Medical Forum / General / Dentistry / August 2006
should I sue the dental clinic
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mdk - 25 Jul 2006 00:31 GMT Hi experts,
In a dental clinic I had root canal and porcelain crown done for my upper molar. At the time of the first examination, they found there was a big cavity in the molar but said it could be saved. Unfortunately the doctor forgot to remove the cement the crown was done and some time later I felt great pain in my gum and went to them. It proved that it was because the forgotten cement was pointing into my gum, which caused the pain. They tried to remove the cement, but unavoidably damaged the crown (otherwise the cement couldn't be removed since it is so hard and hidden inside) . They did a new crown on it free of charge. After about 6 months, the corner crown was broken and I went to them to check, it was the crown they redid last time. When the doctor was about the did another crown for that tooth (would be the 3rd crown) a problem is found: there is a big fracture in my tooth and it is not worth to do anything on that anymore because it couldn't be save any more. Now the money of some one and half thousand spent on it for root canal and crown was wasted and i lost the tooth forever. I had to remove the tooth.
While I had the crown on I took great care to avoid chewing/biting hard thing with that tooth. I think the fracture happened right in the tooth on which the crown was redone, such was not a coincident. It is because they stress the tooth and take off more from my tooth the second time they did the crown my tooth became fragile and easier to break.
I want to sue them for their own mistake causing me to lose a tooth. If so how can i start off, the x-rays are all in their hands.
Timmy
Steven Bornfeld - 25 Jul 2006 03:11 GMT > Hi experts, > [quoted text clipped - 26 lines] > > Timmy Besides the fact that this is a relatively small case which is unlikely to be taken by a lawyer on a contingency basis, there is the issue of how you demonstrate that treatment was negligent. Given that fractures are often difficult to detect and may have been present in the first place, what evidence do you have that your treatment was negligent, other than the fact that you lost the tooth?
Steve
Alexander Vasserman DDS - 25 Jul 2006 07:09 GMT mdk
I agree with Steven. This is a very gray area which you will not get anywhere with and it will waste a lot of time. Unfortunately losing 1 tooth is not the end of the world and it could be very easily replaced say with an implant. You are going to find it hard even if you win the cost of an implant from this dentist or his/her malpractice insurance to split the reimbursement with the lawyer and still replace your tooth. From your story it is clear to me that something is causing porcelain fractures and fractures of your own tooth to the point that it is unrestorable. Your best bet is to approach the dentist on a friendly note and ask to relace the crown again provided you paid for the implant. Perhaps he is willing to put in his labour to make you happy and perhaps if you are nice about it he can persuade the lab that made your previous 2 crowns to make you a new one since the porcelain did not hold up to your bite and could have been made too high. I think this is a reasonable request and you may be surprised that this dentist may agree to this. I understand that you invested in a root canal build-up and extraction of this tooth and it seems to you why you should have to spend more $$$ on an implant. I can tell you there are people who spend $$$ on a build-up and crown and after they get the crown glued in their tooth abscesses and they need another root canal build-up and the crown replaced. So they are paying twice for the same crown because no one could forsee that the tooth would abscess. There are others that get a root canal done to find out the root canal is not successful and after repeated attempts at redoing the root canal and crown they end up losing the tooth and end up in the same boat as you needind an implant/abutment and new crown. Your situation is not that uncommon in the industry and because of this you will find it hard to prove your case is unrelated to the way your bite is naturally. Remember there was a reason why this tooth needed a crown in the first place AND THIS IS nobody's fault. You will get more with sugar and good relationship than with a lawsuit for a 2-3.5K dollars which you will have to split with the lawyer who may not even take your case. And even if you could find a laywer to help you with this, by the time you get your $$$ more damage will occur in your mouth. The fact that this dentist replaced the crown in the first place after the cement tell everyone that he/she has a concience and that is a good thing when things like this happen.
> > Hi experts, > > [quoted text clipped - 35 lines] > > Steve Tex - 25 Jul 2006 10:00 GMT >> I want to sue them for their own mistake causing me to lose a tooth. If >> so how can i start off, the x-rays are all in their hands. >> >> Timmy You can start off by bending over and kissing your a.s good-bye! Ha ha! Then you can make a decision to kiss your teeth good-bye or kiss your money good-bye.
Or you can get a lawyer and then you can kiss it all good-bye!
Even though it seems like the deck is stacked ....it really is! Your best bet is to do like others suggest....kiss the Dentist's a.s and hopefully they'll cut you a break and maybe you'll wind up saving a few bucks and actually wind up being a poorer but success story.
jd023456 - 26 Jul 2006 01:40 GMT Sue the Son of a Bitch!!! Get a lawyer that works on a contingency fee basis if you can and GO FOR THE f.cking JUGULAR!!! These a.sholes understand only 1 thing-$$$$$-so HIT them where it hurts them the most-in the wallet! At least make a phone call or two-what would it hurt? Of course asking a newsgroup that consists of a lot of dentists is like asking the fox to leave the chickens alone with the door open and no guard!
> >> I want to sue them for their own mistake causing me to lose a tooth. If > >> so how can i start off, the x-rays are all in their hands. [quoted text clipped - 11 lines] > hopefully they'll cut you a break and maybe you'll wind up saving a > few bucks and actually wind up being a poorer but success story. Alexander Vasserman DDS - 26 Jul 2006 04:32 GMT jd023456
to fix this problem from scratch it will cost no more than $4000K Show me the $$$$$ in this case and please explain how it is going to hurt. What are you going to do sue because you are missing a tooth and as a result your wife won't have sex with you and it is causing undue stress. Get real. Again good luck finding a lawyer on contingency for 1/3 of $4000.00. and guess what he will still have to come up with the third to fix the problem and by the time the trial is over the cost to repair this missing tooth is going to go up. If people are going to engage in these frivulous lawsuits, the malpractice insurance rates will go up (just give an insurance company an excuse to raise their rates, they are worse than the oil companies) resulting in higher fees for everyone so that people like you can bitch more.
