A patient attended her dental practice for an emergency appointment. After assessing the tooth and taking a radiograph, the treating GDP diagnosed periapical infection. He discussed treatment options of no treatment, root canal therapy or extraction, and the patient opted for an extraction, which was booked in for three days later.
On the day of the appointment the practice did not have any lignocaine local anaesthetic in stock, which was the GDP's preferred choice for anaesthetising the tooth using an ID block injection. As an alternative, the GDP administered articaine local anaesthetic via infiltration, but this wasn't effective and he was unable to achieve sufficient local analgesia to proceed with the extraction. He apologised to the patient and gave her antibiotics, advising her to return for the extraction two weeks later when he was next available.
However, after experiencing pain in the affected tooth soon after the appointment, the patient went to a different practice and had the extraction performed just one week after the originally scheduled date.
The patient complained directly to the GDP's practice, claiming for unnecessary delay in treatment, pain and additional dental charges. These included the cost of the extraction and two courses of antibiotics, incurred as a result of the tooth not being extracted on the scheduled date.
The GDP turned to the DDU for advice and a claims handler was assigned to the case. The claims handler sought a clinical opinion which indicated that the GDP was responsible for the delayed treatment, and that if he was unable to complete the treatment himself he could have considered alternative arrangements to do so, by another dentist if required. This would have been in the patient's best interest and would have limited ongoing pain before the extraction could be completed.
The GDP confirmed that no charges had been refunded to the patient, and because the clinical advice was unsupportive of the member's actions, he agreed to the claims handler's suggestion of a settlement offer of £100 to compensate the patient for the avoidable delay, pain suffered and the cost of antibiotics.
Since the affected tooth had needed extracting in any event, the offer did not include the cost of the subsequent extraction. The DDU made the offer on the member's behalf without admission of liability, and the patient accepted.
- It is essential that treatment is fully explained to patients and they are made aware of possible outcomes if treatment is not successful. In this case the patient knew the tooth needed to be extracted, but as a result of the GDP not being able to complete this, she suffered avoidable pain for over a week before it was done at a different practice.
- If treatment can't be completed at the scheduled time, this needs to be explained to the patient and arrangements made to complete the treatment as soon as possible. Depending on the circumstances, this may involve arranging for the patient to be seen by a colleague within or outside of the practice.
- Although the GDP was not directly responsible for the lack of availability of the local anaesthetic of choice in this case, they would be expected to comply with GDC Standard 1.7.7. This states that, 'If you believe that patients might be at risk because of your health, behaviour or professional performance or that of a colleague, or because of any aspect of the clinical environment, you must take prompt and appropriate action.'
This article also appears in the DDU's Cautionary Tales 2018. Read it in full on our website, along with other case studies from members.