Dental Practice Heroes

Lessons from a Lawsuit w/ Dr. Taher Dhoon

• Dr. Paul Etchison, Dr. Taher Dhoon • Season 3 • Episode 71

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Every dentist dreads it: the day a case turns into a lawsuit. And often, it’s not the actual dentistry that gets you.

In this episode, Dr. Taher Dhoon gets candid about a worst-case scenario he’s facing in real time. He shares what mistakes opened the door to litigation, and the steps every dentist can take to avoid the same fate. You’ll learn best practices for case management, tools for documenting consent, and how to use the CANDOR process to resolve issues before they escalate.

Don’t wait for a lawsuit to test your systems — find out what to fix now!

Topics discussed in this episode:

  • The missteps that lead to a lawsuit
  • Why relationships and follow-ups matter
  • When and how to initiate the CANDOR process
  • Navigating the CANDOR process
  • How to protect yourself from litigation

Get more information on the Colorado Surgical Institute:
https://www.coloradosurgicalinstitute.com/

For Taher's Informed Consent Forms mentioned in the episode.  Click Here

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Paul Etchison:

No matter how good you are, some cases just don't go as planned, and when they don't, it can get messy fast. Today we got Dr Tahir Dune and he's going to help you prepare for what no one likes to talk about how to protect yourself, your patient and your practice for when that unexpected thing happens. You'll hear important lessons from a case that he's navigating right now and find out what steps you can take to prevent a complication from turning into a board complaint or, worse, a legal case. This is going to be one that you're not going to want to miss. Pay attention, take some notes. Let's get to it.

Paul Etchison:

You are listening to Dental Practice Heroes, where we help you create and scale your dental practice so that you are no longer tied to the chair. I'm Dr Paul Etcheson, author of two books on dental practice. So that you are no longer tied to the chair. I'm Dr Paul Etcheson, author of two books on dental practice management, dental coach and owner of a $6 million group practice in the suburbs of Chicago. I want to teach you how to grow and systematize your dental practice so you can spend less time practicing and more time enjoying a life that you love. Let's get started. Hey, how's it going today? Welcome back to the Dental Practice Heroes podcast. I am joined by one of my good friends, dr Tahir Dune. He is the founder and lead instructor at Colorado Surgical Institute Just a surgical genius, I like to call him. He's the person I text when I have problems and he's been on the podcast quite a few times. So welcome back to here. How's it going, man?

Taher Dhoon:

It's pretty good. I mean dentistry wise fucking crushing it. And then, from a home perspective, we had a washer just dump all this water on our second floor. No, and it came through the ceiling. I was in the living room and light water was dripping on my shoulder from one of the lights and I was like oh shit.

Paul Etchison:

I ran upstairs and it had dumped like I don't know 10 gallons or something upstairs, and so we had the floors torn up, and water is the worst Whenever it gets somewhere it doesn't belong.

Taher Dhoon:

Yeah, and over the past 14 years this is like my Achilles heel, I think I've had like six water incidences in all the houses I've lived in over 14 years, Like I've done everything wrong with water man Jeez, and maybe it's your diet, maybe you're doing something to the pipes. Dude, it's Indian food. I don't want to say it.

Paul Etchison:

I knew you didn't want to say it, but good old, yeah. So, dude, I love our topic today. We're going to talk about how to protect your practice. I think I read somewhere that in every dentist career we will either have at least one board complaint or one lawsuit. I don't know what the exact stat is I have still yet to experience mine, but damn, I've gotten really close a lot of times. But we're going to talk about protecting your practice against things like that, because nobody wants to go through things like that and if you've ever talked to anyone who has, even if they didn't settle or lose or just going through it, it's not fun, I'm going through it.

Taher Dhoon:

It's not fun. I'm going through it right now and it's all pretty fresh. I actually met the patient yesterday and so I'll kind of go through that story in a minute. Yeah, but if you do surgery and you do enough of really anything, that's maybe bigger cases crown and bridge cases, endo cases, especially surgical cases like wisdom teeth implants, full arch it's kind of a bound to happen type of thing. Lawyers are compensated 30 to 40% of the settlement and they get their fees covered also, and so the patients are just picked up. If the lawyer thinks that this is a good case, they'll just take the case to see if they can just drag out a hundred grand from you from a settlement or something like that.

