The Indian dental litigation landscape: An analysis of judgments on dental negligence claims in Indian Consumer Redressal Forums.

INTRODUCTION: Dental malpractice/negligence litigations against dentists in India is not widely studied. The aim of this study is to report the Indian dentist related litigation landscape in consumer redressal forum (CRF) and to understand more of the nature of the same. MATERIAL AND METHOD: 111 cases of judgments of dental malpractice in Indian CRF were collected. Useful information was extracted, reported in a grid and statistically analyzed. Data was compared by claim, specialty, treatment offered, days lapsed and compensation awarded. P ≤ 0.05 was taken as statistically significant. RESULTS: In all, 44 (39.63%) dentists were found guilty. Thirty dentists had produced at least one evidence in their favor. Among them, 23 outcomes were in dentist's favor.(P = 0.02) The mean wait for final judgment was 1945 ±â€¯1286(193-6762) days. The mean compensation claimed was INR 577287 ±â€¯905898. Presence of evidence (dentists/patients) had an impact on the days to reach a judgment as well as compensation. CONCLUSION: Indian dental litigation landscape CRF has been described for the first time. We identified that CRF litigation of dental malpractice are few, as compared to number of procedures performed in India. Oral surgical procedures were often involved and 40% of instances, dentists were guilty and mean compensation awarded was INR 103998 ±â€¯158976.

Medicolegal Considerations Involving Iatrogenic Lingual Nerve Damage.

The aim of this review is to improve risk management strategies through analysis of the anatomic, semeiotic, and medicolegal aspects that characterize iatrogenic lingual nerve damage (LND) and its legal consequences in the case of legal proceedings for a claim for compensation. In dental practice, LND can be caused by local or general anesthesia or by mechanical, chemical, or thermal mechanisms. A certain postoperative identification of LND etiopathogenesis is often very challenging because it can be difficult to show at what time the damage occurred and which mechanism actually caused it. Clinical tests assessing lingual nerve sensory capabilities have a low sensitivity and moderate specificity, whereas instrumental tests have the advantage of not being affected by data interpretation subjectivity by both the operator and the patient. The quantification of permanent LND is not uniformly established, and there are no specific standard worldwide indications. From a medicolegal point of view, LND is a complication that may or may not be caused by surgical error. The 2 different concepts of "expectability" and avoidability or preventability allow one to discriminate between professional liability and fate and therefore to determine the surgeon's imputability in LND. Despite clinical competence and practice in performing the medical or surgical procedure, the clinician risks a lawsuit for negligence if he or she does not warn the patient about all relevant risks regardless of their frequency. Informed consent plays an essential role in minimizing litigation; the patient must be informed-with both his or her level of culture and ability to understand being taken into consideration-of the diagnosis, prognosis, and therapeutic perspectives and their consequences, in addition to all other viable alternative therapies, as well as the risks of nontreatment.

Cleft Lip and Cleft Palate Surgery: Malpractice Litigation Outcomes.

OBJECTIVE: This study examined malpractice claims related to cleft lip and cleft palate surgery to identify common allegations and injuries and reviewed financial outcomes. DESIGN: The WestlawNext legal database was analyzed for all malpractice lawsuits and settlements related to the surgical repair of cleft lip and palate. MAIN OUTCOMES MEASURES: Inclusion criteria included patients undergoing surgical repair of a primary cleft lip or palate or revision for complications of previous surgery. Data evaluated included patient demographics, type of operation performed, plaintiff allegation, nature of injury, and litigation outcomes. RESULTS: A total of 36 cases were identified, with 12 unique cases from 1981 to 2006 meeting the inclusion criteria. Six cases (50%) were decided by a jury and six by settlement. Five cases involved complications related to the specific surgery, and the other seven were associated with any surgery and perioperative care of children and adults. Cleft palate repair (50%) was the most frequently litigated surgery. Postoperative negligent supervision was the most common allegation (42%) and resulted in a payout in each case (mean = $3,126,032). Death (42%) and brain injury (25%) were the most frequent injuries reported. Financial awards were made in nine cases (after adjusting for inflation, mean = $2,470,552, range = $0 to $7,704,585). The awards were significantly larger for brain injury than other outcomes ($4,675,395 versus $1,368,131 after adjusting for inflation, P = .0101). CONCLUSION: Malpractice litigation regarding cleft lip and palate surgery is uncommon. However, significant financial awards involving perioperative brain injury have been reported.

