ACOMS Review - Summer 2019 ACOMS Review July 2019

and treatment of the patient. It is important that Conclusions J U LY 2 0 1 9 complications are followed and managed by the Consider turning your ‘SOAP’ note into a ‘SOARP’ oral and maxillofacial surgeon. Instead, in this note. The acronym becomes subjective, objective, case, the patient continued to follow-up with her assessment, REASONING, and plan. Oral and primary care provider, Dr. B., which ultimately maxillofacial surgery will never be risk free, but delayed follow-up and management by Dr. J and taking reasonable steps to minimize your risk can allowed for miscommunication and potentially help you practice with confdence. The more your Failure to Diagnose Infection Leads to Sepsis chart can stand on its own, the better. competing treatment therapies (e.g. the use of and a Malpractice Suit against OMS bacteriostatic and bacteriocidal antibiotics at the Robert A. Strauss, DDS, MD same time). Malpractice Minute The opinions B expressed this post are the opinions of the individual authors and may not reﬂect the opinions of MedPro Group or any of A C K G R in OU ND its individual employees. This document should not be construed as medical or legal advice. Because the facts applicable to your situation complications and do not may respond routine therapies, is incumbent on professional the OMS to consider may vary, or When the laws applicable in persist your jurisdiction differ, to please contact your it attorney or other advisors if you have common diagnoses. When a tertiary care interpretation, center for consultation any questions alternative related to and your less legal or medical obligations or appropriate, rights,state or referral federal to laws, contract or other legal questions. OMS Preferred is the be marketing name used to illustrates refer to the oral seemingly & maxillofacial products offered by MedPro Group. MedPro should considered. This case how routine surgeryrelated cases can become malpractice allegations. Group is the marketing name used to refer to the insurance operations of The Medical Protective Company, Princeton Insurance Company, PLICO, Inc. and RRG Group. All insurance products are underwritten and administered by these and other Berkshire C A MedPro SE DIS C U Risk S S I Retention ON Hathaway affliates, including National Fire & Marine Insurance Company. Product availability is based upon business and regulatory The patient was a 53-year-old female who presented to her general dentist, Dr. M, for treatment of pain in the approval and may differ among companies. ©2019 MedPro Group Inc. All Rights Reserved. upper left quadrant. The medical history was only significant for a permanent work-related partial disability. The social history revealed a 1 PPD smoking history and 3-6 drink per day alcohol history. After examination, Dr. M scheduled the patient one week later for extraction of teeth 14 and 15 and prescribed Cephalexin and Darvocet in the interim. The patient returned for that appointment and had the two teeth extracted without incident. Seven weeks later the patient went back to Dr. M with the complaint of pain and thermal sensitivity in the area of the surgery. X-rays showed no obvious abnormal findings. Thermal testing showed the remaining maxillary dentition in the upper left quadrant was vital and Dr. M diagnosed a likely maxillary sinusitis. He then referred the patient to her primary care physician, Dr. B, for management. The primary care provider, Dr. B, saw the patient the same day and prescribed Ceftin and analgesics. After two weeks the patient felt no better. She followed up with Dr. B who prescribed a 10-day course of Ciprofloxacin and obtained a CT scan of her sinuses, which revealed no abnormalities. Another eleven days passed before Dr. M referred the patient to Dr. J, our insured oral and maxillofacial surgeon, who examined the patient, reviewed the CT scans and felt that there was no acute odontogenic infection that required treatment. Dr. J prescribed chlorhexidine and advised the patient to improve her daily oral hygiene. Of note, the patient verbally requested another systemic antibiotic prescription because she was “afraid of getting an infection.” Dr. J explained that she had just come off the 10-day course of Ciprofloxacin and that he felt a further course of empirical systemic antibiotics was not advised. The patient returned to Dr. M three days later with left sided facial tenderness, pain and swelling. He diagnosed an acute abscess, prescribed Clindamycin, Zofran (for an undocumented reason but presumably for antibiotic- related nausea) and analgesics. Importantly, no surgical management was undertaken at that time. The patient was not seen by Dr. J for another four days, at which time she was found to have stable, continued facial MALPR AC TIC E MINUTE | JULY 2019 ©2019 MedPro Group Inc. All Rights Reserved. PG 1

ACOMS Review - Summer 2019 ACOMS Review July 2019 | Page 12