Many legal firms are initially approached by a Client venting their spleen about dissatisfaction with dental treatment. Un-resolved problems, protracted pain or poor communication are often the main precursors. Surprisingly, if there is a good relationship, patient’s will rarely complain and actually blame themselves for it going wrong. It is my experience that it is the fundamental breakdown of the relationship or the failure for it to form in the first place that underpins most Claimants to seek out legal redress.
After the letter of claim is prepared with a resume of the history of the complaint has provided the Claimant’s view of events, the dental records of the miscreant are obtained and an Expert Witness opinion is sought
Not uncommonly, the costs to the Claimant and Counsel wish to be minimised at this stage and a scouting exercise is pursued with a request for an initial screening report restricting the Expert to one or two hours of their time to see if the case has any merit.
Now let’s assume the Expert accepts and the letter of claim and dental records are sent I shall use a real clinical example to proceed.
Let’s take a patient who has been under the care of a general dentist for 20 years before they discover they have advanced periodontal disease with bone loss that will invariably lead to tooth loss after attending another dentist. A review of their dental records by the obliging general dental practitioner Expert shows limited documentation related to assessment of the gums, except intermittent advice to brush their teeth a bit more, and routine scaling every six months. When the patient attends another practitioner they suddenly feel shocked and aggrieved due the “failings” of their previous practitioner.
Blame is apportioned and a screening report follows after the review of the dental records demonstrates where the omissions are serially pointed out. Ah, ha you are now all thinking. We’ve got him. Breach of Duty. Now go for the jugular
In the meantime, the patient (now Client) trots off to a periodontist who reinforces the terrible state of the gums and the enormous costs of complex implant dentistry that is required to put things right. Due to the complexity of the proposed treatment, the former Expert cannot provide an opinion as he/she is a general dentist with no specialist training. In addition, their report did not allow them to examine the patient.
I am then instructed to examine the Client to provide the Current Condition, Prognosis and Treatment options in my capacity as a Specialist in Restorative Dentistry, perhaps 18 months after they attended the periodontist. At the consultation the Client presents with ongoing severe active periodontal disease associated with abundant plaque deposits throughout. It is clear this patient has not taken a blind bit of notice despite repeated visits to the periodontist, and is quite ill- suited to expensive dental implants. Not only do I consider that he/she is a candidate for conventional dentures, but I consider that he shows such a disregard for his own responsibility for optimum oral health that in all probability he is behaving as he did with the Defendant, ignoring advice and failing to comply. In essence, the Client is wholly culpable for their own tooth loss. My report has now totally contradicted that of the first “Expert”.
It may not surprise the Reader that Counsel are often furious with my conclusions and imply that I have ventured beyond their instructions for the Condition and Prognosis Report. Not so, I point out. My duty is to the Court. Their error is to assume that a second Expert will always agree with the conclusions of a previous Breach of Duty Report. The only way to avoid contradictions between the two reports is to ensure only one Expert is engaged. In essence, the screening report was worthless.
All the views and opinions expressed by the author are
personal but I would welcome public debate on all the issues
Toby Talbot BDS MSD (Washington) FDS RCS, Specialist in restorative dentistry, prosthodontics, endodontics and periodontics with over 20 years as an Expert Witness with a specific interest in dental negligence litigation claims
Website: www. talbotclinic.co.uk
Tel: 01225 426 222