The Australian litigation landscape - oral and maxillofacial surgery and general dentistry (oral surgery procedures): an analysis of litigation cases.

BACKGROUND: There are persistent concerns about litigation in the dental and medical professions. These concerns arise in a setting where general dentists are more frequently undertaking a wider range of oral surgery procedures, potentially increasing legal risk. METHODS: Judicial cases dealing with medical negligence in the fields of general dentistry (oral surgery procedure) and oral and maxillofacial surgery were located using the three main legal databases. Relevant cases were analysed to determine the procedures involved, the patients' claims of injury, findings of negligence and damages awarded. A thematic analysis of the cases was undertaken to determine trends. RESULTS: Fifteen cases over a 20-year period were located across almost all Australian jurisdictions (eight cases involved general dentists; seven cases involved oral and maxillofacial surgeons). Eleven of the 15 cases involved determinations of whether or not the practitioner had failed in their duty of care; negligence was found in six cases. Eleven of the 15 cases related to molar extractions (eight specifically to third molar). CONCLUSIONS: Dental and medical practitioners wanting to manage legal risk should have regard to circumstances arising in judicial cases. Adequate warning of risks is critical, as is offering referral in appropriate cases. Preoperative radiographs, good medical records and processes to ensure appropriate follow-up are also important.

Evaluation of dental malpractice cases in Kerman province (2000-2011).

INTRODUCTION: Dental practitioners, like other health-care professionals, might engage with legal claims and be sued if patients are not satisfied with the dental treatment. The aim of this study was to provide data on dental malpractice claims in Kerman, Iran, from 2000 to 2011. MATERIALS AND METHODS: In the present descriptive cross-sectional research, a retrospective evaluation was carried out of dental malpractice claims in Kerman, Iran, during 2000-2011, based on the decisions of expert committees in medical malpractice cases by the Kerman Legal Medicine Organization and the Medical Council of the Islamic Republic of Iran. A valid and reliable questionnaire was designed in three sections, based on previous studies. The SPSS 18 software program was used for data analysis. RESULTS: During the 11-year period, 64 decisions had been taken in relation to dental malpractices. The majority of complaints involved fixed prosthodontics and oral surgery usually by private practice and general dental practitioners. In 56.7% of clinical cases and 40% of non-clinical cases of malpractice claims, dental practitioners had been found guilty. CONCLUSIONS: Like all other medical staff, dental practitioners are under the obligation to comply with the laws of the country they practice. They also have to adhere to ethical principles as well as the acceptable standards and protocols of diagnosis and treatment. These data can alert them to the need for greater care and professionalism when treating their patients.

Managing the untoward anesthetic event in an oral and maxillofacial surgery practice.

The safe and efficient use of outpatient surgical anesthesia modalities is a significant part of the training and expertise of the oral and maxillofacial surgeon. Although adverse outcomes are rare, they can have considerable traumatic psychological and professional consequences for the surgeon involved. The goal of this article is to develop guidelines to educate the doctor, the second victim, on how to manage a bad outcome and how to navigate through a difficult and arduous process.

Medical litigation in oral surgery practice: lessons learned from 20 lawsuits.

The aim of this study was to investigate all the lawsuits related to oral surgery practice over a period of three years, and to analyze the different causes of litigation. Inclusion criteria involved all the closed cases that proved malpractice against an oral and maxillofacial surgeon or involved a dentist who performed an oral and maxillofacial surgical procedure. The most common causes of litigation were oro-antral communication, neurological deficit, and bleeding. The study presented the lessons learned from 20 cases, and concluded that most of the lawsuits in oral surgery practice can be prevented either through preoperative measures or by dealing with the impact of the surgical error through good patient rapport and communication.

Risk management in the dental office.

