Deputy Commissioner, Carolyn Cooper has highlighted the
importance of providing clear information to allow consumers
to make an informed decision about their care and give
informed consent in a decision published by the Office of
the Health and Disability Commissioner.
In her
decision, Ms Cooper found a dentist in breach of the Code of
Health and Disability Services Consumers’ Rights for care
provided to twin girls when they received early orthodontic
(orthotropic) treatment between 2017 and 2019. The treatment
was provided by a general dentist with assistance from
various orthodontic auxilliaries at a dental
service.
In May 2017, a mother took her daughters
(twin girls) for an orthodontic consultation with a dentist
for concerns she had about their “crooked” teeth. The
dentist recommended a two-phased orthodontic approach for
both girls. The treatment undertaken over a two year period
was considered “early orthodontic treatment” and included
removable plates, braces, and retainers.
The girls
attended the dental service for various appointments with
the dentist and orthodontic auxiliaries. The mother sought a
review from another dentist when she became concerned about
the progress of her daughters’ treatment, and, following
this, she terminated the therapeutic relationship.
Ms
Cooper considered expert advice provided, that “early
orthodontic treatment” is a contentious area of dental
practice with little evidential basis, and it is crucial to
ensure the patient has all the facts, and appropriate
literature on both sides so they can make up their own mind,
without being swayed one way or the other by the
practitioner”.
“I would expect the mother to be
informed there was a lack of clear evidence supporting early
orthodontic treatment, and of the clinical justifications
for recommending the treatment plan, despite the lack of
clear evidence, the risks specific to the procedure, and
details of alternative treatment options specific for her
daughters.
“Without this information, the mother was
not in a position to give her informed consent to the
treatment for her daughters, so I find the dentist in breach
of the Code,” says Ms Cooper.
Adequate documentation
is an integral part of clinical practice, and the
requirement for practitioners to keep clear and accurate
clinical records is a fundamental obligation. These
standards are set out by the Dental Council of New Zealand.
It is important when undertaking treatment, practitioners
thoroughly document in the clinical notes all assessments,
diagnoses, treatment undertaken, progress, reasoning,
recommendations, and discussions.
“I am critical the
dentist, did not record robust and detailed clinical notes
to support his clinical view, and ensure details of the
treatment and subsequent consultations for both girls were
clearly documented,” says Ms Cooper.
As a healthcare
provider, the dental service is responsible for providing
services in accordance with the Code. Ms Cooper was
concerned several examples of inadequate record-keeping and
provision of information reflected deficiencies at a
practice level.
While Ms Cooper did not find the
dental service in breach of the Code, she made an adverse
comment regarding the insufficiency of processes in place at
the dental service to support its practitioners to provide
patients with adequate information and obtain informed
consent for treatment.
Ms Cooper recommended the
dentist provide a written apology to the family, and arrange
an external audit to ensure adequate informed consent was
obtained and clinical documentation was of an appropriate
standard. She further recommended the dental service develop
and provide training to staff on clinical documentation and
informed consent, develop a written information sheet
containing information specific to early orthodontic
treatment and consult with the Dental Council of New Zealand
(DCNZ) to ensure the dental service’s informed consent forms
and policies are consistent with DCNZ
guidance.
Following events of this case, the dentist
has made changes to their practice to improve
record-keeping, underwent two competence reviews with DCNZ
with recommendations made to improve communication, written
information, and informed consent and completed training on
informed consent and patient communication.
The dental
service has also made changes to its practice, which include
ensuring its note-keeping practices are more detailed and
thorough and updated their consent forms and
letters.
Notes
This case relates to a
complaint made to HDC in 2020. We aim to investigate
complaints as promptly as possible, while ensuring natural
justice and the interests of all the parties involved to
provide information, and respond to evidence put forward by
others is considered.
The full
report of this case can be viewed on HDC’s website –
see HDC’s ‘ Latest
Decisions‘.
Names have been removed from the
report to protect privacy of the individual involved in this
case. We anticipate that the Commissioner will name Te Whatu
Ora (previously DHBs), and public hospitals 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. 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).
© Scoop Media
Discussion about this post