INFoRMED CoNSENt/tREAtMENt: TOOTH BEYOND SAVING
BACKGROUND: Mr J attends his regular dentist – Mr D – with pain in a lower left molar. Mr D examines the tooth and fi nds it badly infected. He advises the patient that the tooth needs to be extracted but this procedure cannot be done until the infection clears. He prescribes Mr J antibiotics and advises him to return in a few days. Two days later Mr J phones the dental
surgery complaining of severe pain. Mr D is away so he attends another dentist – Mr S. The dentist examines the tooth and advises immediate extraction despite the previous advice from Mr D. No discussion is recorded in the notes of potential alternatives to extraction such as root treatment and there is also no record of any investigations such as radiographs or vitality testing to assess the state of the tooth.
Mr S administers a local anaesthetic and
tells the patient to sit in the waiting room. Only a few minutes pass before Mr J is called back to the dental chair. The patient tells the dentist that his lip and tongue have not yet gone numb and that he can still feel pain in the tooth. Mr S says “It will be okay” and proceeds with the extraction. Mr J fi nds the extraction painful and when he cries out Mr S (it is later alleged)
DISCLOSURE: CALL RECORDINGS
BACKGROUND: Mrs L has been in regular telephone contact with her general practice over the past few weeks regarding numerous issues including availability of appointments and repeat prescriptions. There has been some disagreement over the exact nature of what has been discussed and Mrs L has now requested copies of the recordings of her calls with the practice. The practice is unsure how best to respond to the request. GP, Dr F, is concerned about the privacy of the receptionist who features in the phone calls and is worried about what Mrs L might do with the recording, such as posting it online. He seeks advice from MDDUS.
ANALYSIS/ OUTCOME: Under the Data Protection Act (DPA), WINTER 2014
individuals have a right to access their personal data – including that contained in electronic recordings – in an intelligible form by making a subject access request. Dr F is therefore advised to provide Mrs L with a copy of the recordings. For ease, the practice could off er her a transcript of the calls or invite her to listen to the calls at the practice, but she has the right to ask for a copy of the audio recording. The DPA stipulates that this can be provided for a maximum subject access request fee of £10 plus any photocopying costs.
In terms of the privacy concerns, the DPA has a provision to protect third parties who could be identifi ed
from the information
being requested. If the request for disclosure cannot be met without identifying a third party then, unless that third party consents, it is not necessary to comply. In this case, however, the identity of the receptionist is already known to Mrs L so there would be no breach of confi dentiality in that regard and this would not be grounds to refuse the request.
Dr F is also advised that Mrs L has the
right to use the recording as she wishes, which may include making it available publicly, i.e. online.
KEY POINTS
• patients have the right to access personal data held about them by practices, including audio recordings.
• Concern over how the patient might use the data is not reason enough to refuse a subject access request.
21
tells him to “Shush”. The dentist applies “considerable force” and the tooth fractures. He proceeds then to remove fragments of bone and tooth from the tooth socket. Mr J is given a pad to bite on to stop the bleeding and discharged. A few months later Mr S receives
notifi cation from solicitors that the patient is pursuing a claim of clinical negligence.
ANALYSIS/OUTCOME: In the letter of claim it is alleged that Mr S failed to carry out an adequate investigation of the tooth in order to determine the necessity for extraction and there was no discussion of alternative treatments. Thus, consent was not informed. The patient is claiming for personal injury and damages and for the costs of dental work to replace the missing molar. Mr S contacts MDDUS and all
correspondence and dental records in the case are dispatched to a GDP expert who
produces a report. The fact that no radiographs of the tooth were taken by either dentist makes it impossible for the expert to comment on the state of the molar prior to extraction but this does not mean the decision to extract was fl awed. Had Mr S, on examination, judged that no other treatments were viable to save the tooth then the patient’s consent to extraction would be informed by that clinical judgement. But the dentist’s notes from the consultation consist of a single line: “LL6 Ext LA”.
MDDUS advisers and solicitors consider the full evidence and although the expert report is supportive of Mr S they conclude the defence is vulnerable due to the dentist’s lack of adequate treatment notes. It is agreed best to settle the case out of court.
KEY POINTS •
•
Ensure full treatment options and risks are discussed with patients and record these discussions in the notes.
Consent can be withdrawn at any point during treatment – so do not ignore signs of patient distress.
• A bad experience in the dental chair increases the risk of a complaint or claim.
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24