This article is devoted to risk-management strategies regarding oral surgical procedures in the general dental office. Lawsuits are more likely to be filed following poor outcomes related to oral surgical procedures rather than after operative or prosthetic dental procedures. The article is not meant to discourage practitioners from performing oral surgical procedures if they have the experience, training, and appropriate skill set to complete the planned procedure. Rather, it advises clinicians as to the steps one can take to limit the chances of litigation from occurring, and avoid the emotionally and painful time-consuming process associated with a malpractice lawsuit.

Litigation in National Health Service oral and maxillofacial surgery: review of the last 15 years.

Litigation claims are increasing in medicine but we know of little detailed analysis of those published concerning oral and maxillofacial surgery (OMFS) despite information being freely available from the NHS Litigation Authority (NHSLA) under the Freedom of Information Act. We obtained information from the NHSLA on clinical and non-clinical negligence claims in OMFS from April 1995 to August 2010, and analysed the data with outcomes and a further breakdown of subspecialty. During the period 318 claims relating to OMFS were registered. As expected, because of the high volume of patients treated, the highest number of claims related to dentoalveolar surgery and minor oral surgery. The total amount paid out was in excess of £5 million, and the highest claim (more than £300,000) during the period was for misdiagnosis of an oral cancer. Litigation in OMFS is increasing, as is the number of cases that necessitate compensation by the NHSLA. We discuss the trends and implications.

Professional liability in oral surgery: Legal and medicalstudy of 63 court sentences

Objectives: Dentistry, like all other health care professions, has in recent years been subjected to an increase inlegal pressure by patients. Nevertheless, there are areas of activity in dentistry in which, whether because of theirfrequency or due to the importance of the damage and sequelae claimed, this legal pressure is greater. Amongstthese areas of activity is that of oral surgery.Study design: To be meticulously analyzed in this report are 63 sentences issued by courts of second instance orhigher levels regarding lawsuits involving oral surgery. The data collection file includes 13 variables. The descriptiveand comparative statistical study by cross-referencing certain variables provides us with a clear and accuratepicture of the lawsuit profile.Results and conclusions: Implantological surgery was the practice subject to the most claims due to surgery (55.6percent: 35 sentences), and it drew our attention that in 71.4% of all cases (45 sentences) there was a ruling againstthe professional. The most frequent range of damage payments was between €18,001 and €60,000 (40.9%: 18sentences), the highest amount having been €24,000, an important factor to take into account when contractingprofessional civil liability insurance (AU)

Iatrogenic damage to the mandibular nerves as assessed by the masseter inhibitory reflex.

Iatrogenic injury of the inferior alveolar or lingual nerves frequently leads to legal actions for damage and compensation for personal suffering. The masseter inhibitory reflex (MIR) is the most used neurophysiological tool for the functional assessment of the trigeminal mandibular division. Aiming at measuring the MIR sensitivity and specificity, we recorded this reflex after mental and tongue stimulations in a controlled, blinded study in 160 consecutive patients with sensory disturbances following dental procedures. The MIR latency was longer on the affected than the contralateral side (P < 0.0001). The overall specificity and sensitivity were 99 and 51%. Our findings indicate that MIR testing, showing an almost absolute specificity, reliably demonstrates nerve damage beyond doubt, whereas the relatively low sensitivity makes the finding of a normal MIR by no means sufficient to exclude nerve damage. Probably, the dysfunction of a small number of nerve fibres, insufficient to produce a MIR abnormality, may still engender important sensory disturbances. We propose that MIR testing, when used for legal purposes, be considered reliable in one direction only, i.e. abnormality does prove nerve damage, normality does not disprove it.

Temporomandibular disorders assessment: medicolegal considerations in the evidence-based era.

Summary Temporomandibular disorders (TMD) are a frequent finding in cases of facial trauma or dental malpractice, and legal claims for TMD damage have been increased over the years. Temporomandibular disorders assessment in the medical legal setting is complicated by the peculiarities of these disorders, whose symptoms are heterogeneous, fluctuant, and recognise a multifactorial origin. A systematic Medline search in the National Library of Medicine's PubMed database pointed out that, despite the medical legal aspects of the dental profession are gaining a growing attention, there is a paucity of literature dealing with patients with TMD assessment. For these reasons, evidence-based knowledge in the field of TMD diagnosis and treatment was summarised in this article with the aim of providing useful suggestions for a medical legal approach to TMD.

