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I was sued (unsuccessfully) by a patient after completing endodontic treatment and crowns on both mandibular cuspids. She is an 80-year-old, medically compromised patient whose ultimate treatment plan was a new upper denture and a lower partial denture to replace her periodontally involved anterior teeth and missing posterior teeth. Even her expert was challenged to fault the work done or the treatment plan. In court on the witness stand, the patient stated that her new dentist was going to do implants and he suggested she see an attorney about the work I did. The dentist said that she then could afford his "good dentistry." Isn’t there an ethical issue here?
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Every ethical practitioner believes that his or her treatment plan is the best possible for the patient. Yet, we have all seen treatment we would not necessarily choose for a particular patient. However, as the ADA Principles of Ethics and Code of Professional Conduct1 (ADA Code) clearly states under the Principle of Justice, Section 4.C.1, "[a] difference of opinion as to preferred treatment should not be communicated to the patient in a manner which would unjustly imply mistreatment."
Nevertheless, we must keep uppermost in mind that, according to the ADA Code, Principle of Beneficence, we are duty-bound to treat our patients in such a way as to promote their welfare. The ADA Code also obligates us, under the Principle of Justice, Section 4.C, to report any "instances of gross or continual faulty treatment by other dentists" to the appropriate agencies. We also must inform our patients of their present oral health status. At times, this may include comments regarding faulty treatment if we have "a reasonable basis" to believe our statements to be true.
If, in fact, the patient’s subsequent treating dentist advised her to sue you to gain the financial resources necessary to complete his treatment plan, which he allegedly says is considered "good dentistry" (implying your treatment was not), the issue of a potential ethical impropriety does indeed arise.
The ADA Code espouses patient autonomy as its first Principle. This includes "involving patients in treatment decisions in a meaningful way." The inherent difference in power between dentist and patient could make it very easy to unduly influence an elderly and medically compromised patient. The ethical question is whether that happened in this case. The information you provided suggests that there was a breakdown of communication on several levels. If the patient’s own expert was challenged to find fault with the treatment, why did the patient go forward with her litigation? Was there a scientific basis for stating that one treatment option is superior to another (ADA Code, Section 5.A.2)?
The Principle of Beneficence, mentioned earlier, also states, "The most important aspect of this obligation is the competent and timely delivery of dental care [should the other dentist wait until after the trial to provide treatment?] within the bounds of clinical circumstances presented by the patient [are implants—and all that subsequently would be involved—appropriate for this medically compromised patient?], with due consideration being given to the needs, desires and values [even after litigation, could the 80-year-old really afford implants?] of the patient."
You do have options. This may include contacting the dentist who, according to the patient, planned the "good dentistry" so that you can hear his side of the story yourself. The ADA Code, part IV, Interpretation and Application, states that
[a]nyone who believes that a member-dentist has acted unethically may bring the matter to the attention of the appropriate constituent (state) or component (local) dental society ... . A member who is found guilty of unethical conduct ... may be placed under a sentence of censure or suspension or may be expelled from membership in the Association.
Or, given the amount of emotional and financial resources you’ve already expended, you may just want to leave the matter behind and move on. It’s your call.
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