teeth injury after anesthesia compensation

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tweekin19

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I had a patient bite on an oral airway after waking up and subsequently knocked out a veneer. Is it better to pay out of pocket for their dental expense or should I have them file a claim with my malpractice carrier? I am afraid my premiums will go up if I do especially since I'm new to private practice.

The intubation was smooth. The patient needed an airway of some sort after extubation. I am trying to think how I could've better prevented this.
I saw the PACU nurse struggle trying to take the airway out as the patient kept clamping down so thought this was the most likely cause. I just don't want a repeat of this happening in the future. For patients with veneers is there a better alternative to the plastic oral airway if they need support afterwards? I weighed the possiblity of placing a nasal airway but knew it had its own risks of nasal trauma.
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tweekin19 said:
I had a patient bite on an oral airway after waking up and subsequently knocked out a veneer. Is it better to pay out of pocket for their dental expense or should I have them file a claim with my malpractice carrier? I am afraid my premiums will go up if I do especially since I'm new to private practice.

The intubation was smooth. The patient needed an airway of some sort after extubation. I am trying to think how I could've better prevented this.
I saw the PACU nurse struggle trying to take the airway out as the patient kept clamping down so thought this was the most likely cause. I just don't want a repeat of this happening in the future. For patients with veneers is there a better alternative to the plastic oral airway if they need support afterwards? I weighed the possiblity of placing a nasal airway but knew it had its own risks of nasal trauma.
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I wouldn't even call this a dental injury. This sounds like it happened with minimal force. Veneers are fairly cheap, and if it fell out you just need them to go back to the dentist to glue it back on. You could call up their dentist. Could well be done for free.
 
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LOVE the soft nasal airways. Can also use them orally too if you’re particularly worried about the harder plastic oral airways.
 
tweekin19 said:
I had a patient bite on an oral airway after waking up and subsequently knocked out a veneer. Is it better to pay out of pocket for their dental expense or should I have them file a claim with my malpractice carrier? I am afraid my premiums will go up if I do especially since I'm new to private practice.

The intubation was smooth. The patient needed an airway of some sort after extubation. I am trying to think how I could've better prevented this.
I saw the PACU nurse struggle trying to take the airway out as the patient kept clamping down so thought this was the most likely cause. I just don't want a repeat of this happening in the future. For patients with veneers is there a better alternative to the plastic oral airway if they need support afterwards? I weighed the possiblity of placing a nasal airway but knew it had its own risks of nasal trauma.
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So what if they get AKI after a surgery you going to get em a new kidney? No need to be emotional about it. Tough luck. It’s a veneer. Cost of doing business. Cheap veneers don’t make care within reasonable standards malpractice or your problem.

Some of my partners make sure to document poor dental hygiene before cases. Meth teeth can just crumble away.

Personally, I have a partially fake tooth from playing Sports. It cracks off every few years. This is an expected outcome. I would imagine veneers are a similar story.
 
Is this something that we really need to be paying for? I’ve never understood it. Obviously it’s unfortunate but it’s an established risk. As far as I know, surgeons aren’t offering their personal cash when they nick the bowel or slice a ureter..
 
You have them file a claim with your malpractice carrier and that could end up on your NPDB report. I would look at the specific rules from the NPDB to see if it is something that would be reported to them. If it ends up on your report you will be answering questions about it for the rest of your career every time you consider changing jobs or getting new privileges somewhere.
The standard practice in every place I have ever been is to treat these patients with respect and care and offer to pay for them to see their dentist. Anything further than that needs to be a mutual arrangement between the two parties.
 
Blockit said:
You have them file a claim with your malpractice carrier and that could end up on your NPDB report. I would look at the specific rules from the NPDB to see if it is something that would be reported to them. If it ends up on your report you will be answering questions about it for the rest of your career every time you consider changing jobs or getting new privileges somewhere.
The standard practice in every place I have ever been is to treat these patients with respect and care and offer to pay for them to see their dentist. Anything further than that needs to be a mutual arrangement between the two parties.
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If a claim is paid on your behalf by the hospital, by your insurance carrier or your employer, they are required to report to NPDB. If you woolier a personal check there is no duty for you to self report.

On the flip side, a dental injury is unlikely to result in a lawsuit since the dollars involved are relatively low.

