Community Dental Health

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Cover Date:
March 2015
Print ISSN:
0265 539X

The incidence and nature of complaints against dentists for the treatment of children in Israel from 1992–2011

© BASCD 2015 doi:10.1922/CDH_3453Moskovitz04

The incidence and nature of complaints against dentists for the treatment of children in Israel from 1992–2011
N. Givol, T. Frenkel, N. Tickotsky and M. Moskovitz

Medical Risk Management Company and Medical Consultants International Ltd. of the Madanes Group, Israel; 2Department of Paediatric Dentistry, the Hebrew University – Hadassah School of Dental Medicine, Jerusalem, Israel; 3Bar Ilan University, Ramat Gan, Israel

Objectives: Medical literature lacks information about complaints against dentists who treat children. The present study aimed to evaluate the reports filed to Medical Consultant International (MCI) regarding paediatric dentistry in 1992–2011. Basic research design: Most dentists in Israel (85%) are obliged by their professional liability insurance policy to report adverse events to MCI. Reports were analysed using a structured form that included demographic details of the treating dentist, patients and parents, type of treatment, the result and the dentist’s attitude. MCI dental consultants’ decisions were evaluated by two specialists in paediatric dentistry. Results: The number of complaints per year is increasing. Complaints involved maltreatment (33%), case mismanagement (25%) and complications that required additional treatment (26%). Communication was problematic in 60% of cases. Only 16.7% of complaints developed into an actual lawsuit. Most complaints were against female general practitioners and against dentists who worked in community dental clinics located in peripheral areas. Treating permanent teeth increased to 3.6 times the probability of developing into a lawsuit. 59% of event records had missing data. Seventy-five percent of the cases rose from elective treatments while 25% concerned emergency treatments. One third of the cases required additional treatment in a hospital i.e. abscess drainage, foreign body swallowing or other physical damages. Conclusions: Better case selection and documentation, better training of dentists who treat children and more appropriate attitude toward patients and parents, are likely to reduce the number of complaints. Key words: risk management, insurance, malpractice, pediatric dentistry, liability, Israel

The concept of risk management is based on the principle that risk can be managed, reduced or prevented. The main target of risk management in hospitals is increasing the safety of treatment for the patients (Abbott et al., 2005). A safer treatment with less adverse results will reduce the costs of compensation in case of litigation. The need for a risk management program began as a response to the increase of alleged malpractice litigation (Graskemper, 2002). From the point of view of health providers there is also a risk for the medical team. For hospitals and professional liability insurers, it is the financial risk that is of primary concern; to individual practitioners the substantial risks are emotional stress and potential damage to professional reputation. Clinicians have to predict the obstacles, risks and complications that may develop during interaction with the patient. One of the strategies to avoid adverse events is learning from previous events and working according to a risk management program (Hills, 1990). Providing dental treatment to children and adolescents raises particular risk management issues: • From a legal point of view a patient that is younger than eighteen years of age is not entitled to offer consent as this is the role of the parents or legal guardians, providing they understand the diagnosis, treatment options and risks. • Often a third party (a parent/guardian) is observing (and interpreting) treatment procedures.

The child or adolescent patient presents behavioural and physiological differences from healthy adults, i.e., resistance to treatment, unpredicted responses, need for treatment under sedation or general anaesthesia etc. These behaviours may increase the risk of adverse treatment outcome. Events of malpractice not alleging negligence could better be described as “professional liability” cases. In those occasions the patient demands compensation for a damage that is not due to negligence (Carmi, 2003). Studies on the topic of risk management in dental care for children are scarce. One study was held in the USA between 2004 and 2006 and included 376 malpractice reports related to dentistry for 0-19 year old children (Thikkurissy and Casamassimo, 2008). In Israel two studies on risk management in adult patients were conducted, one concerned implant dentistry and the other endodontics (Givol et al., 2002; 2010). Around 650 new reports of potentially problematic dental care are filed to Medical Consultant International Company (MCI) in Israel every year, 14% of them are related to children’s dental treatment. Reports are filed by patients’ parents, lawyers or by the dentists as most dentists in Israel (85%) are obliged by their professional liability insurance policy to report adverse events to MCI. The aim of the present study is to evaluate the reports filed to Medical Consultant International Company (MCI) regarding dentistry for children in the years 1992 to 2011. To the best of our knowledge this is the first attempt to analyse the risk factors associated with complaints in paediatric dentistry.

Correspondence to: Dr Moti Moskovitz, Department of Pediatric Dentistry, Hadassah School of Dental Medicine, P.O.Box 12272, Jerusalem 91120, Israel. Email:

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N. Givol, T. Frenkel, N. Tickotsky, M. Moskovitz

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