Important Questions to Ask to Determine if there was a Deviation in the Standard of Dental Care in Georgia when Treating a Patient Requesting Dental Implants ~ part two

dental lab blog june 22This is a follow up my last blog post titled, “Important Questions to Ask to Determine if there was a Deviation in the Standard of Dental Care in Georgia when Treating a Patient Requesting Dental Implants ~ part one.”  The following are more of some of the important questions that should be asked to determine if the Standard of Care was followed when Treating Patient Requesting Dental Implants:

6.) Was an an Informed Consent Obtained?

Why is this important?  The patient must consent to the procedure, and the clinician must obtain a signed informed consent from the patient prior to the procedure.

7.) Was a Pre-Operative Evaluation Performed?

Why is this important? A careful evaluation and understanding of the bone anatomy and architecture, including the quantity and quality of available bone, are mandatory before implant placement to avoid and/or reduce complications by proper patient selection and evaluation.

8.) What Complications Did the Patient Experience?

Why is this important?  The clinician must identify the following post-operative complications and mange them appropriately: 1.) Implant mobility; 2.) Pain; 3.) Numbness; 4.) Trauma; 5.) Infection; and 6.) Bone Fractures.

9.) Was the Patient Provided with Medications Post-Operatively?

Why is this important?  Antibiotics must be provided post-operatively and the following are some of the recommended antibiotics to help control post-operative infection: 1.) Cephalexin; 2.) Amoxicillin; and 3.) Clindamycin

10.) Was the Patient Provided with Post Operative Instructions?

Why is this important?  To ensure the implants durability and success, the clinician must provide adequate instructions to the patient regarding proper maintenance of the mouth and implant.

11.) Were any Delayed Post-Operative Complications Identified?

Why is this important?  The following are possible delayed post-operative complications associated with implant placement that should be addressed including, but not limited to: 1.) Unstable Implant; 2.) Implant Malposition; 3.) Excessive Vertical and Horizontal Bone Loss; 4.) Unanticipated Bony Deficiency; 5.) Dehiscence; 6.) Fracture of bone during the osteotomy; or 7.) Hyperplastic soft tissue response and graft failure.

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Important Questions to Ask to Determine if there was a Deviation in the Standard of Dental Care in Georgia when Treating a Patient Requesting Dental Implants ~ part one

dental june 22 blogIn my last three blog posts part one, part two, and part three, I discussed the recent ruling by the Georgia Supreme Court involving when the Statute of Limitations should be tolled in a particular case.  The case in point was a case that involved a woman who was receiving dental care for implants and later for a prosthetic.

None of the courts (the Trial Court, the Appellate Court, nor the Supreme Court) addressed the issue of whether or not there was Dental Malpractice committed in the placement of the implants since the trial court granted summary judgement to the Defendant and the Plaintiff’s appeals were addressing the issue of the improper granting of summary judgement, and not whether or not Dental Malpractice had been committed.

Since the Georgia Supreme Court remanded the case back to the trial court reversing the trial court’s ruling of summary judgement, at some point in the future the trial court will hear this case, unless the case  settles out of court, and the issue will be at that time will be, in large part, whether or not there was Dental Malpractice when the Plaintiff was treated for dental implants.

The following are some of the important questions that should be asked and answered to determine whether or not dental malpractice has occurred when a patient requests dental implants, and why these questions are important:

1.) Was the Patient’s Need for a Dental Implant Documented?

Why is this important?  Presence of one or more of the following indicate that a dental implant may be necessary: (1) a single missing tooth with the potential for preservation of the adjacent teeth; (2) a dental gap requiring more than one implant with the potential for preservation of tooth substance with and a clear disadvantage for conventional therapy; (3) a free-end gap with posterior teeth in the opposing jaw that contraindicate removing partial dentures; (4) reduced residual dentition with only one to three remaining teeth that indicated a need for implants to provide support for a fixed partial denture; and (5) an edentulous upper or lower jaw.

2.) Was a Thorough Medical History Obtained?

Why is this important?  Past Medical History (PMH) includes all past and current illness, hospitalizations, surgery, trauma, allergies, and medications. The date, location, and physician/surgeon for each hospitalization and/or surgery should also be included if available. Of particular importance are medications for oral manifestations including, but not limited to, immuno-suppressives, antibiotics, cardiac medications, and psychotropics.

