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New Mexico Dental Journal, Summer 2016
Case 2
The patient was displeased with the esthetics of six units of
anterior crowns provided by Dr. Y. “They don’t look right. They
don’t feel right. The contour on one crown keeps catching my
lip. I don’t hold any malice towards Dr. Y. I think he did the
best he could. I just want my money back. With that, I can get
treatment from Dr. Z, a prosthodontist.”
Prior to seeing Dr. Y, she had extensive posterior crown and
bridge construction from a previous dentist, who had retired.
The patient also had a personal relationship with the ceramic
lab technician, whom her previous dentist utilized. Both this
certified laboratory technician and previous dentist had fees in
the upper 1-2% of labs and dentists nationally. They provided a
level of service rarely even seen in clinical textbooks. They also
charged fees commensurate with that level of service.
The fees of Dr. Y were far more modest. Esthetics and contours
of these anterior crowns were well within standard of care, but
certainly not to the idealize level of her previous care. Crown
margins were slightly rough (slightly shy or minimally over-
hung), but well sealed. In short, the patient received a dental
service above standard of care, at a very reasonable price. Yet,
the patient demanded much more, for a fairly minimal fee.
After review of the case, the patient was advised that Dr. Y’s
service of the anterior clinical crowns was within standard of
care, which is a chief factor in civil malpractice claims. For the
relative low price she paid, she received value for her money.
There was a rub. The patient exhibited extensive damage of
periodontal disease, with significant bone loss. Dr. Y failed
to document this in the patient’s record, and failed to take
radiographs, beyond those limited to the anterior segment.
The patient was not informed of her periodontal disease or
risks associated with periodontal disease, offered treatment for
periodontal disease, or referred to a periodontal specialist for
evaluation and treatment. Failure to inform, treat, or refer; all
represent elements of periodontal care malpractice.
Dr. Y was advised of his vulnerability to a potential claim
for malpractice based not on his anterior crowns which was
the patient’s chief concern. The potential claim would most
probably be for issues surrounding the patient’s undiagnosed
and untreated periodontal disease which would certainly be
addressed by the prosthodontist. That claim for damages
would almost certainly exceed the amount the patient paid
for her anterior crowns.
Dr. Y was advised that the patient at this point in time, only
wanted her money back. He was advised to obtain a hold-harm-
less waiver document, from his malpractice insurance carrier,
or one could be provided for him. The patient stated they were
very willing to sign a waiver of damages, with no admission of
wrongdoing by Dr. Y, in exchange for prior moneys paid. Dr. Y
would be off the hook, for a potential future malpractice claim.
Conclusion
One can’t begin to sample the vast range of possible situations
brought forth to your NMDA peer-review colleagues. These
volunteer doctors are there for you, the standing of the dental
profession, and to serve the public welfare. Membership has its
privileges and benefits. This represents just one of the benefits
of NMDA Membership. By the way, you don’t need to wait for
a disgruntled patient complaint to peer-review to seek consulta-
tion with your colleagues.
WCDDS: Jared Montano
NWDDS: Julius Manz
ADDS: Kevin Harrison
EDDS: Melinda Hacker and Dale Goad
SWDDS: Richard Owen
SFDDS: Michael Davis
Peer Review is a free mediation service available to NMDA Members designed to avoid the costs, time
and emotional stress of litigation. Concerned patients can file a request with the NMDA. Volunteer dentists
work to find viable mediation solutions, without any admission of wrongdoing by any party. Potential
patient compensation is limited, to the amount initially paid. No moneys are given for possible punitive or
compensatory damages. The volunteer doctors are your colleagues.
Report from NMDA Peer Review,
continued