> Sue the Son of a Bitch!!! Get a lawyer that works on a contingency fee > basis if you can and GO FOR THE f.cking JUGULAR!!! These a.sholes [quoted text clipped - 19 lines] > > hopefully they'll cut you a break and maybe you'll wind up saving a > > few bucks and actually wind up being a poorer but success story. Tex - 26 Jul 2006 09:39 GMT >to fix this problem from scratch it will cost no more than $4000K >Show me the $$$$$ in this case and please explain how it is going to [quoted text clipped - 9 lines] >rates, they are worse than the oil companies) resulting in higher fees >for everyone so that people like you can bitch more. It the arrogance you have by having people by the balls is what is disgusting. Cracks like the start of the 2nd paragraph should be reason enough to make people consider biting off their nose to spite their faces so to speak.
The really interesting thing is even if he sues there will be someone that will take his money down the road to fix the problem. It's not the high fees nor the malpractice or malpractice insurance that rubs people the wrong way....It's the you need this and I can do this no problem as long as you put the $$$ up front....then when you can't do this or this goes a tad south it's the ...opps put some more $$$ up and we can get this all fixed up.
Funny how all the blame gets put back on the people who might get a little satisfaction from bitching a little...they already forked their money over and you want to blame them after they have already been screwed...
In my other post my point was not to sue....what the hell why get screwed a second time by another party....but if you said something to me like the start of the 2nd paragraph I'd sue your a.s even if it wasn't on a contigency basis and I had to borrow the money to do it. Of course you would never say this to somebody outside of a newsgroup or unless it was down at the club amongst your peers.
Tony Bad - 26 Jul 2006 19:02 GMT > It the arrogance you have by having people by the balls is what is > disgusting. Cracks like the start of the 2nd paragraph should be [quoted text clipped - 20 lines] > Of course you would never say this to somebody outside of a newsgroup > or unless it was down at the club amongst your peers. The comment that offended you was made because such claims are commonly made when people file dental malpractice claims. There are certainly instances where such cases are merited, but often, in an attempt to pad the case and make it worth their while, attorneys will include some odd damage or pain and suffering claims. Loss of sexual consort is a common one.
If comments like that disgust you, you should vent at an attorney, not a dentist. The poster who made the comment was trying to illustrate how absurd a law suit could get if a contingency type attorney was involved
T
Tex - 26 Jul 2006 23:40 GMT >> It the arrogance you have by having people by the balls is what is >> disgusting. Cracks like the start of the 2nd paragraph should be [quoted text clipped - 32 lines] > >T My line to begin with was to not sue...as then you'd just be getting screwed twice.
No, I didn't read it so much as laying it off on the attorney...as much as I did go ahead sue...who cares...it's just going to cost you either way and we will get your money one way or another. Fee's will just go up if we lose was the theme I read.
I didn't say I was offended either....I said I was disgusted by the attitude of 'some' dentists in regards to here we will try this and if it doesn't work we will try this ...as long as you cough up the dough each time. Without putting it onto the table that 'try' is the operative word and not do. And making it clear the fee only covers the attempt and can have little to do with the results.
Personally I've had a few rips by dentists and lately I have had good experiences with my last two. I say two because the one I had underwent back surgery and cut his practice back...the one he suggested I continue with is working out quite well too.
With both of them it has been a two way street....I'm up front with them and they are up front with me. No real surprises. They present me with options and I get to make the decisions. I had one tooth in bad shape....My options were root canal or extraction...when I leaned towards extraction he said, How about I attemt to fix it and if I go too deep then it really does have to be extraction or root canal...I said ok....he said he was lucky but he managed to fix it....no rc & no extraction...I have the tooth 12 years later and paid for a filling.
On another one I said extraction....he wanted to go root canal...we stuck with extraction and when he got the tooth out he said he was glad we went that way because a root canal wouldn't have worked.
Another one I yelled ( :) ) extraction and he was so sure he could successfully root canal it he told me that if I would allow the RC I would only have to pay if it worked....if it didn't then just pay for the extraction....the fellow he sent me to when he cut back his patient load operates the same way.
Previously I went to one and was talked into some filling in front....paid upfront and had it done....Then when I had a problem with a tooth I had to go dentist hunting because he had retired...the new fellow (the 1st one above) took care of my problem of the moment and meanwhile suggested I get all the temporary filling redone permanently! I almost jumped out of the chair...Temporary fillings?
He said yes, and was the reason for the color changes taking place...That's when he offered to do them and if I wasn't happy he wouldn't charge me anything....
So no I'm not against dentists as a whole and I'm not sue happy either...nor do I expect miracles where they aren't possible...and admit I have some responsibility in the process too (I'm not the best at preventive & following up) ...I just want a fair shake for my buck and am willing to pay the freight for results and if it's going to be an iffy deal I want to know up front...so I can decide if the risk matches my pocket book.
Alexander Vasserman DDS - 27 Jul 2006 00:50 GMT The really interesting thing is even if he sues there will be someone that will take his money down the road to fix the problem. It's not the high fees nor the malpractice or malpractice insurance that rubs people the wrong way....It's the you need this and I can do this no problem as long as you put the $$$ up front....then when you can't do this or this goes a tad south it's the ...opps put some more $$$ up and we can get this all fixed up
I don't tell my patients what they need. I approach the patient from a paradigm "you do not need anything" after all people do not need teeth to live successful happy and productive lives. The patient approaches me with a problem and I simply offer a solution or two, the decision to proceed with one solution or another or to go to someone else who can provide other solutions is up to the patient. I do not scream anything or twist anyone's arm to sit in my chair. Obviously some solutions may be better for that particular individual and and it is always up to the patient to decide what is best for them. It may be difficult for you to understand how that works because you are used to having doctors tell you what you need. I have no idea why you are so bitter about dentists I can't think of anyone who would purposefully want to run a business dealing with services in such a way as to create unhappy customers. Our business relies on referrals 100% and if we have unhappy patients we won't be in business for very long. So please show me the $$$$$ you are talking about.
