Furious over legal issue that came up today bone graft/extraction

[sharon]

I was scheduled for surgery this morning. I was feeling somewhat positive going in and more than anything looking forward to getting it over with. I got there, signed the consent form then went to the treatment room. She asked a few questions one of them being have I taken any medication this morning. Yes, 7.5 mgs of valium. Everything stopped right there because apparently one can't sign a consent if they are under the influence of mid altering drugs. There was no way out of this and now my appt is rescheduled for two weeks.

Needless to say I am furious as I wanted this to be over with and NO ONE told me I couldn't take anything before hand because I had a consent form to sign. They sent me pages of instructions before the appt and nothing in there mentions this. I'm surprised because I have had a few procedures (c-copes, biopsies) in which I had taken valium before (with their knowledge) and it didn't stop anything, I still signed consent forms with no problems, the procedures went on as usual.

Is this the norm???? The dentist said if he prescibed it he would have told me but since he didn't he had no way of knowing. I am quite sure on my initial consultation I told him I always take valium beforehand because of my dental phobia, we had quite a consersation about the phobia as a matter of fact.

So now surgery is two weeks away, I have to take time off to go sign a consnt form, and then have to take more time off from work and get all nervous again (and so much for a good Thnksgiving dinner).

Where can I find this law? and why aren't thely legally respsonsible to tell me I have to sign somehing at a time when my mind is clear from drugs? and why have other doctors totally ignored the law?

 

[drm]

The issue, legally speaking, is that a consent form is not valid if you are impaired enough to not be able to make a rational decision. The big gray area is how impaired is too impaired. Some people on that dose of valium have no mental deficits while others have major mental deficits. The dentist likely has a low tolerance for any type of legal risk (everyone is different). Perhaps he had a bad experience in the past with being sued. Ultimately it's a judgement call and he probably tried to make the best one he could in the situation, whether it was correct or not. Sorry you had to go through that! I'd probably bring the issue up in a polite manner with him and ask if in the future he could include that information on his pre-op forms. Most dentists welcome feedback of that sort to improve how they do things.

 

[sharon]

The issue, legally speaking, is that a consent form is not valid if you are impaired enough to not be able to make a rational decision. The big gray area is how impaired is too impaired. Some people on that dose of valium have no mental deficits while others have major mental deficits. The dentist likely has a low tolerance for any type of legal risk (everyone is different). Perhaps he had a bad experience in the past with being sued. Ultimately it's a judgement call and he probably tried to make the best one he could in the situation, whether it was correct or not. Sorry you had to go through that! I'd probably bring the issue up in a polite manner with him and ask if in the future he could include that information on his pre-op forms. Most dentists welcome feedback of that sort to improve how they do things.

Thank you so much drm. I'm glad to hear from you as to exactly what this means from a legal standpoint. So it's a judgement call, which is good to know but I was obviously NOT impaired enough to have difficulty making a rational decision. I could walk, I could talk, I could fill out the form, I could make small chit chat, I could tell them my name and birthdate. The dentist certainly wasn't the one who made the decision, it was made before I even saw him. (in fact they never even asked me how much I took, so I didn't say 7.5 mgs, I just said I took valium, for all they know it could have been 1 mg and even if it was that tiny amount they probably wouldn't have gone any further.)

In the medical history forms I filled out before my initial consultation I clearly wrote I take valium as needed. So if he looked at my forms, which I'm sure he did, he would have seen right there that there is a possibility I would have some in my system. And the "implant coordinator" who I talked with several times certainly should have had this info.

And I just looked at my calendar and see my appt is THREE weeks away, not two, so it's three more weeks of worrying about this.

I certainly will mention to someone there that is was wrong for them not to tell people about this especially when it is clearly on my record that I take valium. What about the people who take valium daily, can they never, ever sign consent forms?

I am so tempted to go elesewhere and have this done but then I would have to start all over with a new surgeon and new consult appt and this first place would probably charge me something outrageous for cancelling out on them.

 

[drm]

People who take it everyday are definitely competent to sign consent forms. The dosages are such that it reduces anxiety but doesn't generally produce any mental impairment. It sounds like your dose before the appointment was about the same. Generally, if I can hold a normal conversation with someone and I don't notice anything unusual, I consider them to be OK to sign a consent. This is especially true if they have a valid prescription for it and take a normal dose for anxiety as needed. Sounds like an unfortunate situation where they followed some office policy blindly without thinking if it actually makes sense for you.

