12. Everyone agrees the wrong tooth was removed. As we would expect the Practice would remove the correct tooth, we can see there is an indication of a failing here.
13. We therefore turned to consider what the impact of this was. We note Miss H is concerned this will mean additional appointments and associated expense for the orthodontic treatment.
14. The Practice’s response explains that that Miss H’s orthodontist (from North Cumbria Integrated Care NHS Trust - NCIC) explained that although removing the wrong tooth is not ideal, she can work around that. It is clear a certain number of teeth needed to be removed for the planned orthodontic treatment. Whilst one of these was removed in error, we can see this was the LL5 rather than the adjoining tooth (the LL4). As such, the appropriate number of teeth were removed overall, but one was next to the one that should have been taken.
15. Miss H’s mother says this failing is likely to cause three to four months of delay in the treatment, with additional appointments and added costs. We note that when the Dental Practice originally shared this information (September 2023) the orthodontist suggested that they could change their mechanics during brace treatment to attempt to correct the error. The same record indicates they told Miss H’s mother that this would not be detrimental to the treatment, and they would still be able to align the teeth albeit it may take slightly longer treatment to correct.
16. The orthodontic records from 21 December 2023, suggest that the orthodontist has again speculated there may be an impact on the result or that treatment will take longer. Again, they could not be clear how long treatment will take.
17. Overall, the orthodontist has indicated there may be an impact but cannot be clear on what that would mean. We have considered whether further advice may be helpful in this but are not persuaded that an independent adviser would be able to add more than the clinician currently engaged in her treatment.
18. Additionally, according to Miss H the initial treatment time can take between two to three years. Therefore, its unlikely to be completed soon. It would be very difficult for us to assess any possible impact on a treatment that it’s not yet completed. As such, whilst there may be an impact this is not certain nor are we able to assess this presently.
19. Accordingly, we are unable to say, what, if anything, is required to address unknown additional treatment time or any associated costs. Similarly, we cannot say what impact, if any, will have on her studies. As such, we would be happy for Miss H to bring the matter back once there is any clarity on impact. To minimise any issues with our time limit we would urge her to do so as soon as she is clear about what the overall impact is.
20. We also note Miss H has explained this was very upsetting experience for her and her mother and led to a loss of faith in the Practice. We have no doubt it will have been very upsetting. We therefore turned to consider what has been done to address this by the Practice.
21. According to our Principles of Remedy – ‘Being customer focussed’, public bodies should promptly identify and acknowledge maladministration and poor service and apologise for them. In addition, under the heading ‘Putting things right’, (of our Principles), we expect where maladministration or poor service has led to injustice or hardship, public bodies should try to offer a remedy that returns the complainant to the position they would have been in otherwise. This amongst others includes, an explanation, an apology and financial compensation.
22. We have seen that as soon as the wrong tooth was removed the practice informed them about this and apologised. Additionally, we can see they offered them £200 to address this. We have considered whether that was reasonable.
23. We fully appreciate the upset caused but note this was a specific instance of distress and whilst we do not wish to take away from it, we note this was of a relatively short duration. We know the extraction occurred in September 2023 and when the Practice approach the orthodontist the same month, they confirmed they should be able to adjust treatment to manage this.
24. As such it fits within the description of Lever 2 of our SOI which describes occasions as those causing a degree of distress, inconvenience or minor pain. However, it also notes it includes instances where an injustice was more serious but only took place once or was of short duration. In these cases, we consider that an apology is not suitable by itself. The recommended amount for Level 2 is between £200-450.
25. We fully appreciate Miss H does not consider £200 adequate but as above this falls within the parameters we would expect, and we are satisfied it meets our Principles of remedy. As we would have suggested a similar level, we do not believe any further action on our part is required.