> >to fix this problem from scratch it will cost no more than $4000K > >Show me the $$$$$ in this case and please explain how it is going to [quoted text clipped - 34 lines] > Of course you would never say this to somebody outside of a newsgroup > or unless it was down at the club amongst your peers. Tex - 27 Jul 2006 02:50 GMT >It may be difficult for you to >understand how that works because you are used to having doctors tell >you what you need. I have no idea why you are so bitter about dentists I'm not bitter about or towards dentists as a whole...been a couple I wouldn't piss on if the were on fire I will admit.
How do you know what I'm used to or not....you make a bunch of assumptions as well evidently like to talk down to people.
Alexander Vasserman DDS - 27 Jul 2006 22:33 GMT Not sure what assumptions you are talking about. When I made the decision to go into dentistry, I thought I can make the experience better for people. I thought that I can open people's understanding of the field and not make it such a terrifying place. I thought I could make critics like yourself rethink everything after all now we would have one of our own an inside man in the profession. It becomes very hard to do this when you encounter people that have negative views about the profession and just because you graduated and went into the field you are made to feel responsible for everything that was done wrong in the past. Oh well no matter how muh you try you can't please everyone.
> >It may be difficult for you to > >understand how that works because you are used to having doctors tell [quoted text clipped - 5 lines] > How do you know what I'm used to or not....you make a bunch of > assumptions as well evidently like to talk down to people. Tex - 28 Jul 2006 03:08 GMT >Not sure what assumptions you are talking about. >When I made the decision to go into dentistry, I thought I can make the [quoted text clipped - 7 lines] >that was done wrong in the past. Oh well no matter how muh you try you >can't please everyone. Well off hand your assumption I'm bitter towards dentists...I said I have run into a few I didn't care for and I had a post about a couple I'm quite satisfied with (no response on that one).
Critic's like myself....come now. I just said dentists that are rips are rips...those that aren't aren't.
I no more have negative views about dentists or the profession than I do about washing machine repairmen....if they as individuals rip me off I'm not too happy with either.
Maybe if you are getting those feelings of being responsibile for everything done in the past...you could give up one of those afternoon golf sessions and get a little couch time in...even without insurance you could afford it.
Maybe I'm not the sharpest knife in the drawer...still I think the patient, client, sucker, or whatever should take responsibility and the doctor, quack, dentist or whatever should take responsibility...if I as the patient don't follow instructions or suggestions then I shouldn't complain if things go haywire on the other hand if you as the doctor make a mistake or try something that in all likely hood hasn't much chance of success without being upfront about it then you should eat it instead of just passing it off as oh well...for a few more $$$ we will get it all straightened out.
You don't have to please me or even work miracles....just give me a fair shake for my buck and the truth even if it's not what I want to hear.
I don't think suing is the answer to miracles not being performed...on the otherhand malpractice insurance wouldn't exist unless of course there is such a thing as malpractice...I mean why would you shell out the bucks for it? Hopefully for the reasons I have fire insurance...a fire could happen...not so I can burn the house down and not worry about it.
Alexander Vasserman DDS - 29 Jul 2006 07:50 GMT In the dental industry there is no requirement to maintain malpractice insurance. When I was in Dental School I ran into 2 attorneys that were trying to get in as patients and they were talking about dental malpractice insurance, they said they could not understand why dentist maintain malpractice insurance. They said that if a dentist did not maintain this insurance no attorney would take the case even if it was not on contingency basis since the practice could be operating as a corporation which is renting all the equipment and deducting the payments as an expense thus transfering income to the dentist while sheltering liability. An even if a case was filed the corporation could be dissolved and a new one formed the next day. The reason dentists want to maintain malpractice insurance is for the benefit of a patient that gets severly disabled. Although in real world malpractice seems to bring in bad air between parties and destroys the dentist patient relationship instead of strengthening rapport and understanding that even dentists are infalable and can make mistakes. I believe communication is key in these situations and can eliminate these law suits.
> >Not sure what assumptions you are talking about. > >When I made the decision to go into dentistry, I thought I can make the [quoted text clipped - 44 lines] > fire could happen...not so I can burn the house down and not worry > about it. Tex - 29 Jul 2006 10:18 GMT >In the dental industry there is no requirement to maintain malpractice >insurance. When I was in Dental School I ran into 2 attorneys that were [quoted text clipped - 14 lines] >I believe communication is key in these situations and can eliminate >these law suits. I did a google and read all your posts from 2004. I can see the comment about the wife not having sex because ya lost a tooth is probably your wry way of making a point.
I also picked up on the fact if one doesn't have letters after their name and those should have something to do with being a dentist you aren't too concerned with discussion....it's a dentisty ng so I can live with that.
Here's something I read in one of your past posts:
"You want to make sure the dentist you go to is honest, has the guts to admit to a mistake, and if a mistake was made is willing to correct it."
Now that I can live with also and in fact was my whole point from the patient side of the deal...ya know the one with no letters behind their name.
Another thing I read from a past post of yours:
"When I was an associate, I constantly had to change treatment plans because the managing dentist or owner would overdiagnose. The owners did not like that but I did not care the patient always came first. We were doing concious sedation with dental assistants who were not trained, it was a nightmare. The worst is that some of these places had these charts where they give you very little space to write to cover your a.s. This was one of the reasons why I opened my own practice and left the associate scene."
This being the case I can applaud you. On the other side of the coin from reading enough posts and going to your website I can see you would never be my dentist (I couldn't afford you) and I wouldn't be your patient (You wouldn't want someone who can't afford you and one who is a smoker such as myself...not to mention my situation (a large part by choice I admit) has been to have a dental plan which is usually based on pain...I have pain I seek my dentist out and come up with the $$$ even if I have to borrow it).
