This is a bridge from the previous post, since it also involves Minnesota, and gives some teeth to my argument that the Land o’ Lakes is facing a brush with ethics decay. At the root of our tale some yawning cavities in the ethical hygiene of a dental professional. (Note my generous restraint in leaving quite a few potential puns for you to add in the comments. Consider the challenge a moment of tooth, er, truth.)

But I digress. Dr. Kevin Molldrem and Molldrem Family Dentistry face a lawsuit from a disgruntled patient, Kathleen Wilson, who claims the Eden Prairie dentist harmed her in the process of performing over 30 dental procedures in a single five hour appointment. Molldrem, she alleges, put in eight crowns, did four root canals and filled the cavities in 20 teeth during a single visit in July 2020. In the process, according to the lawsuit, Molldrem used anesthesia “well in excess of (the) recommended dosage” and engaged in “falsifying medical records” regarding the amount administered.

Update 1: I finally have the complaint (thanks to JutGory). The news reports did not accurately convey the sense of the lawsuit, concentrating excessively on the sensational feature of all that dental work at a single session. The complaint’s complaints are:

—“Plaintiff has incurred and will continue to incur medical costs for the dental care required to address the harms caused by Dr. Molldrem’s negligence.”

—“Plaintiff has incurred and will continue to incur lost income and loss of earning capacity as a direct result of Dr. Molldrem’s negligence.”

—“Plaintiff has endured and will continue to endure pain and suffering, embarrassment, emotional distress, and disfigurement as a direct result of Dr. Molldrem’s negligence.”

Update 2: The complaint also accuses the dentist of failing “to create a care plan that would effectively address decay and tooth dissolution” and “failing to control gingival inflammation and bleeding” during the lengthy visit. That’s the harm alleged, as well as damage that required repair by other dentists. Based on what was revealed about the suit in the media and the fact that the expert report for the plaintiff mentions “trauma,” discomfort” and “anxiety,” I assumed that pain and suffering were also alleged in the suit, as they virtually always are when medical negligence is involved. And sure enough, they were. However, my statement in the original post that the suit claims the dentist’s marathon session “caused great pain and suffering” was speculation stated as fact, so I’ve removed it.

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The dentistry expert retained by Wilson’s attorney agreed with the dentist’s diagnosis that “virtually every tooth” in Wilson’s mouth was in bad shape, but concluded that Molledrem’s treatment for Wilson was improper. For Wilson “required a slow, thoughtful, careful and measured response to her disease.” Trying to fix everything at once in a single nightmarish sitting was, the expert ruled, inhumane.

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UPDATE 3: I confess to have been led astray and confused by the way every news report I read on this (I first learned about on a “Believe it or not!” themed site that reports weird news). Since the lede in every report was that a dentist performed over 30 dental procedures on a patient at a single sitting and she subsequently sued, I concluded that the suit focused on that, and the natural consequences of the dentist subjecting the woman to such an unimaginable ordeal. However, the law suit complains about the unsatisfactory results of the appointment. In other words, if the dental work done in those five hours-plus had been effective and satisfactory, there might have been no law suit. I did not get that sense from the news reports, and I checked several. My fault. I should know by now that the news media often distorts legal stories by emphasizing the most sensational and unusual facts.

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The ethics codes for the dental profession do not specifically address this unusual set of facts. Under “Emergency Care,” the American College of Dentists Ethics Handbook states,

A person with an emergent dental condition should be examined and either treated or referred for treatment. In such situations, the patient’s health and comfort must be the dentist’s primary concern, not compensation or convenience. If a dentist cannot accommodate the patient’s emergent needs, a reasonable effort should be made to have the patient seen in a
timely manner by someone capable of treating the condition.

It seems self-evident that doing all of these procedures at one time might be convenient for the dentist but is hardly an approach that shows proper concern for the patient’s comfort. The handbook advises under “Best Interests of the Patient,”

The “best interests” of our patients means that professional decisions by the dentist must consider patients’ values and personal preferences. This requires that dentists carefully communicate with their patients, and listening is of paramount importance. Sometimes patient desires conflict with professional recommendations. Patients must be informed of possible
complications, alternative treatments, advantages and disadvantages of each, costs of each, and expected outcomes. Together, the risks, benefits, and burdens can be balanced. It is only after such consideration that the “best interests” of patients can be assured.

As questionable as this dentist’s treatment seems to have been, I must confess that I don’t understand this story at all. Unless Kathleen Wilson was being held down in the dentist’s chair against her will like Dustin Hoffman while Laurence Olivier was asking, “Is it safe?” in “Marathon Man’s” most harrowing scene, nothing stopped her from saying, “OK, that’s all I can stand right now. I’ll make appointments to finish the rest.” I’ve told dentists to stop and finish up later. Haven’t you?

That aspect of the case should make the lawsuit a tough sell, since the victim of a tort usually has a duty to mitigate damages if possible. In addition, it is impossible for a dentist to install new crowns in one sitting because a mold has to be taken of each tooth and the crown has to be manufactured before it can be installed. There is important information missing here.

Update 4: See Update 3. Furthermore, the patient couldn’t mitigate damages here because the harm was the result of how the procedures were executed, not the fact that they were all done at the same time. If they had all been successful, there would not have been a lawsuit, presumably. Also, I subsequently learned that the patient was subjected to an IV sedative. I did not surmise this initially (maybe I should have) because none of the procedures mentioned usually require that. If she was unconscious or otherwise seriously impaired, she might not have sensed the passage of time or been in any condition to stop the dentist and say, “That’s it for today!”

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Nonetheless, I seldom get the chance to ponder dentistry ethics, and this story brought back fond memories of my only dentistry ethics program, which I presented at a national convention. It was a very lively two hours: the dentists proved to be very opinionated and passionate, and several of my hypotheticals triggered intense debate.

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Update 5: A clarification: the long multi-procedure ordeal is the reason this is a dentistry ethics post, and why the post exists at all. The fact that the dentist may have botched the work is a malpractice issue. Malpractice is usually not the focus of EA.

Update 6: The expert report can be read here. It clarifies a lot that the news reports (and my post derived from them) left unclear. The patient saw Dr. Molledrem two more times after the initial visit before seeking the advice and treatment of other dentists. Regarding that visit, the expert’s central conclusion is that Dr. Molldrem “attempted to restore all of her teeth in one visit. In so doing, he breached the standard of care in several ways,” primarily that “providing 8 crowns, 4 root canals and 20 restorations in a single visit is impossible to achieve if each of these procedures is done properly.“

The expert report also notes that the 8 crowns, 20 fillings and 4 root canal treatments were “performed under IV sedation” along with the local anesthetic. I presume from this that the patient was unconscious, which, if true, addresses the issue of whether she could have ended the session herself.

A patient can’t be blamed for accepting the recommendations of a medical professional, though this story stands as one more cautionary tale. When a recommended procedure or course of treatment seems illogical or extreme, patients need to be prepared to seek second opinions.

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Much gratitude to JutGory for tracking down the expert report.