Failure to Take Progress X-rays During Orthodontic Treatment and
Failure to Read X-rays

Two of the most common problems we see in malpractice claims are the failure to take progress X-rays and the failure to read X-rays that were taken. In malpractice claims handled at AAOIC, it is not uncommon to see initial X-rays and then 2-3 or more years of treatment and then final X-rays after treatment is completed. Sometimes, even the final X-ray is missing.

The failure to take any progress X-rays during treatment and final X-rays when treatment is completed weakens the doctor’s defense if, after the treatment is over, root resorption is discovered, or pathology is found. The plaintiff will accuse the orthodontist of practice below the standard of care for failure to diagnose root resorption or discovering pathology that occurred during treatment. They will assert that if the root resorption had been discovered earlier in progress X-rays, treatment could have been altered and teeth would not have been as damaged or lost.

For pathology, they will claim that if diagnosed early, the lesion would have been much smaller and not have caused as much damage. In both cases, without diagnostic evidence to the contrary, it is very difficult to defend those types of claims.
 

Additionally, there are times when one of our insureds has taken progress X-rays that show root resorption or pathology but they were not read by the doctor. There is no documentation in the chart, and/or there was no discussion with the patient about an appropriate course of action. If root resorption or pathology is present on a progress X-ray and nothing is done about it until the damage is discovered after orthodontic treatment is completed, it is likely that liability will be established by a plaintiff for failure to diagnose.

The judgments or settlements awarded in these cases can be significant. So, it is very important that if you take an X-ray, you must read it and note your findings in the patient’s record. That is the best way to protect yourself and help your patients.
 

When should you take progress x-rays?  It is recommended that at the very least a progress X-ray be taken about halfway through treatment or at about the one-year mark. If there are periodontal concerns or impacted teeth or initial concerns about root resorption, you should consider taking progress X-rays more often.

We all want to practice with the ALARA principle in mind—As Low As Reasonably Achievable. However, use common sense, take those images that protect the patient and enable you to discover and diagnose potential root resorption or pathology—and be sure and read the X-rays that you take and document your findings in the patient’s record!

From the Desk of the Underwriter: The More You Know…
 

Your Policy Has a Doctor/Patient Relationship Condition
Did you know the AAOIC policy has a requirement that insureds must perform a comprehensive examination of all patients they plan to treat; and that appropriate diagnostic records are obtained and studied for which any resulting diagnosis, treatment plan or treatment recommendation will be based? In addition, the patient’s progress must be regularly monitored or there is documentation that an attempt was made to do so.

The AAOIC professional liability policy has a Doctor-Patient Relationship condition.  Please read your policy carefully and be aware of the Conditions of Coverage as well as the Policy Exclusions. These are very important things to know and may preclude coverage issues in the event of a claim. 

Email Addresses Are Important

When it is time to renew your AAOIC professional liability policy, we will notify you via U.S. Mail approximately 60 days prior to the expiration date of the policy and that notice will be sent to the last address that you provided to our office. We will continue to remind you via email approximately every 15 days until you renew your policy. We do this not to inundate your email box but because insurance coverage is extremely important. When your policy expires, you are not covered and you begin to self-insure in the event of a loss. Don’t let that happen. Keep your insurance coverage current. Remember to keep AAOIC informed of a good email address or provide a second contact if necessary and please read those emails from us.

We Are Saving Trees! No More Paper, No More Clutter

Effective immediately, when you renew your malpractice policy with AAOIC, you will receive your Policy Declarations, Policy Form, and supplemental coverage documents electronically, which you may print at your convenience or save to a paperless file. Saving the documents electronically allows you to access your policy documents whenever needed.  If you prefer the paper documents, just let us know and we are happy to mail them to you.

Steps to Follow in the Event of a Patient Complaint or Claim
If you receive a patient complaint or claim, consider the following recommendations:
1.    Call your insurance representative. If you have a conversation with a patient or a family member who has expressed dissatisfaction with the treatment, give your insurance representative a call to discuss what happened and what to do.
2.    Have your information on hand. You will need to provide key information from the patient’s record. Access to the file or computer record during the telephone call will save time.
3.    Anticipate a return call. Make sure you leave telephone and fax numbers so that your insurance representative can contact you. If you are insured with the AAO Insurance Company (a Risk Retention Group) (AAOIC) and have encountered an incident or claim, contact AAOIC Claims Representative Jessica Kaesberg, Shannon Hall, or AAOIC Claims Manager Elizabeth Franklin at 401 N. Lindbergh Blvd., St. Louis, MO 63141-7816. The AAOIC claims phone line number is 800-240-2650. Click on Claims. The AAOIC welcomes the opportunity to work with you. 

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