Dentist failed to diagnose patient's cancer
Oct 4 2007


By Steve Evans


A NUNEATON dentist faces being struck off the dental register after missing a patient's mouth cancer.

Lutz Reinhardt, who lives in Haunchwood Road, Stockingford, had seven appointments with the patient over an 18-month period.

But, it is claimed, he ignored her fears about a growing red sore under her tongue.

The 54-year-old woman, known as Patient A, needed two operations and had part of her tongue removed after she was seen by another dentist who referred her for urgent hospital treatment.

Mr Reinhardt, who was practising at the Camp Hill Dental Practice in Camp Hill Road, Nuneaton, is appearing before the General Dental Council in London, where he admits failing to diagnose the lesion or advising the patient it could be malignant.

He also admits failing to refer the patient to a specialist or taking an adequate social or medical history, or making any record of the lesion in her dental records.

Mr Reinhardt, who qualified in Germany 11 years ago, could be struck off the dental register if the GDC decides his fitness to practise is impaired by reason of misconduct.

Yesterday's hearing was told that the patient was now taking civil action against Mr Reinhardt for his treatment between December 2004 and March 2006.

"I'm left with a portion of my tongue missing and it's not going to get any better," she told the hearing.

She broke down in tears as she told how she also suffers from tongue numbness, damage to her taste buds and salivary glands.

She faces more operations and a three-year wait for doctors to give her the all-clear, in case cancerous cells return.

But Charles Foster, for Mr Reinhardt, claimed at the hearing that the patient was exaggerating to fleece money from him in the civil courts.

Mr Foster said she was an unreliable witness who was "over-egging" her story.

He said: "Whenever this patient can be contradicted by the documents that we've got, she is contradicted by the documents.

"Her account as we trace it through the notes just doesn't hang together."

He claimed the woman had exaggerated "in an effort to bolster her claim for damages".

Although Mr Reinhardt has admitted failing to diagnose the lesion, the GDC is deliberating in private whether the remaining allegations denied by him have been proved.

The hearing continues.

Question:
Should a dentist be struck off if he/she does not diagnose a mouth cancer?

Choices:
Yes
No

Question:
Should a dentist be struck off if they do not refer a patient with a suspicious lesion to a specialist?

Choices:
Yes
No

Question:
Should a patient sue a dentist for damages under the above circumstances?

Choices:
Yes
No

Question:
Do you think the patient was exagerrating her problems following treatment for her mouth cancer?

Choices:
Yes
No

 

My first reaction was "Why don't they let the dentist have the same treatment, and then he can see if she was over-exagerating", but I really wouldn't wish it on anybody.
Her damages should allow for the fact that she won't be able to work for quite a while, her loss of enjoyment of food, her fear that the cancer may come back, amongst others. How can you put a price on that?

Jenni

I am in the middle of the same process.
Robin and i reported his dentist to the General Dental Council in December 2006 ,three weeks after his diagnosis of cancer.They considered the evidence,decided he had a case to answer and it was referred to the Fitness To Practice department.
Over the last ten months the legal team have been obtaining medical records,Doctors statements,Robins statement, defence statements and the hearing was due on September 11th.This date has since been put back and is yet to be arranged. As you are all aware Robin died long before the hearing date,aand i was surprised to get an e- mail asking me to read the defence statement from the dentist and more to the point DID I WISH TO PROCEED.
Why the hell wouldnt i want to proceed?.As far as i am concerned this mans negligence contributed to my husbands death at the age of 44years,with barely half his life behind him,of course i want to proceed.
Having read the dentists statement i was even more determinedto go ahead,as his lies are just so unbelievable as to be a joke.According to him Robins ulcer was fully healed and was not evident at examination on 20th October.