I have written two personal checks to patients in my career. (Poor technique by the CRNA OR SRNA). Also told a few “no” because their teeth were crap.
 
dabears505 said:
Just pay cash and be done with it. Had it happen to me, I'm so glad I went that route instead of having to click yes if I've had claims against me.
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Seriously? Pt will file a claim against a veneer? What kind malpractice lawyer will take this case? a few hundred bucks????
 
These responses are amusing. My last academic job - lawyers would ask me 'did you document and tell them about risk of dental damage?" If yes they would tell the patient to pound sand. If no I think they would set up work w dentists.
 
dr doze said:
If a claim is paid on your behalf by the hospital, by your insurance carrier or your employer, they are required to report to NPDB. If you woolier a personal check there is no duty for you to self report.

On the flip side, a dental injury is unlikely to result in a lawsuit since the dollars involved are relatively low.

I have written two personal checks to patients in my career. (Poor technique by the CRNA OR SRNA). Also told a few “no” because their teeth were crap.
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This terrifies me as someone who is interested in anesthesia as a specialty...
 
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Airway said:
I advise all residents to think about medicolegal climate when choosing a location for a job...
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I'm upset by the fact that you are held responsible for others mistakes. If I break someones teeth or mess something up, that should be on me... but I am not a fan of being held legally responsible for someone else's mistakes.

Might be an obvious question, but don't CRNAs/students have their own malpractice insurance?
 
frosted2 said:
I'm upset by the fact that you are held responsible for others mistakes. If I break someones teeth or mess something up, that should be on me... but I am not a fan of being held legally responsible for someone else's mistakes.

Might be an obvious question, but don't CRNAs/students have their own malpractice insurance?
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If you are supervising-you are often at least partially responsible.
 
To the OP, I would suggest a soft bite block in the future. 3-4 4x4 gauze rolled and then taped, put it between the molars (I'm sure you know how to make one, that was just for posterity). I'd always been taught not to use the OPA's as a bite block substitute since pt's can crack their teeth on them. You could probably get away with using them for the rest of your career and never have a problem, but I'm guessing you're gonna slightly stress about this in the future and to me, that isn't worth the worry.
 
dr doze said:
If a claim is paid on your behalf by the hospital, by your insurance carrier or your employer, they are required to report to NPDB. If you woolier a personal check there is no duty for you to self report.

On the flip side, a dental injury is unlikely to result in a lawsuit since the dollars involved are relatively low.

I have written two personal checks to patients in my career. (Poor technique by the CRNA OR SRNA). Also told a few “no” because their teeth were crap.
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why SRNA. isnt CRNA responsible for the SRNA. why are you writing a check to them
 
I say just cover it. It doesn’t happen often, and it isn’t terribly expensive.

Getting lawyers/malpractice involved is almost always the wrong answer.

We are a private group with employed CRNAs. We have a good group of anesthetists who feel awful the couple of times it has happened (even in poor dentition people). We have decided to just pay it out as cost of doing business, make things easy for the patient and a bit of goodwill/grief reduction for the CRNAs.
 
frosted2 said:
I'm upset by the fact that you are held responsible for others mistakes. If I break someones teeth or mess something up, that should be on me... but I am not a fan of being held legally responsible for someone else's mistakes.

Might be an obvious question, but don't CRNAs/students have their own malpractice insurance?
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That's the game when you're billing for them

MD only homie
 
narcotics999 said:
Seriously? Pt will file a claim against a veneer? What kind malpractice lawyer will take this case? a few hundred bucks????
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Sadly yes a patient might and a lawyer might take the case. It’s common. Sometimes it’s done in small claims court.

Often best to pay cash for dental injuries if legitimate.
 
dr doze said:
Because the amount of money was worth a quick, clean, simple closure to the incident to me. I perceived that it might save my a potentially moderate headache.
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Is it though? Did you have them sign a waiver of liability or something? If someone is going to hire a lawyer over a tooth why wouldn’t they also hire a lawyer over the emotional trauma of having that tooth fixed?
 
chessknt said:
Is it though? Did you have them sign a waiver of liability or something? If someone is going to hire a lawyer over a tooth why wouldn’t they also hire a lawyer over the emotional trauma of having that tooth fixed?
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I didn’t have them sign a waiver. I judged the patient trustworthy. No different than settling a fender bender without involving your insurance company. Granted that both are risks.
 
