DENTAL COUNCIL STATEMENT
“To jaw-jaw is always better than to war-war.”
One could not agree with everything Sir Winston Leonard Spencer-Churchill said, but that much he got right. In any relationship, disputes will arise - sometimes due to simple, but important, failures in communication, on other occasions, following grievous actions or omissions.
The Dental Council welcomed the advent of the Dental Complaints Resolution Service. Dental Councils, past and present, are aware that the majority of complaints (a term I use in its broadest meaning) received by the office of the Council related to matters which are outside the legal remit of the Council; they do not relate to issues of professional misconduct or unfitness to practice for physical or mental reasons. Indeed, the majority of complaints received by Council are broadly consumer-type grievances.
For this reason, the Dental Council has radically revised the way it handles complaints in recent years. Previously, the Council investigated matters where it was reasonably clear at the outset that the complaint was not going to meet the standard of professional misconduct. This meant that the patient was taken through a lengthy process that was never going to resolve the issue. At the same time, the dentist was taken through a stressful regulatory process that was never likely to make an adverse finding against them. Clearly, this type of situation does not best serve the public interest.
The Council now spends a significant amount of time discussing the exact nature of the problem with the patient and tries to advise accordingly. Dispute resolution should reflect the gravity of the event. Most problems are best resolved between the patient and the dentist and, if appropriate, we recommend that the patient discuss the matter with the dentist directly. However, some problems do require the Dental Council to investigate and the patient is taken through our process. Even though the number of
fitness to practise inquiries the Dental Council has held has increased in recent years, the number of investigations undertaken has dramatically reduced.
However, grievances of a less serious nature which require resolution regularly arise; in many of these cases it is possible for a mediated solution to be found. Sometimes the patient has already discussed the matter with the dentist and other times, due to what happened, the patient is a little uncomfortable going back to the dentist. The Dental Complaints Resolution Service is ideally placed to try to find a solution acceptable to both the patient and dentist as it allows both parties the opportunity to explore, in a non-confrontational setting, a broad range of possible solutions to their dispute.
The Dental Council encourages dentists to develop an ethos within each dental practice which promotes the resolution of complaints in a timely, amenable manner. Dentists are required, having developed a complaints resolution policy, to clearly display this policy for patients to see.
Mediation is a cost-effective dispute-resolution process of great value to patients and dentists. We acknowledge the important work the Dental Complaints Resolution Service is doing and we will continue to work closely with Michael Kilcoyne into the future.
Dr Eamon D Croke President Dental Council
DENTAL PROTECTION STATEMENT
Resolving concerns
As with any other professional service, there may be times when things may not go entirely to plan and complaints arise. The complexity of dental care has increased over the years and at the same time, patients’ knowledge of dentistry and their expectations have increased. During challenging economic times patients can develop a more consumerist attitude to their treatment. Until recently, patients in Ireland have had few avenues open to them when a complaint or concern has arisen. Instructing a solicitor or complaining to the Dental Council can sometimes be a slow process with an unpredictable outcome. In reality, patients are often seeking an explanation and an apology for what happened, neither of which are the focus of Dental Council or legal procedures.
Dental Protection has always promoted the concept of patient access to fair and transparent complaints mechanisms which focus on resolving the complaint at an early stage. Dental Protection believes that the introduction of the Dental Complaints Resolution Service by the IDA benefits both patients and practitioners alike. It provides another avenue for the resolution of patient complaints, with the benefit of being simple, easy to use and fair to both parties, with the emphasis being on local resolution. Patients will be reassured that practitioners who participate in the IDA’s Dental Complaints Resolution Service are committed to meeting patient expectations and also to resolving concerns locally and directly with the patient on occasions when this has not been possible. In the rare circumstances where it is not possible for the dentist to resolve the problem in-house, further assistance is available to the patient and the dentist through this scheme. The whole process is reassuringly simple to use, easy to access, and often results in quick resolution to the satisfaction of both parties. Similar systems have been successfully introduced in New Zealand, Hong Kong, and the UK where they have proved more
attractive to both parties than the alternative of legal procedures or Dental Council procedures.
