Investigation Report 200601144

  • Report no:
    200601144
  • Date:
    November 2008
  • Body:
    Fife NHS Board
  • Sector:
    Health

Overview

The complainant (Mrs C) raised a number of concerns, alleging that the community dentist (Dentist 1) fitted a denture which had been incorrectly prepared.  Also, she was unhappy about the clinical decision which was taken to proceed with treatment.

Specific complaints and conclusions

The complaints which have been investigated are that:

  • (a) the community dentist (Dentist 1) proceeded with treatment using an incorrectly prepared denture (upheld); and
  • (b) Mrs C subsequently disagreed with the decision taken, to continue with treatment without regard to the stressful circumstances which applied (partially upheld).

Redress and recommendations

The Ombudsman recommends that the Board:

  • (i) identify and evaluate the measures which are now in place to prevent this occurring again;
  • (ii) consider the use of a pre-extraction appointment to ensure full understanding of a treatment plan;
  • (iii) draw up guidelines to consider management and consent when a patient is under particular stress;
  • (iv) consider the development of a pro-forma to jointly support all clinicians' agreement that the denture made is correctly prepared; and
  • (v) ensure that a full apology is made to Mrs C for the distress and discomfort caused as a result of the treatment option followed in this particular case.

The Board have accepted the recommendations and will act on them accordingly.

Updated: December 11, 2018