dr doze said:
I didn’t have them sign a waiver. I judged the patient trustworthy. No different than settling a fender bender without involving your insurance company. Granted that both are risks.
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I would argue that the barrier to filing a car insurance claim is way lower than bringing a malpractice lawsuit which is what would need to happen to get reimbursed for a tooth injury in which case they would have to prove that you committed malpractice.
 
chessknt said:
Is it though? Did you have them sign a waiver of liability or something? If someone is going to hire a lawyer over a tooth why wouldn’t they also hire a lawyer over the emotional trauma of having that tooth fixed?
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I also felt bad for the patient. I was the doc in charge, a lousy level of skill was given, so It should have been on "us". It was just simpler and emotionally better for me to take this hit. Cost of doing business. I think that those who disagree are totally reasonable.
 
Southpaw said:
this always been paid out of pocket through my group in my experience. I've had one patient followup with a dentist and the dentist took care of the issue free of charge.
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I was an employee when these incidents happened. The Administration are/were incompetent and obstructionist PITAs. Plus they would have had a duty to report. See above post about avoiding headaches.
 
Our group would pay for this. If you offer to pay they accept and it’s done. If you tell them to pound sand, assuming they don’t have meth teeth, they’re going to be asking for pain and suffering, the veneer repair will need to be a dental implant per the new shady dentist, they want to be paid for several days of missed work, etc.
Having said that, if they have dental repairs I warn them that they could be damaged in spite of doing everything right. And I type that in the note, and use a soft bite block at emergence.
It’s not a get out of jail free card, but it only takes 30 seconds and sets reasonable expectations and they can’t say you were negligent in not mentioning it.
 
Lots of good info here for someone that will be entering practice soon.

I insist my tubed patients wake up with a soft bite block. It's easy in my academic joint because we have fancy premade soft rubber ones that fit nicely between the molars. When I was a CA1 I had a patient chomp down on a hard plastic OPA and chipped his front two teeth. They weren't the pearliest of whites I've ever seen but they were far from "meth teeth". I've also had patients chomp down on the tube multiple times. Some of them got a whiff of sux, one of them got negative pressure pulmonary edema. So my "thing" will be bite blocks. If we don't have fancy rubber one's then they're going to get rolled up 4x4's.
 
Mehd School said:
Lots of good info here for someone that will be entering practice soon.

I insist my tubed patients wake up with a soft bite block. It's easy in my academic joint because we have fancy premade soft rubber ones that fit nicely between the molars. When I was a CA1 I had a patient chomp down on a hard plastic OPA and chipped his front two teeth. They weren't the pearliest of whites I've ever seen but they were far from "meth teeth". I've also had patients chomp down on the tube multiple times. Some of them got a whiff of sux, one of them got negative pressure pulmonary edema. So my "thing" will be bite blocks. If we don't have fancy rubber one's then they're going to get rolled up 4x4's.
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Just extubate before they chomp down
 
GassYous said:
Just extubate before they chomp down
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I mean that sounds easy enough. The patient that had negative pressure pulmonary edema was >150 kg and not a simple airway. Just prior to him chomping down he was taking 175cc tidal volumes on a good amount of pressure support. I did an M&M on this case so the details are somewhat fresh.
 
Mehd School said:
I mean that sounds easy enough. The patient that had negative pressure pulmonary edema was >150 kg and not a simple airway. Just prior to him chomping down he was taking 175cc tidal volumes on a good amount of pressure support. I did an M&M on this case so the details are somewhat fresh.
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It's an art. Timing ain't easy
 
I had my teeth whitened by cosmetic dentistry. The treatment did last 1 to 2 hours. I will say that they are not very white. Because I think you only get that with veneers. And my teeth weren't too discoloured anyway, but there was a difference. And I was very pleased with them. 😀
 
anbuitachi said:
how does one just pay cash? what if you hand them a pile of 20s and then they sue you anyway
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would want your attorney or your groups attorney to have them sign something saying that the matter is closed with excepting the payment, however that document is not legally bullet proof and really all you are doing is trying to reduce the chance that they’ll sue you by preemptively covering their damages. This in turn keeps your record clean and lets you avoid headaches such as a deposition etc.
 
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