26 | May 2024 Communication Mishap Between Providers Leads to Malpractice Suit Marc Leffler, DDS, Esq. Proper communication between dental providers is essential when referring a patient for a procedure. In this case study, a dentist refers a patient to an oral surgeon for a tooth extraction, but a miscommunication between the providers causes the oral surgeon to extract the wrong tooth. Key Concepts • Extraction of incorrect tooth • Dental numbering systems • Staff education Background Facts An 18-year-old high school senior began April 1 by receiving the invitation to her upcoming prom that she had been hoping for; at first, she thought the question was an April Fools’ joke, but it was not. After school that day, she went to her previously scheduled dental visit to address two issues: a periodically painful impacted upper right third molar, and a supragingivally fractured upper right central incisor that had been struck by a softball a few months prior. Her general dentist clinically and radiographically examined her mouth, with focus on the areas of concern. He determined that the wisdom tooth ought to be extracted because its angulation prevented eruption, after which he would restore the central incisor (before prom night). Sarah wanted to move things along quickly, so she agreed to head to the oral surgeon the same day for the extraction, even though she was nervous about having her tooth extracted; because she had not eaten anything after breakfast, she could be sedated. Dr. G instructed the office manager to call the oral surgeon’s office to ask whether they could see Sarah to “extract the upper right #8.” The office manager spoke with Dr. O’s receptionist, used Dr. G’s exact words, and was told to “send her over now.” No written referral form or radiograph was given to Sarah to deliver to Dr. O. When she arrived at Dr. O’s office with her mother, Sarah provided a benign medical history, and then signed a “consent form for extraction of ‘upper tooth’” while she sat in the waiting room. A panoramic film was then taken, and Sarah was seated in a treatment room. Dr. O briefly introduced himself to Sarah, reviewed her medical history, looked at the panoramic and the handwritten entry on the day sheet to “extract the upper right #8”, and injected sedative medication intravenously. Once Sarah was sedated, Dr. O remarked to his assistant how unaesthetic the upper right central incisor appeared due to the sports accident. He gave an upper anterior buccal infiltration of local anesthetic and routinely extracted the upper right central incisor. When Sarah’s mother came into the recovery room, she immediately saw that the front tooth had been extracted and began to cry. As Sarah listened to her mother, she thought it was an April Fools’ joke, but it was not. Dr. O became very upset when he heard Sarah’s mother and found out why she was crying, and immediately called Dr. G: it was then that he learned that Dr. G had sought the extraction of the upper right third molar (UR8) rather than the upper right central incisor (tooth #8), the latter of which he planned to cosmetically restore. Both dentists agreed to work together to provide Sarah with an implant at the site of tooth #8 and a crown upon it, all at no charge. That treatment was ultimately carried out, but not before the prom, so Sarah attended wearing a flipper, feeling very self-conscious. Legal Action Shortly after that treatment was completed, Sarah’s newly retained attorney filed a dental malpractice lawsuit against Drs. G and O. The claim against Dr. G was essentially that he had negligently failed to properly communicate to Dr. O the treatment plan he wanted to be carried out. The allegations against Dr. O were that he extracted the wrong tooth because he delegated the interactions with Dr. G’s office solely to non-dental office staff, failed to obtain informed consent for the procedure he performed, and failed to perform the level of patient assessment necessary for this patient’s treatment. Although Sarah had no out-of-pocket expenses for the initial implant placement and restoration, her new general dentist advised her that she may well need to have the implant replaced at least once or twice, and very likely need to have the crown redone every 10–15 years. The suit sought compensation for the projected future dental costs, as well as the emotional distress she suffered and would continue to endure. Discovery & Case Resolution From the early days of the lawsuit, Dr. O acknowledged his errors and his desire to try to “make things right” for Sarah, so he encouraged the attorneys provided by his malpractice insurance carrier to settle the case by appropriately compensating Sarah. However, Dr. G did not see it the same way, believing that, in the end, the responsibility lies with the dentist actually performing the extraction to make sure that the proper tooth is extracted. So, at his deposition, Dr. G placed the entire blame on his oral surgery colleague—a concept referred to as “jousting”—and Sponsored Content
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