Dental Charting Case Study: How You Can Avoid This Malpractice Mistake
Regular readers of this blog should know by this point that even the best dentists make the occasional charting blunder. That’s the entire idea behind The Dental Advocate’s ICDG Charting System, putting the most robust dental charting content into a product to prevent malpractice before it starts (but I digress!).
Here is another real-life example of a dental charting error and the accompanying commentary on how you can avoid these same unfortunate pitfalls. Below, you can see how inferior record keeping routinely costs non-ICGD subscribing dentists.
Dental Charting Error: A Costly Mistake
Dentists: General dentist and endodontist.
Situation: General dentist. Tooth # 8 was non-restorable and extracted Teeth ## 7 and 9 were prepared for a three-unit bridge. A post-extraction PA showed a large portion of the root remained. The general dentist determined not to retrieve the root at that office visit, but to do so before the bridge was seated. The patient was not told of this complication and the progress notes do not reflect the dentist’s thought process.
At the delivery appointment three weeks later, the patient complained of severe pain in # 7. A PA reveled a periapical abscess. An endo referral was given. The bridge delivery was postponed, pending the endo evaluation. Nothing was done to the root tip.
Endodontist. The next day, the endodontist performed a root canal on # 7. His working length and final fill x-rays clearly show the retained root on # 8. He said nothing to the patient about this complication.
The patient (a winter visitor to Phoenix) then elected not have the general dentist seat the bridge, but instead retrieved it for his home-town dentist to cement. This out-of-state practitioner first informed the patient about the remaining root, approximately 2.5 months after the extraction. By then, the area was infected.
Malpractice Lawsuit: Pending litigation. The costs for his home-town general (evaluation, reprep, seat new bridge); endodontist (re-evaluate # 7; place post & core); periodontist (remove the root; bone graft due to infection) to repair the damage were $4,688. Fees for the original extraction and bridge were $2,750. The total “special” damages are $7,438 + pain and suffering. The patient’s most-recent demand is $30,000.
Liability: The general dentist admitted liability. The theory against the endodontist is that he did not report what the general dentist left behind, despite not creating the situation. I do not believe the endodontist bears any responsibility.
Proper charting could have resolved everything.
The general should have written, “PA shows root remaining. Cannot retrieve today because [reason]. Told pt root must be removed within [time frame]. Pt understands.” At the second office visit (when the endo referral was made), the same general type of entry should have been repeated in the progress notes.
2 Dental Charting Pointers:
1) When complications occur, the chart must reflect that (a) the dentist realized the situation, (b) the patient was told that same appointment, and (c) a remedial plan of action was developed (often a specialist referral). I have seen cases where the dentist delays informing the patient (e.g. separated endo file), hoping to correct the problem at the next office visit, but the patient never returns.
The endodontist presents a more difficult case. He was not responsible for the root tip and did not know if it was left by another dentist, or simply broke off that way. But because the ICGD preaches prophylactic charting (to prevent legal entanglements before they occur), the endodontist should have written, “Advised pt of remaining root # 8, and told him to have it removed ASAP.” His report back to the general should have referenced this condition as well.
2) To insulate yourself from malpractice claims, make sure any defect visible in the radiographic field is discussed, whether it involves your work or not, and your notes reflect that the patient was notified.
Had either of these dentist so charted, they would not have been named in the pending litigation.
In order to prevent this same risk from affecting your practice, please incorporate these recommendations into your charting policies. As always, please reach out to me personally if you have any questions or insights to share with me or your fellow subscribers.
Thanks and keep charting!