TEETH WORTH 1.1 MILLION
It’s finally been decided. And it’s been a long time coming. We now know for sure exactly how much a
set of pretty good, but not perfect, teeth are worth. Well, to be precise, we know for sure, for today, in
southern California. Maybe teeth are worth more or less in another place on another day, but that is a
different topic for a different day.
The Los Angeles Superior court decided in Jeffrey v. Gordon, MC001818 that teeth are worth 1.1
million dollars. That’s an interesting number. The number means wealth, financial independence and
freedom to most people. How many of our patients would cheerfully and willingly give up their teeth for
1.1 million? How many of us would do the same? Humm, even a full mouth reconstruction with state of
the art implants this court found to be worth a mere $75,000. And the new teeth would be perfectly and
white, straight and beautiful. . . . Doesn’t sound like such a bad deal!
How did this ‘deal’ come about, you ask? Well, sign up with a managed care plan and incorrectly
(according to the jury!) diagnose a patient and you too could be subject to a judgment of this amount.
That’s what Dr. Leoneed Gordon did in this case. Dr. Gordon was fortunate enough to have Linda
Jeffrey come into his office in 1990. Dr. Gordon took x-rays and did an examination on Linda’s teeth.
He recommended that her teeth be extracted because he said dental work needed was extensive and
would be painful, and even after the dental work Linda would still lose her teeth.
Linda went along with Dr. Gordon’s diagnosis. She had her teeth extracted and full dentures placed.
However, Linda claimed that the dentures didn’t fit well, and that they continually fell out in front of
people causing her a great deal of embarrassment in her job as a school administrator. Linda gave up
with Dr. Gordon and went to another dentist. The new dentist told her that her teeth could have been
saved. (Hindsight is always very clear, isn’t it?!). So Linda sued. And Linda won. The largest judgment
ever against a dentist. And it happened here, in southern California.
Sarcasm aside, I hope, the important part of this case really is the managed care aspect. Linda was
covered under an HMO plan. The court specifically found that an HMO raises an inherent conflict
between the dentist’s interest and the patient’s. (So what’s new, you say.) No managed care plan
changes, in any way, the legal standard of care expected in dentistry. Your full duty and responsibility
for diagnosis, treatment planning, referral duty to outside specialists, etc. remains.
Dental managed care cases are just beginning to churn their way through the court system. Most of the
time, malpractice is not a huge concern to dentists in that damages are most often minimal and
relatively inexpensive to cure, we have a good peer review system, we are covered by malpractice
insurance and basically all malpractice insurance companies take an aggressive stance in settling
claims before they reach the court system. But managed care raises new legal issues, such as
punitive damages against the dentist. In this case, the punitive damage portion was 1.1 million, and
the estimated amount for future dental work was a mere 75 thousand.
So, if you are confused, consider carefully the following guidelines:
1. Be very clear that a legal contract with an HMO, PPO, etc. changes nothing as to your
responsibilities. You may not alter your treatment plan due to reimbursement restrictions set forth in the
contract. If you do, an insurance company is not liable in court. You are.
2. It does not matter whether or not you have seen, read, or explicitly agreed to the contract or its
terms. This often happens in the case of an associate dentist. You are fully liable for the terms of the
contract and all of its language by seeing patients covered under a plan.
3. ‘Hold harmless’ clauses are valid. Although these clauses are beginning to be disputed in large
medical cases, they are and probably will continue to be found valid. That means the insurance
company has no responsibility for any untoward affect to the patient resulting from the provisions or
restrictions in their contract. You are responsible. You must make the correct diagnosis and follow
through with the correct treatment regardless.
4. You may not abandon a patient when a contract ends, or is moved to another treating doctor. Again,
you have the same responsibilities as if no contract existed, regardless of money.
5. And, finally, you may not bad-mouth HMO’s to which you subscribe. It is also dangerous to publicly
bad-mouth HMO’s in general, even if you don’t subscribe. Such activity is the foundation for costly
lawsuits not covered under your insurance policies for interference with contractual relations,
misrepresentation, fraud, etc. Remember these contracts are very carefully worded and the
companies are watching you. Most of the time they can come into your office and review your charts,
your fees, and your method of practice. Do you really want to give them that much power - and for less
money too?
So, you say, how can you possibly make any money by treating patients under these plans?
Humm. . . see #5 above.
© Bette Robin, DDS, JD 9/96
set of pretty good, but not perfect, teeth are worth. Well, to be precise, we know for sure, for today, in
southern California. Maybe teeth are worth more or less in another place on another day, but that is a
different topic for a different day.
