Malpractice issues surrounding medical emergency preparedness in dentistry

Larry J. Sangrik, DDS

 

When I lecture on medical emergency preparedness, I am often asked, “What do I need to do to protect my office from a malpractice suit?” The answer lies in understanding three concepts: (1) the nature of medical emergencies during dental care, (2) what constitutes malpractice, and (3) the expectations of the public.

Understanding medical emergencies

A medical emergency during dental care can be defined as “any time the dentist’s attention is diverted from the dental procedure (or the associated anesthesia procedure) to attend to the patient’s physiological or psychological needs.”1

Using this broad definition means medical events are far more frequent than the once-in-a-career “lights-and-sirens” event some doctors associate with emergencies. In fact, medical emergencies, albeit minor ones, are not uncommon. It is incumbent on all dental offices to prepare for a wide range of scenarios.

Medical emergencies in dental offices occur for one of three reasons.

1. Sometimes dentists are at fault—it’s true. Statistically, errors by dentists are the least likely cause of medical emergencies during dental treatment. However, these emergencies are the most lethal and consequently attract the greatest media response.
2. The event may be random. Imagine the Rose Bowl in Pasadena filled to capacity. This represents the number of people undergoing dental treatment on a typical weekday. Now envision the Rose Bowl, not filled for a three-hour football game, but rather, continually refilled every day, week after week. It is inevitable that a medical event will occur . . . perhaps a heart attack, perhaps a stroke, perhaps hypoglycemia. Although dental patients are spread across the nation rather than collected in a single venue, the principle remains—in any large group of people, random medical events occur.
3. The event may be a reasonable risk of treatment. When a patient faints during an injection, neither the dentist nor the patient is responsible. Syncope is merely an unavoidable complication of injections that everyone must accept.

Unfortunately, merely not being the cause of the emergency is not absolute protection. An old legal maxim says, “In America, anyone can sue anybody over anything.” In determining whether to seek legal counsel, a patient (or the patient’s survivor) is more likely to be guided by three questions: (1) “How serious was the event?” (2) “How rare is the event?” and (3) “How costly was the event?” From the patient’s perspective, medical emergencies that are severe, rare, or costly are probably worthy of a lawsuit regardless of whether or not the dentist is at fault. In short, if something bad happens, expect litigation.