ADVICE PARENTAL NEGLECT
BACKGROUND A dentist – Dr C – has been contacted by local police in regard to a four-year-old girl who has been taken into care and is now living with a foster family. Dr C had examined the child two weeks ago and found multiple grossly carious teeth and referred her to the dental hospital for extraction of the teeth under general anaesthetic. The police are now considering charging
the girl’s parents with child abuse and have requested a statement from Dr C. He is concerned that providing this could breach patient confidentiality and he contacts MDDUS for advice.
ANALYSIS/OUTCOME Ideally, the police would produce a warrant or consent from someone with parental authority (which may be shared between the mother and child services). If these documents are not forthcoming (perhaps any parental involvement would compromise the investigation or increase the risk of harm to the child), further information would be needed to allow the dentist to weigh-up the relative merits of making a non-consensual disclosure. In writing the report the dentist would be
advised to lay out the details as if presenting the case in an oral examination, commencing with the complaint and moving on to examination and then the diagnosis and treatment plan. Apart from being factually accurate, the report should be based on what is contained in the dental records as it is on this basis that the dentist may be questioned in court.
KEY POINTS ●Ensure disclosure is warranted before releasing details of a young child’s dental care without parental consent. ● Always act in the child’s best interests.
CLAIM DELAYED VISIT
BACKGROUND Mr G phones up his GP practice to request a home visit. He explains to the receptionist that he has been feeling unwell and short of breath for the past day and doesn’t feel fit enough to attend the surgery in person. The receptionist quickly explains that the
doctors are very busy and that a home visit won’t be possible until the next day to which Mr G reluctantly agrees. The next morning the practice receives an
angry phone call from Mrs G who informs them that her husband has died of a heart attack, before a GP was able to visit. Three months later, a letter of claim is
received by the practice from Mrs G against the practice partners. It is claimed that, had the receptionist consulted a doctor about Mr G’s home visit request and explained his symptoms, they would have recommended an urgent home visit or to contact emergency services. This may have prevented the cardiac arrest or at the very least Mr G would have been in hospital where he would have received emergency care.
ANALYSIS/OUTCOME Two of the practice’s four partners are MDDUS members and they contact an adviser for guidance in how to proceed. The adviser explains that, as her employer, the
practice partners are vicariously liable for the actions/omissions of the receptionist. In addition, there was no practice policy in place at the time which specifically provided that any patient who was to be booked in for a home visit on a subsequent day should first be triaged by a GP. Following consultation with a member of
the in-house legal team, it is agreed that offering a settlement to Mrs G would be the best course of action. This settlement is shared with the defence organisation of the other two practice partners.
KEY POINTS ●Ensure robust practice policies are in place regarding the triaging of home visit requests. ●Receptionists who are not adequately supported by the clinical team may end up being drawn into giving advice to patients or even turning patients away who should have been seen by a doctor. ●Risk manage accessibility by taking time to ask your team which types of encounters are most difficult so that solutions and safety nets can be designed into the system.
MDDUS INSIGHT / 17
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