The scene

A patient attended a DDU GDP member with pain in an upper molar. The tooth was found to be very tender to percussion and heavily restored with a visible crack.

The member told the patient that the tooth was unrestorable, and discussed treatment options as well as offering a referral to a specialist. The patient chose to have the tooth extracted.

The patient later returned for several appointments with pain and swelling. The member made a diagnosis of an infected socket, and prescribed multiple courses of antibiotics over the following months.

The patient did not report fluid leakage through the nose until almost six months after the extraction took place, and it was eventually established that an oro-antral communication (OAC) had been created. The patient was referred for surgical repair and the site healed well, but they nevertheless suffered from ongoing rhinosinusitis.

The claim

The patient instructed solicitors to pursue a claim against our member. They alleged the member had failed to carry out a full clinical examination, and to appropriately analyse the radiograph in order to give the patient all the treatment options and associated risks - in particular, that there was a significantly increased risk of creation of an OAC.

This was because the roots were very close to the maxillary sinus. The claim therefore alleged that consent had not been appropriately obtained for the treatment.

It also alleged that the patient should have been referred to a specialist so that any OAC could be closed at the same time as the extraction; this would have avoided post-operative complications or the need for further procedures. Although our member had offered a referral, this was on a standard basis and not specifically because of identified risks and advice.

Finally, it was alleged the member failed to identify the presence of the OAC immediately following the extraction, failed to analyse the subsequent radiograph which showed a defect in the antral floor, and failed to refer the patient promptly.

How we helped

We obtained independent expert evidence in order to fully assess the elements of the claim, including the member's actions. If a claim goes to trial, having independent expert opinion can be very important, so we often obtain this early in the process to help decide if a member might be criticised for the treatment they have provided by a judge.

Unfortunately, this evidence agreed with some of the allegations made, which meant we recommended to the member that the case be settled.

Any settlements we make are always and only done with the full consent of the member involved. After discussing and considering the options available with our advisers, and on seeing that some aspects of the claim couldn't be successfully defended, they agreed to give their consent to settle the claim, and an offer was made.

The outcome

Despite making a settlement offer, we nevertheless refuted some of the allegations based of the expert's advice, including that it was reasonable to perform the extraction in the general practice setting, and hence that a procedure would have been required to repair the OAC in any event.

The settlement negotiations continued for several months, before the case was eventually resolved with pre-action settlement for a small sum.

Learning points

• When assessing a tooth before an extraction, consider all relevant information to help decide on the specific risks of the procedure. This will help you to discuss the appropriate options with the patient.
• If a patient has complications following any treatment, make sure you carry out a careful assessment, as well as getting information from the patient so you can ensure they receive any necessary care.
• Don't forget to keep good records of your observations, as well as the discussions you have with a patient.