How To Respond To A Patient Complaint Against A Dentist - Page 4

By Matthew Wilton

Importance of obtaining corroborating evidence

A typical step in responding to a patient complaint is to interview other witnesses who have information with respect to a matter. In many circumstances, I will have to interview all of the staff of a dentist’s office. Where a patient has acted rudely or belligerently, it may be necessary to obtain corroborating evidence from all the other employees. Dental treatment issues also require corroborating evidence. The dental assistant may recall what information you told the patient, concerning informed consent. The dental hygienist may be able to comment with respect to the patient’s poor oral hygiene, if that is a relevant issue. All of this information should be gathered from the outset.

Use of Experts

If I believe that a patient complaint raises a standards of practice issue that may be assisted by having an expert opinion, I will routinely recommend to dentists that even at the ICRC stage, that we obtain an expert opinion. Our firm has a roster of experts that we utilize for RCDS complaint matters. The provision of an expert opinion at an early stage may defuse a potentially troubling situation, or may highlight deficiencies in the treatment or the record. Typical examples of obtaining an expert opinion include the following types of complaints.

a) Recommending unnecessary restorations;

b) Performing unnecessary root canal treatments; and

c) Failing to obtain an informed consent for a complicated implant, crown and bridge or cosmetic dentistry case.

It is the lawyer’s job to contact the expert, and instruct the expert. If a dentist chooses to do this himself or herself, this may cause significant evidence problems down the road. In a serious case that ends up at the Discipline Committee, if a dentist has spoken directly with the expert, that expert will be cross-examined by the Prosecution at the Discipline Committee hearing concerning the specifics of any dialogue with the dentist. If a dentist has advised the expert, “look this is the way I always perform root canals. I have done this a hundred other times”, then the expert will be obliged to recount the information provided by the dentist. This could fatally prejudice the dentist at a discipline hearing. This is why it is always necessary for your lawyer to instruct the expert.

Appropriate tone and language

It is essential that the dentist’s written complaint response be written in a respectful and professional tone. There is nothing worse than a dentist who writes a letter that insults the patient. If a patient complains that a dentist was rude and aggressive, then it certainly doesn’t help the dentist’s cause to write a letter that is rude and aggressive as well. There is nothing to be gained by insulting the patient or the patient’s intelligence. As part of the process your response will be given to the patient/complainant to comment upon.

There is a way to subtly communicate to the Complaints Committee that a patient is an unpleasant individual, without stating this directly or by being insulting. From time to time I have acted for dentists who have been the subject of a complaint by a patient who has mental health issues. There are also ways to communicate this information without being seen as being insulting or demeaning to the patient. For example, at the start of most dentist’s complaint response letters, we recommend providing a summary of the relevant dental history, and medical history. Information about patient’s mental health or medications can be referenced in this section.

Be consistent

One of the virtues of retaining experienced legal counsel is that you can make sure that your version of events is consistent from the outset. If a matter becomes more serious, and ends up at the Discipline Committee, there is nothing worse than a dentist being obliged to change his position with respect to factual and dentistry issues. If you take a position in writing prematurely, without the benefit of all the records or x-rays or input from other witnesses, then you will be stuck with that version of events. If you try to change your story between the time of a complaint response letter, and a referral to the Discipline Committee, then you will be painted as not credible. This is why it is of great benefit to conduct all necessary witness interviews, and obtain all relevant records at an early stage, so that you can put forward a coherent and consistent version of events from the start.

Is the person complaining a patient?

From time to time I see husbands complain about dental treatment received by wives, or parents complain about adult children’s dental treatment. In these circumstances, it is necessary for the dentist or his lawyer to ask the College to obtain confirmation that the patient themselves wishes to make the complaint. There is no right for a parent of an adult child to make a complaint on the child’s behalf, unless the child consents as well.

Complaints by ex-employees or Associates

This is becoming a growth industry. If you fire an individual, there is always the risk that the disgruntled employee will make a complaint to the RCDS with respect to some aspect of your dental practice. Complaints from former Associates, dental assistants and dental hygienists can be especially devastating. I have seen several dentist-clients of mine receive lengthy suspensions, as a result of complaints from disgruntled ex-employees or Associates. The ex-employee may be preparing a list of problem files in the office, so that when she is fired, or when she leaves the practice, she can make a very focused complaint against the dentist. In Ontario, the RCDS has no choice but to investigate these complaints. If an ex-employee provides specific information naming patients, you should know that in Ontario the RCDS has the authority to attend your practice, and remove and review these patient charts, if circumstances suggest that an act of misconduct has taken place.

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