How To Respond To A Patient Complaint Against A Dentist

By Matthew Wilton

Is the information in this article relevant to dentists outside Ontario?

Our firm has acted for dentists outside of Ontario in responding to patient complaints to a regulator. The methodology is essentially the same for every dental regulator in Canada. The Complaints Committee for the relevant province is charged with the responsibility for making decisions with respect to complaints from members of the public. In each province or territory, the Complaints Committee will consider the appropriate standards of practice applicable in the circumstances, and make a decision based on those standards of practice. It is my opinion that the contents of this article will be relevant, and of assistance, to all dentists across Canada in responding to complaints. The methodology is the same, and the basic approach should be the same.

I am setting out below a list of the types of patient complaints I have assisted dentists on. This should demonstrate for all dentists across Canada that the types of complaints we act on are similar to the complaints that all Canadian dentists must deal with:

1) Recommending unnecessary restorations;
2) Failing to put a crown on a root canal treated tooth leading to a tooth fracture;
3) Failing to obtain an informed consent in respect of an expensive crown and bridge case;
4) Failing to monitor the patient’s periodontal status adequately;
5) Leaving a separated instrument in a patient’s endodontically treated tooth;
6) Failing to provide follow up care following extraction of a patient’s tooth;
7) In respect of treating a child under sedation, failing to obtain an informed consent from the parent during a procedure, when more work needs to be     done;
8) Releasing information to a step parent or noncustodial parent in the face of the custodial parent’s objection;
9) Making sexually inappropriate comments to a patient;
10) Touching a patient inappropriately;
11) After administrating oral sedation, releasing a patient without ensuring the patient is sufficiently recovered to be released;
12) Breaching patient confidentiality by disclosing patient information to a relative without appropriate consent;
13) Improperly performing root canal therapy;
14) Improperly placing implants without the appropriate pre-treatment investigation to place the implants properly;
15) Recommending and installing implants when the patient’s dentition will not support implants;
16) Recommending unnecessary cosmetic treatment where the patient’s dentition or oral health suggests that such cosmetic work is contraindicated;
17) Being rude to a patient;
18) Recommending Invisalign treatment solely for the purpose of benefiting the dentist financially;
19) Recommending Invisalign treatment in circumstances where the patient is not a good candidate for orthodontic treatment;
20) Overcharging a patient for orthodontic treatment;
21) Not adequately warning a patient as to the likely cost and length of treatment for orthodontic treatment;
22) Failing to warn a patient about the risk of not treating a particular dental problem;
23) Billing for a complicated extraction when the extraction was not complicated;
24) Overbilling units of scaling;
25) Failing to adequately warn the patient of the risk of parathesia;
26) Failing to refer the patient to a dental specialist;
27) Failing to have adequate infection controls in the office;
28) Failing to follow the Anaesthesia Guidelines;
29) Acting in a conflict of interest;
30) Recommending unnecessary dental appliances, including night guards;
31) Insurance fraud; and
32) Insurance overbilling.

These are just a sample of some of the hundreds of complaints I have assisted dentists with. I have developed a reasonable understanding of the standards of practice in these various areas, that can be of assistance in assisting any dentists in Canada in responding to a complaint.

Why is it important to make an effective response?

Dentists will be familiar with unfortunate colleagues who have had their names published to the entire profession because of professional misconduct. The vast majority of such cases begin with a simple letter or email from a patient complaining about some aspect of their dental care. It used to be a favourite cliché of lawyers acting for dentists, that for the price of stamp a patient could complain about their dentist. Society has evolved, and a large number of patient complaints are now made by email. The patient doesn’t even need to invest in a stamp! Patients can complain more quickly, and it is often the case that when the patient comes back from a dental appointment and is angry and in pain, that patient can fire off an email complaint instantly. There is now less time for “cooling off” or sober second thoughts. This, in conjunction with increased patient expectations, have led to complaints against dentists increasing.

Another consequence of the information age in which we live, is that negative information gets disseminated widely and quickly. An adverse outcome, even at a Complaints Committee level, can be publicized online by a disgruntled patient on numerous web sites. Patients are also going online, in droves, to post reviews on websites such as “RateMDs” or “Rate a Dentist”.

In Ontario, the RCDS has amended its by-laws effective October 1, 2015 to expand the information available to the public on that College’s Public Register. The net result of this transparency initiative is that dentists in Ontario who are ordered by the Investigations Complaints and Reports Committee (the ICRC) to take specified continuing education courses as a result of a practice issue raised by a complaint, will have that disposition posted on the Public Register of the RCDS. In addition, dentists who receive oral cautions from the ICRC in any decisions released after October 1, 2015 will have that information posted on the Public Register. On our firm’s website you will find our article dealing with the RCDS transparency initiative, which explains in full the nature of these changes.

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