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Dental negligence cases: what is causation and why does it matter?

My role within the Dental Negligence Team is to advise people making new enquiries about pursuing a potential clinical negligence claim. I listen to the accounts of those who have experienced poor treatment at the hands of dental professionals and then advise them if we are able to assist them further in pursuing a claim for compensation. In a perfect world we would be able to assist everyone who has been on the receiving end of such treatment but this is not the case. One of the hardest parts of my job is delivering the news when we are unable to assist with a claim. For many people this is hard news to bear, particularly as they may not always be able to understand why we have come to this conclusion, which can be for a variety of reasons.

What do you need to prove to make a clinical negligence claim?

There is essentially a two stage ‘test’ to establish to succeed with a clinical negligence claim:

The first part is fairly obvious – the treatment, or lack thereof, that a person has received needs to have fallen below an acceptable standard, so as to be considered negligent. The standard is judged against the standard of a reasonably competent practitioner, practicing in the relevant field at the relevant time.   It can sometimes be the case that there has already been an admission to the patient that there were failings in their treatment, or we will rely on independent experts to advise us on whether the treatment fell below an acceptable standard.

The second stage, which can be more complex, is the issue of ‘causation’. Causation is the concept that the negligence has to have caused an injury or adversely altered the outcome for a patient. If this cannot be shown, then the claim will not be able to succeed, even where it is established that there was negligent treatment. Naturally many people often focus on the treatment they have received and the fact that they feel they have been wronged rather than the impact that this treatment has had.

To put it simply, the question we need to ask is “Has the negligence made a difference?”
It can sometimes be the case that medical science simply cannot say whether or not negligence has caused a specific injury or worse outcome, or if it would have occurred in any event. In such cases, the law allows consideration of an alternative argument that the negligence made a material (more than negligible) contribution to the injury.  In those circumstances then a claim can succeed where the negligence has materially contributed to the cause of the injury.

Examples of difficulties with establishing ‘causation’

The most usual example of this is where there has been a risk of injury to a person as a result of negligence, but they were lucky enough to escape unscathed. For example, a patient undergoing orthodontic treatment wears their braces for an overly long period of time at the fault of their orthodontist; but thankfully their teeth are not affected by this and they suffer no adverse effects.

Yes, the treatment in terms of the orthodontic planning is wrong and likely to be negligent, but what harm has been caused? There is no injury for which the person could be compensated. The law only allows for compensation where there is an injury, not simply a risk of injury or near miss.

Our advice

The law surrounding negligent dental treatment is undeniably complex and can seem overwhelming at first glance. I and my colleagues always recommend seeking legal advice, even if you are unsure whether you can demonstrate the care you received was negligent or has caused you avoidable harm.  We provide preliminary advice based on our experience as to whether a case is likely to succeed and so should be pursued.  If we are unable to assist, for whatever reasons, we may be able to offer advice as to alternative options available, such as making a formal complaint to the treatment provider.

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