A mother complained about her children's treatment at a dental clinic after a specialist orthodontist found serious problems with their teeth. Natalie Akoorie investigates.
When Cath Darroch was sent an expletive-laden email about herself from a dentist in error, it was the last straw.
Darroch had pre-paid $16,000 to the clinic in central Auckland for orthodontic treatment for her three children, the youngest just 8.
The problem was there were no specialist orthodontists at the clinic, which the Herald is not naming, but the way the service was advertised led Darroch to believe otherwise.
When the children later moved to a specialist orthodontist he told Darroch they would require braces for years longer to correct the treatment, prompting her to try to negotiate a refund for the work not completed.
That's when she mistakenly received the email sent by the dentist to a colleague, which he later apologised for.
"F*** me. How much of this s*** do we need to go through?" it read. "I say f*** them. They have chosen to go somewhere else for convenience so this is on them."
Darroch and her husband chose the clinic because it promoted reduced time in braces and no teeth extractions.
The treatments started young and included a long phase of mouth plates followed by braces.
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Darroch, from Auckland's North Shore, said the issues began to mount up including one incident where she had to stop staff putting braces on her son's bottom teeth by mistake.
At one point Darroch complained to staff at the clinic that a wire on her son's braces was sticking into his gum.
She was told to buy "cutters" from the chemist and clip the wire herself.
Darroch's two eldest children ended up having five years of work each on their teeth, but Takapuna Orthodontic Group specialist orthodontist Dr David Westcott said it should have taken only two years.
What Westcott discovered when he assessed the children's teeth prompted Darroch to complain to the Health and Disability Commissioner.
In a letter to the commissioner, Westcott called the orthodontic treatment unnecessary and extended. Some of his concerns included:
• Increased overbite and receding gums.
• Teeth tipped forward and an impacted molar from extra spacing.
• The need to move teeth back to the position they were before treatment began, known as "round tripping".
• Treatment given too young - one of the children was only 8.
• A high dose radiation CT scan given to the 8-year-old that was not clinically indicated and breached the National Radiation Laboratory's As Low As Reasonably Achievable guidelines.
"In my opinion, this dentist was practising outside his scope of practice, which is a breach of a number of patient rights," Westcott wrote.
Although Darroch received a $4425 refund from the clinic for services not carried out, she spent $30,000 in total on her children's teeth.
Another concerned mother, Denise Dryland, said her two children were psychologically scarred from their treatment at the same clinic and are now both afraid to see a dentist.
"We are appalled. My son endured much more time and grief in the hands of [the clinic] than what was discussed during the initial consultation."
Orthodontist Dr Mo Al-Dujaili, who assessed Dryland's son's teeth after the treatment, noted tooth wear, gum recession, increased overbite and rotated and maligned teeth.
In a response to Darroch's complaint to the commissioner, the dentist said his treatment had been progressing well for the children when they left for logistical reasons.
Through his lawyer, Harry Waalkens, QC, the dentist said he had hundreds of happy patients every year and his practice met the required standard of competence.
"The implicit suggestion that the public may have been misled with reference to advertising and publication is utterly rejected," Waalkens wrote to the Herald.
Waalkens pointed out many general practitioners in New Zealand and overseas practised functional orthodontics, distinct from practices undertaken by registered orthodontists.
He referred to the expletive-laden email about Darroch as a "frank" email between the dentist and someone else, sent to Darroch in error.
A specialist orthodontist is a dentist with three additional years of training through a Doctor of Clinical Dentistry.
A dentist is allowed to carry out orthodontic work but the New Zealand Association of Orthodontists [NZAO] says the practice is a serious problem that needs urgent addressing.
HDC deputy commissioner Meenal Duggal referred Darroch's complaint to the Dental Council of New Zealand, which said practitioners were not required to advertise qualifications on their website and that the dentist's site did not have any misleading advertising.
It also found the dentist was competent.
The HDC decided to take "no further action" but Darroch wants the right to appeal the decision because she says the patient watchdog did not pass on crucial information during its investigation.
Darroch said the HDC did not provide the Dental Council with a copy of the damning assessment of her children's teeth by Westcott.
She also complained the HDC did not contact other unhappy clients she had been asked to provide including Dryland.
Duggal said it was not up to them to contact other patients and that it was not considered appropriate or necessary to share Westcott's response with the Dental Council.
So Darroch complained to the Ombudsman who said proper process had been followed.
"HDC has explained that as Takapuna Orthodontic Group was not the provider being referred to the Dental Council, their correspondence was not included," a senior investigator wrote.
Darroch then complained to Minister of Health Dr David Clark, who referred her to the Ombudsman.
"I think it needs to be specified somewhere that there is no fully qualified orthodontist practising at [the clinic]," Darroch said.
"Their [Dental Council] rules need to be reviewed and changed."
Health and Disability Commissioner Anthony Hill said complainants already have a right of appeal, through the Ombudsman and judicial review in the High Court.
But, according to a recent paper by University of Auckland Professor Jo Manning published in the New Zealand Law Review, the Ombudsman will only intervene if the HDC procedure is unfair.
The HDC itself only reopens cases in extreme circumstances where new evidence has come to light or procedural errors are discovered.
Hill said the role of the HDC was to promote and protect the rights of people using health and disability services.
"We carefully assess the complaints we receive and try to resolve them in the most appropriate manner, taking into account the issues raised and the evidence available."
He said in Darroch's case the Dental Council was the most appropriate agency to consider her complaint.
"There are a number of options for resolving a complaint and in some situations other agencies may be better placed to consider the issues at the heart of a complaint, and in those instances HDC refers complaints to the relevant agency.
"We take a rigorous quality assurance approach throughout our complaints process and, if people have concerns, we encourage them to raise them with us and we will consider them carefully, as we did in this case."
When asked if the HDC uses dentists or orthodontists as expert advisers in cases where dentists are performing orthodontics, Hill said the general approach is for clinical advice to come from a peer of the provider who can advise on what would be considered standard practice in New Zealand. That would be a dentist.
"While it is disappointing that the complainant remains unhappy with the outcome, I am confident in our processes and that her concerns have been heard and assessed by more than one complaints body."
Part 1: Dentists doing orthodontics
Part 2: Investigation, advertising and injury