These kind of things drive me a bit nuts. I hate policies for the sake of having policies. I think every patient should be treated on an individual basis with a focus on their specific needs. If there is a problem, the doctor should personally come in and discuss their reasoning, etc at the very least. Unfortunately a lot of places don't do things that way anymore... which is probably why I started my own office. Woops, I'll get off my soapbox now! As you can tell, this kind of stuff gets me fired up!

 

[sharon]

Hey - it fires me up too, but probably for different reasons.

Thank you again. I will add I was probably a lot more rational with the valium in me than without. Without I'm a shaking basket of nerves and no denstist wants to come near me.

And just a little aside - I've had a problem with severe vertigo in the past and have had to go to the ER via ambulance on a few occassions. Once there of course, I have to sign a consent from. With my vertigo as bad as it is, there is no way I can physically read what I am signing or even keep my eyes open long enough to see the paper and pen as the vertigo is so bad. Seeing the line I have to sign is physically impossible. So you nurse has to put the pen in my hand, hold my hand and direct it to the right spot of the paper where I am to sign. Than I make my scrawl. I have no idea whatsoever I am signing but they insist on it. And they really think I am competent when I am in this situation?

 

[comfortdentist]

People who take it everyday are definitely competent to sign consent forms. The dosages are such that it reduces anxiety but doesn't generally produce any mental impairment. It sounds like your dose before the appointment was about the same. Generally, if I can hold a normal conversation with someone and I don't notice anything unusual, I consider them to be OK to sign a consent. This is especially true if they have a valid prescription for it and take a normal dose for anxiety as needed. Sounds like an unfortunate situation where they followed some office policy blindly without thinking if it actually makes sense for you.

These kind of things drive me a bit nuts. I hate policies for the sake of having policies. I think every patient should be treated on an individual basis with a focus on their specific needs. If there is a problem, the doctor should personally come in and discuss their reasoning, etc at the very least. Unfortunately a lot of places don't do things that way anymore... which is probably why I started my own office. Woops, I'll get off my soapbox now! As you can tell, this kind of stuff gets me fired up!

You are right but the real problem has nothing to do with wither the doctor thought you were competent or not to sign and given truly informed consent. The issue is that you might have an undesirable outcome or even change your mind under some circumstances then decide to sue the doctor. The attorney will say whatever argument relating to being in an altered state. And yes this happens. With little doubt in my mind the doctor/issurance company would settle a lawsuit like this because you can NOT trust a jury.

 

[sharon]

I had quite a phone conversation with the office today. I didn't really expect it to go anywhere and it didn't but I'm glad I said what I had to. I told them how upset I was that no one told me I needed to be valium-free when signing the consent and they should have been aware as it is clearly written in my medical historty that I have a prescription for valium. So she pulls it up just to make sure and sure enough it is there. She agreed that someone should have told this to me. I said, "surely I can't be the first person to come into your offices who has taken valium or one its relatives beforehand and then has to leave because they can't sign the consent." She said it happens "all the time." She had no good answer for me when I asked, why, if it happens all the time, don't you inform people beforehand? She apologized a lot but couldn't explain why it happened or give me any assurance that things will change in the future.

She also explained that it isn't a state or federal law, but rather something mandated by their insurance company.

I'm going ahead with this surgeon for the bone graft in 3 weeks, I want to get it over with asap and I don't have the time to find someone new. Is there any reason why I would have to stay with him for the implant procedure 3-4 months from now? Once it's healed I'm free to chose someone else aren't I? Or am I obligated to stay with him from start to finish?

 

[comfortdentist]

You could change as anyone else could place the implant but if there is a problem with the quality of bone at time of placement who will deal with that issue. Best to stick with the one dentist as long as the problem is just logistical and not with how the dentist is actually treating you.

 

[sharon]

You could change as anyone else could place the implant but if there is a problem with the quality of bone at time of placement who will deal with that issue. Best to stick with the one dentist as long as the problem is just logistical and not with how the dentist is actually treating you.

Not really what I wanted to hear, but it does make sense. Now I have to decide if I should stay with this guy or start all over. I just want it to be over, so mad I still have two more weeks to go because they didn't tell me I can't take valium before signing their consent. They really should be taking something off of my total bill because of their goof up. But I might consider a sincere apology from the dentist and hearing him say they were wrong as enough compensation.