ADVICE ENDING IMPLANT WORK


BACKGROUND A dental surgeon with expertise in implant placement has for the last few years been in a working arrangement at a colleague’s practice in which he undertakes a limited number of procedures for a percentage split in fees after deductions for materials and laboratory costs. The dentist has now decided that he no longer wants to offer implant treatment as he feels the cases undertaken are too infrequent for him to maintain competence. A new surgeon with more experience has agreed to take on the implant work. He contacts MDDUS for advice on who


will have responsibility for the ongoing care of the implant cases he has undertaken and completed. The dentist also wants reassurance that he will be fully indemnified


for any problems arising in future from any of his completed cases.


ANALYSIS/OUTCOME An MDDUS dental adviser replies by letter


KEY POINTS ●Ensure that you maintain ongoing competence for any procedures you undertake. ● Inform patients of future care arrangements if moving on from a practice. ●MDDUS offers occurrence-based cover for any treatment ‘incident’ arising while in membership.


saying that the case is little different from the situation when any dentist retires or leaves a practice. The member is advised to inform relevant patients of the change and ensure a system is in place to monitor the implant treatment and provide appropriate care should any problems arise. He is advised that problems can


sometimes arise when implants fail later after being restored by a different dentist, but in the end liability will be determined by expert opinion after examination of the clinical records and/or the patient. In terms of any complaint or claim, MDDUS liability is occurrence-based meaning the member will have access to indemnity for treatment carried out while in membership regardless of when the claim is made, even when he has ceased clinical work or retired.


COMPLAINT INGESTED BUR


BACKGROUND A dental surgeon – Mr H – is polishing a restoration when a friction grip bur falls out of the handpiece. A dental nurse has been applying suction but is unsure if the bur was caught in the system. Mr H asks the patient to sit up


immediately and rinse but there is no sign of the bur so the dentist inserts another bur and finishes polishing. On completion of the treatment he advises the patient of the missing instrument and suggests that it was most likely caught in the suction system but that there is the possibility it might have been ingested or, much less likely, inhaled. Mr H advises the patient that he will first


check the suction system and filters and if the bur is not found it would be advisable to attend hospital for further assessment and perhaps a radiograph. A technician checks the system but no bur is found. The patient is advised to attend hospital along with a note of relevant information about the instrument (size, shape, photograph, etc). Nothing is found on X-ray and the patient is advised to return if he experiences chest symptoms. An angry letter of complaint is hand-


delivered by the patient the next day which includes a demand for compensation.


ANALYSIS/OUTCOME An MDDUS adviser assists Mr H in


composing a letter of response to the complaint. The dentist first expresses regret that the incident occurred and promises that the practice will conduct a significant event analysis to look at possible ways of preventing such a mishap in future – including contact with the manufacturer of the handpiece for an explanation of why the bur detached. In addressing the demand for


compensation Mr H states that, while sympathetic, he maintains that the incident was not due to any negligence on his part and thus compensation would not be appropriate. However, the practice offers to refund the cost of the treatment without any admission of liability. No more is heard regarding the


complaint and the patient remains registered with the practice.


KEY POINTS ● Inform patients immediately if there has been any mishap during treatment. ●Advise patients to attend hospital in suspected swallowing of a dental instrument (with relevant details). ●Contact MDDUS for assistance in complaint handling, especially in cases with potential to escalate into a claim.


MDDUS INSIGHT / 19


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