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The Georgia Supreme Court rules that the Statute of Limitations was Tolled when a Dental patient Seeking the advice of a Second Dentist who was a part of the original treatment, and/or performed part of the original treatment, may have begun to realize that the First Dentist(s) committed Dental Malpractice ~ part three

dentist part threeThis is the further analysis of the case and the Georgia Court of Appeals and the Georgia Supreme Court’s final decisions that were discussed in my prior blog post titled, “The Georgia Supreme Court rules that the Statute of Limitations was Tolled when a Dental patient Seeking the advice of a Second Dentist who was a part of the original treatment, and/or performed part of the original treatment, may have begun to realize that the First Dentist(s) committed Dental Malpractice ~ part two.”

The Defendant’s then appealed the decision to the Supreme Court of Georgia which granted appellants’ petition for a writ of certiorari, directing the parties to brief the following: Did the Court of Appeals err when it held that the statutory period [of limitation] was tolled even after the plaintiff consulted with a second dentist? See Witherspoon v. Aranas, 254 Ga. App. 609, 614 (2) (b) (562 SE2d 853) (2002), overruled on other grounds by Chandler v. Opensided MRI of Atlanta, LLC, 299 Ga. App. 145, 157 (2) (b) (682 SE2d 165) (2009).

The Supreme Court stated that the tolling statute already provides that, where the defendant has engaged in fraud by which the plaintiff has been debarred or deterred from bringing an action, the period of limitation runs only from the plaintiff’s discovery of such fraud. OCGA § 9-3-96.

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The Georgia Supreme Court rules that the Statute of Limitations was Tolled when a Dental patient Seeking the advice of a Second Dentist who was a part of the original treatment, and/or performed part of the original treatment, may have begun to realize that the First Dentist(s) committed Dental Malpractice ~ part two

dental office part twoThis is the further analysis of the case and the Georgia Court of Appeals and the Georgia Supreme Court’s final decisions that were discussed in my prior blog post titled, “The Georgia Supreme Court rules that the Statute of Limitations was Tolled when a Dental patient Seeking the advice of a Second Dentist who was a part of the original treatment, and/or performed part of the original treatment, may have begun to realize that the First Dentist(s) committed Dental Malpractice ~ part one.”

On February 13, 2008, Dr. Arnold, after examination of the Plaintiff, treated her by remaking the prostheses and also told the Plaintiff about the the improper placement and angulations of the implants that Dr. Gallant had concealed from the Plaintiff this entire time. As a result, the Plaintiff brought Dental Malpractice claim again Dr. Gallant on January 26, 2010.

The Defendant filed a motion for summary judgement claiming that the suit was time-barred. The Plaintiff, on the other hand, argued that the statute of limitations was tolled by the Defendant’s fraudulent concealment of his opinion about the improper placement of the implants. The Plaintiff argued that she did not discover the issues with the implants until she saw Dr. Arnold on February 13, 2008, which was less than two (2) years before she filed the complaint.

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The Georgia Supreme Court rules that the Statute of Limitations was Tolled when a Dental patient Seeking the advice of a Second Dentist who was a part of the original treatment, and/or performed part of the original treatment, may have begun to realize that the First Dentist(s) committed Dental Malpractice ~ part one

dentist part oneOn June 16, 2014, the Georgia Supreme Court upheld the Georgia Court of Appeals decision to reverse the trial court’s granting of summary judgement in a case whereby the trail court held that the statutory period of limitation was not tolled after the Plaintiff consulted a second dentist in a potential Dental Malpractice Case. The case is S13G1733. GALLANT, et al. v. MacDOWELL .

The Plaintiff, Ursula MacDowell, was to undergo services necessary for a full mouth prosthodontic reconstruction that would involve a dentist, Dr. Winston, to extract teeth and place implants into the Plaintiff’s jaw that another dentist, Dr. Gallant, would use to install the dental prostheses.

In August, 2006, after the first of many implant procedures, Dr. Gallant determined that the implants were not properly placed which would make the prostheses installation difficult. Dr. Gallant consulted with another dentist, Dr. Hal Arnold, who confirmed Dr. Gallant’s observations.

Dr. Gallant, instead of informing the Plaintiff of his opinion or discussing options of treatment with her, instead decided to use his own judgement and work around the obstacles created by the improperly placed implants and moved forward with the installation of the prostheses.

