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Hospital dentistry litigation in England: clinical negligence claims against the NHS 2015-2020

British Dental Journal (2022)Cite this article

Abstract

Introduction Litigation against the NHS in England is rising. The aim of this study was to determine the incidence and characteristics of hospital dentistry clinical negligence claims in England.

Methods A retrospective review was undertaken of all clinical negligence claims in England held by NHS Resolution relating to hospital dentistry between April 2015 and April 2020. Analysis was performed using the information for cause, patient injury and claim cost.

Results A total of 492 claims were identified, with an estimated potential cost of £14 million. The most frequent causes for clinical negligence claims included failure/delay in treatment (n = 175; £3.9 million), inappropriate treatment (n = 56; £1.8 million) and failure to warn/obtain informed consent (n = 37; £1.5 million). Wrong site surgery was cited in 33 claims. The most frequent injury reported was dental damage (n = 197; £4.3 million), unnecessary pain (n = 125; £2.3 million) and nerve damage (n = 52; £2.4 million).

Conclusion Clinical negligence claims in hospital dentistry are related to several different aspects of patient management and are not limited to treatment complications alone. Human ergonomics and patient perception of dentistry cannot be controlled but a focus on patient safety measures and effective communication can serve as tools to combat these factors.

Key points

  • NHS Resolution provides expertise to the NHS on resolving claims and works with the Getting It Right First Time programme to share learning for improvement of patient care.

  • The most cited injury in litigation claims towards hospital dentistry was dental damage, unnecessary pain and nerve injury.

  • 'Failure/delay in treatment', 'inappropriate treatment' and 'failure to warn/gain informed consent' were the most common cause of litigation claims in hospital dentistry.

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References

  1. UK Parliament. Managing the costs of clinical negligence in hospital trusts. 2017. Available at https://publications.parliament.uk/pa/cm201719/cmselect/cmpubacc/397/397.pdf (accessed January 2022).

  2. Alanazi A S, Alqurashi M A, Al-Hanawi M K. Causes and Outcomes of Dental Malpractice Litigation in the Riyadh Region of the Kingdom of Saudi Arabia. Saudi J Health Syst Res 2021; 1: 108-114.

  3. Hamasaki T, Hagihara A. Dentists' Legal Liability and Duty of Explanation in Dental Malpractice Litigation in Japan. Int Dent J 2021; 71: 300-308.

  4. Nassar A A, Demyati A K. Informed Consent in the Health Care System: An Overview from a Dental Perspective in Saudi Arabia. Saudi J Health Syst Res 2021; 1: 11-15.

  5. NHS Resolution. Annual report and accounts 2018/19. 2019. Available at https://resolution.nhs.uk/wp-content/uploads/2021/07/Annual-report-and-accounts-2020-2021-WEB-1.pdf (accessed February 2022).

  6. McWilliams A B, Douglas S L, Redmond A C et al. Litigation after hip and knee replacement in the National Health Service. Bone Joint J 2013; DOI: 10.1302/0301-620X.95B1.30908.

  7. Talbot C L, Ring J, Holt E M. Litigation relating to conditions affecting the shoulder and elbow: an analysis of claims against the National Health Service. Bone Joint J 2014; DOI: 10.1302/0301-620X.96B5.33257.

  8. Machin J T, Forward D P, Briggs T W R. Clinical negligence: is orthopaedics learning from it? Bone Joint 360 2020;9: 6-10.

  9. O'Connell R L, Patani N, Machin J T, Briggs T W R, Irvine T, MacNeill F A. Litigation in breast surgery: unique insights from the English National Health Service experience. BJS Open 2021; DOI: 10.1093/bjsopen/zraa068.

  10. Kirthi V, Neffendorf J E, Navaratnam A V et al. Litigation in Ophthalmology against the National Health Service in England. Ophthalmology 2021; 128: 1487-1489.

  11. Navaratnam A V, Hariri A, Ho C, Machin J T, Briggs T W R, Marshall A. Otorhinolaryngology litigation in England: 727 clinical negligence cases against the National Health Service. Clin Otolaryngol 2021; 46: 9-15.

  12. Machin J T, Hardman J, Harrison W, Briggs T W R, Hutton M. Can spinal surgery in England be saved from litigation: a review of 978 clinical negligence claims against the NHS. Eur Spine J 2018; 27: 2693-2699.

  13. Getting It Right First Time. Litigation. 2022. Available at https://www.gettingitrightfirsttime.co.uk/cross-cutting-stream/litigation/ (accessed February 2022).