Now having said that I will add most likely I would wind up at a place you describe you worked as an associate....and even there I would make the final decisions and not as you said previously do just what I was told. Though from what you write about your experience and some us unlettered patients share or know...at times there will be mistakes made and they won't all be the patients fault...and in those instances bitch is about all we will wind up with because one they will stick together and two like you say even if we sue and even if we win we will most likely come out on the short end of the stick...thus one of the reason I said don't sue....just kiss your a.s good-bye or kiss the dentists a.s and hope for the best...or the realistic option of moving on and finding one to correct the mistake and if it's his mistake can admit it.
Personally I have been fortunate in the sense I'm not in the big city and locally it's easier to get an idea going in who you are dealing with....People are known even outside their professional settings..in my case I went to school with the 1st one I talked about in another post...and the 2nd one was his recommendation along with some local knowledge from other sources. The 1st dentist knew my $$$ situation and knew my lack of being an ideal patient as far as plans & prevention...he explained this to the 2nd dentist and got his ok before he recommended me....So went in not totally in the dark and the dentist wasn't totally in the dark...so far it has worked out ok.
If I win the lotto I might make the call or take the ride over the hill and let you make me beautiful....of course I'll hold back I was the one that had the exchange with you on sci.med.dentisty...:)
Alexander Vasserman DDS - 30 Jul 2006 06:10 GMT Tex
I have to applaud you for doing all that research on me. Personally I would not have the time or patience. I am confused why you think I'm against smokers, I see them all the time and I if they never hear the lecture about smoking I give it to them only once and those that have heard this lecture which is the majority of smokers, I understand them and try to work with them. As far as me being affordable, I am definetly not cheap and I am not the most expensive dentist in the neigbourhood. At the same time the difference between what you consider being affordable and expensive goes towards the best lab technicians, newest restorations and top of the line materials used in the office. It's not cheap to be on top of technology and constantly taking continuing education classes to keep up with everything. If you did a survey of procedured done by most general dentists and compare that to what I actually do in my office, you will quickly find I have the longest list. The reason I take these courses is because I want to provide the best treatment plan for the problem and if a dentist does not know one part of dentistry very well or is not comfortable doing it, chances are they are going to exclude that from the treatment plan and many times it may be a mistake. So I am not getting filthy rich in this profession nor was it my intent. And I can back that up with the fact that I'll bet the car you drive is nicer and newer than mine. My car (year 1990) is on it's second engine and that is just from commutes over the years. With my fees despite being on the high side when you consider the actual value are more than fair and anyone that appreciates the value can afford me. BTW there are many ways to make treatments affordable. On occasion when I see that a patient despite their economic situation rich or poor who appreaciates my dentistry by taking care of their oral health and expressing concern, I usually end up throwing in a few freebies. In my book they may be your teeth but it is my face.
Take Care.
> >In the dental industry there is no requirement to maintain malpractice > >insurance. When I was in Dental School I ran into 2 attorneys that were [quoted text clipped - 84 lines] > hill and let you make me beautiful....of course I'll hold back I was > the one that had the exchange with you on sci.med.dentisty...:) Tex - 30 Jul 2006 08:41 GMT >Tex > [quoted text clipped - 31 lines] > >Take Care. I may have over stated the smoker part and lumped you in with the general theme heard from dentists once one reaches adulthood and is a smoker.
I normally wouldn't have bothered to continue on by replying once it looked as though things were back on a fairly smooth track...it's just that the smoking part was my overstatement.
Well I do have plenty of time these days as I'm about 4 months into retirement...patience, not really...I like to read so that part wasn't a big deal.
Nor do I wish to leave giving you the impression I think you are getting filthy rich...even if you are more power to you...I'm not against people making what they can...I just don't want to feel like or actually get ripped off in the process of them doing so. I did chuckle about the car comparison though...it might depend on what make 90 you have :) I do have an 06 with sixty payments or should I say about 52 left..it was one thing I allowed myself when I retired. Probably be my last one unless something drastic happens.
Like I said ....if I hit the lotto!
You Take Care Too
Bill - 30 Jul 2006 03:27 GMT > In the dental industry there is no requirement to maintain malpractice > insurance. This is true, there is no legal requirement. However, without the insurance, a dentist who loses a malpractice case runs the risk of a huge financial judgement against him. This causes financial problems, or possibly can lead to bankruptcy.
> When I was in Dental School I ran into 2 attorneys that were > trying to get in as patients and they were talking about dental > malpractice insurance, they said they could not understand why dentist > maintain malpractice insurance. In order to gain protection in the case of financial loss. Also, in the case of a malpractice suit, the insurance will generally pay for the legal defense costs as well. This allows the dentist to continue working for his patients and earning a living for his family while the case slowly grinds its way through the legal system.
> They said that if a dentist did not > maintain this insurance no attorney would take the case even if it was [quoted text clipped - 3 lines] > sheltering liability. An even if a case was filed the corporation could > be dissolved and a new one formed the next day. These attorneys were very badly informed. In medicine and dentistry, there is no corporate sheltering of liability. Malpractice lawsuits, under the law, "penetrate the corporate veil."
Licensed practitioners of the healing arts are responsible for their own actions without regard to the existence or nonexistence of a corporation. The license to practice medicine or dentistry is issued to an individual, not to a corporation, so it is that licensed individual who is legally and financially responsible for the treatment he renders.
- dentaldoc
Alexander Vasserman DDS - 30 Jul 2006 06:40 GMT dentaldocThese attorneys were very badly informed. In medicine and dentistry, there is no corporate sheltering of liability. Malpractice lawsuits, under the law, "penetrate the corporate veil."
Licensed practitioners of the healing arts are responsible for their own actions without regard to the existence or nonexistence of a corporation. The license to practice medicine or dentistry is issued to
an individual, not to a corporation, so it is that licensed individual who is legally and financially responsible for the treatment he renders.
