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Patient With Bleeding Gums Loses “Dirty Instrument” Case Against Dentist

By August 25, 2020September 10th, 2021Michael's Operatory

This type of stuff makes my blood boil.

It’s something EVERY dentist will have to deal with at some point in their careers: an unhappy post-op patient complains of bleeding teeth, abscessed and irritated gums.

“What could have caused this?”, asks the unhappy patient.

“Hmmm…. Could be gingivitis, canker sores, chemotherapy, etc.”, responds the dentist.

But the patient isn’t hearing it.

The only thing that the patient seems to be zeroing in on is what they’ve been hearing in the news over the past few years (and any dentist’s worst-nightmare): the dentist must have used non-sterilized instruments which caused them to have bleeding gums!!!

So the patient alleges that that’s what must have done it!  They heard it from their friends, who heard it from the media.  Public health shutting down offices.  Letters being sent to patients to get themselves tested for HIV, HEPATITIS, AIDS, etc.  Class actions.   Yada… Yada… Yada…

“No!  Absolutely Not!  Never.  In all my years, I’ve never used non-sterilized instruments,” the dentist responds.  “I’ve made patients wait until the instruments cool down after coming out piping hot out of the Statim or Autoclave, etc.   I would never jeopardize my license by using dirty instruments.  Plus, it couldn’t have been because of that: you yourself have been here for years and never had an issue.  There must another explanation.  So, if it’s that concerning to you, you may wish to see a specialist”.

But again the patient isn’t hearing it.  “I can’t believe YOU used dirty instruments on me!”.  And then they complain to the RCDSO.

So the RCDSO then does its prolonged investigation (at significant time, energy, financial and emotional cost to the poor dentist who’s done NOTHING wrong we must assume) and asks the dentist to provide their clinical notes, respond to the allegations, etc.  And the dentist replies back and says: they would absolutely never use non-sterilize instruments;  staff are trained; the practice follows all IPAC standards and protocols; all equipment is being used appropriately; the patient is mistaken; the patient was seen by other dentists and hygienist at that practice for years and has never had any issues;  the patient was referred to a specialist.

And do you think any of this would persuade the patient to not drag the dentist through the mud and be forced to defend themselves?  No.

The RCDSO investigates and finds in favour of the dentist and decides that no corrective action is required.

And the unhappy patient appeals.  The saga continues on up the chain. Poor dentist keeps having to spend sleepless nights and countless dollars on lawyers to defend their best practices.

And this experience, unfortunately, is probably more common than we know about.  We only hear about it when cases reach the higher echelons of the appeals process.  Like in the recent decision from the Health Professions Appeal and Review Board from August 18, 2020 entitled D.B. (patient) and P.I.W (DDS).   In that decision, the Health Professions Appeal and Review Board reviewed and confirmed the decision of the RCDSO’s Inquiries, Complaints and Reports Committee.  In other words: the patient lost… AGAIN.

Sadly enough, after the complaint is made, the patient was discovered to have an auto-immune disorder which caused their gums to bleed (and unbeknownst to the dentist or patient at the relevant times).  But did that stop the investigation, decision or appeal from happening?  Nope.  Not at all.

Here are some take-aways for other dentists if a patient complains about excessive gum bleeding post-op:

  • Take very good clinical notes.
  • Suggest the patient see a specialist.
  • Make sure your IPAC standards are up to par (i.e. you’re following public health / RCDSO standards).
  • Have well-trained staff.

Here’s what offends me about this particular case:

  • It happened in 2014/2015, but this decision (an appeal of the RCDSO’s Inquiries, Complaints and Reports Committee) is happening in August 2020.
  • It was easy for the patient to complain.  It probably didn’t cost them anything other than a little bit of time to make up allegations.
  • It’s disheartening because the allegations are simple to make and cost nothing to make and yet are capable of causing so much damage to the dentist’s well-being (be it financial, emotional, etc.) and reputational harm to the practice (this decision is now public, although the names of the parties are abbreviated).
  • The dentist went through so much trouble throughout their entire career to only use freshly sterilized instruments that this was a full assault on their integrity as a professional health care provider.
  • The patient refused to see a specialist about their gums when one was recommended because their insurance wouldn’t cover it; so the patient is happy not to spend money to discover the truth, but the dentist likely spent thousands or even tens of thousands of dollars to defend themselves, their practice, and their team.

I was happy the patient lost; I almost wish they could have been ordered to pay the dentist’s legal fees and restitution for dragging their good name in the mud.  And the RCDSO and the appeals process should not have dragged the dentist through the process for 5-6 years before ultimately finding he didn’t do anything wrong; there should be a process to simply end these vexatious matters from ever reaching this level of scrutiny.  It’s simply ridiculous that tax-payers like myself are paying tens of people’s salaries (including 3 members of the Health Professions Appeals and Review Board) to figure out that a patient’s gums were bleeding because they had an auto-immune disorder AND NOT BECAUSE of some fabricated story about non-sterile instruments being used.  And to think that this could have been avoided if the patient maybe paid a few bucks and went to see the specialist that their dentist even suggested.

I’m not saying that all dentists are innocent; I’m sure there’s a few bad apples out there.  But this one wasn’t a bad apple; did everything by the book; and still had to defend themselves for years over a patient’s bleeding gums.

Protect yourself out there!