A five-year survey for dental malpractice claims in Tehran, Iran.

OBJECTIVES: Dentists, like other doctors, can face punitive and legal consequences if patients are not satisfied with the dental treatment. The purpose of this study is to provide a database for dental malpractice claims in Tehran. METHODS: We conducted a retrospective study of dental malpractice claims In Tehran, between 2002 and 2006, based on the decisions of expert committees in medical malpractice cases by Tehran's Legal Medicine Organization and Islamic Republic of Iran's Medical Council. RESULTS: During these 5 years, 412 decisions related to dental malpractice were made. The majority of complaints were in fixed prosthodontics and oral surgery and also most of them concerned the private sector. Most of the cases were against general dentists. In the 56.7% of clinical cases and 40% of non-clinical cases of malpractice claims, dentists were found faulty. CONCLUSIONS: Like all other medical staff, dentists are under the obligation to comply with the legal rules in the country they practice. They also have to consider ethical principles as well as the acceptable standards and protocols of diagnosis and treatment. These data can alert them to the need for greater care and ethical professionalism when treating their patients.

Informed consent in dental malpractice claims. A retrospective study.

With the introduction of informed consent in dental practice in Spain during the last ten years activity has been focused on avoiding complaints rather than on giving adequate information to the patient. However, in the eyes of many professionals the document by which patients accept the cost or estimated charge of treatment is the equivalent of informed consent. Although Spanish law permits verbal consent in some cases (low risk therapeutic activities), some dentists interpret this law in a very broad way. The aim of this paper was to study the fulfilment of informed consent in relation to professional malpractice claims presented to the College of Dentists of the province of Murcia, south east Spain (regional professional association) during the last twelve years (n=52). Evaluation of the complaints pointed to adequate professional behaviour in 14 cases and malpractice in 38 cases (in 29 of which the treatment applied was technically correct but with inadequate information provided during the process, while nine cases represented technical errors). The written document of informed consent was absent in 40 cases, although the verbal information supplied was considered adequate in 14 cases. When the document of informed consent was present (12 cases) it was considered unsuitable, although adequately complemented by oral information.

Medicolegal aspects of replanting permanent teeth.

Replantation of a permanent tooth is an intervention that carries the same responsibilities in terms of informed consent as a surgical procedure. Unlike many procedures that can be planned in advance, an avulsion requires decision-making shortly after the injury, often by a distraught patient or parent. Under these circumstances, patients or parents prefer, or may even pressure, clinicians to make the replantation decision for them.Later, the parents may seek advice of other professionals or be confronted by lay opinions or Internet information that may lead them to doubt the decision or even feel betrayed by the dentist who provided the acute care. This article uses an actual parent complaint to illustrate the medicolegal aspects of the replantation decision and describe measures to be taken by the clinician faced with this situation.

Implant dentistry at the focus of liability lawsuits.

PURPOSE: In recent years, the growing readiness on the part of dental patients to take legal action has resulted in an increasing number of medical liability lawsuits. The aim of this retrospective analysis was to highlight aspects of these lawsuits of special significance, to subject them to both qualitative and quantitative analysis, and to show how conflicts can be avoided. MATERIALS AND METHODS: Forty relevant court decisions from the year 1984 onwards were found in online databases and through direct inquiries at the courts. These were supplemented by 21 reports prepared by experts at the University of Muenster, Department of Dental Medicine, commissioned by courts in connection with ongoing lawsuits. Analysis was initially based on formal aspects of the cases and reports. It was later supplemented by differentiated assignment of the questions addressed by the courts to the expert consultants. The principles underlying the judgments as to the liability arising from the terms of the contract were also assigned to the expert consultants in a differentiated manner. RESULTS: The results revealed marked differences in the frequency of liability-prone aspects of treatment. While the majority of judgments referred to the obligation to take due care during the preparatory and treatment phases, infringement of the obligations to provide information and to keep records played more than a minor role. Moreover, 90% of all cases represented combined charges covering various aspects, including those related to consequential failings. DISCUSSION AND CONCLUSION: The detailed qualitative analysis of the grounds quoted and of the lines of reasoning can therefore be summed up in clearly defined recommendations aimed at helping the clinician avoid conflicts by observing the judicial requirements.