Dr Amanda with Street smile Solutions straight smile solutions.com and I just heard a great
podcast I don't know if any of you guys listen to The protrusive Dental podcast it's one of my
favorites Jazz gulati he's a good friend of mine um he's in the UK and he has a great podcast and
he just did one where he interviewed somebody who had been sued and how they went through it
and granted that was in the UK which is a little bit different than the us but
um at the very least I thought you know what I had a similar experience it's been over 10 years so
statute of limitations I feel pretty comfortable talking about it now it was highly traumatic
at the time even though I really had nothing to be upset about now that I think about it um and
I want to tell you guys kind of what happened and how I got through it and maybe perhaps why
I am for those of you who have worked with me one-on-one why sometimes I hammer at home that
if you're not gonna do perfect you need to make sure you outline all the other options that the
patient was given in writing and explain the risk benefits and Alternatives of all those sub options
and it's a tedious process first of all you need to understand it and only an orthodontist is
going to really understand this those of you who are general dentist pediatric dentists even now
there's a lot of periodontist and prosthodontists doing Ortho you don't understand it and which is
why those of you who are just winging it and taking these engine courses these gallers
these molasses these you know different little aligner course here and there and thinking you are
protected you are 100 not protected as a matter of fact I would call your liability insurance before
you even get started with ortho just to see what additional documents they might have for you now
when you work with me I'm not an attorney I'm not doing that I'm just there for clinical questions
so I can explain to you what the options are and maybe guide you to what might be the
better options what might be the risk benefits and Alternatives of each option but it's your job to
present that to the patient your job to document that you presented to the patient that's not my
job okay so let me tell you about my particular situation and I'm going to try to explain it
as well as I could given that it was well I mean the actual event I mean the the litigation
and the issue with the Dental Board was about 10 years ago the actual patient was seeing goodness
had to be close to 12 or 13 years ago a long long time ago so um I was working at a DSO as
an orthodontist in a DSO in California I'm not going to mention the office not going
to mention the city I'm not going to mention the DSL because I don't I don't even want to go there
um and yeah this DSO I mean they had General dentists they had pediatric dentists they had
oral surgeons on staff I don't think they had any other Specialists that I know of an orthodontist
you know so an ortho would come into the office maybe um you know one day a week two days a week
um split the office you know share the chairs whatever okay so regular funnel
of patients to screen for Ortho at that time in that office granted this I probably saw
this patient trying to think in that office that I was working at I started working there
before I had my second kid so it had to been 2007 2008 2009 and I still worked there I worked there
for about five years so sometime between I saw that patient somewhere between 2007
and maybe 2011. it was a long long time ago so kind of a baby in my career so um I was a 1099
which now that I think about it had I done things differently I would have 100 required a W-2 back
then it was a little more normal for orthodontists to sign 1099 agreements remember with that you
know yeah maybe you get paid a little bit more but you also pay all your own insurance and you handle
all your own issues that come up right um we had a really bad situation that happened and some really
shady stuff happened I loved loved loved that job like loved it pay was really good um I did drive
to quite a few offices that were maybe an hour 30 minutes to two hours from my house you know
so I didn't work a ton of days maybe three days a week but there were long days but I love the
patients I love the office I love the support pay was good they were very supportive it was
like a dream job you know I could work three to four days a week make take home full-time money
um of course paid my own taxes I felt like they supported me really well um really happy with the
team the staff the office managers the treatment coordinators yeah I really had zero complaints I
honestly thought I was going to work at that DSO for my rest of my life like I was not upset at all
and then something like weird happened along the way where they started pushing out their real and
I produced like like big money for them like in good work really really good work like combination
of good quality work and good money like not only for me but for them they made tons of money off me
like four five six starts a day was not abnormal so I know I had twenty Thirty forty thousand
dollar days I mean easily and you know I got what initially it was a base pass bonus production then
they switched me to a percentage Collections and it wasn't super high it was maybe like 20 20 30
24 I can't remember but I know I didn't pay lab fees which was good um somewhere in there when
they switched me out that didn't upset me at all like I was like cool no I know I can produce and I
think it was a way that they wanted to push me out they were one to bring in cheaper you know cheaper
orthodontist lower overhead orthodontist and maybe did a less appliances things like that I don't
know I was going to do it the way I was going to do it because I did a really good Dentistry I knew
that much anyways I'm trying to set the Baseline so you guys understand kind of the Dynamics of it
um eventually they started doing crazy Shady stuff what ultimately ended up happening is
in the front doing some paperwork um and then there was a one of the offices there was a mom
who was beaten on her kid there was I don't know five six seven year old and she was whipping this
kid basically in the you know in the office and I was like whoa you know like are you guys gonna
stop this you know this is this is first of all I'm a mandated reporter with child protective
services obviously as a healthcare provider that's what I agreed to do that is my license I have to
