In response to the growing number of UK patients seeking treatment (medical and dental) abroad in recent years, the NHS has produced a sensible checklist for patients which is aimed at assisting potential purchasers in identifying warning signs as well as recommending that they undertake their own thorough research before committing to any treatment packages.
Many UK dental clinic websites express the concerns of their practitioners around the standard of treatment provided abroad, where regulatory requirements may vary, and UK practitioners are now seeing a steady increase in the number of patients here who are seeing problems such as over-preparation of teeth and the need for corrective treatment, following dental treatment they have received abroad. This also often erodes the savings patients were seeking to make by paying for treatment outside of the UK.
Whilst the cynical patient might label such reports an expression of self-interest by UK practitioners, when the BDJ runs an article on 'Turkey Teeth' highlighting the risks and concerns, then there is a need to probe further.
Dental tourism has gained popularity in the last few years through social media and reality television shows, with a growing number of celebrity influencers promoting overseas dental work. Turkey is often a favoured destination for those seeking treatment. As referenced in the below survey, and a feature of some of the claims we are managing, one of the most popular tourist treatments is the placement of very white and square crowns known as 'Turkey Teeth' given that they are widely undertaken whilst patients are 'on holiday' in Turkey.
A recent survey commissioned by the BDA of 1000 UK dentists, suggests a staggering 86% of patients who travelled abroad for dental treatment, required corrective treatment on their return to the UK, which raises significant concerns both for patients and the dental profession generally.
In this article, we consider the regulatory and legal implications for those patients seeking treatment from overseas practitioners who have failed to demonstrate the level of competence required from a UK-based dental practitioner when carrying out treatment. We also address whether a patient who has suffered pain and requires restorative treatment can recover compensation, where the substandard treatment was provided outside of the UK.
Regulatory considerations
Many advertisements targeted at UK patients for overseas dental treatment highlight that the dental practitioners are GDC registered. Whilst superficially, this may be reassuring, there is no guarantee of an equivalent standard of care and although, if dis-satisfied, a complaint can be made to the GDC, any action taken will take time for the GDC to investigate. Even if suspension/removal from the register ultimately occurs, it will not prevent that practitioner from continuing to treat other patients provided they comply with their home country's regulatory requirements.
Bringing a claim
Where a patient has received substandard treatment abroad and is seeking compensation via legal proceedings, the process is far from straight forward. Since the relevant treatment is provided abroad, UK law may not be applicable and cross-jurisdictional issues will arise which may require legal advice in both the UK and the country in which the treatment was provided.
Even if a patient receives treatment abroad from a UK registered clinician and has some of their consultations in the UK, this may not provide patients with the reassurance and protection they seek as was evidenced in the claim of Clarke v Kalecinski & Others [2022] ('Clarke'). Although, it is worth noting that the treatment in this case was provided Pre-Brexit – and there are currently no reported legal claims in relation to recent dental negligence outside of the UK.
In Clarke, the Claimant had travelled to Poland for cosmetic medical treatment. The surgeon was UK trained and registered and the initial appointments were undertaken in London. The subsequent surgery performed in Poland was substandard and the patient developed sepsis and required extensive corrective (lifesaving) treatment in the UK. Although the patient was able to secure some damages, the case had a number of procedural challenges (resulting in her suing the surgeon, clinic and insurers of the clinic). Due to the very low level of insurance cover in place for the clinic the overall damages received was far below what the Claimant would have recovered had there not been such a restriction or indeed engagement from the surgeon and/or clinic (neither responded to the litigation).
Advice for patients and UK dental practitioners
Patients who travel abroad for dental treatment need to be alive to the risks associated with these seemingly attractive cost savings, which are often achieved at the expense of skill sets, standards of care and even the products deployed, all frequently being lower than in the UK. If extensive restorative treatment is recommended at the outset without a physical examination or review of the patient's records, this should immediately ring alarm bells about the likely standard of treatment being offered. UK dentists should ensure that appropriate advice is provided and documented in the patient's dental records when they indicate they are considering treatment outside of the UK.
Comment
Key takeaways for dentists with patients who have received treatment abroad include:
- Ensuring all records and radiographs from the clinic abroad (translated into English) if possible have been obtained, thereby enabling the dentist to make an informed assessment about whether they are able to provide corrective treatment and if this falls within NHS criteria i.e. is it 'clinically necessary'.
- Producing detailed contemporaneous records which document all of the discussions around the patient's assessments, further treatment options and prognosis.
- Where issues are outside the dentist's scope of work or are overly complex, it will be important to consider appropriate specialist referral at the earliest opportunity.
- Where a dentist is considering declining treatment, they must consider GDC Principle 1 and whether the patient's best interests have been put first. Many dentists are unwilling to take on the risk of providing care after extensive treatment abroad, which could be in contravention of the GDC's standards and may leave them vulnerable to regulatory investigation.
As the number of patients travelling abroad for treatment continues to rise, dentists in the UK need to remain alert to the risks for their patients. Litigation in relation to treatment provided abroad is sparse due to the numerous and complex procedural issues. Increasingly it is likely that UK dentists will be left to pick up the pieces for patients who have experienced substandard treatment abroad, often returning with more problems than they left with, albeit with limited legal remedies.
Should you wish to discuss any issues raised in this article please contact Vicki Swanton or Sabrina Mahmood.
DWF's national healthcare team acts on behalf of a large number of clients, from individual insureds, insurers, private hospitals, the Medical Protection Society, NHS Resolution and directly for a number of NHS Trusts. Our specialist team, led by Vicki Swanton, is on hand to assist with all possible challenges including complaints, claims, regulatory, disciplinary, and criminal or coronial investigations.
