Vicarious liability in private and public dental clinics

Abstract

A 25 year-old patient attended the clinic to have four teeth extracted under conscious sedation. Following a thorough examination and medical history it was found that she had a heart murmur. The dentist prescribed an antibiotic to be taken one hour prior to the dental treatment. The patient reported that she was allergic to penicillin and this was confirmed on her medical history chart. Consequently, a prescription was given for a 3g sachet of erythromycin as an oral suspension. The following day, the patient went to the pharmacy to obtain her medication, but was informed that they only had amoxycillin available in 3g sachets. The pharmacist telephoned the dental clinic to request permission from the dentist to change the prescription to amoxycillin, and as the dentist was unavailable, a staff member gave him the permission to issue the amoxycillin. When the patient came to collect the prescription she was not informed that it had been changed and assumed that her prescription did not contain penicillin. Subsequently, the patient attended for dental treatment carried out and informed the dental assistant that after taking her antibiotic she was feeling unwell. Treatment was to be carried out under sedation and the anaesthetist, realising that the patient was allergic to penicillin and had taken amoxycillin, administered antihistamine. No treatment was carried out at that appointment and the patient was discharged home by the anaesthetist when he felt that she was well enough and in no medical danger. However, when the patient returned home, she became unwell, suffered a fall and sustained an injury to her right hand. The dentist admitted that there had been a lack of communication between the dental surgery and the pharmacy and that as a result, amoxycillin had been prescribed despite the fact that the patient was allergic to it. Unfortunately the pharmacist was unable to identify the member of staff to whom he had spoken and who had given him permission to change the prescription.