report this you know um what's going on it was bad like bad like scary bad like I would have
called the cops bad you know um they were like no no this is our culture um we're not calling
the cops you know just let it happen this is this is we don't get involved you know and I disagreed
with the office manager so I I did report it to CPS because that is my job and whole after that
there was a major blowback um like major major blowback I don't know what ultimately ended up
happening but I know I did the right thing that was that was legally my job and if had I been
this is where it had I been a W-2 they couldn't have fired me for that you know and they didn't
directly fire me for that they just started squeezing me out like they would like do like
shady stuff and I'm still gonna get to this case but I really want to explain to you you know what
happened so that you can know sometimes when you're a 1099 or even part-time you know don't
have your own practice weird things can happen and even if you're doing great dentistry and
you think you're really well loved and you think that you're making the money and it's a win-win
for everybody I don't know sometimes people just they're stupid people out there that don't know
how to run businesses appropriately and they're looking to make the most money even if they have
a substandard provider but anyways ultimately they started squeezing my schedule they started
doing Shady things like only giving me one chair instead of four five or six only giving me one
assistant and since I was on production I'd only make like 50 bucks a day which was like this is
not worth it I'm not coming in for this type of schedule and they were like too bad and I
guess in my contract I basically it hadn't fine print that I'd be fine with any size
and anything you know these are things you never even thought because it never even came up right
so just keep that in mind okay anyway so now you guys know like I ended up leaving that office
um going to some other offices so this was you know all the old DSO that I no longer worked for
when this complaint came up a few years later and I think honestly if this had complaint had
come up when I worked there I think they would have super backed me up I mean they handled
everything always and I knew I didn't do anything wrong I also knew I did an excellent job at
um documentation initial records progress records and progress panels on every case
I remember I did have it on this one after you know before 12 months or as needed to check Roots
um I had impeccable treatment plans where I would go over especially if it was not there are many
options I'd go over all the options write them down have the patient actually sign that they
that they're explained date and that all other options were given so I had a signed treatment
plan I had progress records I had initial records I had great notes from every visit it it was
pretty much an airtight so this case was this at this time this DSO didn't know Invisalign and if
this line was pretty subpar back then anyways now that I think about this case I probably
would have done it with Invisalign and I did have cephs on every case so um you know it it was it
was a perfect case it was impeccable they they had nothing so evidently this patient and this patient
was amazing like we were every time she'd come in she'd be super happy super friendly talking to me
we were cool she always had a lot of questions and concerns and we'd sit down and take our time and
you know go over it so in any case what ultimately ended up happening is that I left the office and
um a couple years later this landed on my plate where I got a letter from the California Dental
Board saying that there's been a complaint it's now going to the peer review committee
um you'll have an opportunity to get a copy of your records and defend your case right
and then a board of your peers will review it and let you know you know it's basically
arbitration we'll let you know the outcome you know and then as needed you can get your
liability insurance involved so I mean whenever there's a complaint there's different ways right
there is ultimately there's ways where it comes from the Dental Board and that's fairly common
um and you know the patient's hoping to get something out of this are hoping to get you
in trouble or it can come directly from an attorney if it comes directly from attorney
I'd definitely be a little more worried but then usually your liability insurance will pick it up
um and handle it but usually most attorneys aren't going to take a dental related case pro bono you
know most patients are not going to pay these are the type of patients that are looking for
money they're looking for payoffs so they're not going to take it pro bono unless they do
their due diligence and they see that you did something wrong so I'd certainly be a lot more
worried if it came from attorney than it came from the Dental Board anyone can submit a complaint to
the Dental Board and it's going to get reviewed right so I did end up luckily getting a copy of
all my records I went through it with fine tooth comb I was like this was this was airtight that I
did nothing wrong here and I had I dotted my eyes across my T's I had my progress records initial
records I had all my signatures done informed consents were done and signed ahead of time like
you know so I mean I felt pretty good but it was just like a ridiculous amount of work writing up
what I did explaining going back and forth took it was so stressful right because I was like am
I gonna have to pay this patient 20 30 40 50 Grand I don't have this money you know and
I didn't really want to go through my liability insurance if I didn't have to you know ultimately
just because it can raise your rates and your premiums and I mean I don't know exactly how
that works but I just I wanted to handle it on my own so I think that was probably pretty dumb
but anyways so turned out I won you know it was a lot of work it was a lot of stress I was quite
offended just because I knew I had done such a great job and let me tell you clinically about
this case if I remember it correctly she was an adult with um over Jet and asymmetry one side
was solid class one the other side was Solid Rock Solid class two overjet midlines off so
um clearly probably what and but she wasn't skeleton class too so um front teeth were flared
in the ceph so it was a pretty slam dunk I mean nowadays I probably would have said hey let's take
out third Muller's let's do Invisalign let's use some sequential distalization that's probably what
