By Dr Annalene Weston, Dentolegal Consultant, Dental Protection
This case study was published in RiskWise - 2020 - Issue 2 under the title 'The road to hell is paved with good intentions'.
The restrictions placed on the practice of dentistry as a consequence of COVID-19 meant that we were unable to provide patients with their usual care. The higher the level of restriction, the more limited the treatments we could provide were, and there can be no doubt that this created many issues for patients and practitioners alike. There can also be no doubt that despite the difficulties caused, these restrictions did address the key objectives of:
• Proportionate, pre-planned response to the possible escalation of COVID-19 based on the evolving community context
• Staged restriction of dental services to reduce transmission risks for COVID-19
• Avoidance of likely burden on medical primary care and emergency services should access to urgent dental care cease.
Many practices offered some services during level 3 restrictions to assist their patient base with urgent care. Dr T worked in one of these practices and attended to a new patient who presented with pain from periodontal disease and a broken tooth. A discussion ensued about the restrictions, and what could and could not be done. Consequently, a temporary filling using the ART technique was placed. The patient pleaded for more to be done, and ultimately Dr T picked up the ultrasonic scaler to attend to the periodontal concerns, truly believing this to be in the patient’s best interests.
Prior to commencing the treatment the patient advised they only had limited funds, and Dr T agreed to carry out all the treatment for those funds only, discounting the fee by 50%, as an act of kindness.
After the patient left, Dr T felt uneasy about breaching the restrictions, but comforted himself that he had helped a patient at their time of need; after all, he had provided a huge discount so had not profited from the treatment. Unbeknown to Dr T, the patient was stood at reception, refusing to pay on the grounds that Dr T was unethical, as he had worked in breach of the restrictions. Somewhat stunned by these allegations, the receptionist waived the debt; the patient left and promptly reported the practitioner to AHPRA for breaching the guidance.
Dr T received a notice from AHPRA regarding this breach, and also a desktop infection control audit. Had Dr T failed to demonstrate adequate knowledge and performance of infection control procedures at the practice, he would have faced immediate suspension.
Dental Protection talked through the matter with Dr T and assisted him both with the desktop review and also his communications with AHPRA. On our advice, Dr T immediately acknowledged to AHPRA that he had shown a significant lapse of judgement in breaching the guidance, and immediately undertook some CPD in ethics. The desktop infection control audit revealed some minor discrepancies of which AHPRA was advised, with immediate steps taken to remedy them. The practice undertook some infection control CPD collectively and Dr T waited for the judgement to come, hoping that this was not the end of his career.
Pleasingly, AHPRA took a very proportionate approach to this matter. Dr T was cautioned for his lapse in judgement, and acknowledgment was made of the effort that he and his practice had put in to ensuring that the requisite standards were met.