Lost Crown. Septic Patient. Collapsed Lungs. $1.2 Million Med-Mal Settlement.

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The 72-year-old plaintiff underwent a crown procedure in May 2018. The dentist dropped the crown into the woman’s throat. The crown landed in her trachea – but the dentist believed the lost crown fell into her esophagus. To work its way through the digestive tract, ending you know where. An x-ray would have ended the mystery. The dentist did not order an x-ray, and instead recommended his patient drink water and eat some crackers. Plan B.

Time passed. The patient developed respiratory problems and sought care at a local hospital. The hospital performed a CT scan, which detected the presence of a foreign object in the patient’s lungs. Can you guess what it was?

Here’s where the plot thickens: The radiologists mentioned the foreign object in their report, but this detail was missing in the summary and introductory paragraphs.

The doctor who ordered the CT scan (and received the report) never learned a foreign object was in the patient’s lung. And the radiologists made no additional efforts to bring this detail to his attention.

Uh-oh.

Let’s advance to September 2018. Five months have passed. The patient/plaintiff is now in the ER. She’s septic. Both lungs collapsed. The crown was eventually identified and removed at a different hospital. The advanced nature of the patient’s infection kept her in the hospital for several weeks. The patient eventually recovered after a month of intense in-patient rehabilitation.

So, who got sued? The dentist? His practice? The hospital?

All the above.

The patient claimed the dentist acted beneath the standard of care by neglecting to use a dental guard when placing her crown. The fact the dentist did not order x-rays after he dropped the crown injured his defense. As to why the patient failed to cough out anything in the trachea is a mystery. Perhaps she was sedated.

The claims recently settled.

The hospital settled for $675,000.

The dentist for $550,000.

Thus the $1.225 million headline.

The plaintiff’s attorneys stated:

“We were able to show through the depositions of those two radiologists that their improper documentation of the dental fragment, coupled with their failure to report their finding directly to our client’s attending physician—known as non-routine communication—was a significant deviation from the acceptable standard of care.”

The take-home-points: If you lose an object in the patient’s body, you must take ownership of tracking said object down. The dentist assumed the crown landed in the patient’s stomach. If it did, the object would likely pass through the patient’s system within a few days.

But if the crown landed in the patient’s lungs (an object dropped into the throat can only travel one of two roads), it will turn into a problem – potentially a life-threatening problem.

An x-ray could have identified the location of the crown and expedited its removal.

Though we can’t be certain, it is possible this simply wasn’t a conversation the dentist wanted to have with the patient. The crown probably landed in the patient’s stomach. Why create anxiety (or risk a malpractice claim) if the object didn’t make its way into the patient’s lungs?

Would you bet your license on a coin flip?

Let us know your thoughts in the comments below.

“Can Medical Justice solve my problem?” Click here to review recent consultations…

all. Here’s a sample of typical recent consultation discussions…

Former employee stole patient list. Now a competitor…
Patient suing doctor in small claims court…
Just received board complaint…
Allegations of sexual harassment by employee…
Patient filed police complaint doctor inappropriately touched her…
DEA showed up to my office…
Patient “extorting” me. “Pay me or I’ll slam you online.”
My carrier wants me to settle. My case is fully defensible…
My patient is demanding an unwarranted refund…
How do I safely terminate doctor-patient relationship?
How to avoid reporting to Data Bank…
I want my day in court. But don’t want to risk my nest egg…
Hospital wants to fire me…
Sham peer review inappropriately limiting privileges…
Can I safely use stem cells in my practice?
Patient’s results are not what was expected…
Just received request for medical records from an attorney…
Just received notice of intent to sue…
Just received summons for meritless case…
Safely responding to negative online reviews…

We challenge you to supply us with a medico-legal obstacle we haven’t seen before. Know you are in good hands. Schedule your consultation below – or click here to visit our booking page.

Jeffrey Segal, MD, JD

Chief Executive Officer and Founder

Dr. Jeffrey Segal, Chief Executive Officer and Founder of Medical Justice, is a board-certified neurosurgeon. Dr. Segal is a Fellow of the American College of Surgeons; the American College of Legal Medicine; and the American Association of Neurological Surgeons. He is also a member of the North American Spine Society. In the process of conceiving, funding, developing, and growing Medical Justice, Dr. Segal has established himself as one of the country’s leading authorities on medical malpractice issues, counterclaims, and internet-based assaults on reputation. Dr. Segal was a practicing neurosurgeon for approximately ten years, during which time he also played an active role as a participant on various state-sanctioned medical review panels designed to decrease the incidence of meritless medical malpractice cases. Dr. Segal holds a M.D. from Baylor College of Medicine, where he also completed a neurosurgical residency. Dr. Segal served as a Spinal Surgery Fellow at The University of South Florida Medical School. He is a member of Phi Beta Kappa as well as the AOA Medical Honor Society. Dr. Segal received his B.A. from the University of Texas and graduated with a J.D. from Concord Law School with highest honors. In 2000, he co-founded and served as CEO of DarPharma, Inc, a biotechnology company in Chapel Hill, NC, focused on the discovery and development of first-of-class pharmaceuticals for neuropsychiatric disorders. Dr. Segal is also a partner at Byrd Adatto, a national business and health care law firm. Byrd Adatto was selected as a Best Law Firm in the 2021 edition of the “Best Law Firms” list by U.S. News – Best Lawyers. With decades of combined experience in serving doctors, dentists, and other providers, Byrd Adatto has a national pedigree to address most legal issues that arise in the business and practice of medicine.