  14. Getting It Right First Time. Hospital dentistry. 2022. Available at https://www.gettingitrightfirsttime.co.uk/medical-specialties/hospital-dentistry/ (accessed February 2022).

  15. General Dental Council. Principle Three: Obtain valid consent. 2013. Available at https://standards.gdc-uk.org/pages/principle3/principle3.aspx (accessed February 2022).

  16. Beckett H, Radford J. 'Montgomery consent': decision of the UK Supreme Court. Montgomery v Lanarkshire Health Board [20151. [2015] UKSC 11; [2015] WLR 768. Pract Midwife 2016; 19: 27-29.

  17. Kashbour W A, Rousseau N S, Thomason J M, Ellis J S. Provision of information on dental implant treatment: Patients' thoughts and experiences. Clin Oral Implants Res 2018; 29: 309-319.

  18. Leigh B. Progress towards a decision record is lamentable. Clin Risk 2016; 22: 16-20.

  19. Srinivasan J, Jones K, Laugharne D. Assessment of patient satisfaction using a digital consent package for wisdom tooth procedures: a pilot study at Royal Derby Hospital. Br J Oral Maxillofac Surg 2020; 58: 217-218.

  20. NHS England. Commissioning Standards. Available at https://www.england.nhs.uk/primary-care/dentistry/dental-commissioning/dental-specialities/ (accessed January 2022).

  21. Morris A J, Burke F J. Primary and secondary dental care: the nature of the interface. Br Dent J 2001; 191: 660-664.

  22. British Dental Journal. Human factors' board releases position paper. Br Dent J 2020; 229: 11.

  23. National Advisory Board for Human Factors in Dentistry. Available at https://nabhf.home.blog/ (accessed January 2022).

  24. NHS England. Revised Never Events policy and framework. Available at https://www.england.nhs.uk/patient-safety/revised-never-events-policy-and-framework/ (accessed January 2022).

  25. Bailey E, Tickle M, Campbell S, O'Malley L. Systematic review of patient safety interventions in dentistry. BMC Oral Health 2015; 15: 152.

  26. Jacob O, Gough E, Thomas H. Preventing Wrong Tooth Extraction. Acta Stomatol Croat 2021; 55: 316-324.

  27. Chang H-H, Lee J-J, Cheng S-J et al. Effectiveness of an educational programme in reducing the incidence of wrong-site tooth extraction. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2004; 98: 288-294.

  28. Lin C-S, Wu S-Y, Yi C-A. Association between Anxiety and Pain in Dental Treatment: A Systematic Review and Meta-analysis. J Dent Res 2017; 96: 153-162.

  29. Coulthard P, Bailey, E, Bridgman C. Introducing clinical triage for oral surgery referral management in England. Oral Surg 2014; 7: 143-151.

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Authors and Affiliations

  1. Department of Oral Surgery, Royal National ENT and Eastman Dental Hospitals, University College London Hospitals, 47–49 Huntley Street, London, WC1E 6DG, UK

    Jessica R. Blanchard & Sonita Koshal

  2. Royal National ENT and Eastman Dental Hospitals, UCLH, 47–49 Huntley Street, London, WC1E 6DG, UK; Getting it Right First Time Programme, NHS England and Improvement, Wellington House, 135–155 Waterloo Road, London, SE1 8UG, UK

    Annakan Navaratnam

  3. NHS England and Improvement, Wellington House, 135–155 Waterloo Road, London, SE1 8UG, UK

    John T. Machin & Tim W. R. Briggs

  4. Getting it Right First Time Programme, NHS England and Improvement, Wellington House, 135–155 Waterloo Road, London, SE1 8UG, UK

    Elizabeth Jones

Authors
  1. Jessica R. Blanchard
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Contributions

Jessica R. Blanchard: conception and design, acquisition of data, analysis and interpretation of data, drafting the manuscript and revising the manuscript. Sonita Koshal: conception and design, analysis and interpretation of data, drafting the manuscript and revising the manuscript. Annakan Navaratnam: conception and design, acquisition of data and drafting the manuscript. John T. Machin: drafting the manuscript and revising the manuscript. Tim W. R. Briggs: acquisition of data and revising the manuscript. Elizabeth Jones: conception and design and revising the manuscript.

Corresponding author

Correspondence to Jessica R. Blanchard.

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The authors declare no conflicts of interest.

Ethical approval was not required for this study as it is an anonymised service evaluation.

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Blanchard, J., Koshal, S., Navaratnam, A. et al. Hospital dentistry litigation in England: clinical negligence claims against the NHS 2015-2020. Br Dent J (2022). https://doi.org/10.1038/s41415-022-4965-4

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