The Los Angeles Superior court decided in Jeffrey v. Gordon, MC001818 that teeth are worth 1.1
million dollars. That’s an interesting number. The number means wealth, financial independence and
freedom to most people. How many of our patients would cheerfully and willingly give up their teeth for
1.1 million? How many of us would do the same? Humm, even a full mouth reconstruction with state of
the art implants this court found to be worth a mere $75,000. And the new teeth would be perfectly and
white, straight and beautiful. . . . Doesn’t sound like such a bad deal!
How did this ‘deal’ come about, you ask? Well, sign up with a managed care plan and incorrectly
(according to the jury!) diagnose a patient and you too could be subject to a judgment of this amount.
That’s what Dr. Leoneed Gordon did in this case. Dr. Gordon was fortunate enough to have Linda
Jeffrey come into his office in 1990. Dr. Gordon took x-rays and did an examination on Linda’s teeth.
He recommended that her teeth be extracted because he said dental work needed was extensive and
would be painful, and even after the dental work Linda would still lose her teeth.
Linda went along with Dr. Gordon’s diagnosis. She had her teeth extracted and full dentures placed.
However, Linda claimed that the dentures didn’t fit well, and that they continually fell out in front of
people causing her a great deal of embarrassment in her job as a school administrator. Linda gave up
with Dr. Gordon and went to another dentist. The new dentist told her that her teeth could have been
saved. (Hindsight is always very clear, isn’t it?!). So Linda sued. And Linda won. The largest judgment
ever against a dentist. And it happened here, in southern California.
Sarcasm aside, I hope, the important part of this case really is the managed care aspect. Linda was
covered under an HMO plan. The court specifically found that an HMO raises an inherent conflict
between the dentist’s interest and the patient’s. (So what’s new, you say.) No managed care plan
changes, in any way, the legal standard of care expected in dentistry. Your full duty and responsibility
for diagnosis, treatment planning, referral duty to outside specialists, etc. remains.
Dental managed care cases are just beginning to churn their way through the court system. Most of the
time, malpractice is not a huge concern to dentists in that damages are most often minimal and
relatively inexpensive to cure, we have a good peer review system, we are covered by malpractice
insurance and basically all malpractice insurance companies take an aggressive stance in settling
claims before they reach the court system. But managed care raises new legal issues, such as
punitive damages against the dentist. In this case, the punitive damage portion was 1.1 million, and
the estimated amount for future dental work was a mere 75 thousand.
So, if you are confused, consider carefully the following guidelines:
1. Be very clear that a legal contract with an HMO, PPO, etc. changes nothing as to your
responsibilities. You may not alter your treatment plan due to reimbursement restrictions set forth in the
contract. If you do, an insurance company is not liable in court. You are.
2. It does not matter whether or not you have seen, read, or explicitly agreed to the contract or its
terms. This often happens in the case of an associate dentist. You are fully liable for the terms of the
contract and all of its language by seeing patients covered under a plan.
3. ‘Hold harmless’ clauses are valid. Although these clauses are beginning to be disputed in large
medical cases, they are and probably will continue to be found valid. That means the insurance
company has no responsibility for any untoward affect to the patient resulting from the provisions or
restrictions in their contract. You are responsible. You must make the correct diagnosis and follow
through with the correct treatment regardless.
4. You may not abandon a patient when a contract ends, or is moved to another treating doctor. Again,
you have the same responsibilities as if no contract existed, regardless of money.
5. And, finally, you may not bad-mouth HMO’s to which you subscribe. It is also dangerous to publicly
bad-mouth HMO’s in general, even if you don’t subscribe. Such activity is the foundation for costly
lawsuits not covered under your insurance policies for interference with contractual relations,
misrepresentation, fraud, etc. Remember these contracts are very carefully worded and the
companies are watching you. Most of the time they can come into your office and review your charts,
your fees, and your method of practice. Do you really want to give them that much power - and for less
money too?
So, you say, how can you possibly make any money by treating patients under these plans?
Humm. . . see #5 above.
© Bette Robin, DDS, JD 9/96
| Bette Robin 1-877-DrRobin Dentist, Attorney, Real Estate Broker 1-877-377-6246 |
 | |  | |  | |  | |  |
DrRobin@BetteRobin.com
17482 Irvine Blvd., Ste. E
Tustin, CA 92780
Tustin, CA 92780
Call:
Fax:
Fax:
877 DrRobin
714-421-4407
714-398-8808
714-421-4407
714-398-8808
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