Having recently had a crown placed, I cannot remember a guard being placed to catch a crown if it was dropped. I could not see it. But I was pretty fully reclined which would have somewhat protected the airway if something dropped in the posterior pharynx. If it was swallowed at that point, then, it should have gone down the esophagus. The reason that the patient did not cough was more likely due to the local anesthetic injected, and some tracking of that anesthetic, rather than sedation. It would be unusual for sedation to be used for a crown placement. Beyond that, if a crown was being placed and was lost, that crown had to be custom molded and manufactured for the patient. So if the crown was being placed and was lost, what did the dentist do to fill in that huge gap in the tooth once it is drilled down to prepare for the crown placement? Did the dentist just fill this in with composite? Did the dentist’s staff not know? What did the dentist tell the staff. Cardinal rule here, is if you make a mistake, own it and fix it and tell the patient. The radiologists often seem loathe to call up and report abnormal findings, which is below the standard of care, and they should specifically and carefully put that into their report diagnoses, summary. Early treatment would have been curative with a bronchoscopy, and foreign body removal.
Decades ago, I had a patient in his 70s, that was an engineer and had created a bridge that could have teeth added to it, as he lost additional teeth. He told me about that preop. One of the teeth popped loose during intubation, with just a light touch of the endotracheal tube, but the tooth was dead, and had just been sitting in the gum…there was no bleeding from the gum. There was no root to the tooth. We retrieved the tooth, gave it to the patient, and apologized to him. We offered to pay for the new tooth that was going to go into the bridge, but he refused. He came back for several additional anesthetics and teased us about the loss of his tooth. Chewing gum or biting into an apple would have removed the tooth outside of the operating room. It is unknown why his dentist had not removed the dead tooth as it was a constant aspiration hazard. Clearly the tooth had been long dead.

2 thoughts on “Lost Crown. Septic Patient. Collapsed Lungs. $1.2 Million Med-Mal Settlement.”

retired

February 18, 2022 at 11:19 pm

Having recently had a crown placed, I cannot remember a guard being placed to catch a crown if it was dropped. I could not see it. But I was pretty fully reclined which would have somewhat protected the airway if something dropped in the posterior pharynx. If it was swallowed at that point, then, it should have gone down the esophagus. The reason that the patient did not cough was more likely due to the local anesthetic injected, and some tracking of that anesthetic, rather than sedation. It would be unusual for sedation to be used for a crown placement. Beyond that, if a crown was being placed and was lost, that crown had to be custom molded and manufactured for the patient. So if the crown was being placed and was lost, what did the dentist do to fill in that huge gap in the tooth once it is drilled down to prepare for the crown placement? Did the dentist just fill this in with composite? Did the dentist’s staff not know? What did the dentist tell the staff. Cardinal rule here, is if you make a mistake, own it and fix it and tell the patient. The radiologists often seem loathe to call up and report abnormal findings, which is below the standard of care, and they should specifically and carefully put that into their report diagnoses, summary. Early treatment would have been curative with a bronchoscopy, and foreign body removal.
Decades ago, I had a patient in his 70s, that was an engineer and had created a bridge that could have teeth added to it, as he lost additional teeth. He told me about that preop. One of the teeth popped loose during intubation, with just a light touch of the endotracheal tube, but the tooth was dead, and had just been sitting in the gum…there was no bleeding from the gum. There was no root to the tooth. We retrieved the tooth, gave it to the patient, and apologized to him. We offered to pay for the new tooth that was going to go into the bridge, but he refused. He came back for several additional anesthetics and teased us about the loss of his tooth. Chewing gum or biting into an apple would have removed the tooth outside of the operating room. It is unknown why his dentist had not removed the dead tooth as it was a constant aspiration hazard. Clearly the tooth had been long dead.
Kaz Zymantas

February 19, 2022 at 12:32 pm

There is no standard of care to place a dental guard. Not quite sure what a dental guard is. Probably some sort of rubber dam or cotton gauze. That is not routine to place a rubber dam or gauze in the back of the throat on a non sedated patient. This sounds like it was a molar crown and most patients could not handle having gauze placed in their throat unless sedated. The big error occurred when the dentist did not send the patient immediately to the hospital or radiation center to get a chest and abdominal x-ray. The dentist may have just stuck his head in the sand believing all will be good in the end.

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