Dentists’ Legal Liability and Duty of Explanation in Dental Malpractice Litigation in Japan

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Abstract

Introduction

Dental litigation accounts for approximately 10% of medical cases in Japan. This study sought to identify factors related to dentists’ legal liability in Japan, including their duty to explain procedures and treatments to their patients.

Methods

We analysed court decisions in 166 dental malpractice cases litigated in Japan between 1978 and 2017. To identify factors related to the legal liability of dentists, an analysis was performed to evaluate the associations among patient characteristics, dentist characteristics, litigation, and dentists’ explanatory behaviour.

Results

Of the 36 cases related to dentist liability, the study identified 23 cases (63.9%) of litigation in which the dentists were found to be in violation of their duty to provide an explanation. Regarding the severity of injury, the ratio of death and permanent disability was significantly higher in decisions in which the purpose of the explanation was something other than obtaining the patient's consent compared with decisions to obtain the patient's consent ( P = .014).

Conclusions

In cases in which the dentist was found legally responsible, the proportion of cases involving procedural negligence with the explanation of medical guidance was significantly higher. Dentists should pay careful attention not only to the patient's consent but also to their explanations, including “medical guidance.” Moreover, they should recognise that inappropriate explanations correlate with serious errors.

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Most cited references 28

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Physician-patient communication. The relationship with malpractice claims among primary care physicians and surgeons.

D Roter, John Mullooly, T Dull … (1997)

To identify specific communication behaviors associated with malpractice history in primary care physicians and surgeons. Comparison of communication behaviors of "claims" vs "no-claims" physicians using audiotapes of 10 routine office visits per physician. One hundred twenty-four physician offices in Oregon and Colorado. Fifty-nine primary care physicians (general internists and family practitioners) and 65 general and orthopedic surgeons and their patients. Physicians were classified into no-claims or claims (> or =2 lifetime claims) groups based on insurance company records and were stratified by years in practice and specialty. Audiotape analysis using the Roter Interaction Analysis System. Significant differences in communication behaviors of no-claims and claims physicians were identified in primary care physicians but not in surgeons. Compared with claims primary care physicians, no-claims primary care physicians used more statements of orientation (educating patients about what to expect and the flow of a visit), laughed and used humor more, and tended to use more facilitation (soliciting patients' opinions, checking understanding, and encouraging patients to talk). No-claims primary care physicians spent longer in routine visits than claims primary care physicians (mean, 18.3 vs 15.0 minutes), and the length of the visit had an independent effect in predicting claims status. The multivariable model for primary care improved the prediction of claims status by 57% above chance (90% confidence interval, 33%-73%). Multivariable models did not significantly improve prediction of claims status for surgeons. Routine physician-patient communication differs in primary care physicians with vs without prior malpractice claims. In contrast, the study did not find communication behaviors to distinguish between claims vs no-claims surgeons. The study identifies specific and teachable communication behaviors associated with fewer malpractice claims for primary care physicians. Physicians can use these findings as they seek to improve communication and decrease malpractice risk. Malpractice insurers can use this information to guide malpractice risk prevention and education for primary care physicians but should not assume that it is appropriate to teach similar behaviors to other specialty groups.

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Relation between negligent adverse events and the outcomes of medical-malpractice litigation.

Hal Sox, H Burstin, A. J. Brennan (1996)

