Bette Robin, DDS, JD 877 DrRobin
SELECT PRACTICE SERVICES, INC. / DENTAL PRACTICE SALES
SELECT PRACTICE SERVICES, INC. / DENTAL PRACTICE SALES
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
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
DrRobin@BetteRobin.com
17482 Irvine Blvd., Suite E
Tustin, CA 92780
Tustin, CA 92780
Tele:
877 DrRobin
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DrRobin@BetteRobin.com
17482 Irvine Blvd., Suite E
Tustin, CA 92780
Tustin, CA 92780
877 DrRobin
Tele:
714.421.4407
Fax:
714.398.8808