Taher Dhoon:

So the case I'm going through right now we did a bilateral nerve reposition and in the consent form it talks about potential for a jaw fracture. You know I did a repair case. She had five implants. I had to remove four of the implants. You know, graft everything, rebuild it all, move the nerves, place new implants and she ended up fracturing the jaw behind one of the distal implants through the channel I made to move the IAM. You know the nerve and so it's a common complication. It was just a green stick fracture, which means it's just a crack in the mandible, but it's not like a full compound fracture where you know it's two separate pieces of bone. Nonetheless, sent her to an oral surgeon.

Taher Dhoon:

Mistake number one I made was I sent her to an oral surgeon that I didn't really have a good relationship with. I didn't even know the guy, I just heard good things about him, like hey, he really supports GPs doing surgeries. It's like okay, awesome. Like I don't refer a lot of surgery out, I refer a lot of perio, but I don't refer a lot of like all MFS, you know, like plating and things like that. So this guy didn't know me from anyone, had a good conversation and he did one surgery where he removed one implant and then plated the fracture. From that perspective I was like, okay, well, maybe he could have just monitored it. It's just a green stick, but at the same time who's to kind of quarterback his decision-making protocol?

Taher Dhoon:

But what he did after that is he didn't let me know. He ran a second surgery and he didn't contact me. He didn't ask for records I have 10 years of records on this patient and he ended up making a couple of mistakes because he made assumptions about the case and he removed all the implants, all the grafting, crippled her basically, and it's a shit show at this point. Like I had four really good implants in there, I could have moved forward with her case. We just had to, like you know, delay a couple of months and now she's in the denture and now she needs like subperiosteal implants and she's burnt out and she's not going to do anything. Yeah, and so it's really bad, right.

Taher Dhoon:

And so, at the end of the day, the areas where I wish I would have done this differently are A have good relationships with surgeons. In my area. If I'm being honest with myself, I haven't taken the time to reach out to a lot of people and say, hey, this is what I'm doing and these are the things I do on a common basis, and you know, like, hey, like, let's have a good relationship, and I think that's important to have, because now they assume I'm a GP who teaches GP surgery and I have a bad reputation because I have Colorado Surgical Institute and they don't actually know what we're all about. Number two is good communication with the patient. I handed out the patient, I had good communication, but then I kind of didn't follow up a lot.

Taher Dhoon:

I was like, okay, she's in good hands, all as well, so good follow-up is going to be important too. And then three is sending over the specialist. Even if they don't ask for a referral or any kind of documentation, send them everything. Send them your treatment plan, send them like a synopsis, tell them exactly what you plan on doing, because I had a really good game plan. I had like four different scenarios that I could have taken her based on how she healed, and he kind of screwed them all up and I can't do anything. Like my malpractice company said, you can't touch her anymore. Even if you wanted to, don't even do it. And me and her are close. I mean, we're not that close anymore, unfortunately, but we were very close.

Paul Etchison:

Why is that? What is the reason for the malpractice carrier telling you just did that you can't do her case ever again?

Taher Dhoon:

Because now I'm owning everything that the oral surgeon did by doing her case. Now I'm kind of absorbing all of that. So I can't, because I have to be able to say like I did not ask for, that, I don't agree with that treatment modality, that he went and did and so I can't treat her anymore. So they're just like refer away.

Paul Etchison:

It's such a bad situation because it's almost like not really the patient's fault, not really your fault. It's like a complication, but yet you center this place and it sucks. You know, going back to having a relationship with your specialist that you refer to like this is something that I've never personally I guess like intentionally did. But I have an oral surgeon that I can talk to. I've got an endodontist, I've got two orthodontists and I did develop those. But that was like right when I opened, you know how they always come into your office and like hey, we brought you cookies, let's do lunch. I'm like I want to do lunch with you, you don't want to do lunch with me. I'm not that interesting. How do you do this? Like you mentioned, you haven't been doing it and you haven't made much of effort. I mean, how would somebody go about doing this and how do you think you're going to do it?