The dental profession has embraced the IDA’s Dental Complaints Resolution Service and sought Michael Kilcoyne’s assistance in resolving what has, at first glance, appeared to be an irresolvable issue. An independent view can often assist both parties in identifying the way forward.
On occasions the patient may have been embarrassed to contact their dentist. However, once it has been explained to them that the dentist will deal with the matter professionally and courteously and would welcome the opportunity to resolve the concern, the patient has moved forwards and the matter has been resolved. This can be particularly important in a region where the dentist and patient can easily come across one another socially and it can avoid on-going social discomfort.
The introduction of the Dental Complaints Resolution Service has increased patient awareness of practice complaints procedures.
For those who are unaware, a quick discussion with Michael Kilcoyne can point them in the right direction. Michael has proved to be an accessible and knowledgeable facilitator, who is respected by both patients and dentists. The success of the DCRS is in no small way due to his skills.
Dental Protection Limited (registered in England No. 2374160) is a wholly owned subsidiary of The Medical Protection Society Limited, which is registered in England (No.36142). Both companies have their registered office at 33 Cavendish Square, London W1G 0PS.
FACILITATOR’S REPORT
28 disputes resolved
The Dental Complaints Resolution Service (DCRS) was established in April 2012 by the Irish Dental Association. However, the service operates completely independently of the Association.
The service acts as an independent mediator of complaints by patients about their dentists. Any patient whose complaint falls within DCRS' remit, can use the Service free of charge. It is also free to dentists who are members of the Irish Dental Association. Dentists who are not members of the Association can still choose to engage with the DCRS for a fee of €90.
The Service runs a very helpful website – www.dental complaints.ie –on which patients and dentist will find a great deal of information about how to make or deal with a complaint. Patients will find the correct procedures and formats for making a complaint on the site, while dentists can see how to access professional guidance on dealing with any complaints.
Making a complaint to the Service
Patients who have raised an issue with the nominated person in the dental practice in question, and are not satisfied with the initial response they have received, may contact the Dental Complaints Resolution Service. Details of the complaint must be submitted in writing to the Service, either by email, or through the post. The Service will then try to mediate an agreement between the two parties. In the case of dentists who ignore two or more emails/letters regarding a complaint, the Service will then write to both indemnity providers advising them of the complaint against a named dentist and asking them to offer their assistance to the dentist concerned, if they are that dentist's indemnity provider.
Complaints in 2013
Between January 1 and December 31, 2013, the Service
accepted a total of 130 complaints (see summary panels on page 8). Up to December 31, 28 of these cases had been resolved. In most cases, the results involved either a refund of fees, an apology, or retreatment at no extra cost. Of these, one case was unable to be resolved by the Service, and the patient decided to take legal action.
A further 102 cases were still being processed by the end of 2013, and many have been resolved in early 2014. Certain cases are currently being dealt with, but are awaiting a full response from the dentist, or an opinion from a third party. An estimated 10% of cases will not be able to be resolved by the Service, and are likely to be referred to solicitors.
Of the dentists who had complaints made against them, 60 were confirmed to be members of the Irish Dental Association, while 15 were confirmed to be non-members.
Several enquiries made by phone to the Service did not materialise as complaints, as callers were advised to try and resolve the issue directly with the dentist. The Service is not expecting any further contact from them at this time.
The Service rejected six complaints during 2013 – two were anonymous complaints, and four lay outside the Republic of Ireland; therefore, the Service could not deal with them.
The largest amount paid out to a complainant in 2013 was € 40,000, for retreatment work required, and for the stress caused to the patient.
Commentary
The Dental Complaints Resolution Service is into its second year of operation, and has been widely accepted by the profession as a mediator to resolve disputes between patients and their dentists. Patients who have had their cases resolved have expressed their satisfaction with the DCRS process. Increasingly, dentists have begun to refer cases to the Service in order to find a resolution. Sometimes dentists who have had to carry out
repair work on a patient who has had poor dental work done by another dentist, will contact the Service with a complaint. The length of time it takes to resolve a complaint can vary greatly from a month, to a year, to a year and a half. Generally, it depends on the response of both sides; sometimes a dentist will be slow to respond to the complaint, while other times, a patient might not be correct, or might not be divulging the full story. However, the average time it takes to resolve a case is about two months.
