The Dental Association of Malta has expressed concern about a court judgment that ordered compensation to be paid to a patient who suffered chronic facial pain and a permanent disability after procedures by dentists Jeffrey Pullicino Orlando and Alex Azzopardi.
The association said the presiding judge appeared to have based his conclusions on his own "moral certainty", ignoring a report drawn up by the court-appointed expert and the testimony of four expert witnesses.
The judgment focused on a root treatment which was performed by Pullicino Orlando which ended up being too short and had to be rectified.
Rectification was carried out by Azzopardi a few weeks later. Notwithstanding, the patient still complained of persistent, debilitating pain in her lower jaw and further interventions were carried out in repeated efforts by different practitioners to seek to resolve the problem.
The association observed that from the court proceedings it transpired that the patient was also seen by other dental surgeons in the past, for various other treatments including a root canal treatment in the same area on another tooth, which had also failed and the tooth in question needed to be removed.
It said it was concerned that key expert witnesses’ opinions were disregarded.
"The expert, Prof. J. Portelli concluded that the chronic pain which the patient is suffering from cannot be a result of a root canal treatment. He also referred to the testimony of Dr Marilyn Casha, pain specialist, and concluded that the pain was oro-facial in nature attributed to maxillary and mandibular nerves on the right side of the face – Chronic Facial Pain Syndrome. This completely goes against the conclusions arrived at by the judge in his judgment," the association said.
The judge, Francesco Depasquale, decided not to give weight to Prof. Portelli’s report was because the patient was not directly examined by him.
"Although this is factually correct, it is our opinion that this does not mean that all that was written in the report – including a detailed analysis of all the extensive medical history of the patient, and reasons why the source of pain is not of dental origin - can be simply thrown out and disregarded. If the court truly cannot give weight to an expert’s report, the least that could be done is to appoint another expert to analyze the case and make sure that the right scientific dental facts have been presented and explained," the association said.
It said that another point in the judgment which from a scientific point of view was incorrect was that a short root canal treatment was a result of negligence.
"There are many justifiable reasons why a root canal cannot be completely accessed or filled. Various studies have been carried out over the years and the consensus is that a successful root canal treatment may or may not be a short one, it insisted.
It said the judge decided to ignore the advice given to him by several experts in their field including a former dean of the Faculty of Dental Surgery, a pain specialist and three other specialists whom the patient had gone to after the alleged negligence was committed.
"It is expected that all medical and dental professionals act in the best interest of their patients and in accordance with all ethical and moral obligations. That said, the risk of being made liable for complications which can arise from any treatment when the experts agree that there was no negligence is indeed a slippery slope, which could have serious ramifications for medical professionals, insurers and the Maltese population in general alike," the association said.