Health Professions Review Board

Transcription

1 Health Professions Review Board Suite 900, 747 Fort Street Victoria British Columbia Telephone: Toll Free: (within BC) Facsimile: Mailing Address: PO 9429 STN PROV GOVT Victoria BC V8W 9V1 Website: DECISION NO HPA-098(a) In the matter of an application under section 50.6 of the Health Professions Act, R.S.B.C. 1996, c. 183, as amended, (the Act ) for review of a complaint disposition made by an inquiry committee BETWEEN: The Complainant COMPLAINANT AND: The College of Dental Surgeons of BC COLLEGE AND: A Dental Surgeon REGISTRANT BEFORE: Victoria Kuhl, Panel Chair REVIEW BOARD DATE: Conducted by way of written submissions concluding on December 20, 2013 APPEARING: For the Complainant: Self-represented For the College: For the Registrant: Greg Cavouras, Counsel John B. Arneson, Counsel I DECISION [1] Upon reviewing the application of the Complainant I confirm the disposition of the Inquiry Committee. II INTRODUCTION [2] This complaint was filed due to unsatisfactory dental treatment the Complainant received from the Registrant in 2010 and The Complainant had been a patient of the Registrant since [3] The Complainant s treatment resulted in failed dental implants requiring removal by an oral surgeon and a set of dentures that did not fit the implants. The Complainant also had an allergic reaction due to the repeated use of an antibiotic over several months prior to surgery. In addition, the Registrant failed to obtain a proper signed

2 DECISION NO HPA-098(a) Page 2 informed consent prior to surgery. The consent form the Complainant signed did not include the installation of implants and locators as one of the procedures. [4] The Complainant s file at the College became dormant for over a year. Subsequent to the Complainant s request to the HPRB for review of the College s delay the file was re-opened and the Inquiry Committee concluded its investigation on May 29, III BACKGROUND [5] In May 2010, the Complainant consulted the Registrant about obtaining dental implants and dentures to replace her remaining teeth which they agreed he would remove. The Registrant noted she had an impacted wisdom tooth which he would attempt to remove when he performed the implant surgery. [6] During the discussions as to what the Registrant had planned for her the Complainant indicated that she wanted the Registrant to give her all options so that she could choose the best and most ideal option. The Registrant stated that at the time he believed he was being considerate of her concern about cost so he recommended the most cost effective option. [7] The Complainant denies she had shared financial concerns with the Registrant and says she did not indicate she wanted a cheaper solution. She asked to see a complete set of models so she could consider the options. The Registrant did not have a complete set of models that would show the placement of the implants and the type of dentures. [8] After much discussion that involved dental terminology, the Complainant believed she would be getting implants suitable for fixed dentures. She then asked the Registrant to choose the best option. The Complainant agreed with the Registrant s recommendation and he proceeded with the surgery. [9] On September 30, 2010, the Registrant extracted the remaining teeth but was unable to extract the impacted wisdom tooth. The Registrant performed an alveoplasty (smoothing the bone following tooth extractions), and placed four implants in a straight line in her anterior lower jaw. The implants with locaters to be added later would be used to hold her new dentures in place. [10] The Complainant was immediately concerned when she saw the placement of the four implants which were in a straight row in the frontal part of the mandible (lower jaw) and not spaced evenly on the jaw as she had seen on pictures on the internet. She spoke to the Registrant about her concern and also noted that one implant was higher than the others. The Registrant assured her that the surgery had been successful.

