When a patient goes from dentist to dentist, it's an obvious red flag. What happens when the dentist doesn't find out until it's too late?
Posted in Dental Insights on Thursday, June 20, 2024
Mrs. Aldon was in her 60s when she first saw general dentist Jake Parks. A friend had referred Mrs. Aldon because Dr. Parks was less expensive than most other dentists and would do all of the restorative work himself.
Mrs. Aldon came in for an appointment with Dr. Parks to be evaluated for having a tooth extracted and her bridgework redone. At this first visit, Dr. Parks took a periapical film.
Dr. Parks determined the tooth was badly decayed, and he advised Mrs. Aldon to have the tooth removed during this first visit. Mrs. Aldon agreed to the procedure, and though Dr. Parks’s notes did not reflect any details about the extraction, the procedure appeared to be uneventful.
At the next visit, Mrs. Aldon requested a treatment plan to help restore a number of teeth, so her teeth would “look better.” The clinical examination indicated extensive past dental work, and the treatment plan developed by Dr. Parks involved primarily redoing two bridges in the upper arch.
Patient Says X-rays Already Taken
When Dr. Parks told Mrs. Aldon he would need to take a full mouth series of films, she shared that she had these taken in the past couple of months. Mrs. Aldon said she would bring the films in, and Dr. Parks agreed to use these films instead of obtaining new ones.
During the next several visits, Dr. Parks began work on Mrs. Aldon’s upper mouth in preparation for the restoration of the bridgework. Dr. Parks prepared a number of the upper teeth and placed temporary bridgework. Dr. Parks again asked Mrs. Aldon to bring in the full mouth films, and she assured Dr. Parks she would do so.
Around this time, several notes in the records indicated complaints by Mrs. Aldon about the temporary bridgework. These reflected complaints of pain and sensitivity, concerns about shading of the temporaries, and comments about their “bulky” feel. However, it was also noted that Mrs. Aldon was a bruxer, which likely contributed to her difficulties.
After the patient’s fourth visit to receive occlusal adjustments to the temporary bridges—two of which were emergency visits—Dr. Parks felt Mrs. Aldon needed an evaluation by an endodontist. At this point, he still hadn’t received the full mouth set of films, and Mrs. Aldon refused to have new films taken. However, she did agree to see an endodontist—just not the one Dr. Parks recommended.
After Mrs. Aldon had an appointment with an endodontist, Dr. Jed Bart, she returned to see Dr. Parks. She told him that Dr. Bart said she didn’t need endodontic care. Hearing this, Dr. Parks was concerned about Dr. Bart’s evaluation and conclusion. He didn’t believe Dr. Bart had removed the temporary bridges to fully examine the teeth.
Dentist Reluctant to Continue Treatment
Dr. Parks tried to call Dr. Bart but was unable to reach him, so he told Mrs. Aldon that until he was confident the endodontic review was appropriate, he would hold off on further treatment.
At this point, Dr. Parks started having additional concerns about treating Mrs. Aldon. There had been approximately six visits with the patient, half of them on an emergency basis, in a relatively short period of time. This indicated to Dr. Parks that ongoing care would be difficult.
Later that evening, Mrs. Aldon called Dr. Parks’s office demanding to speak with him. She said she was in pain and wanted either an emergency appointment or pain medications. Dr. Parks was not in the office, so his service provided his emergency phone number at home.
When Mrs. Aldon called the dentist’s house and learned that Dr. Parks was not immediately available, she lashed out with profanity at Dr. Parks’s wife. At that point, since Mrs. Aldon was in a stable condition, Dr. Parks told Mrs. Aldon to find another general dentist to treat her. When he arrived at the office the following day, Dr. Parks recorded in the charts the facts of the case and his decision to discontinue treatment of Mrs. Aldon.
Prosthodontist Takes Over Care; Lawsuit Ensues
The next day Mrs. Aldon went to Dr. Lex, a prosthodontist who advised her that she had a retained root tip in her mouth from the extraction done by Dr. Parks. Dr. Lex recommended extracting the root tip. He then recommended an extensive (and expensive) treatment plan for restoration of Mrs. Aldon’s mouth.
Dr. Lex performed additional preparations on the upper teeth that Dr. Parks had previously prepared. Dr. Lex then referred the patient to an endodontist where she had five root canals on teeth initially prepared by Dr. Parks. Mrs. Aldon went on to have some of these restorations completed. Months later, she had surgery to remove the root tip. Around this time, Mrs. Aldon decided to sue Dr. Parks for dental malpractice.
In the course of the lawsuit, Mrs. Aldon disclosed she had seen at least seven dentists prior to treating with Dr. Parks. Two of these dentists had recommended extracting the tooth that Dr. Parks removed. The records revealed that Mrs. Aldon’s last full mouth films were taken almost two years before she saw Dr. Parks.