On 4th December (6 weeks later) Robin was examined at Royal Surrey Hospital after urgent referral by our GP on November 24th.This visual examination revealed a 1.5cm ulcer on the lateral surface of the right side of his tongue and a 4x3cm swelling on the left side of his jaw.
Pathology revealed a poorly differentiated squamous cell carcinoma,APPARENT on the mucosal surface.The carcinoma was ulcerated with invasion into the underlying intrinsic muscles and chronic inflammatory infiltrate.(and all in 6 weeks !!!i dont think so)
Robin had seen his dentist 4 times since May and each time he complained of the ulcer which he had had for some time and the dentist said was caused by an ill fitting denture which he replaced twice and charged Rob nearly £600.00 he also advised he use bonjela for the pain.

The investigation by the General Dental Council is nothing to do with money,i am not suing the Dentist(though perhaps i should) it is purely based on my wish for no human being to suffer the way Rob did because of professional negligence.If the dentist is struck off i dont give a damn,as far as i am concerned he is not fit to be let loose.None of this will bring my husband back but i hope and pray it may make more dentists aware of the responsibility they have in the early detection of Mouth Cancer.

liz x

I think i'm going to play devils advocate here...
Ok,
My lymph node presented itself in the summer of 2005. & my G.P. said it was 'nothing to worry about as it sometimes happens'. It felt like a large grape under the skin at this point. & was noticeable.
In the dember my hearing went funny in my left ear & in January the heavey nose bleeds started. I was given a synus spray and antibiotics & was told it was a synus infection. I went back again 2 months later - more antibiotics & spray. & again 2 months after that. Again i pointed out the lymph & this doctor referred me to ENT, the rest is history!
So i'd had my cancer over a year before i was diagnosed.
I felt so let down by the doctors. But came to the conclusion that they aren't gods, and i'm so young that they over looked anything sinister.
But NOW they will learn from it and be more cautious.
I've been told often that they should be held accountable for not referring me sooner. & even had the cheek to insinuate that it was MY fault for not goung back to them frequently enoguh! But i thought it was no big deal! Thety're the doctors not me!

i think Liz is 100% right to go ahead with what she's doing for Rob.

& i think it's down to the individual to do what feels right for them, in their circumstances.

To me it seems we need to create a balance. Dentists can't refer EVERY ulcer for a closer inspection, the system is jammed up with waiting lists as it is! BUT Dr. Joshi gives good advice, if the ulcer/lesion etc hasn't healed within 2 weks - it needs to be investigated.

I don't feel everyone should sue. Dentists and G.P.s will be afraid to say boo to a goose & the other extreme as i said before is the system wont be able to cope with all the non-urgent biopsies etc. BUT i DO think they should be made aware of their fateful actions & made accountable for their mistakes.

So that's my

Chelle your attitude is very laudible and you are very lucky you feel so much empathy with the professionals.I wonder if you found yourself in my position that you would feel quite so generous.
An empty heart,an empty bed and a fatherless child can change your perspective on how much you can allow human error to be an excuse.

Based on what I've read here (& it can only be part of each story in so few words) the case Dr Joshi highlights & Robin's case seem to carry a heavy suspicion of "should have done a lot better" to say the least.

With Chelle's case I think she's right - who would suspect someone so young & healthy would have something so sinister attacking them? There were other likely explanations for the symptoms.

Indeed in my case the hospital were amazed that my GP had refered me (a 49 year old non-smoker) without giving me a course of antibiotics first. I'm just glad he did!

Liz,
I wouldn't say my attitude was laudable. I'm not saying the G.P's in my case were faultless... & i DO believe they should be made aware of their mistakes - and i dont' think human error is an excuse either! But - i can see why this happened in MY case.

As i said in my last post, i think in Robs case you're 100% right to see this through to the end. & as you said - it's not about the money. It's about them being made accountable for there mistake.

& if i were in your position i'm sure i'd be just as angry and determined as you!

But every case is different. I don't think MY G.P. should be struck off. I think he should learn from his mistake and recognise that complacentcy doesn't cut it regardless of age.

I'm speaking from MY experience. Yours & the one above are completely different.

I know it's something you're passionate about and i wasn't trying to rustle anyones feathers.