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75 or more Center for Disease Control (CDC) Workers in Georgia were Exposed to Anthrax: CDC states that their own protocols were not followed in the incident

toxic for blog june 20 2014Approximately 75 or more workers at the Centers for Disease Control (CDC) and Prevention may have been exposed to anthrax bacteria due to a safety problem in a lab, WSB TV reports citing an Associated Press story. This happened as a result of Anthrax bacteria that was not properly inactivated and moved to a lab with lesser biosafety measures that were not designed to handle such samples, the Centers for Disease Control and Preventions says.

The workers assumed the samples were inactive and, therefore, didn’t wear adequate safety gear while handling them causing the workers to be exposed to the potentially dangerous bacteria. When anthrax spores get inside the body, they can be “activated,” according to the CDC website and when this activation occurs the bacteria may multiply, spread into other parts of the body, produce poisons, and eventually cause severe illness.

The problem was discovered last Friday, when live anthrax bacteria were found on some materials being gathered for disposal.  Agency officials said the staff members are being monitored or given antibiotics as a precaution against exposure to the disease-causing bacteria. Fortunately, there is no risk of exposure for other CDC staff, family members or the general public, The Atlanta Journal-Constitution says. Furthermore, Centers for Disease Control and Prevention officials plan to review safety protocol with all employees since the agency’s own protocols were not followed in this situation.

This is a classic case of a Worker’s Compensation Claim. Worker’s Compensation Claims exist when an employee is injured on the job regardless of fault.  In this case, it was clearly the fault of the employer and the employer has acknowledged that it did not even follow its own procedures leading to this potentially tragic incident.

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Child Dies in Georgia After Being Strapped in a Car Seat All Day and Left in a Hot Car: Parent forgets to drop the child off at Child Care on the Way to Work

chid dies in hot car blog june 19One of the most sad and worst case scenarios happened on Wednesday in Georgia when a parent driving to work forgot to drop off his 22 month old son at daycare leaving his son strapped in the car seat in an SUV all day on a day where temperatures were in the low 90’s, and the child died as a result of the father’s actions.

The father realized the terrible fate only after he left work and was driving home.  Once he discovered the fatal error, he pulled into a parking lot where paramedics were not successful in reviving the child.  WSB TV reported that late that afternoon the child’s distraught father was taken away in handcuffs by authorities.  As of this date, the Father has been charged with the murder of his son in this incident.

Unfortunately, this is not the first time that this has happened.  This happened again Monday only this time in Florida, when a 9-month-old baby died after his father apparently forgot him in his pickup truck for hours with outside temperatures hovering around 90 degrees.  Last year, two babies died on the same day under similar circumstances in Maryland and Virginia.  Furthermore, according to KidsandCars.org babies dying in hot cars happens about 38 times per year across the United States.

The report comes in similar to this: A parent is going to work with the child in the backseat, the parent forgets about the child, the child is left in the hot car, and the outcome is tragic, and predictable.  Such deaths continue to occur with disturbing frequency and are happening to parents from all walks of life.

In 2009, Washington Post columnist Gene Weingarten wrote a Pulitzer Prize-winning story attempting to answer how parents can forget their own children in cars. “What kind of person forgets a baby?,” Weingarten asked. “The wealthy do, it turns out. And the poor, and the middle class. Parents of all ages and ethnicities do it. Mothers are just as likely to do it as fathers. It happens to the chronically absent-minded and to the fanatically organized, to the college-educated and to the marginally literate. In the last 10 years, it has happened to a dentist. A postal clerk. A social worker. A police officer. … A Protestant clergyman. … An assistant principal. It happened to a mental health counselor, a college professor and a pizza chef. It happened to a pediatrician. It happened to a rocket scientist.”

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America’s Streets: Death Traps based on Poor Road Designs; among other things.

cityscape street blog june 17 2014We are all a part of America’s streets whether as a driver, pedestrian, bicyclist, or just living in our homes and walking our neighborhoods, and having to go out and check our mail. But, are America’s Streets becoming Death Traps? Statistics show that driver error and high speed limits can increase the probability of pedestrian deaths, and now there is a new culprit: Poor Road Design .

In Georgia, the question has been asked: Which streets do you feel are most unsafe in your town, and how do you think your local government can help reduce pedestrian deaths? One solution is that we need more developments like the Atlanta Belt Line in Atlanta, Georgia where pedestrians and bicyclists can safely participate in the outdoors without the dangers of the street.

