Picture it. A patient still has discomfort after receiving endodontic treatment from her general dentist. She is told by a subsequent endodontist that retreatment is necessary because there is a separated file in one canal and the obturation of another canal is deficient with periapical infection present. The patient feels this wasn’t her fault and wants the dentist to refund and pay for the retreatment which exceeds her dental plan.
Let’s say the dentist argues that he did the best he could and is not obligated to refund / compensate the patient as he warned her pre-operatively of the risks of endodontic treatment which occurred in this case. The patient may well be upset with such an answer. Who should be responsible for the dental retreatment?
The dentist’s perspective could deem his position appropriate as endodontic therapy does have its risks and the dentist may believe that he should not be responsible for risks that are known to come with the procedure and in fact do occur. The patient may think the dentist was negligent; or she may wonder if the endodontist had rendered the root canal treatment initially, instead of the general dentist, would the same adverse outcome likely have arisen? If she believes “no,” this will exacerbate the situation. Is it reasonable that the patient or third party payor be left to solely pay the entire retreatment costs?
In clinical practice, many factors can contribute to a less than desirable outcome. However, from an ethical perspective, would it be more reasonable and fair if the dentist were to offer to help resolve the situation which he himself created, even if inadvertently? For instance, if the dentist had charged his usual and customary full fee for the endodontic treatment performed, then if the usual outcome (eg. no separated file, no deficient obturation of the canals, and symptoms resolved), was not achieved, would it not seem “right” that some type of refund or payment to the patient be in order since the desired objective of the dentist’s therapy was not attained? On the other hand, mitigating factors such as lack of patient co-operation, difficulty with the case or refusal of the patient to see an endodontist pre-operatively could well mitigate against such goodwill gesture being offered by the dentist.
Where dental retreatment is concerned, even if a dentist feels he is not legally liable for any wrongdoing, it may be helpful to keep in mind the relevant ethical factors which can guide the dentist’s conduct. In Ontario, Principle 1 of the RCDSO Code of Ethics states: “The paramount responsibility of a dentist is to the health and well-being of patients.”1 Not only will a reasonable, fair and compassionate handling of the situation comply with the ethical obligations of the dentist, but it may well resolve the dispute in the best interests of both patient and dentist.
Disclaimer: This article is intended to provide information of a general educational nature only and is not to be taken as legal advice upon which you are to rely for any specific situation. Appropriate legal advice should be obtained prior to taking any action in any specific situation or circumstance.
Rollin M. Matsui maintains a full-time law practice in Richmond Hill and a part-time dental practice in Toronto, Ontario. In his law practice, he primarily acts for dentists in complaint and professional misconduct related matters. He is also the Executive Director of the Canadian Dental Protective Association (CDPA) and the Program Director of the CDPA Assistance Program. He is the Oral Health Journal Editorial Board Member for Ethics.
REFERENCES
1.Royal College of Dental Surgeons of Ontario, Code of Ethics (Schedule 5 to By-law No.1, November 2004)