Some of the most difficult cases than can arise involve veneers, crowns, bridges, etc. For example, an argument may arise over a crown if it breaks after treatment. A patient will argue that all of the decay was not cleaned out originally when the crown was being fitted, while the dentist will argue that it was.
The Service is likely to be having a positive knock-on effect for dentists’ defence bodies, because many cases are now resolved outside of the courts. The faster something is resolved, the less it will cost the defence bodies.
Michael Kilcoyne Dental Complaints Resolution Service
ADVICE AND SUMMARY
Advice to dentists
The most important advice that the Dental Complaints Resolution Service can offer to dentists is to listen closely to their patients. Even if the dentist believes they are not in the wrong, they should address their patient's views. There will always be a certain amount of complaints when you are providing a service, and sometimes these can be resolved, or even avoided, simply by communicating.
Advice to patients
If you have a complaint against your dentist, you should always raise it with the dentist first. Explain the problem calmly and clearly, and try to resolve the issue. If necessary, seek a second opinion from another dentist. If the complaint is not resolved satisfactorily, contact the Dental Complaints Resolution Service. In order to deal with the case, the Service must receive your complaint in writing, and once that is received, work will commence on resolving the complaint as soon as possible.
Types of complaint
The majority of complaints that were made to the DCRS in 2013 concerned fees. However, a large number of complaints were made about the standard of work. These included: fillings, crowns, bridges, root canal, etc. Nearly one-third of complaints that arose involved a failure by the dentist to communicate clearly and correctly with the patient.
The Service is happy to mediate a resolution of these issues. However, the Service cannot deal with issues arising from treatment that takes place outside of the Republic of Ireland, nor can it handle complaints made about treatment available under the public dental care schemes, i.e., the Medical Card Scheme, and the PRSI Scheme.
Summary of Dental Complaints to December 31, 2013
The DCRS received more than 262 calls in 2013, and 1,230 emails/letters. Of these, 130 complaints were accepted.
Twenty-eight cases have been resolved.
Some of the results involved: -refund of the fees paid; -apology; and, -additional work to be carried out at no extra cost.
One hundred and two cases are currently awaiting resolution.
-Of the complaints, 60 of the dentists involved were confirmed IDA members, while 15 were confirmed non-members.
-Six complaints were not accepted; two were anonymous, and four lay outside the remit of the Service.
-One complaint was made regarding a dentist who is now deceased. The dentist's wife has engaged a solicitor to represent her interests.
-Three dentists contacted the Service seeking advice. Of these, one dentist has had their issue resolved.
The main issues of complaint were as follows:
-standard of work: fillings, crowns, bridges, dentures, etc.; -failure to explain treatment costs; -problems with continuing care; -failure to address pain; and, -post-operative pain.
What the DCRS has learned from complaints received in 2013
1.Communication is hugely important. If the patient and dentist would communicate clearly with each other about an issue, it would reduce the amount of complaints made by about 40%. In a lot of cases that the Service deals with, a patient comes back to the dentist with a problem, and the dentist does not listen to their complaint.
2.If a patient complains, the dentist should deal with it immediately. The issue is not going to go away, so there is no point ignoring it.
3.The patient needs to be kept informed of the treatment plan every step of the way. If a dentist discovers that other work needs to be done, they should always tell the patient before proceeding with that work. The patient needs to be kept informed of what costs that treatment will incur.
4.From a patient's point of view, whatever chance there is of getting poor dental work corrected here in Ireland, there is little to no chance of resolving the problem if the work was carried out overseas. There are different laws and regulations in other countries, which make it far more difficult to obtain a refund or retreatment for poor workmanship.
5.It is the belief of the Service that there needs to be tighter regulations regarding businesses who fit out premises as dental practices and then let them out to dentists. These companies should be in some way liable if the practicing dentist carries out work of a sub-standard nature and then vacates the premises.
“If a patient complains, the dentist should deal with it immediately.”
requested that she be refunded the full amount of €500 that she had paid for the crown.