Records Reveal Multiple Treaters
Moreover, at the same time Mrs. Aldon was treating with Dr. Parks, she was also seeing two other dentists. Yet, she never disclosed to any of the dentists that she was also being treated by others.
Not only did Mrs. Aldon see several treaters before and during her care with Dr. Parks, she also saw a large number of treaters afterward. All tallied, there were 20 dentists and related treaters identified in Mrs. Aldon’s lawsuit.
By the time the lawsuit was filed, it was two years after Mrs. Aldon’s treatment began. This first lawsuit lasted approximately four years, and Mrs. Aldon went through three sets of lawyers. All three attorneys ultimately decided not to pursue her case.
Eventually, Dr. Parks’s case was voluntarily dismissed. This is a process in which a plaintiff has a one-time opportunity to dismiss the case and then refile it within a year. Right before the one-year deadline, Mrs. Aldon found a fourth attorney to refile her case.
In this second lawsuit, Mrs. Aldon identified an expert who examined her approximately seven years after Dr. Parks’s treatment. This expert criticized Dr. Parks for preparing the teeth without a full mouth set of films. He contended Dr. Parks should have known that he left a root tip in Mrs. Aldon’s mouth and advised her of this fact. This would have alleviated the need for five root canals and allowed the root tip to have been removed sooner, with fewer complications.
Defense Counters
Dr. Parks’s defense team obtained a solid expert to defend the care he provided. This expert testified:
- Dr. Parks did not need a set of full mouth films to perform preparatory work.
- He did not know he had left a root tip in, and it was not negligent to do so.
- The root tip was not symptomatic nor was it even removed until months after its discovery.
- The teeth were prepared again by a subsequent treater.
It was clear throughout the case that Mrs. Aldon was extremely interested in a settlement. Dr. Parks, however, refused to consent to settle the case, and his malpractice insurance company supported his decision.
The case proceeded to trial. Before jury selection, the trial judge agreed to Dr. Parks’s request to bar Mrs. Aldon’s expert testimony. The judge made this decision because the expert had only relied on what Mrs. Aldon had told him and not on the dental records.
Mrs. Aldon appealed, and the appeal was successful. However, Dr. Parks was ultimately victorious in the case. This victory, however, came only after a long-fought, 12-year battle with more than $150,000 in legal expenses.
What Can We Learn?
Problem patients
While hindsight is 20/20, there were numerous red flags about the patient in this case. She came in on an emergent basis for removal of an excessively decayed tooth, yet she clearly had extensive dental work done prior. She wanted to improve the “look” of her teeth rather than the health of her mouth. She was a chronic complainer who seemed to have a low level of patience. She did not follow Dr. Parks’s referral recommendation.
Stand your ground
Though Mrs. Aldon assured Dr. Parks she would bring in films, Dr. Parks should have waited to treat her until he had them in hand. Another option would have been to contact the previous dentist to obtain copies of the X-rays.
Multiple treaters
Mrs. Aldon clearly was a patient who hopped from treater to treater. Communication with those prior providers might have revealed some of the problems sooner—before there was an opportunity to find a basis for any criticism.
Ending the doctor/patient relationship
There are reasons, including patient noncompliance, when it is permissible for the dentist to end the doctor/patient relationship. However, this must be done in a legally accepted way to prevent allegations of abandonment. In this case, Dr. Parks did not take all the proper steps, and he was fortunate this didn’t become another factor in the lawsuit against him. (Please consult with your attorney or the Professional Solutions’ claims staff at 1-800-640-6504 to discuss specific considerations with the termination of the doctor/patient relationship.)
Records
Dr. Parks was thorough in his documentation. Without the records to back him up, his attorney would have had difficulty stating with certainty that his dental care was consistent and within the appropriate standards.
Long-spanning case
Lawsuits can drag on for several years, making the choice of a malpractice insurance company very important. In this case, Dr. Parks’s care was staunchly defended by a solid, well-qualified attorney and expert, and he was ultimately successful after a twelve-year battle.
Consent to settle
In this case, Dr. Parks strongly believed he provided the appropriate care and treatment, and he wanted to have his day in court rather than settle the case. Fortunately, his malpractice insurance company backed him up. At Professional Solutions, no case will be settled without your specific agreement. This ensures that you have every opportunity to defend your good name.
About the Author
Linda J. Hay is a partner in the Chicago office of HeplerBroom, LLC. Ms. Hay has practiced in the professional liability defense arena for more than 25 years and has tried numerous cases to verdict. She is actively involved in a variety of defense bar, professional liability and risk management organizations. Ms. Hay can be reached at Linda.Hay@heplerbroom.com.