- dentaldoc
Interesting point. However I have not read anywhere in the dental practice act that a dental licence has anything to do with financial responsibility and legal obligation to the patient. Perhaps there is some case law on this I do not know. If there is case law all I could say is that case was poorly argued. The California Board of Equalization (the government people that collect sales tax in the state) consider dentures, and crowns to be personal property and hence taxable (which is passed on to the patient) even though in medical histological terms a tooth is an organ and crowns /dentures are actually prosthetics which give this organ function for eating etc... Well if you are dealing with providing services to personal property, I do not see what that has to do with a dental licence and how that can pierce the corporate veil. Interesting thought isn't it. It was once explained to me that judges in our courts are like 3 year old children that need to be educated and guided every step of the way. So it is possible that if this case law exists it was argued poorly. Another example I can briefly give you although I am not an expert on US law is the abortion decision, it should never have been allowed to go to the federal level because it is not the correct court for this decision. I am not going to start a discussion here on that issue or that I am happy or unhappy of the result, I am just pointing out that in our legal system lots of mistakes and inconsistancies are made. So perhaps you may be correct that there may be somebody that may put the squeeze on a dentist incorporated and without malpractice insurance. And then again I have not heard of a case where actual financial payment was made, and maybe this has to do with the fact that dentists usually carry coverage and do not want to be bothered with being in court and burdened with financial hardship during the process.
Bill - 30 Jul 2006 23:46 GMT > dentaldoc wrote: These attorneys were very badly informed. In medicine and > dentistry, [quoted text clipped - 14 lines] > practice act that a dental licence has anything to do with financial > responsibility and legal obligation to the patient. Under state law, malpractice is committed by a licensed practitioner (a person), not a corporation.
Every malpractice attorney knows this. When they sue for malpractice (known legally as professional liability), they know that the existence of a corporation is of no effect in shielding the doctor from the consequences of his actions.
Plain and simple, the existence of a corporation does not shield the doctor from liability for his professional treatment.
> Perhaps there is > some case law on this I do not know. If there is case law all I could [quoted text clipped - 4 lines] > histological terms a tooth is an organ and crowns /dentures are > actually prosthetics which give this organ function for eating etc... You will have noticed, I'm sure, that there is absolutely NO sales tax to the PATIENT upon the delivery of dentures by a dentist. The DENTIST pays sales tax to the LAB when a denture is furnished to the dentist by the lab, but there is NO sales tax added to the patient's tab on top of the quoted fee for the dentures.
That's because the Board of Equalization regards the dentist, not the patient, as the recipient of taxable goods. The dentist receives the dentures NOT for his own medical use, but as items he purchases in the course of his business. These inanimate items are taxable goods at that stage of their existence.
When the dentist provides the dentures to the patient, he is providing a medical service, so the dentures are NOT taxed when given to the patient.
In other words, if a dentist quotes a fee of $900 to a patient for a denture or a crown, he does NOT add the 8% sales tax and collect $972. That would require a Resale Number from the Board of Equalization, and the filing of sales tax forms and the remitting of the tax to the state -- which we don't do as dentists. It's ILLEGAL in California for a dentist to charge sales tax on a dental service -- that's why you and I haven't been doing it!
This point is clarified by the cases where dentists have their own-employee dental technicians in the office, casting crowns and flasking dentures in the back room while the dentist sees patients in the patient rooms. There is NO sales tax charged to the dentist for work done by employees. There is NO sales tax charged to the patient by the dentist. Hundreds of dentists hire their own dental lab technicians as employees -- and there is no sales tax.
> Well if you are dealing with providing services to personal property, I > do not see what that has to do with a dental licence and how that can > pierce the corporate veil. What does it have to do with a dental license? Simple. Without a dental license, you can't provide dentistry to any patient. And without providing dentistry, there can be no malpractice.
The law provides that there is NO "corporation" protection from liability in medical and dental malpractice cases. Every malpractice lawyer knows this.
> Interesting thought isn't it. It was once explained to me that judges > in our courts are like 3 year old children that need to be educated and > guided every step of the way.
>From a practical standpoint that may be true, but my advice is that it would not be wise to mention this in court. :-)
Best regards, - dentaldoc
Alexander Vasserman DDS - 01 Aug 2006 09:33 GMT > > dentaldoc wrote: These attorneys were very badly informed. In medicine and > > dentistry, [quoted text clipped - 25 lines] > Plain and simple, the existence of a corporation does not shield the > doctor from liability for his professional treatment. ok but when there is no malpractice Insurance, amount of $$$ they can collect decreases significantly and interest to pursue the case drops. As you may know it is very difficult to collect $$$ from an individual. Look at OJ Simpson, the victom families have yet to see their money. He has even accused of having pirate satalite in his residence and he still plays golf in florida.
> > Perhaps there is > > some case law on this I do not know. If there is case law all I could [quoted text clipped - 10 lines] > the lab, but there is NO sales tax added to the patient's tab on top of > the quoted fee for the dentures. The Sales tax is passed on to the patient in the fee. If there was no sales tax the total fee would be lower. Labour and Services are not taxable only Property. A handful of Dentists (for example Mclauren DDS a prosthedontist) Itemize their fee from the lab Fee. And if you Itemized the Lab fee you will see the sales Tax.
> That's because the Board of Equalization regards the dentist, not the > patient, as the recipient of taxable goods. The dentist pays sales Tax on medical supplies gloves, copy paper etc... that is used in providing the services just like any other service business such as a repair place. A repair place is very similar in that it itemizes the Labour from the Parts which are taxed and the whole fee is passed to the consumer. Dental Implants are not considered parts but medical devices and even if the dentist buys the implant fixtures themselves (not the abutments screws etc..) these are not taxed. The dentist receives the
> dentures NOT for his own medical use, but as items he purchases in the > course of his business. These inanimate items are taxable goods at that > stage of their existence. The dentures or prosthetic teeth are not used by the dentists he simply retrofits them into the patient just as prosthetic limbs. However Prosthetic Limbs are considered medical devices and even though the doctor recieves them from the lab just as dentures, there is no sales tax associated with these items. The lab absorbs the cost and tax of the raw materials. Only time raw materials are not taxed is when they are used for the diagnosis of the patient. An example is Barium sulfate which is used for radiographic diagnosis. And to purchase this material a resale permit is not required. I know this because I have recently encountered this.