Taher Dhoon:

I think the first step is is just kind of calling around to your friends who are GPs in the area and finding out like who's like a good person to approach and then just dropping them a line and saying, hey, you know, I'm trying to implement more surgery in my practice. What I think that's going to mean is it's going to mean I'm going to have more referrals to send because I'm going to understand. I understand more now and I understand more of what I want to do and also what I don't want to do. And if you're someone who I can send those things that I don't want to do to, that's great. And every once in a while, can I pick your brain? I'd love to just ask you questions from time to time, keep it very noncommittal, but at the same time you're telling them hey, I'm going to do some stuff and I'm going to be relying on you for mentorship, and then the relationship grows from there and and you'll find people who are really benevolent and love to teach and help, and even if they're specialists, they like to help GPs. And then you also have some people who actually just tell you who they are and they're like not interested. Man like you shouldn't be doing that and that's okay, right, and then you know who to stay away from. So that's step one is cultivating a good group. Step two is having a good group of people you can call right away, because when I saw the fracture in her x-ray, I called. I had like a whole text list of all the mentors who come and teach at Colorado Surgical so I texted them all and I had like three phone calls in five minutes. I had a group discussion on what to do while the patient was in the chair. So at the end of the day, it's really nice to have people you can rely on.

Taher Dhoon:

There's something called the candor process I want people to know about. So it's a new legal thing that came out where it's called candor, where if you think there's an adverse outcome that's occurred, you as the physician or doctor can initiate the candor process, meaning you contact malpractice and you say, hey, there was an adverse outcome, I want to get ahead of this. You have to initiate it before there's ever a demand made official demand made by the patient. Then what happens is you guys meet in some back room her lawyer, your lawyer and you guys get to talk through the process. Everything said in that room is not admissible in any court. Any board conversation, anything, and you can actually agree to a settlement value in that one discussion.

Taher Dhoon:

Malpractice pays it and nothing is reportable to the National Practitioner Data Bank. Nothing is reportable to your state board. Nothing is reportable at all. It's all just swept under the rug because you got ahead of the curve. So that's something that we tried to do in this situation. Unfortunately, the patient denied the Kandor process, but nonetheless it was illuminating for me to even find out that it existed as an option.

Paul Etchison:

We have complications all the time. Is this, when you're sensing this could litigate. I feel like doing endo, busting a file. I'm not going to be like, okay, we've got to Kandor. Now you know. I'm going to be like, hey, go to the endonist and see if they can get that out. I mean, most of the time it's still at 01 and I'm just going to operate right on top of it. But when is it time for us to start that process?

Taher Dhoon:

That's a tough question and because the thing is, you got to get ahead of it. So I would say more so than not. I think if you did something where you're like you know what I could have done better, I could have done this better and something happened, and even if it was consented, and even if you're dialed in or maybe hey, you got shitty notes or like oh fuck, like I didn't get a consent form on this and something bad happened, dude candor all day long. Get ahead of this thing, because the lawyers will chew you up in court if you don't have rock-solid consent forms.

Paul Etchison:

So this is when you think you could possibly go to court.

Taher Dhoon:

Correct, or if you're just like you know what I made a mistake. Right, I made a mistake. Let's just get ahead of this thing Like shit happens.

Paul Etchison:

Because I'm wondering, like with the cases where I've had some complications and like, hey, you know what? This is not how we intended it to go, but this is how it went. What do you want to do? I'm happy to redo it, I'm happy to give your money back. What do you think is fair? And sometimes they say, yeah, I just want my money back to go somewhere else and I go, okay, great.

Taher Dhoon:

Okay.

Paul Etchison:

I feel like I would prefer to do it that way rather than go and meet and have to do lunch with the patient and their attorney. Yeah, okay.

Taher Dhoon:

Awesome question. So okay, if you can give them back what they paid in your practice, you can have them sign a form that just says, hey, I won't sue you, you give them the money back, all as well. But if they ask for one penny more than what they paid you, that's when you would do candor, because if you do 1% more than what they paid, the practice it's viewed as a settlement, and if it's a settlement it has to be reportable, and then you have to disclose it. So at that point, that's when candor is going to come in play, when you think you need to potentially have more money going to this person than what they actually paid for business essentially.