You didnt sweetheart i just feel old and alone and find the enthusiasm of youth a bit much to bear sometimes.You keep your ideals chelle they make you who you are.

love liz

Well my view is that GP's are more "general" in nature than Dentists. My own GP's failed to diagnose chronic heart disease and my own caricinoma of the larynx 4 years later. I was referred in both cases only because I was fortunate to have private medical insurance and demanded referral. I do not expect GP's to be Consultant Specialists but there comes a point where when symptoms will not go away referral should be automatic for a second opinion. As it happens because of the PMI I probably was seen much sooner that if the GP had referred me sooner through the NHS and in each case the "instant" consultations (within 7 calendar days of referral) were in my opinion material to my survival.

Dentists however are by definition more accountable for oral cancers, they may not come across many examples in reality but their specialism (by comparison to GP's)and training should make them more aware and alert to the possibilities and referral to ENT or MAXFAX Units should be standard procedure for any suspicious conditioin not responding to "first aid" treatment.

Suing and complaining, well it depends, I did not complain about my GP's, and I was not financially prejudiced as a direct result of either event, so had no reason to sue. In Dr Joshi's reported case I would both complain and sue, in Liz's case I would complain. Now that Rob has passed on suing is still something that Liz should consider as she has been prejudiced both finacially and emotionally, but she has a couple of years left to make that decision. If the GDC does not support the complaint suing would not be productive, it would be expensive and stressful and people do not sue for the "money"; they sue to be compensated for their losses, financial and emotional. No one in their right mind would want to be hurt or go undiagnosed. Again whether the negligence was responsible for the ultimate death of a patient with such an aggresive disease is difficut to prove, if treatment had started sooner but for the negligent consultations what Professional in hind sight will give evidence of the probability of survival had the patient been referred sooner? In the lady's case her damages arose from the delay between the onset of her condition and its ultimate diagnosis, she could not refer herself: but I am pretty sure that each one of us having travelled this road of afflication knew in our hearts that something was seriously wrong with our bodies, I certainly did on both occasions, hence my insistence on being referred.

There is no right or wrong here there is professional misconduct and there consequences which each have potential for varying degrees of distress as a result. Each case needs to be considered in the light of its own circumstances.

<<<...had seven appointments with the patient over an 18-month period.>> and <<< failing ... making any record of the lesion in her dental records.>>


These seem like crucial sentences to me. Two examinations and it's an internal judgement on the part of the dentist as to what the lesion might be. We all know that not all lesions are cancers and to some extent we must allow professional judgement to operate. So watch and wait - but after a lesion still being there by the third exam I believ the dentist should have acted fast. 7 examinations seems like negligence if nothing was done to send the patient to someone more expert. Conclusion - unprofessional.

My son was complaining of pain in his leg and going to the sick bay (he was in the Navy) for 14 months!!!!!! before a new physiotherapist (who treated him for the third time) decided there should be some response by now and sent Aaron off for x-rays. 'Something' showed up and with MRI's etc in hand, there was a 10.5cm tumour in his femur by the time we got to the specialist (he said under normal circumstances a tumour would be about 2.5 by the time a patient reached him).
Once diagnosed, the dust didn't get a chance to settle because just a bit of panic was setting in. How I would love to have had the chance to face that first physiotherapist and all of Aaron's lecturers who gave him a hard time for being a malingerer and skipping lessons to go to the sick bay. I don't know what I would have said or done ~ probably howled at the injustice of it all but I really wanted to make them all stop and think about the effects they all had on his life (he was 17 when diagnosed)by their assumptions.
At that point we didn't know that he would be undergoing surgery for about 5 years before it was all fixed and that was quite apart from chemo etc and a stuffed career.
There would be no compensation because the Navy could not be held responsible for the tumour. Through it all his treatment was first class ~ and so it should have been.
So many mixed emotions for you Liz and the sad thing is ~ nothing will bring Rob back. Do what you have to do and what is right for you.
Thinking of you with love
Deborah