You Be The Judge: A Dose of Reality by Jeffrey J. Tonner, JD

The court’s ruling
Had you been the judge, how would you have ruled? Select one of the four options below:

1. Grant the motion, finding that the dentist had no duty to inform Charlie that he should resume Coumadin use.
2. Grant the motion, because the plaintiff did not name Pappas as a defendant and therefore does not believe he breached the standard of care.
3. Deny the motion, reasoning that whether Pappas had a parallel duty is for the jury to decide.
4. Deny the motion, ruling that Pappas had a dual responsibility with the physician to ensure that Charlie resumed his blood-thinner medication.

The court’s decision and practice pointers for this type of situation:

C. Deny the motion, reasoning that whether Dr. Pappas had a parallel duty is for the jury to decide.

Sometimes the issue of whether a particular health care provider has a legal duty to act is clear, while in other situations it remains murky. Here, the judge stated that she was unsure whether the dentist also should have warned Charlie to restart his Coumadin use, but that this duty was at least plausible. In such instances, each side will present expert testimony and the jury will decide whether a standard of care existed for Dr. Pappas.

Once the motion was denied, the plaintiff then filed a claim to convert the dentist to a "regular" defendant; meaning, Charlie could receive damages from the physician and/or the dentist.

As for Pappas, the jury must first determine whether he had a duty to instruct his patient to resume the blood-thinner medicine. If it decides he did, then it must complete this form:

Percentages of Fault
Fault of Charlie (if any) ___ %
Fault of the physician (if any) ___ %
Fault of Dr. Pappas (if any) ___ %
Must total one hundred percent 100%

The percentages are then multiplied by the damages. For example, suppose the jury determined this ratio:

Charlie: 10%
Physician: 75%
Pappas: 15%

If they awarded $1 million for present and future medical damages plus pain and suffering, the physician would pay $750,000; Pappas, $150,000; and Charlie would gain nothing for his 10 percent contributory negligence.

Practice pointer
After surgery, most dentists give the patient (or their escort, if oral conscious or IV sedation is used) written postoperative instructions. The progress notes should state, "Oral and written POI given," or words to that effect.

This item should be added to your laundry list of written postoperative instructions:

"If you have been taken off blood thinners (Coumadin, Warfarin, etc.), or if your current medications have been altered at all due to your dental surgery, you must contact your physician ASAP to determine if and when you should resume your medicines. Delaying this telephone call could have potential life-threatening or other serious consequences."

Pappas could have avoided this legal entanglement completely, had he read this article in advance. Please change your written POIs immediately, so you do not suffer this dentist’s fate. Good luck and keep charting!