Luckily, I was able to stop it, return the chair to the proper Trendelenburg position, and continue working. I joked with the patient, saying, "I think you may have broken my chair." When it came time for him to exit the chair, I was only able to move it back up to a 40° angle. At that time, I was convinced that the chair was broken. The patient had to exit the chair himself, laughing. "I am sorry I broke your chair," he said.
To be honest, it was not a laughing matter.
I should preface this by saying the patient was morbidly obese. He was over 6 feet 6 inches tall, weighed several hundred pounds, and had to move the armrests out to accommodate his backside. He was able to sit still during his preventive visit, but during the restorative, he squirmed and pushed back until the chair gave way. He did have adequate anesthetic (as per his comments), he was just not a still patient.
Sheri B. Doniger, DDS.
Loyal readers of this column know that I am a small practice with only one treatment room. The Belmont chair was not new but gently used over my years in practice. A broken dental chair in another practice may not be as much of a crisis as in mine.
After the patient left, I assessed the chair. It was completely incapable of moving up. Luckily, he was the last patient of the day. I immediately called Patterson, and the person I spoke with said he thought the chair would be able to be repaired.
The next day my favorite Patterson repair expert visited us. He discovered that not only was the weld joint snapped but the actual frame of the chair was bent backward. He attempted to find the part that was broken, but since the chair was two decades old, they did not have replacement parts available. Since Belmont chairs are now being built in Japan, it would take three to four weeks for the part to arrive. After two hours and several phone calls, he admitted that the chair was irreparable. I would have to purchase a new one.
Now I was basically out of business. I had to cancel the entire next several days of patient appointments, and I had no idea how soon I would be able to order a chair and have it installed. My dental assistant called our patients, saying our dental chair was out of service. Patients understood, some happy for the respite, all rescheduling.
I then had to make several phone calls, searching for a new chair that was locally available and to find out if my business insurance would cover a claim on the chair.
I have to admit, I am a fan of Belmont dental chairs. They are truly workhorses in the dental world. I had to make a few phone calls to see who had a Belmont chair similar to the one we were working with and, more importantly, who had one NOW. Luckily, I found a small dealer in a nearby suburb who had a Belmont floor model and would be able to install it on Thursday. Practice saved!
What about the insurance?
Now, onto the insurance claim. I called my carrier, and they said it sounds like wear and tear on the unit. Yes, the chair was 20-plus years old but gently used. We do not abuse our dental equipment. We follow maintenance protocols and perform regular checkups. Since we were a policyholder for several years, they obliged and filed a claim. A claims adjuster contacted me and said it was probably stress from the constant use of the chair, but he agreed to inspect the chair. I mentioned that he had better visit our office quickly because the chair was being replaced on Thursday.
Luckily, he arrived just as the new chair arrived and had a chance to look at the broken chair. The folks who installed the new chair told him that this was highly unusual, that this dental chair should have lasted a lot longer and pointed out the frame being bent. He took several photos. As he was leaving, he reiterated that it was most likely not a replaceable cost due to the age of the chair, but he would let us know.
Surprisingly, the claims adjuster came through. With the research I had presented on chair weight limits, as well as the documentation by both Patterson and the installer for the new dental chair, they agreed it was a credible claim. Second problem solved.
The final piece of this scenario is the patient. I had contacted the ADA, Illinois State Dental Society, Chicago Dental Society, and my dental malpractice company to ask about potential liability to dismiss a patient who, conceivably, may break my chair again with his girth and mass. None had a good response. Each asked me to contact the other. I followed instructions to see what I should do, and the only information I received was to "tread lightly" because obesity is covered under the Americans With Disabilities Act.
We always contact our patients after operative visits. Upon calling this patient, I asked how his teeth were doing. He said they were great: no discomfort, no soreness. Perfect. Then I mentioned that the chair was broken and I had to purchase a new one. He thanked me, then volunteered that he would seek out a new dentist who has a chair "he can fit in."
Lesson learned: Although we are not allowed to dismiss patients for any reasons covered under the disabilities act, we are allowed to let them know at the start of treatment that our equipment may not safely hold them. When they come into the practice, this needs to be discussed to limit any liability.
I have since spoken to another colleague who had a similar situation with a morbidly obese patient. I guess this happens more than we want to think about these days. When I asked him how he handled it, he said, "I ate the repairs." I would have had to do that as well, had the insurance company not come through.
Interestingly, during all of my phone calls, I found out that dental chairs can withstand 450 pounds of seated pressure but only 250 pounds pushing backward. This is a key fact in today's society, with the emerging morbidly obese patient population. Chairs are available for patients who have difficulty fitting into conventional chairs; for example, Diaco Dental manufactures one. But for the majority of dental chairs in our practices, they are only able to accommodate those weights listed. Who knew? No one -- until it happens to you.
Sheri B. Doniger, DDS, practices clinical dentistry in Lincolnwood, IL. She has served as an educator in several dental and dental hygiene programs, has been a consultant for a major dental benefits company, and has written for several dental publications. Most recently, she was the editor of Woman Dentist Journal and Woman Dentist eJournal. You can reach her at firstname.lastname@example.org.
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