> When the dentist provides the dentures to the patient, he is providing > a medical service, so the dentures are NOT taxed when given to the > patient. > > In other words, if a dentist quotes a fee of $900 to a patient for a > denture or a crown, he does NOT add the 8% sales tax and collect $972. No the cost of the crown and the tax involved in its manufacture is included in the $900 along with the actual dentists labour. for example lets use better numbers and lets elaborate on what is actually happening here. lets say the gold and porcelain raw materials thas go into the crown are worth $50 there is sales tax added to this $50 and is paid by the lab to its suppliers. that tax with the raw materials gets passed next to the dentist along with the lab technicians labour fee of $150. so we are at $204. then there is sales tax for the manufacture of the actual crown which includes taxing the technician's labour because it was directly responsible for the production of the crown so $204*1.0825=$220.83 which is the bill given to the dentist. The dentist then takes this crown and retrofits it into the patient for a cost of $800 labour +220.83=$1020.83 which is paid by the patient. Yes we like round numbers so the labour would have really been $799.17.
Now I have called the board of equalization on this issue and asked why lab labour gets taxed and was told just as a DVD player gets full tax to a consumer even though there is labour costs in that so does a crown. However they said if you sent in a denture for repair thelabour for the repair should not be taxed. Although most labs out of ignorance will charge sales tax for a repair.
> That would require a Resale Number from the Board of Equalization, and > the filing of sales tax forms and the remitting of the tax to the state > -- which we don't do as dentists. It's ILLEGAL in California for a > dentist to charge sales tax on a dental service -- that's why you and I > haven't been doing it! It is illegal to charge sales tax without actually applying for the licence that allows the state to make you file a sales tax return and collect the sales tax you have charged. Dentists mostly deal with services and avoid this sales tax because it means we have more forms to fill and inventory to maintain. In fact dentists that sell toothbrushes etc... are really supposed to maintain this permit and collect sales tax and pay it to the state. There is a loop hole for this in that bleach gel is considered a medicine Rx and is not taxed, tooth brushes are either given away hence no tax or sold as part of soft tissue program. In fact if you did sell the actual toothbrush you are supposed to collect salestax and fillout additional sales tax return and submit it and the collected sales tax to the board of equalization.
> This point is clarified by the cases where dentists have their > own-employee dental technicians in the office, casting crowns and [quoted text clipped - 3 lines] > the dentist. Hundreds of dentists hire their own dental lab technicians > as employees -- and there is no sales tax. Not true in the city of los angeles if you have a lab technician as part of the practice you are required to maintain and pay for the additional permit collect the tax fill out the tax return at the end of the year and mail the payment to the board of equalization. If there are dentists who are not doing this they are breaking the law. When I was applying for my business licence they were going to make me get this permit and collect sales tax even for the Silver in the silver fillings until they realized that I did not have a dental lab as part of my business.
As far as the inconsistancies seen between prosthetic limbs and dentures or crowns or fillings and what is taxed, the board of equalization says that is the fault of our dental associations having a weak lobby. The rest of the medical profession fought for this and was successful but dental prosthetics are still considered as personal property and hence is taxed because these prosthetics are not placed in the body with permanent intent to stay there. Recently Implant fixures were accepted as medical devices and I believe this is because implants are used in hip and other places. When I called the prsident of the CDA and expressed my concerns about how the government sees or professional body his comment was. We have other things to worry about and we do not have the resources for this despite the need to keep health care costs down for the consumers. I suppose when we are dealing with insurance companies that pay only $1000/year in benefits(determined by foreign licensed dentists from mexico/costa rica etc...) and our association does very little to change this and insurance companies have such a powerful effect on the population in making them believe that they should only have 2/cleanings a year despite their periodontal health and their own doctors recomendations, the actual dental care costs are not that hight to worry about this for the average joe. However for patients who really do want to take take of their teeth, the costs are very high and yet they are alone in this.
> > Well if you are dealing with providing services to personal property, I > > do not see what that has to do with a dental licence and how that can [quoted text clipped - 17 lines] > Best regards, > - dentaldoc Bill - 10 Aug 2006 19:27 GMT dentaldoc wrote:
> > the dentist. Hundreds of dentists hire their own dental lab technicians > > as employees -- and there is no sales tax.
> Not true in the city of los angeles if you have a lab technician as > part of the practice you are required to maintain and pay for the [quoted text clipped - 5 lines] > fillings until they realized that I did not have a dental lab as part > of my business. ______________________________
This is a matter of interpretation and application of the law. The low-level officials we dentists have to deal with will generally try to get the most money out of us, even if they are not following the intent of the law.
Their interpretation is reasonable only if you are running a dental lab out of your office. A dentist has to be careful how he hires and pays a lab tech, to be sure that it isn't being run as a dental lab business, which would be subject to sales tax.
There are a number of dentists who run a lab as a separate business in the back room. If the lab is indeed a separate business, which accepts lab work orders from other dentists, or which bills the dentist as though he is a client instead of an employer, then of course, the lab work is taxable to the dentist.
If the lab tech is just an employee like a dental assistant or the office manager, then no tax applies. You don't pay sales tax on anything your employees make in their course of employment, as they are not selling it to you. Sales tax is due only when you buy something. If a dentist has set up his lab tech employee properly as an employee, then the dentist has already paid the sales tax on the dental materials anyway.
