Disclosure of adverse events

An adverse event is an injury caused by clinical management rather than a patient’s underlying disease or condition. Openness and transparency in responding to such occurrences is considered a key ingredient in improving patient safety. It is also just good practice.

Patients are partners in their own health care and they are entitled to know when things go wrong. Withholding information can cause patients to become angry or suspicious, destroying the trust that is the cornerstone of any dentist-patient relationship. Failing to disclose or even delaying disclosure of an adverse event can impair a patient’s ability to obtain the treatment required to mitigate its effects.

Timely and complete disclosure of adverse events is an ethical obligation for all health professionals, including dentists. The RCDSO has consistently advised its members of their duty to inform patients of unexpected incidents and to discuss with them any further or remedial treatment that may be required as a result. The RCDSO endorsed the Canadian Patient Safety Institute’s Canadian Disclosure Guidelines (updated version available at www.patientsafetyinstitute.ca) as being consistent with the RCDSO’s requirements for informed consent and the principles contained in its Code of Ethics.

What many health care providers may not know is that the duty to disclose is also a legal obligation. For those practicing in a hospital setting, notifying hospital administration of any adverse event resulting in death or serious injury is mandated under the Public Hospitals Act. For dentists and other health professionals in any practice setting, the legal duty arises from their role as fiduciaries, which requires them to act with the “utmost good faith and loyalty” toward their patients. This extends to being honest and forthright in providing clinical information. Any breach of this duty can give rise to liability for damages, including punitive, exemplary or aggravated damages, for which PLP does not provide indemnification.

In order to comply with best practices, disclosure of an adverse event should:

  • occur as soon as reasonably possible after the member becomes aware of it;
  • be made by the treating dentist;
  • include a discussion of the facts relating to the incident;
  • include a description of the actual or possible consequences for the patient, together with recommendations and/or referrals for further or follow-up care.

Members are also advised to document the details of any disclosure discussion (e.g. time, date, place, attendees, facts discussed, questions raised, answers given, treatment recommendations, etc.) in the patient chart.