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History of Negligence

Hi Kara! I had a patient who has been coming in to the office I work at for 10 years. The patient has an SRP the first visit and has had subsequent perio maint cleanings every three months for 10 years. I had never seen this patient beforeand I wanted to do my own full assessments.

The last probing depths were taken 3 months prior to the visit in question. She had 2mm-3mm generalized increases. She had BOP, radiographic calculus, radiographic bone loss, clickable sub calculus when exploring, and new class 2 mobility on her lower anteriors.

I spoke with the dentist to discuss the fact that she needs referred out immediately. I emphasized that her disease is active and appears to be rapidly worsening since we last saw her.

He told me to do the perio maintenance and bring her back in 4 weeks to do an SRP.

I told him I would be more comfortable having her come back tomorrow and do an SRP and refer her to the periodontist. The dentist was adamant on forcing me to just do the perio maint.

I ended up refusing to treat her due to not wanting to commit malpractice.

The hygienist who has been seeing her for years did her perio maint in 15 minutes and sent her on her way.

Please let me know if there is another way to handle this. Thank you!



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In my opinion, you did the right thing, both for the patient and the protection of your license. I cannot speak to the treatment given by the other hygienist. I will say that if a patient needs SRP, a prophy, perio maint, or D4346 should not be done beforehand. Doing it beforehand implies the patient is “healthy” or has “stable periodontium,” which, in this case, is not true. Billing as such could be seen as insurance fraud.
 
It seems that you have a bigger ethical issue than just this one patient, though. It sounds like you and the other clinicians in the office, including the doctor, are not on the same page as far as best practices, patient protocols, and standards of care. I hope I’m wrong, and this was just a one-time situation!

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