3 DECISION NO HPA-098(a) Page 3 [11] The next step was to have dentures made and fitted. The Complainant opted to wait for a time to allow the gums and bone around the implants to heal before being fitted for new dentures. [12] When the Complainant did visit the denturist recommended by the Registrant she was still under the impression the dentures would be fixed to the implants. When she requested to see a model of how the dentures would look, the Denturist was unable to produce a model that was reflective of the denture the Complainant would receive. [13] The Complainant, trusting that the Denturist would have had the Registrant s orders, believed the dentures would be fixed. The Denturist proceeded to make and fit the dentures. However, they were made as moveable and not fixed to the implants as the Complainant had expected. The Denturist had difficulty fitting the dentures to the implants. [14] For the first few weeks the Complainant did not complain about the fit of the dentures but over time they became increasingly uncomfortable. She was unable to wear the dentures for more than three or four hours and often went without them. [15] On the occasions when she contacted the Registrant about the fact the dentures were not working for her, he sent her back to the Denturist. [16] After a year and 13 visits to the Denturist who attempted to make the dentures fit, the Complainant became exasperated. The Denturist said she could do no more and the Complainant should go back to the Registrant. The Complainant claims she received no solutions from the Registrant. The Registrant claims he did try to work with the Complainant although he did not offer any solutions. [17] The Complainant then consulted another general dental surgeon (Dentist A) for a second opinion in September 2011 one year after the Registrant did the surgery for implants. Dentist A used a CBCT (cone beam computed tomography) examination and found the cause of unstable dentures to be due in part to a thin receding bone in her lower jaw and in part due to the unusual placement of the implants. [18] August 2012, Dentist A referred the Complainant to an oral maxillofacial surgeon ( the Oral Surgeon ), who indicated the implants were failing and their long term stability could not be guaranteed. In January 2013, the Oral Surgeon removed the implants placed by the Registrant and also extracted the impacted wisdom tooth. [19] In March 2013 the Complainant visited a second Denturist who was able to adjust the original dentures to allow her to wear them temporarily without implants. [20] The Complainant made an attempt to recover from the Registrant the costs of the tooth extraction and implant surgery which had failed. The Registrant, his insurance company and the Complainant were unable to come to agreement on a settlement.

4 DECISION NO HPA-098(a) Page 4 IV ISSUES [21] The main issues on this application are to determine whether the investigation of the Inquiry Committee conducted was adequate and whether its disposition was reasonable. V ADEQUACY OF INVESTIGATION [22] The Complainant submits that the investigation was not adequate. She submits there were errors and omissions and bias in favor of the Registrant in the investigation. The remedy she seeks is to have the complaint returned to the Inquiry Committee to be investigated more exhaustively. She believes that a new and a more thorough investigation would result in a disposition that addresses more of her complaints. [23] The Complainant also wants the Registrant to be reprimanded, and asks me to give directions to the Inquiry Committee requiring the Registrant to engage in improvements in his standard of care, adherence to the Code of Conduct and better record keeping. The complaint itself and the remedy taken should be sufficient notice to the Registrant. [24] The Registrant submits he had an adequate treatment plan, and that the surgery, although ultimately not the outcome, was successful. He submits he adequately explained the treatment plan prior to surgery and that the Complainant understood his plan. He also submits that the investigation conducted by the Inquiry Committee was adequate. [25] The Complainant identified errors in the material produced by the College that are revealed by a careful comparison of records and submissions in the Record. In the following paragraphs I comment on those that are relevant to the adequacy of the investigation. [26] The Complainant is justified in her frustration with the manner in which her complaint to the College was handled. The first matter is the Complainant s concern that the delay in the investigation compromised the investigation. Her concern was that reliable recollection of incidents fades over time and this would affect the disposition. [27] The College s initial letter acknowledged her complaint and outlined the complaint process but did not advise her of her right to a review by the Review Board. The right of a Complainant to request a review by the Review Board is part of the complaint process established by the Act. In the case of a delayed investigation the Complainant had no knowledge of her recourse and in this case had to obtain that information from the Minister of Health. [28] The Complainant being unaware of her right to a Review by the Review Board was informed by the Minister in January 2013 of her right to the Review Board process. She then applied to the Review Board for a Delayed Investigation Order (Review Board Order No HPA-034) following which her complaint became active again.

