The adequacy of dental care services provided to a man by
a dentist and his failure to comply with professional
standards was highlighted in a decision published by Deputy
Health and Disability Commissioner Dr Vanessa
Caldwell.
In her decision, Dr Caldwell found the
dentist in breach of the Code of Health and Disability
Services Consumers’ Rights (the Code), for failing to
monitor his patient using capnography, while he was at least
moderately sedated during wisdom tooth extractions, and to
maintain adequate patient notes. She also found the dentist
in breach of the Code for his failure to refer the man to a
specialist or for an ACC treatment injury claim at a
sufficiently early stage, and not conducting sufficiently
detailed examinations of the man at two follow-up
appointments.
A man underwent surgery for the
extraction of his wisdom teeth. During the extraction of one
of the teeth, the dentist severed the man’s lingual nerve
accidentally and did not notice the injury at the time, or
during either of two follow-up appointments.
Dr
Caldwell considered the adequacy of the care provided to the
man, both at the time of the extractions, and in the
follow-up care, as well as the adequacy of the dentist’s
clinical notes, and whether his sedation practice complied
with professional standards. She acknowledged the dentist
was an employee of the dental service, who had in place a
number of company policies, which the dentist was required
to follow.
“In my view, the dentist’s errors were
the result of individual clinical decision-making, and were
not directly the result of shortcomings in the policies and
procedures of the dental service. I find that the dental
service did not depart from the appropriate standard of
care,” says Dr Caldwell.
Dr Caldwell recommended the
dentist arrange for an audit of his patient notes, provide
evidence of completion of safe sedation training, reflect on
and review his practice in light of HDC’s expert
advisor’s comments, and apologise to the man. She further
recommended the dental service confirm implementation of new
policies relating to safe sedation and treatment injury,
audit compliance with those policies, and use this case as a
basis for staff training.
Following these events, the
dental service introduced new policies for Sedation and
Treatment Injury to mitigate some of the risks to patients.
The dentist has also told HDC he has taken this matter very
seriously and made changes to his practice, and he has
learned considerably from the incident, and is confident it
will not be repeated.
“Complaints offer a significant
learning opportunity, to reflect on how care could be
improved – to create positive change for consumers and
healthcare providers. The additional policies suggest that
the dental service has taken the complaint seriously, and I
am pleased to see the dentist has learned from this
incident, and made changes to his practice,” says Dr
Caldwell.
Editors notes
The full
report of this case can be viewed on HDC’s website –
see HDC’s ‘ Latest
Decisions‘.
We anticipate that the Commissioner
will name providers found in breach of the Code, unless it
would not be in the public interest, or would unfairly
compromise the privacy interests of an individual provider
or a consumer.
More information for the media and
HDC’s naming policy can be found on our website here.
HDC
promotes and protects the rights of people using health and
disability services as set out in the Code
of Health and Disability Services Consumers’ Rights (the
Code).
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