ACOMS Review - Summer 2019 ACOMS Review July 2019 | Page 10

Malpractice Minute
Malpractice Minute
J U LY 2 0 1 9
The primary care provider, Dr. B, saw the
Failure to Diagnose Infection Leads to
patient the same day and prescribed Ceftin and
Sepsis and a Malpractice Suit against
analgesics. After two weeks the patient felt no
OMS Failure to Diagnose Infection Leads
to Sepsis
better. She followed up with Dr. B who prescribed
a 10-day course of Ciprofloxacin and obtained
a DDS,
Malpractice
Suit against OMS
Robert A. and
Strauss,
MD
a CT scan of her sinuses, which revealed no
Robert A. Strauss, DDS, MD
abnormalities. Another eleven days passed before
Background
Dr. M referred the patient to Dr. J, our insured
BACKGROUND
When complications
persist and do not respond
When complications persist and do not respond to routine oral
therapies,
is incumbent on surgeon,
the OMS to consider
and it maxillofacial
who examined
to routine therapies, it is incumbent on the
alternative and less common diagnoses. When appropriate,
referral
to a tertiary
care center
the
patient,
reviewed
the for
CT consultation
scans and felt that
OMS to consider alternative and less common
should be considered. This case illustrates how seemingly there
routine was
cases no
can acute
become odontogenic
malpractice allegations.
infection that
diagnoses. When appropriate, referral to a
required treatment. Dr. J prescribed chlorhexidine
tertiary care
should be
C A S center
E D I S C for
U S consultation
SION
and advised the patient to improve her daily oral
The This
patient
was a
53-year-old how
female seemingly
who presented to her general dentist, Dr. M, for treatment of pain in the
considered.
case
illustrates
hygiene. Of note, the patient verbally requested
upper can
left quadrant.
The
medical history allegations.
was only significant for a permanent work-related partial disability. The
routine cases
become
malpractice
another systemic antibiotic prescription because
social history revealed a 1 PPD smoking history and 3-6 drink per day alcohol history.
she was “afraid of getting an infection.” Dr. J
Case Discussion
After examination, Dr. M scheduled the patient one week later
for extraction
teeth had
14 and
15 come
and prescribed
explained
that of she
just
off the 10-day
The patient
was a 53-year-old female who
Cephalexin and Darvocet in the interim. The patient returned
for
that
appointment
and
had
the
two
teeth
course of Ciprofloxacin and that he felt a further
presented extracted
to her without
general
dentist, Dr. M, for
incident.
course of empirical systemic antibiotics was not
treatment of pain in the upper left quadrant.
advised.
Seven
weeks later
patient
went back for
to Dr. a M with the complaint of pain and thermal sensitivity in the area
The medical
history
was the
only
signifcant
of the
surgery. X-rays partial
showed disability.
no obvious abnormal
permanent
work-related
The findings. Thermal testing showed the remaining maxillary
The patient
returned
to Dr.
three
days
dentition
in
the
upper
left
quadrant
was
vital
and Dr. M diagnosed
a likely maxillary
sinusitis.
He M
then
referred
social history revealed a 1 PPD smoking history
later with left sided facial tenderness, pain
the patient
her alcohol
primary care
physician, Dr. B, for management.
and 3-6 drink
per to
day
history.
and swelling. He diagnosed an acute abscess,
The primary care provider, Dr. B, saw the patient the same prescribed
day and prescribed
Ceftin and analgesics.
After an
two
Clindamycin,
Zofran (for
After examination,
Dr.
M
scheduled
the
patient
weeks the patient felt no better. She followed up with Dr. B
who prescribed a 10-day
course
Ciprofloxacin for
undocumented
reason
but of presumably
one week and
later
for extraction
of teeth
and
obtained
a CT scan of her
sinuses, 14
which
revealed no antibioticrelated
abnormalities.
nausea) and analgesics.
15 and prescribed Cephalexin and Darvocet
Importantly,
no surgical
management
was
Another
eleven
days passed
before for
Dr. M that
referred the patient
to Dr. J, our insured
oral and maxillofacial
surgeon,
in the interim.
The
patient
returned
undertaken
at
that
time.
The
patient
was
not
who examined
patient,
the CT scans and felt that there was no acute odontogenic infection that
appointment
and had the the
two reviewed
teeth extracted
seen
Dr. J to for
another
four
required treatment. Dr. J prescribed chlorhexidine and advised
the by
patient
improve
her daily
oral days,
hygiene. at Of which
without incident.
time prescription
she was because
found she
to have
stable,
continued
note, the patient verbally requested another systemic antibiotic
was “afraid
of getting
facial
swelling
but
was
subjectively
feeling
worse.
an infection.” Dr. J explained that she had just come off the 10-day course of Ciprofloxacin and that he felt a
Seven weeks
later the patient went back to
Dr. J then extracted tooth 16 due to new, acute
of empirical systemic antibiotics was not advised.
Dr. M with further
the course
complaint
of pain and thermal
apical periodontitis. Two more days elapsed and
sensitivity The
in patient
the area
of the
surgery.
X-rays
returned
to Dr.
M three days
later with left sided facial tenderness, pain and swelling. He diagnosed
the patient again returned to Dr. M who noted
showed no
obvious
abnormal
Thermal
an acute
abscess,
prescribed findings.
Clindamycin,
Zofran (for an undocumented reason but presumably for antibiotic-
continued swelling and sent the patient back to
testing showed
the remaining
maxillary
dentition
related nausea)
and analgesics.
Importantly,
no surgical management was undertaken at that time. The patient
Dr. J.
in the upper
left seen
quadrant
was
vital four
and
Dr.
M time she was found to have stable, continued facial
was not
by Dr. J for
another
days,
at which
diagnosed a likely maxillary sinusitis. He then
Dr. J saw the patient that day and took an x-ray.
referred the patient to her primary care physician,
Although he noted no purulence, Dr. J extracted
Dr. B, for management.
MALPR AC TIC E MINUTE | JULY 2019 ©2019 MedPro Group Inc. All Rights Reserved.
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MedPro Group Inc. All Rights Reserved.
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