5 DECISION NO HPA-098(a) Page 5 [29] The College defended this delay initially as work overload and ultimately as difficulty with their file tracking system which they have now corrected. [30] The Inquiry Committee is in breach of the Act s (2), when it fails to advise a Complainant that it has not made a disposition within 255 days of the date of its receipt of the complaint and also when it fails to advise of an expected date of the disposition. [31] I do not, however, accept the Complainant s submission that the lengthy delay was intentional or that it seriously affected the investigation. There is sufficient information in the Record to substantiate the events that occurred during the Complainant s experience as a patient of the Registrant and his treatment of her. [32] On the issue of the alleged inaccuracies in the Investigator s report to the Inquiry Committee, I have reviewed the inaccuracies noted by the Complainant between the recorded telephone conversation and the Investigator s written report and did not find any material differences that would have impacted the investigation or its conclusions. [33] I do comment, however, that the signed Implant Consent form is inaccurately noted in the investigators report, the College s submission and the Registrant s statement of points as having been signed prior to surgery. That was not the case. [34] The implants and locators were not listed as a procedure to be performed on the Implant Consent form. However, the Investigator s report to the Inquiry Committee dated April 24, 2013; in the section entitled Complaint Investigator s Comments corrected his earlier statements by noting the inadequacy of the consent forms. [35] The Complainant stated she did not expect a perfect investigation but in fact her expectations were that every incident she put forward for her case against the Registrant would be included and adjudicated upon in the investigation. Neither the Complainant nor the Registrant may have agreed with everything in the Investigator s report however the process he followed in collecting information and reporting it to the Inquiry Committee was satisfactory. The material submissions of the complainant were considered. [36] Though not perfect, the investigation did give both the Complainant and the Registrant the opportunity to present all the information they wanted to submit in writing as part of the Record. [37] The Inquiry Committee conducted several telephone interviews with key witnesses including the Complainant and the Registrant. The Inquiry Committee requested and received written reports from the Registrant, the Denturist, Dentist A and the Oral Surgeon. [38] The College engaged a specialist dentist as a consultant to review all the collected information. The Inquiry Committee was given a 15-page investigator s report with a detailed summary of all of the information collected. The Inquiry Committee

6 DECISION NO HPA-098(a) Page 6 consisted of 11 members, dental surgeons, dental assistants and lay members. In addition, seven staff attended. [39] Although in the Complainant s view the investigation was neither adequate nor satisfactory, it did provide sufficient evidence for the Inquiry Committee to arrive at a disposition that took into account many if not all of the Complainant s complaints and concerns. It is unreasonable to expect that all Complainant s concerns and complaints would be accepted and incorporated in the disposition. VI REASONABLENESS OF THE DECISION [40] Despite a significant delay in addressing this complaint, in my opinion the Inquiry Committee conducted an extensive, satisfactory and adequate investigation. [41] In considering the reasonableness of the disposition, it is noteworthy that there were two meetings of the Inquiry Committee to review this complaint: one being the weekly meeting on April 30, 2013, and the other being on May 28, [42] The Complaint Investigator recommended in his memo to the weekly meeting dated April 24, 2013, that the Registrant should take a College approved hands-on course on diagnosis and treatment planning and surgical implant placement. [43] The Registrant by signed letter on May 14, 2013, accepted the Complaint Investigator s recommendation and agreed to take further training in a 3-day course at the regional university dental school that would improve his skills in the areas of implant diagnosis, treatment planning, record keeping and consent forms. [44] The Investigator recommended to the Inquiry Committee at their May 28, 2013, meeting that they approve his recommendation that the letter of agreement from the Registrant that he would take a remedial course be approved as an appropriate resolution of the complaint. [45] The Inquiry Committee approved the recommendation and in their letter to the Complainant stated, the College is satisfied that this course will address the concerns raised by your complaint in a meaningful way by improving the Registrant s clinical knowledge and skills in this area. [46] This action was the basis of the Inquiry Committee s disposition and I find it to be a reasonable disposition in that it falls within the range of reasonable outcomes. [47] On the basis that I have found the Inquiry Committee s investigation to be adequate and its disposition reasonable, I confirm the Inquiry Committee s disposition of the complaint against the Registrant.

7 DECISION NO HPA-098(a) Page 7 VII CONCLUSION [48] In making these decisions I have considered all of the information and submissions whether or not specifically identified in this decision. Victoria Kuhl Victoria Kuhl, Panel Chair Health Professions Review Board May 28, 2014