P v B & N (2020)
21 crowns placed over 2 days causing damage to the teeth, jaw/TMJ, neck, back, causing speech problems and psychological issues.
Out of Court settlement £265,000.00
I received instructions to act on behalf of Mrs P (hereafter referred to as the Claimant) in connection with negligent Dental treatment provided by two Defendants at the same practice based in Gloucestershire, one was a dentist- Mr B and the other was a dental technician- Mr N.
The Claimant attended the Defendant in order for him to provide two crowns, where implants had been inserted at UR2 and UL2.
The technician, Mr N, persuaded the Claimant that her bite was incorrect and that this needed to be treated first. The Claimant had no physical symptoms, and this had never been raised by any previous Dental Practitioner. She was advised that her lower jaw would need to be brought forwards before the two crowns could be fitted.
Subsequently, Mr N advised the Claimant that 21 crowns would need to be fitted though no letter of explanation, no treatment plan and no estimate of costs was ever provided in breach of GDC guidance.
The aforementioned was subsequently done over a two-day period, without any provisional crowns or check that good occlusion had been achieved. No warning of the possible adverse consequences of the treatment was ever given and, in no sense, could valid consent be said to have been obtained.
The Claimant experienced numerous post treatment problems with biting, chewing and speaking along with muscle aches and headaches. The aesthetics of the crowns were not of satisfactory quality and she was suffering with bleeding when cleaning her teeth.
The pain in the Claimant’s jaw and temples gradually got worse and two crowns fell out. The crowns were replaced, however the Claimant was advised that her jaw had moved forwards. The Defendants then shaved the Claimant’s remaining front teeth down in order to accommodate her upper teeth.
The Claimant was left with no bite at all and was left unable to talk properly. Her teeth protruded and she was left with ongoing pain and a clicking on her right side which was indicative of temporomandibular joint dysfunction (TMD)
The DDU represented the dentist Dr B. The technician Dr N’s indemnity situation was unclear but appeared to have personally instructed William Graham Law Solicitors in Cardiff for assistance.
Dental and medical records were obtained and a letter of claim drafted. The Letter of Claim contained a clear summary of the facts and the main allegations of negligence upon which the claim was based.
The Letter of Claim was served and the DDU acknowledged receipt of the same and requested copies of the Claimant’s medical records. Hempsons Solicitors were, thereafter, instructed on behalf of Dr B, the dentist.
Over 13 months elapsed since the Claimant’s Letter of Claim was served and, despite frequent chasers, the Defendant refuse to engage and provide a response to the full and comprehensive allegations of Breach of Duty and Causation pleaded within the Letter of Claim.
The Claimant helpfully kept a detailed chronology of her ongoing symptoms and treatments, and the same was utilised to prepare a detailed and comprehensive Witness Statement addressing Liability and Quantum in order to supplement the claim. Witness Statements were also obtained and prepared on behalf of both the Claimant’s partner and her daughter in support of the claim.
The Defendants, Mr B and Mr N, were in disagreement as to the correct apportionment to Liability. This was, in turn, affecting the progression of the Claimant’s claim and was causing the Claimant great distress.
Liability was subsequently denied by WGL -Mr N the technicians Solicitors on the basis that being a dental technician he was not responsible for the treatment.
As the Defendants refused to provide a decision in respect of Breach of Duty, the Claimant proceeded to conduct further investigations into Liability and sourced suitable experts to instruct to provide an opinion in this immensely complex case. A number of suitable experts in Restorative Dentistry were approached and a report was obtained.
The restorative consultant provided Reports addressing Liability and Causation and Condition & Prognosis.
In respect of Liability and Causation, the expert was fully supportive of the extensive allegations of Breach of Duty and Causation as pleaded within the Letter of Claim. With regards to Condition & Prognosis, the expert was of the opinion that the Claimant had suffered TMJ problems and that there was a 20% probability that the 16 teeth, which had been crowned, would need root canal treatment within 15 years.
A settlement offer was received from Hempsons Solicitors on behalf of Mr B. Following a conference with Counsel, it transpired that the Claimant had long term psychological issues, speech problems and chronic pain caused by her TMJ and occlusion following the placement of the 21 crowns. In the circumstances, the Claimant proceeded to source potential experts to advise upon chronic pain and psychological symptoms. A Psychologist was instructed and a depressive disorder with morbid symptoms of anxiety as a consequence of the treatment provided by the Defendant was diagnosed.
Furthermore, the expert opined that the Claimant also suffered with an adjustment disorder in relation to her altered body image.
It was necessary to obtain expert evidence from a suitable consultant in Pain Medicine in respect of Causation and Condition & Prognosis due to the Claimant’s ongoing oral pain. The consultant in pain medicine was of the view that the Claimant had developed chronic temporomandibular pain following the index event and that the Claimant’s pain symptoms and functional limitations were as a direct result of the dental treatment provided by the Defendant. The expert continued to advise that the Claimant was suffering from neck pain arising from constitutional cervical spondylosis, which may have been exacerbated by the dental treatment, and that an MRI scan would be required to establish causation in this regard.
Following a further conference with Counsel the Claimant’s expert endeavoured to update and finalise their reports and the Claimant proceeded to prepare Particulars of Claim and provisional Schedule of Loss.
The Claimant’s provided this provisional Schedule of Loss, together with a Part 36 offer in the sum of £318,831.00. In addition, the Defendant was asked to confirm, unambiguously, that the Claimant’s claim would be brought against the Dr B alone and that the Defendant would thereafter seek a contribution from Dr N. The Defendant eventually advised that they would not be assuming responsibility for the actions of Dr N.
The Claimant issued and served Proceedings. An Acknowledgement of Service was received and a 4-month extension was agreed for provision of the Defendant’s Defence – to enable them to further investigate matters.
Extensive and voluminous medical records were provided to the Defendant, and they proceeded to fail to deliver the Defence within the extended timeframe agreed. This necessitated a further Application on their part and further delayed the matter. The Claimant proceeded to file a detailed Witness Statement responding to the Defendant’s Application and seeking Default Judgement. The Court refused Default Judgement being entered and further extended the time for the Defendant to provide their Defence.
The Defendant proceeded to arrange for the Claimant to attend an examination with a Psychiatrist and a Pain Management Expert.
The parties discussed the merits of an early Joint Settlement Meeting and agreed for the same to take place.
A Defence was finally received from the Defendant more than 4 years post service of the Letter of Claim (no Letter of Response ever having been provided).
The RTM took place in Chambers, however, unfortunately, the parties were unable to reach any agreement as to settlement.
Following the round table meeting, the Defendant put forward a settlement offer which was not accepted by the Claimant.
Notice of proposed Allocation to the Multi-track was received and the parties proceeded to prepare Proposed Directions, Directions Questionnaires and Costs Budgets.
Further confirmation was sought from the Claimants Pain Management expert, as to the type of future Pain Management treatment the Claimant would required, together with an outline of the future costs involved.
Further comments and observations were sought from the Claimants restorative consultant addressing the Claimant’s Dental treatment plan.
A CCMC was listed at Telford County Court and costs budgets were approved.
The Claimant proceeded to prepare and file her list of documents for disclosure.
Steps were taken to finalise the Claimant’s detailed and comprehensive Witness Statement for service, together with the statement of her Partner and her daughter.
Prior to the service and exchange of Witness Statements, the Claimant, in one final attempt to settle the claim before incurring further additional costs, put forwards various Calderbank offers.
Extensive negotiations ensued between the parties with a compromise eventually being reached in the sum of £265,000.00