Paul Etchison:

Wow, that's a good point to make. I think that's really helpful for a lot of people to hear. What else in this like, have you learned out of?

Taher Dhoon:

this situation. So we all know the progress notes like, do your notes? I had a couple of notes that I did a week later and the lawyers didn't really care one way or the other. Just don't do it like 10 months later, don't change records at all, have your consent form signed and dated and everything initialed on it. So thank God, I was like buttoned up on that and I had mine saying hey, there's the risk of fracture, and it was initialed and signed and everything was clean on my end for that. So that's one of the main reasons I'm not like overly concerned about this case.

Taher Dhoon:

And then, when it really comes down to it, what I've started doing on cases over maybe like 10 or 15,000, just depending on whatever your personal preferences is, you can do two things. You can get an AI transcription thing that just goes on the back of your phone and it just like transcribes both parties' conversation and you just go through the consent form and you talk about all the things and you ask them if they have any questions. I just do it old school. I just go on my phone into the voice memo thing and I just record it and I tell the patient hey, I'm going to record this consent form. It's a really long conversation. I just want to make sure we're both very clear about expectations on this one. Now, I'm not doing this when I meet the patient for the first time, I'm getting case acceptance the first time without scaring the shit out of them, and I'm kind of talking about benefits of the procedure. And then when they come back in for their pre-surgical records, then the second appointment is designated to scare them. But also it's like it's delivering the message with confidence and saying scary things with confidence. That actually is really. It really makes the patients feel at ease and they're in the right place.

Taher Dhoon:

Because you're someone who's just very comfortable with saying, hey, you draw my break and it's not going to happen, and it's happened once in my career and at the same time, like it's just something I want you to know about. It's my job to make sure you know these things, but also, it's not gonna happen, I don't think you need to worry about it. Okay, there's just an off chance that it occurs. So if you speak like that and you're always cognizant like hey, I'm recording this conversation, this is getting read back in a deposition. They're gonna play in a deposition. You know they're going to play this in court. I need this thing to be rock solid. Then you can have that empathetic conversation but talk about pros and cons of the surgery and also, while you're doing it, you have to talk about the alternative treatment options.

Taher Dhoon:

So I have a second case where the surgery was great. It was six implants in the maxilla over five implants on the mandible FP3, you're just regular all on four, all on X approach. But she came back to try to sue me because I didn't present the FP1. So the FP1, for those of you that don't know is that like three on six, it's like segmented bridges on individual implants type of deal. And because I didn't have it in my consent form that I didn't present all her options to her, she tried to have a case against me.

Taher Dhoon:

Now that was thrown out and it didn't really. But at the end of the day, we are hearing that if you don't present all the treatment options to patients and they're not informed of what their options are, that you could open yourself up. So it's one of those things, like you know with getting a tax audit. You know if you pay your kids it's not a bad thing, but if you pay your kids and have a home office and have your car deducted and deduct all your clothes, well then, the IRS is going to flag you. So it's like it just depends how many things add up when a lawyer looks at the case.

Paul Etchison:

And if you don't have an informed consent like signed, like even signed, like you're immediately dead. That's what I've heard that the informed consent won't save you, but if it's not there, you're dead.

Taher Dhoon:

Correct, correct. Yeah, I actually have this like. We did a presentation on this I think it was something where they looked at 52 cases and 40 out of 52 cases there was no written consent. So when they go back and look at this, you need a written consent. Verbal consent doesn't mean crap anymore. It's good to have verbal consent, but the video recording is rock solid and then having their signature and a dated rock solid and I would advise anyone to do that. In any case, where you think it's complex and you can re-remind them of like, hey, we did talk about this because it's not their job to remember everything. It's your job to explain it in a way that puts them at ease, where they don't want to sue you.

Paul Etchison:

You know, I've never recorded a treatment consent before and I think most docs listening are like, oh, I have to record it. Well, I'm not even doing it, my assistant just hands them a form and they sign it. But I would say there's nothing more vindicating than when a patient says we told them something on the phone and they make a big stink about it and we send them the phone recording where they said what we really said. Like, oh man, I must have misunderstood. Like yeah, that's what I was saying. It feels so good.

