ADVICE BAD TATTOO
BACKGROUND A 15 year-old-girl – Jemma – attends a consultation with Dr L. She is tearful and requesting a medical note to allow her to have a tattoo on her upper arm cosmetically altered. Jemma had the tattoo done by an illegal
artist and is upset by the appearance. She claims it has led to serious bullying at school and has left her depressed. She has approached a legitimate tattoo parlour but they are requesting a doctor’s letter. Dr L offers to refer Jemma to a plastic surgery service for laser removal but she declines. The GP contacts MDDUS for advice on
the matter. He asks if, as a GP, his assessment along with a letter would be sufficient under current UK legislation.
ANALYSIS/OUTCOME An MDDUS adviser looks further into the matter. She advises that under UK law it is an offence to tattoo a person under the
KEY POINTS ●Keep notes of all discussions with patients justifying decisions made. ●Ensure you check current UK law in regard to cosmetic treatments.
age of 18 except when the tattoo is performed for medical reasons by a duly qualified medical practitioner or by a person working under his or her direction. In this case a legitimate licensed tattooist has asked the patient to obtain a doctor’s report confirming that there is a bona fide medical reason for this minor to have a tattoo cosmetically altered.
Dr L is advised that he must first
consider whether Jemma has a legitimate medical reason to have her tattoo revised and secondly that he is satisfied for the licensed tattooist to work “under his direction”. In the end Dr L supplies the medical note and the tattoo is revised. Jemma now feels less self-conscious.
CLAIM IMPACTED WISDOM TOOTH
BACKGROUND Mr K presents at his dental surgery with pain in the lower right jaw. Examination reveals a decayed and impacted wisdom tooth (LR8) and the patient is booked in for an extraction by one of the practice partners – Dr G. A week later Mr K attends the surgery
and is administered a local anaesthetic. Dr G attempts the extraction using forceps but the tooth is shattered and a periapical X-ray is taken to ascertain the position of the retained roots. The dentist explains to the patient what has happened and prescribes amoxicillin. Mr K is referred to another dental clinic where the roots are removed utilising sedation and a local anaesthetic. Four months later a claim for damages is
received by the practice citing clinical negligence in the treatment of Mr K’s
impacted wisdom tooth. It is alleged that the dentist should have taken a pre- treatment X-ray of LR8 to ascertain the position and size of the roots in order to formulate a competent treatment plan. Failure to do so resulted in the failed extraction and the need for further surgery to remove the retained roots, along with consequent prolonged pain and swelling suffered by the patient.
ANALYSIS/OUTCOME An expert report is commissioned from a dental surgeon who reviews the notes and associated radiographs. He states that examination of the post-extraction periapical X-ray clearly demonstrates angulation of the crown and roots which were mesially impacted. In his view a pre-treatment X-ray would have alerted Dr K that a simple forceps extraction was
unlikely to be successful. A pre-treatment plan would also have given the dentist pause to consider whether he was competent to extract an impacted wisdom tooth or if the case would have been better referred to an oral surgeon. The expert concludes that in his view the
pain and swelling suffered by Mr K until the roots of LR8 were removed were the result of negligent care on the part of Dr G. MDDUS in agreement with the member offers to settle the case.
KEY POINTS ●Ensure pre-treatment radiographs taken to accepted guidance. ●Do not undertake procedures beyond your competence.
MDDUS INSIGHT / 19
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