Michael Kilcoyne wrote to the dentist, enclosing a copy of the complaint. Although he was very reluctant at first, taking the line that there was no problem with the metal-based crown, the dentist eventually agreed to pay the patient a €500 refund.
Mr Kilcoyne believes that this case shows that you need to be mindful of the patient’s stated preferences, and discuss and receive their consent for the most appropriate treatment plan. The dentist should not just decide on a course of action, without any agreement from a patient. In most cases, people will take the dentist's advice if they are told in advance and everything is explained to them clearly.
Mr Kilcoyne also believes that the presence of rudeness in this particular case was a recipe for disaster. This case could have been avoided if there had been clearer communication between the dentist and his patient.
Case 3 – failure to keep patient informed
This case, from the east of the country, concerned a female patient who attended a clinic with a problem with her front tooth. Following an x-ray, she was told that the tooth was beyond saving, due to internal resorption from a polyp on the gum. Both dentists in the clinic agreed that the tooth could not be saved and would have to be extracted. However, they suggested that the patient go for a second opinion, and recommended a dentist who specialises in root canal treatment. The patient's x-rays were then forwarded to this clinic.
When the receptionist at the specialist clinic rang the patient to make an appointment, the woman requested that that the dentist look at her x-rays first, as she did not want to waste money on an appointment unless she was sure the tooth could be saved. The dentist then phoned her back with the message that she believed she could save the tooth. The patient then decided to go ahead with the treatment, which consisted of two separate sessions. During the first session, the nerve was removed, and during the second session, the patient had root canal treatment. Each visit cost €250, making the total cost of treatment €500.
After the final visit, the patient was told that the tooth could not be saved after all, and was likely to break. The tooth lasted less than three months before it broke.
“...the presence of rudeness in this case was a recipe for disaster.”
The woman had the tooth extracted and a temporary denture was put in place.
The patient contacted the Dental Complaints Resolution Service after two of her phone calls to the specialist dentist went unreturned. Her preferred method of redress was a full refund for the cost of treatment. Michael Kilcoyne informed the dentist in question of the complaint, and after some correspondence back and forth, the dentist agreed to give the patient a full refund to the sum of €500.
Michael believes that this situation could have been resolved if the dentist had kept the patient informed every step of the way, and stopped the work when she realised that the tooth could not be saved. Instead, the patient was put through unnecessary, painful dental work.
Case 4 – an unsatisfied customer
This case concerned a female patient in the south-east area. The patient attended a particular dental clinic because a dentist working there had been recommended to her by several friends. The patient made an appointment, as she was aware that she would need a filling, as part of her tooth was broken. When she arrived at the clinic, the patient mentioned to the dentist that she had been highly recommended. The dentist was puzzled at first, and then said that it must have been the dentist that she was standing in for that had been recommended. The patient experienced huge pain and discomfort during the filling procedure, and while the dentist was drilling the tooth, part of it broke. After the procedure was completed, the patient reported feeling very weak and uncomfortable for some time. She was given a glass of water with sugar in it to help her feel better. The patient informed the dentist immediately that the tooth she had filled seemed too high, and when she tried to bite, it did not feel right. The dentist said that it looked fine and it would hopefully last, but if not, then she would need to get a crown. Following on from the appointment, the patient was very careful with the filling and ate mainly on the other side of her mouth. However, the filling only lasted three weeks before it fell out. The woman immediately contacted the clinic where she had had the filling done. The clinic agreed to see her five days later, however the patient felt that she needed more urgent treatment, and decided to visit her regular dentist instead.
Her regular dentist immediately commented on how badly the tooth was filled and informed her that the filling had not been finished off properly. This dentist was able to save her tooth and filled it very well.
The patient went immediately to the Dental Complaints Resolution Service, where Michael Kilcoyne informed her that, when making a complaint, she needed to first raise the issue with the nominated person in the dental practice first. The woman then wrote to the clinic, outlining her complaint and requested that
she be reimbursed the €80 for the filling.
The patient received a full refund for the sum of €80. Michael believes that this case should not have come to him, because the amount was quite small, and the patient had not yet contacted the dental clinic about her complaint before coming to the Dental Complaints Resolution Service.
“This dentist was able to save her tooth and filled it very well.”