an adult Class 2 elastic on the left oh she also had bilateral cross bite which is tricky to fix so
I believe I remember the treatment plan we stood a quad Helix which is an adult kind of an expander
which is just tipping to help fix the crossbite worked well she hated it but I think ultimately
we didn't fully fix the posterior crossbite she chose to have it removed and she signed a document
saying I realized that this is compromised I realize that it's not perfect I I'm asking to
get this off I remember I had that document in there um we did take out an upper left premolar
um but we had plenty other options that were in there like leave the over jet just try improvement
with elastics um we had jaw surgery in there but she really didn't need it but for the for the
narrow up a job we had a lot of different options so you declined them all she wanted to take the
the unilateral extraction case with Anchorage and everything I think we had Anchorage so
um when I left the office and I'm sure that was part of the issue it was you know obviously I got
ousted I told you that story um she ended up transferring to another provider she didn't stick
around in the office and the other provider which I hate this I really really hate this when another
orthodontist throws another orthodontist under the bus I always recommend if you see something
weird coming into your office as a transfer first of all you don't know the whole story you don't
make give any negative positive comments anything like that you request a full copy of the records
full x-rays everything documentation treatment plan progress notes everything and you go over
it yourself and then if there's still something clearly Shady going on you can I would call your
own liability insurance because you don't want to get tap you know toggle into it what happened
was this doctor directly threw me onto the bus he told the patient hey let's try to get some money
for you so that you can get veneers um though I think that was the ultimate goal she wanted like
eight units of veneers and she wanted me to pay for it I think that's what it was she she claimed
that her midline was still off well I don't know because I only saw her for half a year she went
to another provider not sure what happened with her midline it was still looking great when I
saw her and I had progress records to back it up so not sure who else got involved and screwed it
up but someone else clearly did wasn't me okay so ultimately I it was settled in my favor I didn't
have to pay anything it just was a huge pain in the butt and a lot of time and a lot of stress
and just personally being I guess really offended you know because I really thought I did great work
and I had taken great care of that patient and I didn't choose to leave and I think what was
also really frustrating is that the office when they ousted me out and and they fired me um you
know they tried to find some various reasons even though everything was fine but I think it
was only came down to that CPS issue where I you know made the complaint about the parent that was
beating their child in the waiting room that was the it was a Cascade of events that started after
that they would tell the patients all kind of shady things as to why I left they'd say
um she left because she's a bad dentist you know she left because she doesn't want
to see you anymore just mean things you know instead of being honest like hey we replaced
or you know she didn't choose to leave you know I I didn't want to leave I was bummed out I really
really loved those offices I didn't even get to say goodbye to my patients you know and
these are people that I established relationships with for five years I'm seeing the siblings and
the parents and you know normally when you leave you get a chance to say Hey you know
I'm gonna be leaving you know maybe I'm moving something like that but you know when it just
ends and you just rip that Band-Aid off like that you know it's it's it's tragic you know for the
patients as well as the doctor and you need that you need to end it but anyways I mean personally
I think it's better if dsos want to get rid of somebody at the very least they could do some type
of severance agreement you know so that you leave on a positive no they leave on a positive note and
you settle things but anyways regardless I want it not a problem it's just stressful now that I
think about it it shouldn't have been as stressful as it was it was just the first time it happened
um who knows these things can happen again I mean obviously there's statute of limitations but it
comes down to you guys it's your job to make sure you have an informed consent on every case it's
not your front office's job it's your job you're the dentist I never ever put one bracket on any
patient and any system that's of mine that's listening to this has worked with me you know
I refuse to put a bracket on patient until I checked all the paperwork was it all signed
properly you know is the patient 18 signing their own as a patient under 18 do we have a co-signer
is the informed consent sign is the treatment plan signed um is everything explained do they
have any questions um are all the risk benefits and Alternatives explained do we have a signature
on that et cetera et cetera do we need any supplemental informed consent forms I created
my whole batch of supplemental informed consent forms for pretty much every possible thing from
impacted canines to other stuff and a lot of that you'll see in my document store and
it's free for anyone that decides to become a concierge or VIP member we give you access to
our whole document Store everything's for free so anyways just letting you all know
be really careful if you're doing Ortho as a non-orthodontist make sure you're doing
everything right and you know those type of if you can get into any of those lectures they're
really the best lectures and I feel like there's just none of that going on for all these GPS that
are doing Ortho I think a lot of these cases are going to blow up in your face and I definitely
get consulted on a lot of cases you know just as an expert in that opinion you know how would I
do things you know either by insurance companies attorneys other dentists and y'all are doing some
crazy stuff out there and you're not dieting your eyes and you're not crossing your teeth and this
is going to come back and blow up in your face so definitely get it done all right thanks so much