If the lab tech orders and buys the materials, then the Board of Equalization has grounds for saying that he is not an employee, but is running a business, and then the dentist has to get additional permits and pay sales taxes.
When a dentist sets up a dental practice, it would be wise to avoid calling any employees anything but employees. It would not be wise to call any part of the practice a "lab" or even a "hygiene center," as any additional titles, no matter how cute and trendy, can be used by license officials as an excuse to claim the dentist is running multiple businesses. That would mean more fees and money for them.
I'm sure that the business license officials in Los Angeles and elsewhere have encountered many cases where the dentist was running a dental lab out of his office, but who tried to pretend that the lab tech was just an employee. The officials then would tend to assume that every lab tech is running a separate business, even if that is not the case.
If the lab tech bills the dentist for his work, he is not an employee under the meaning of the sales tax laws, and he is running a dental lab business. As a separate business, sales tax is due. So I'm not surprised that the tax officials would assume the worst at first, and make you prove otherwise. (I was born in Los Angeles and finally moved out. Enough is enough!)
Best regards, - dentaldoc
Bill - 10 Aug 2006 19:51 GMT > I suppose when we are dealing with insurance > companies that pay only $1000/year in benefits(determined by foreign > licensed dentists from mexico/costa rica etc...) and our association > does very little to change this ___________________________
Since the dental association does not control the insurance companies or the employers who pay for the insurance, we don't have the power to determine how dental insurance is designed.
Actually, the dental association has been pressuring the insurance companies about the low limits for MANY years. The problem is with the employers. A higher benefits means higher premiums, which the employers don't want to pay, even though dental insurance is very cheap compared to medical insurance.
The huge increases in medical insurance every year cause the employers to try to cut back on dental insurance. Sometimes employers choose to drop dental insurance entirely. In order to prevent this loss of business, the insurance companies offer cheap dental insurance with low annual limits. __________________________________________
> and insurance companies have such a > powerful effect on the population in making them believe that they > should only have 2/cleanings a year despite their periodontal health > and their own doctors recomendations _____________________________________
Very true -- much of the population doesn't realize that dental insurance is only a financial product, not a health care product, and is NOT designed to provide any kind of framework for an individual's dental health. _________________________
, the actual dental care costs are
> not that hight to worry about this for the average joe. However for > patients who really do want to take take of their teeth, the costs are > very high and yet they are alone in this. __________________________
Some patients complain that dental care seems expensive to them.
Actually, the cost of dental care is LESS than 5% of the cost of all healthcare spending each year. As a proportion of the public's total spending, dental care is rather cheap.
In my opinion, a lot of those people who complain about dental care costs, when the real costs are proportionately so cheap, are people who failed to plan ahead or budget their own personal finances. My impression is that most people spend far more on tobacco, alcohol, movies and entertainment than they do on their own dental health.
- dentaldoc
Alexander Vasserman DDS - 11 Aug 2006 06:31 GMT I suppose if the lab tech is the employee of the pactice and does not bill the office or collect other work then you are correct and I agree with you. However very few dental practices can affort to keep a lab tech solely to handle the lab work from that office. Most of these lab guys eventually go out and open up their own labs vs be an employee and have zero deductions.
The associations have done very little for us as far as insurance companies are concerned. The insurance companies continue to play their games. Delta Dental which was started by the association of dentists turned into a monster. They still discriminate based on zip code, still "lose claims" and stall payment as much as possible, still play around with the ada codes which the ada designs, they still send payment to the patient for non providers and include a note telling the patient that their portion could be less if they went to a delta dentist provider thus increasing the financial strain on dentists both on and off the plans. So on this point I am going to disagree with you.
Joel344 - 26 Jul 2006 12:14 GMT I disagree. There is not a good understanding of what happened here.
I bet the tooth is salvageable.
Joe
-- Joel34
Jacob - 26 Jul 2006 15:52 GMT You should talk with your dentist about this problem and see what can be done and at what cost. You certainly have the option of suing, and you could talk with a lawyer to see what they think about this. It is difficult to understand precisely what happened from reading your text, and it is even more difficult to make an assessment without examing you. If you go to court, this case would not be for a large amount of money, and you would have to give the lawyer at least 1/3 of what you win [that is IF you win], and also pay expenses for the expert witness, etc. In the end, you would probably get about 40% of what you won [IF you won] and the case would likely be worth less than $5000.
> Hi experts, > [quoted text clipped - 26 lines] > > Timmy Jan - 29 Jul 2006 17:05 GMT > Hi experts, > [quoted text clipped - 26 lines] > > Timmy Mistake #1.
You should not have gone to a dental clinic.
Mistake #2
Getting the root canal.
The general public knows not about the dangers/risks of root canals.
http://www.toothwisdom.net/r.root_canals.html
http://www.integratedhealthpractice.com/treatment.asp#Root
ll root cancel fillings have the potential to casue bad health. This is because, althought the nerve has been removed, bacteria still colonise in the minute tubules of a tooth. These bacteria produce toxins which enter the body causing potential harm. An area of residual infection which is left under the gum, usually following, but sometimes a long time after an extraction can cause problems. Symptoms can be coincided with the energetic links to the body as well as localised problems.
http://www.zip.com.au/~rgammal/RCTframeset.htm
http://www.ericdavisdental.com/root_canals.htm
http://www.whale.to/d/root2.html
http://www.drshankland.com/rootcanal.html
http://webpages.charter.net/kyarbrough/rootcanals.htm
http://www.dentistry-toothtruth.com/faq.htm
http://www.cfsn.com/maz/
http://cnorman.best.vwh.net/blazing/dental.html
http://rheumatic.org/teeth.htm
http://www.zip.com.au/~rgammal/root_therapies.htm
http://zap.intergate.ca/root.html
http://www.dentistryholistic.com/education.html
http://www.hugnet.com/Root_Canals.html
http://www.karlloren.com/ultrasound/p25.htm
http://www.hallvtox.dircon.co.uk/hallvt.html
Root Canals. A tooth has miles of tiny canals running through the root. A dead or root filled tooth will have bacteria in these canals. There is no way of removing the bacteria once they are in there.
