This takes a lot of time to set up, but it is time well spent. It is a lot harder in a corporate group, because you cannot always customize things to your choosing.

 

[wannagiveup]

Do you use autonote? Did you contact your malpractice carrier as soon as you found out about the pending lawsuit and they assigned a lawyer to you? Would you have gotten your own personal attorney in hindsight and gone to trial? Just curious are you allowed to dismiss a patient (as in terminating patient-provider relationship) as an employee at your corporate office?

 

[Molar Whisperer]

Do you use autonote? Did you contact your malpractice carrier as soon as you found out about the pending lawsuit and they assigned a lawyer to you? Would you have gotten your own personal attorney in hindsight and gone to trial? Just curious are you allowed to dismiss a patient (as in terminating patient-provider relationship) as an employee at your corporate office?

I'm not as computer savvy as many young-uns. I would like some young-uns to help me with my slow server...my computer is always non-responsive...took me 20 min to send some documents from my regular office to another location....Currently I'm using an outdated Dentrix at the DMO. I made my own templates, put it in PDF, copy, paste, bam/done...if the computer responds.

When she made that comment I wasn't sure what to do. I thought she was kidding because I didn't think I did anything wrong. No lawyers will touch a case unless they will get big dollars...naive me. No I didn't notify my carrier. Shortly after, that DMO fired me...thank God. I got the law suit notice about a year later. I wasn't sure what damages I caused and I thought I wrote good notes. I looked her up and found 2 meth related charges and thought this will clear me...naive me again. I don't think I have anything to gain by going to trial other than best case scenario cleared my name (the suit named my DMO instead of me) minus 10s of thousands in lega fees. I don't think my carrier will pay for my own attorney. After practicing more than 22 yrs, I don't know how to terminate a patient...thanks for the heads up...I will find out. I'm taking some accountability. I should have treated that case differently.

 

[Molar Whisperer]

I'll give an example of my endo write up. I'm blessed with an operating microscope. "Under 8x magnification using operating microscope, no internal caries, fracture, resorption found, all pulpal tissue removed, all canals located and cleaned."

 

[wannagiveup]

I'll give an example of my endo write up. I'm blessed with an operating microscope. "Under 8x magnification using operating microscope, no internal caries, fracture, resorption found, all pulpal tissue removed, all canals located and cleaned."

Do you include pulpal and periapical dx? Do you chart perio pd when doing RCT? Do you list what kind of sealer you used in your documentation? How's your back and neck doing??

 

[Molar Whisperer]

Do you include pulpal and periapical dx? Do you chart perio pd when doing RCT? Do you list what kind of sealer you used in your documentation? How's your back and neck doing??

I have to change my name so you guys won't come after me with pitchforks. I always include both pulpal and periapical..."#30 pulpal necr with asymptomatic apical periodontitis"

Pt arrived for RCT #
Reviewed Medical History:
Medications Taken:
Drug Allergies:
X-rays taken/reviewed:
Exam: (Radiographic & Clinical Findings)
Chief Complaint:
Pain:
Percussion:
Palpation:
Cold test:
Periodontal probe:
Tooth sleuth:
DX:
Pt consents to RCT #
BP P
20% Benzocaine topical anesthetic
3% Mepiv Pl x
2% Lido 1/100k epi x
No adverse reactions to anesthetics
TX: Rubber Dam isolation, routine pulpal access
Operating Microscope Magnification (8x) & (12.5x), no internal caries, fracture, or
resorption detected, verified removal of all pulpal tissue and located all canals.
Clean & shaped canals using Wave One rotary instrumentation x
Verified WLs with Apex Locator
Canals patent with size #10 K-file
Full strength NaOCl & EDTA irrigation under activation, RC Prep instrument lubrication
[Ca(OH)2 canal dressing placed to allow for endodontic disease to resolve] DELETE IF FINAL OBTURATION IS DONE
Gutta Percha obturation with BioRoot bioactive Sealer
Final restoration with Fuji Equia
Good Prognosis
Discussions: Pt advised of fragile tooth condition after RCT, precautions, PO & Home
care instructions, final cuspal coverage (crown) needed.
Pt tolerated procedure well, left in good condition.
RX:
NV:
PARQ
DA

 

[wannagiveup]

oral cancer screening?

 

[Molar Whisperer]

oral cancer screening?

At NP or periodic exam...

Head and neck: WNL, no facial asymmetry
Oral conditions: slight hyperker tissue right lateral tongue, pt was advised and 2 wk followup planned.

 

[Molar Whisperer]

Do you include pulpal and periapical dx? Do you chart perio pd when doing RCT? Do you list what kind of sealer you used in your documentation? How's your back and neck doing??

Sorry I missed the back and neck. I don't really have issues. When doing root canals, every endodontists chant...access access access...you can't paint a room thru a key hole. What is good access? Your DA can stick paper points on every canal of every 2nd molars. So if I don't feel like it, I'll have my DA obturate for me (just kidding).