Taher Dhoon:

Yeah, it really does. It really does. And here's the thing like we are right more times than they are right, like this is what we do every single day. We say it every single day to the patients and they just don't remember, and it's really not their fault for not remembering.

Paul Etchison:

So going forward. What are you personally changing from going through this process?

Taher Dhoon:

So the recordings are getting done on every patient above $10,000 in my private practice. The consent forms I just rewrote for all of them. So there's a couple of like one-liners in the consent forms and I'm happy to share the consent forms with everyone. Is that I can just put that in the show notes or something like that?

Paul Etchison:

Paul, yeah, yeah, send me a link. I'll put it in the show notes.

Taher Dhoon:

So we have a lot of good consent forms with Colorado Surgical Institute, but I just redid the private practice ones as well. So we'll have like a couple of different ones you guys can pick from. Just remember change the name I had another doc having like me getting consented in another state. So change the names. Change all the logos, all that stuff. You guys are more than happy to have you have them. So update your consent form.

Taher Dhoon:

So a couple of one-liners in there that I have are I give doctor doing consent in the surgery to do additional procedures if needed, Because if they're sedated and you got to wake them up, then explain everything in a post-op, then reschedule another surgery to just fix the smallest thing in the world. Give me permission to do what I need to do according to my best judgment. I also put in there if they don't follow the rules, there are extra expenses associated with repairs and redoing the procedure at full cost, and they sign and initial that one too. So it's just like this whole thing, like I don't fix stuff for free. I'll fix it for free if I want to.

Taher Dhoon:

I'll fix it for free if you made all your post-op appointments and you did all the things you need to do, but it's my choice to do it for free and so those types of things just put my mind at ease because then I can be gracious and I can give people what I want to give them and help them. But I don't have to be like forced. I hate being forced to do something, and if a patient comes in with force and then I'm painted into a corner because I don't have documentation that's protecting me, it's the worst feeling in the world. You kind of feel like violated at that point.

Paul Etchison:

There's so many things we can do in the practice that we have patients sign, but there's no discussion about it, so it's irrelevant, it doesn't matter. We do the same thing on our treatment platforms and says this is just an estimate that most people have, this, you know, and we want the patient to sign it, but my team knows it's not. Hey, this initial, this it's. We're having a discussion. Do you understand that, mr Jones? Yes, I do, you know, and it makes it different if it ever comes out 100%.

Taher Dhoon:

And one thing I like to put on the treatment acceptance form where they sign on the treatment they're accepting, is a blurb at the bottom that says, for whatever reason, if you owe a small amount of money under $99 that we'll, as a courtesy to you, we'll just bill your credit card on file, so you don't have to have someone on payroll going to call them to collect $15 because insurance underpaid a little bit. I just charge the card. But I like having the signature on that and we put it in the treatment acceptance form.

Paul Etchison:

Yeah, we do the same thing as well with our financial policies, and that saves us a lot of time, but we still send them a statement saying we're going to charge it on this date, because occasionally we get someone that calls and says you can't do that. We say, well, where would you like to pay it with? It just works. So, tahir, talk about Colorado Surgical Institute and what you guys provide for dentists.

Taher Dhoon:

Yeah, so at a very high level. I mean you can come in and do live patient surgeries. We have a lot of videos and curriculums we send out. But lot of videos and curriculums we send out. But you can do wisdom teeth, single implants, lateral sinuses, full arch digital workflow. We have zygomas and pterygoids and all the crazy stuff in Brazil, so we really have a full, robust program. We even can train dental assistants to do phlebotomy and sticky bone and all that prep work and scanning. We have a program for hygienists on implant maintenance. So really anything that you need in this forum. When it comes to anything clinical, we're creating content and having live patient courses associated with those as well.

Paul Etchison:

Awesome dude. Thanks so much for coming on. Dr Tahir Doon from Colorado Surgical Institute, Go check out their website, coloradosurgicalinstitutecom.

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