http://www.toothwisdom.net/
Toxicity from Root Canals
The next subject to be discussed are root canals and their possible source of toxicity. Approximately twenty five million Americans undergo root canal therapy every year in an effort to prevent the loss of teeth that have abscessed. The root canal is the left portion of the tooth which houses the vital organs such as the nerve and blood vessels. The dentist endeavors to clean and sterilize this canal and fill it with a sterile, non toxic inert material. This usually renders this tooth serviceable and non painful; however, the entire inner hard core of the tooth is made of dentin which has several million dentinal tubules. These tubules allow the circulation of lymphatic type fluid to circulate from the vital organs of the root canal to the outside of the tooth. This is a viable circulatory phenomenon which has a purpose. It services the periodontal ligament as well as the sensory aspect of the nerve and blood centers in the root canal. If the body chemistry is healthy, the flow of lymphatic fluid is from the root canal to the outside of the tooth. This creates an irrigation for the tooth and usually prevents the accumulation of plaque to form. When the body chemistry is not healthy, then the circulation is from the outside of the tooth to the inner root canal. This allows for no irrigation, but rather an accumulation of plaque to form. There are many more reasons for maintaining the integrity of the circulation in the dentinal tubules. Root canal therapy completely destroys this integrity, and what happens to the non-circulating fluid in these tubules? This fluid as it ages becomes stagnant and becomes a toxic substance. This porous structure now becomes a septic mass emanating poisons into the body. Is this what you want? Mercury amalgams are said to be the caskets of the body. Root canals are said to be the cadavers of the body.
I do not recommend root canals for anyone. Each individual has a right to their decisions. Many people simply do not wish to lose a member of their body. I respect this, and I always discuss the consequences.
The next area of discussion is whether the root canal filling actually sterilizes the apical end of the tooth. There are so many lateral canals at the root end of the tooth where bacteria can harbor that it is unlikely that a complete aseptic condition exists. This, however, is a debateable subject. Again, the complete acceptance of root canal therapy as a viable substitution for extraction is completely and whole heartedly supported by organized dentistry. You are in violation of the code of ethics if you speak out against root canal therapy. When I was a practicing dentist, I always let the patient make that decision after explaining all pros and cons.
FOR IMMEDIATE RELEASE:
>California Judge Approves Landmark Warning on Mercury Use in Dentistry.
>(San Francisco, CA) - For the first time anywhere, dentists will be >required to post a warning about the dangers of mercury in their dental >fillings. A California Superior court judge finalized the language for >the warning to be posted in dentists' offices here today.
>The warning will read as follows:
>Notice to Patients, Proposition 65:
>Warning on dental amalgams, used in many dental fillings, causes exposure >to mercury, a chemical known to the state of California to cause birth >defects or other reproductive harm.
>Root canal treatments and restorations including fillings, crowns and >bridges, use chemicals known to the state of California to cause cancer.
>The U.S. Food and Drug Administration has studied the situation and >approved for use all dental restorative materials.
>Consult your dentist to determine which materials are appropriate for your >treatment.
>The exact language of the warning was argued and then finalized before >Superior Court Judge James A. Robertson II between the California Dental [quoted text clipped - 3 lines] >mercury dental fillings and root canals. The agreement also allows non-CDA >dentists to opt in to the agreement and post the warning.
>The warning is the result of a lawsuit filed by The Law Offices of Shawn >Khorrami on behalf of As You Sow, a not-for-profit foundation dedicated to >advocacy and activism in the public interest.
>"This is the first admission by organized dentistry that amalgams pose a >potential health risk," says Shawn Khorrami, lead attorney. "The only >problem is that it's about 100 years too late."
>This California consent judgment follows on the heels of recent lawsuits >filed in Georgia, Texas, Ohio and Los Angeles, California charging that [quoted text clipped - 6 lines] >risks to certain users. Mercury, a highly toxic substance, is the most >widely used substance in dental fillings today.
>The use of mercury-based thimerosal in vaccines also has been the source >of the recent controversy in the Homeland Security legislation.
>Khorrami filed the lawsuit against Roger Fieldman D.D.S., Inc., the >Citadel Dental Group, Inc. dental offices, dental laboratories and >private dental schools and training programs with more than nine >employees. The suit won the enforcement of Proposition 65, Safe Drinking >Water and Toxics Enforcement Act [Health & Safety Code § 25249.6].
>Proposition 65 requires that a clear and reasonable warning be provided to >persons prior to their exposure to a chemical known to cause cancer or >reproductive harm. This statute lists mercury, contained in dental >amalgam, as a substance that can cause reproductive toxicity. The lawsuit >was based on the absence of warnings to patients treated with amalgam >restorative materials in dental offices.
>The judgment on Proposition 65 mandates that all dental offices with more >than nine employees provide warnings on the dangers of Mercury dental >fillings to patients. Those in non-compliance could incur a fine of up to >$2,500 per day.
>Press may contact: Jackie Gladfelter at 650-218-1856 or D. Infusino at >415-225-7970; call Attorney Shawn Khorrami at 818-947-5111.
>### Jan jdrew63929@aol.com
PS. The character jd who posts here uses foul language. FACT- I did not and never have used.
The blathering all about it being me. Shows these *centain*posters are here to Harass.
Good Luck Timmy.
Joel344 - 30 Jul 2006 18:11 GMT Joel344 - 01 Aug 2006 13:05 GMT > Jan jdrew63929@aol.com > [quoted text clipped - 5 lines] > > Good Luck Timmy. R E P L Y
The person could lose 2 mebbe 3 e-mail accounts by using the initials jd. Do they know that?
Joely
PS!~ What do you mean by the term, "bladdering?" Is it what I think it is
-- Joel34
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