Legal liability in bisphosphonate-related osteonecrosis of the jaw

Abstract

Bisphosphonate-related osteonecrosis of the jaw (BRONJ) is an adverse reaction that may occur in patients administered with bisphosphonates (BP). This condition can cause high morbidity and hinder quality of life. Its treatment is complex and often unsatisfactory, and prevention strategies may have limited effectiveness, if any. Thus, managing patients treated with BP may result in exposure of the practitioner to legal liability or malpractice claims: legal actions pursuant to BRONJ are reported to be underway on three continents. Nonetheless, the attribution of liability, if any, is a complex process requiring, on the basis of current knowledge, a robust and pragmatic approach to the facts, which must be identified from the point of view of the time, place and individuals involved. This means a comprehensive consideration of the sequence of actions from bisphosphonates prescription to BRONJ occurrence (as well as immediately after, and any action potentially related to its causation or worsening) is required in order to determine if a breach in informing, diagnosing, managing or referring the patient took place, as well as determining if the patient was compliant in attending to prescriptions and follow-up programmes.

A critical synthesis of the role of the pharmacist in oral healthcare and management of medication-related osteonecrosis of the jaw

“…The potential legal implications have previously been reported, including the finding that malpractice claims have been made in relation to MRONJ. 32 The poor knowledge of oral health amongst pharmacists, GPs and patients was evident in this work and corresponds with findings reported in other studies; 9,21 this is particularly apparent in relation to the crossover between oral health and general health and well-being, representing a focus for targeted educational initiatives. The introduction of interprofessional education in oral health could potentially facilitate an improved and reciprocal working knowledge that translates into increased implementation of preventive advice in relation to those medicines associated with MRONJ and the consequent provision of oral health advice to identifiably at-risk patients.…”

“…The potential legal implications have previously been reported, including the finding that malpractice claims have been made in relation to MRONJ. 32 …”

Awareness of the risk of developing medication-related osteonecrosis of the jaw among bisphosphonate users

“…Clinicians are not only expected to maintain up-to-date knowledge about MRONJ and its risk factors but they are also required to convey this information to patients scheduled for BP treatment. 25 The lack of patient education about possible MRONJ may also be attributed to the lack of awareness among treating physicians. Most Lebanese physicians were found to have poor understanding of MNROJ, and 37% of them were unaware of this complication.…”

Aesthetic dental procedures: legal and medico-legal implications

“…It must also be recognised that this expected result has been supported, or at least promoted, over time by frank uncertainties and not differing views of doctrine and law. In this sense, it is understood to refer to the controversial issue of the degree of obligation – of means (diligence, behaviour) or of results – to which the health professional is bound in his service, a particularly delicate issue in dentistry and totally controversial in activities for cosmetic purposes [ 6 ].…”