We have previously shown that in New York State the initiation of malpractice suits correlates poorly with the actual occurrence of adverse events (injuries resulting from medical treatment) and negligence. There is little information on the outcome of such lawsuits, however. To assess the ability of malpractice litigation to make accurate determinations, we studied 51 malpractice suits to identify factors that predict payment to plaintiffs. Among malpractice claims that we reviewed independently in an earlier study, we identified 51 litigated claims and followed them over a 10-year period to determine whether the malpractice insurer had closed the case. We obtained detailed summaries of the cases from the insurers and reviewed the litigation files if the outcome of a case differed from the outcome predicted in our original review. Of the 51 malpractice cases, 46 had been closed as of December 31, 1995. Among these cases, 10 of 24 that we originally identified as involving no adverse event were settled for the plaintiffs (mean payment, $28,760), as were 6 of 13 cases classified as involving adverse events but no negligence (mean payment, $98,192) and 5 of 9 cases in which adverse events due to negligence were found in our assessment (mean payment, $66,944). Seven of eight claims involving permanent disability were settled for the plaintiffs (mean payment, $201,250). In a multivariate analysis, disability (permanent vs. temporary or none) was the only significant predictor of payment (P=0.03). There was no association between the occurrence of an adverse event due to negligence (P = 0.32) or an adverse event of any type (P=0.79) and payment. Among the malpractice claims we studied, the severity of the patient's disability, not the occurrence of an adverse event or an adverse event due to negligence, was predictive of payment to the plaintiff.

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Obstetricians' prior malpractice experience and patients' satisfaction with care.

G Hickson, E W Clayton, S Entman … (2016)

To examine the relationship between prior physician malpractice experience and patients' satisfaction with care. Women were interviewed using a questionnaire that contained structured and open-ended questions. Mothers of all stillborn infants, infant deaths, and a random sampling of viable infants drawn from 1987 Florida Vital Statistics were sorted into four groups based on the malpractice claims experience of their obstetricians between 1983 and 1986. Interviews were completed with 963 of 1536 women, most by telephone, 53 by in-person interview. Mothers' responses to closed-ended and open-ended questions about their perceptions of the care they received during their pregnancy, labor, and delivery. Even though none of the women actually filed a claim, a consistent pattern of differences emerged when comparing women's perceptions of care received. Patients seeing physicians with the most frequent numbers of claims but without high payments were significantly more likely to complain that they felt rushed, never received explanations for tests, and were ignored. In response to the open-ended question, "What part of your care were you least satisfied with?" women seeing physicians in the High Frequency malpractice risk group offered twice as many complaints as those seeing physicians who had never been sued. Problems with physician-patient communication were the most commonly offered complaints. Physicians who have been sued frequently are more often the objects of complaints about the interpersonal care they provide even by their patients who do not sue.

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Author and article information

Contributors

Tomoko Hamasaki

Journal

Journal ID (nlm-ta): Int Dent J

Journal ID (iso-abbrev): Int Dent J

Title: International Dental Journal

Publisher: Elsevier

ISSN (Print): 0020-6539

ISSN (Electronic): 1875-595X

Publication date PMC-release: 10 February 2021

Publication date Collection: August 2021

Publication date (Electronic): 10 February 2021

Volume: 71

Issue: 4

Pages: 300-308

Affiliations

[a ]Department of Nutrition, Faculty of Home Economics, Kyushu Women's University, Kitakyushu, Fukuoka, Japan

[b ]Department of Preventive Medicine and Epidemiology, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan

Author notes

[* ] Corresponding author. 1-1 Jiyugaoka, Yahatanishi, Kitakyushu, Fukuoka, 807-8586, Japan. tomotalk@ 123456kwuc.ac.jp

Article

Publisher Item ID: S0020-6539(20)36535-7

DOI: 10.1016/j.identj.2020.12.004

PMC ID: 9275357

PubMed ID: 33581870

SO-VID: 09e246b9-295c-48ca-9a7c-12bdf0cdbaea

License:

This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Dentists’ Legal Liability and Duty of Explanation in Dental Malpractice Litigation in Japan

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Abstract

Introduction

Methods

Results

Conclusions

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UUM Journal of Legal Studies

Most cited references 28

Physician-patient communication. The relationship with malpractice claims among primary care physicians and surgeons.

Relation between negligent adverse events and the outcomes of medical-malpractice litigation.

Obstetricians' prior malpractice experience and patients' satisfaction with care.

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Contributors

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