They say a week is a long time in politics – I’m sure if you’re Theresa May or Leo Varadkar trying to sort out Brexit, it’s a very, very long time. In a way, I’m lucky that I get to work in the more mundane environment of orthodontics that the public is usually a lot happier about. But if not a week, then at least a fortnight can be a long time in orthodontics - at least this fortnight was. Ten days ago, we were getting all sorts of congratulations for winning at the Aesthetic Dentistry Awards and this morning before I was out of bed my phone already had messages about an article in the Irish Times reporting allegations that the HSE orthodontic services had damaged children’s teeth. This had led to an audit (which is a special term for a systematic review of clinical activity with a view to making changes to improve outcomes of treatment).
I knew I’d have to read the article, because this will be what my patients will be taking about all week.
Of course, the first thing I wanted to do was find out when and where this happened and if I was involved in anything bad that was supposed to have happened. Actually the details were that it involved children treated between 1999 and 2002 – they’d all be adults now and it was in the larger Dublin area. At the time, I was studying for my Master’s degree in orthodontics and Membership at the Royal College of Surgeons, and working in the UK.
But although there was a sigh of relief, I was still a bit concerned to hear that my previous tribe was under scrutiny for its care of patients. And then it eventually dawned on me that I almost ended up working in the unit that was treating the patients involved – I had an informal meeting with some of the management team and a walk around the unit while I was over in Dublin to see a reunion concert of surviving members of Thin Lizzy. Because the concert wasn’t on until the Wednesday, after my meeting in Dublin, I called the orthodontic unit in Galway – who had also advertised for an orthodontist – and went down to view their job and in the end, that was the one I took and worked in for 10 years before taking over at Swords Ortho.
Though I wasn’t in Ireland during the time under investigation, I understand it was a difficult time for the specialty in the public sector as it considered different options for how so many children could be looked after by the state for orthodontics.
Technically speaking, it wasn’t the HSE that treated these children as that agency wasn’t set up until 2005, but there were other public sector organisations that carried out healthcare reponsibilities, including orthodontics, before then. What happens with the HSE investigation remains to be seen. I hope things worked out well for the patients in the end. Unlike many other HSE scandals, at least this one doesn’t involve people losing their lives. It does, as often seems to be a problem, demonstrate the many layers of healthcare management in the country (the HSE isn’t the same as the Department of Health, for instance) and the speed at which things get done when someone asks “why”.
What was reported in this story was that two orthodontic consultants had spent 3 years looking into the treatment of orthodontic patients in the area and made a report to the HSE. This report had never been published but it did cause the authorities to commission a very far reaching audit and the reports of the audit are not published yet either.
Another article in the Irish Times talked of a “whistleblower” that made allegations that took nearly 2 decades to investigate.
Later that day, RTE had a feature on “Primetime” which covered the story and showed some photographs of problems that had arisen in some of the patients involved.
To me one interesting thing was the TV report – and the feature on the RTE website.
The several photographs of the patients’ teeth were taken in a clinic. Nowadays people are used to taking pictures on their phones, but certain details on the photos show that they were taken in a dental surgery environment. As one article said, there was a whistleblower and clearly people should be allowed to speak out in the interests of patients, but it wasn’t clear what the Data Protection status of the photos were. I can see that the greater good is served but I have no idea if the patients themselves consented to their pictures being on national TV.
Finally, in the short video report, there were stock scenes of video footage involving root canal instruments when there was no mention of root canal treatment, and a display of different types of dentures, which wasn’t at the time when the narrator was talking about fixing spaces in a patient’s teeth. In other words, the images that routinely get reinforced in popular media for dentistry are the negative ones. Having worked in HSE orthodontics – and left it – I would think the most common image for HSE ortho, and specialist orthodontics in general would be a set of nice straight teeth that bite together well.