From 2003 to 2012, more than 47,000 people, many of them children, were hit and killed while walking outdoors, and an estimated 676,000 were injured. These are just some of the scary statistics outlined in a new report called “Dangerous by Design,” conducted by Smart Growth America’s National Complete Streets Coalition, a group that advocates for better neighborhood planning.

We also discuss these disturbing statistics on our website under Pedestrian and Bicycle Injuries and how we can all use better safety practices as drivers and pedestrians to make our roads safer for Everyone.

Alissa Walker, of Gizmodo, writes in a recent article that our streets, “are enabling our vehicles to become death machines.”  “The problem in this country is that our streets have historically been designed for speed, to help cars go as fast as possible,” Walker says. Gizmodo further lists the least crossable streets in the United States.  Is yours one of them?  You may read more information by visiting Gizmodo for the full article “How Bad Street Design Kills Pedestrians.”

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Attention: Attorneys would be wise to Keep Track of their Time in accordance with the Offer of Settlement Statute and a Ruling by the Georgia Supreme Court

legal symbol june 17 blogLast Monday, the Georgia Supreme Court  ruled that if a Party in a lawsuit obtains a verdict in a case where the attorney’s fee is based on a contingency fee, the Court is not bound due to Georgia’s Offer of Settlement Statute to award the Attorney’s fees based solely on the contingency.

Instead, the Supreme Court ruled that the award can be based on how much the attorney actually did work on the case from the date the settlement offer was rejected through the entry of judgment under what is most commonly know as the Offer of Settlement Statute Official Code of Georgia (O.C.G.A.) Section 9-11-68, and this must be a reasonable amount of attorney’s fees.

The Offer of Settlement Statute was adopted by the Legislature in 2005 as part of tort reform with the intent to, in part, encourage negotiations and settlements and avoid unnecessary litigation. The Statue attempted to fulfill it’s intention by setting forth that if a party rejects a settlement but does not fair much better in court, then that party may have to pay the other parties attorney’s fees from the date of the rejection of the offer through the entry of the judgement. Recently, a case came before the Georgia Supreme Court which asked the court to address, in part, the Offer of Settlement Statute.

The case is Couch v. Georgia Department of Corrections.  In this case, an inmate was injured and filed a lawsuit. In 2007, the Plaintiff made an offer to settle the case for $ 24,000.00. The Defendant, however, failed to respond to the offer which, under O.C.G.A. Section 9-11-68 (c), resulted in a rejection of the offer. The Plaintiff, after over a year, had a trial, and then an appeal, in which he was ultimately awarded $ 123,855.65 for his injuries including post judgement interest and cost courts plus $ 49,542 in attorneys fees which was 40% based on his contingency fee arrangement.

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Emergency Room Standard of Care; Failure to Diagnose and Delay in the Treatment of a Head Injury ~ part three

registration to hospital for june 8 blogThis my final blog post on this topic and continued from my prior blog post titled, “Emergency Room Standard of Care; Failure to Diagnose and Delay in the Treatment of a Head Injury ~ part two,”  with some of the final questions that should be asked and answered in a Medical Malpractice Case in evaluating whether or not the Standard of Care was breached in the Failure to Diagnose and Delay in the Treatment of a Head Injury in the ER:

14.) Q: Did the ER Physician Refer the Patient to a Neurosurgeon?

Why is this important?  All patients visiting the ER a second time with a suspected head injury should be referred to a neurosurgeon as soon as possible and detained in the healthcare facility. This is similar to what I described in the case of the young woman who was paralyzed.

In that case it was the Plaintiff’s contention that the ER Standard of Care had been breached since the woman, who had presented in the ER several times with chest pain, was sent home without determining exactly the nature of her chest pain when she should have been admitted to the hospital until there was a definite diagnosis for her chest pain.  Instead, she was sent home and when she presented to the ER again and was finally admitted it was too late and she became permanently paralyzed from the waist down.

15.) Q: Was the Patient Admitted and Appropriate Treatment Initiated?

Why is this important? As described herein above, all patients visiting the ER the second time with suspected head injury should be referred to a neurologist as soon as possible. Furthermore, all patients must undergo CT scanning (if not done before) and be admitted for observation, even with an apparently normal CT scan. Neurologic checks must be performed frequently during their in-house observation. If the patient’s condition does not improve, then a repeat CT scan must be performed within 12 to 24 hours.

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