Common periodontal malpractice

problems
Failure to diagnose , treat , or refer
periodontal disease process .
Attempt to treat beyond their level of
competence

 To avoid :
scrupulous records
Recommendation and performance of
appropriate treatment
Refferal to a periodontal specialist if
conservative treatment is unsuccessful
Monitoring patients receiving long-term
maintenance therapy, detailed home
care instructions with repeatition

Legal elements of
malpractise
Standard or care :
To be given with the same skill,
expertise , and comprehension as would
be provided by a compararble
practitioner in dental community
Results of the treatment must be
equivalent given the limitations of the
case

 Informed consent :
active partners
Five areas :
Understanding a problem i.e a diagnosis
Proposed treatment and any alternative
treatment fully explained
No warranties or guarantees given
Authorization must allow for a change in
plan if unforeseen circumstances arise
Discussion of all sequelae and side effects

 Beneficence
Providing the patient with best care
If unable refer

 Abandonment
Writing and well documented and sent by
registered mail, return receipt
Dismisal requires following four elements :
Reasonable cause
Provide the patient with the names of three
competent new care givers such as private
dentist, dental school or dental clinic/group
Time frame (usually 30 days), dentists should
provide emergency treatment during that period
Inform patient that all records forwarded to new
caregiver

 Record keeping
Important evidence
Medical dental history, chart notes,
insurance requests, informed consent,
billing statements, radiographs,
photographs and models
Legally the professional written records
carry more weight than the plantiffs
recollections

Practical components in
litigation
Need help of a competent attorney
Best defense avoid lawsuit in the
first place

Legal process

Mediation versus arbitration

often,the court can give attorneys
the option of a court panel or private
mediation
Over the years,the private mediators
have been more effective

Binding arbitration
aggrements
Sometimes problematic in that there
is no rigjt to appeal in case of
adverse result , even when the
arbitrator made an error in
judgement

Small claim cases

Not permitted to have an attorney
Plantiff does not have the rights to
file an appeal if he/she is not
satisfied with the results of a small
claims court judgement
But the dentists do have the right

Malpractise insurance
Insurance covers the costs of the
defense , as well as any awards to
the plantiff
Use insurance companys expertise
very early

Avoidance of lawsuits
Many lawsuits are not initiated because of
an honest mistake; rather,they occur
because the dentist was not empathetic,
frank with information, or helpful in
correcting the problem
Remunerating patients is not viewed by
the legal community as a admission of
guilt ; rather it is a form of good will or
compliance , make signed release at the
time of refund

Peer review
is another alternative to legal
process.
Local dental societies have a panal of
impartial,expert dentist(peer) who
will review cases for member
dentists.
They are not interested in assigning
blame,but only correcting problem.

Federal legislation
OSHA
Universal precautions and blood borne
pathogens
Hazard communication
Waste management
Illness and injury prevention
Violations can result in fines

 Health insurance portability and

accountability act (HIPAA)
Protected health information must be in
standard form and protected
Three standards :
electronic transaction standard
Privacy standard
Security standard

conclusion
Legal awareness & standard of care
is must

reference
CARRANZAS CLINICAL
PERIODONTOLOGY, 11th edition