Dental Assisting Chapter 5

1. Dental Assisting Chapter 5 Dentistry and Law

2. Key terms • Abandonment • Administrative law • Board of dentistry • Child abuse • Civil law • Contract law • Criminal law • Dental auxiliary • Direct supervision • Due care • Elder abuse • Expanded functions • Expressed contract • Felony • General supervision • Implied consent • Implied contract • Informed consent • Infraction • Malpractice • Mandated reporters • Misdemeanor • Patient of record • Reciprocity

3. Key Terms cont. • Res Gestae • Res IpsaLoquitur • Responder superior • Spousal abuse • Standard of care • State dental practice act • Statutory law • Tort law • Written consent

4. Guidelines for charting entries in a clinical record • Keep a separate chart for each patient (even families) • Business and financial information is omitted from the clinical record • It is better to chart more information than needed than not enough • Make chart entry during examination or patient visit • Write legibly and record entry in ink • Date and initial entry • Double check to insure completeness • Properly correct mistakes with line and initials.

5. Lawsuit Malpractice • Duty • Derelict • Direct cause • Damage These four Ds must be present for a successful lawsuit

6. Statutory Law • Consists of two types • Criminal Law~ Involves crimes against society. Involves government agency or/& the board of dentistry. • Civil Law~ Involves crimes against an individual, with another individual initiating legal action. (such as lawsuits)

7. Criminal Law • Criminal law seeks to punish the offender, but civil law seeks to compensate the victim. • Felony~Major crime such as insurance fraud or drug abuse in the dental setting. Conviction may result in imprisonment for 1 year or longer. • Misdemeanor~ a lesser offense that may result in a variety of penalties, including fines, loss or suspension of the license to practice dentistry, mandatory CE.

8. Criminal Law Cont. • Infraction~ Minor offense that usually results in only a fine. For example, it a dentist does not pay his or her license renewal fee on time, a penalty fee is added to the original renewal fee.

9. Civil Law • Civil law is concerned with relations of individuals, corporations, or other organizations. Classifications of civil law that affect the practice of dentistry are: • Contract Law ~ Refers to binding agreement between two or more people. This could involve employment contracts or contracts for patient treatment.

10. Civil Law Cont. • Tort Law ~ Involves acts (intentional or unintentional) that bring harm to a person or damages to property. An example would be a malpractice suit in which a patient alleges that a dentist caused harm or damage to him or her. • Administrative Law ~ Involves regulations established by government agencies, for example, violations of the Occupational Saefty and Health Administration (OSHA)

11. Contract Law • For a contract or agreement to be binding, it must be established between two competent people. This eliminates mentally incompetent persons under the influence of alcohol or drugs, and minors.

12. Contract Law cont. • Expressed contracts~ Established through the written word or by verbal agreement. Expressed contacts are commonly used when the required treatment is extensive or will take a long time to complete. • Implied Contracts~ Established by actions, not by words. Most dental contracts are implied.

13. Tort Law • A tort is a wrongful act by one person that results in injury to another • It may happen accidentally (negligence) or be done intentionally

14. State Dental Practice Act • The primary purpose of a Dental Practice Act is to protect the public from incompetent practitioners • Specifies the legal requirements for the practice of dentistry within each state • An administrative board, usually called the Board of Dentistry, interprets and implements state regulations

15. Included in the Dental Practice Act • Requirements for licensure • Grounds for revocation or suspension • Requirements for continuing education • Duties delegated to auxiliaries • Infection-control regulations • Requirements for persons exposing dental radiographs

16. Board of Dentistry • The members of the state board of dentistry (also referred to in some states as the dental board) are appointed by the governor of the state • The board adopts rules and regulations that define, interpret, and implement the intent of the Dental Practice Act • The board regulates and enforces the laws of practice for dentistry within the state

17. Licensure • To protect the public from unqualified or incompetent practitioners • It is very important to understand the requirements for practice in your state • In every state, anyone who practices dentistry without a license is guilty of an illegal act

18. Licensure by Credential • Allows an individual currently licensed in one state to become licensed in another state IF certain requirements are met • Requirements vary by state

19. Expanded Functions and Supervision • Expanded functions are specific intraoral functions delegated to qualified dental auxiliaries with additional skill and training • When these functions are included in the Dental Practice Act, the dentist may delegate them to the dental auxiliary

20. Doctrine of Respondeat Superior • Respondeat superior means that the employer is responsible for any harm caused by the actions of an employee while the employee is carrying out the business of the employer • In a dental practice, this means that the patient may sue the dentist for an error committed by the dental assistant or dental hygienist • The employee is also responsible for his or her own actions, and the injured patient may also file suit against the dental assistant

21. Patient of Record • An individual who has been examined and to whom a diagnosis has been made by a licensed dentist and for whom treatment has been planned by the dentist

22. Types of Supervision • General supervision (indirect supervision) means that the dentist has authorized and delegated specific procedures that may be performed by a legally qualified dental auxiliary in a patient of record • Exposing radiographs and re cementing a temporary crown that has been dislodged are examples of functions that are often delegated under general supervision • The dentist need not be physically present in the office while such procedures are being performed

23. Types of Supervision (Cont.) • General supervision (indirect supervision) means that the dentist has authorized and delegated specific procedures that may be performed by a legally qualified dental auxiliary in a patient of record • Exposing radiographs and recementing a temporary crown that has been dislodged are examples of functions that are often delegated under general supervision • The dentist need not be physically present in the office while such procedures are being performed

24. Unlicensed Practice of Dentistry • A dental assistant or dental hygienist may legally perform only those functions delegated under the Dental Practice Act of the state in which he or she works • Performing procedures that are not legal is practicing dentistry without a license, a criminal act • Ignorance of the Dental Practice Act is no excuse for illegally practicing dentistry • If the dentist asks you to perform an expanded function that is not legal in your state and you choose to do so, you are committing a criminal act

25. Dentist-Patient Relationship • Duty of care/standard of care • Licensure • Use of reasonable skill, care, and judgment • Use of standard drugs, materials, and techniques

26. Abandonment • Discontinuation of care after treatment has begun, but before it has been completed • Even if a patient refuses to follow instructions and fails to keep appointments, the dentist may not legally refuse to give the patient another appointment • The dentist may not dismiss or refuse to treat a patient of record without giving the patient written notice of termination

27. Patient Responsibilities • The patient is legally required to pay a reasonable and agreed-upon fee for services • The patient is expected to cooperate and to follow instructions regarding treatment and home care

28. Due Care • The patient also has legal duties to the dentist • The patient is legally required to pay a reasonable and agreed-on fee for services • The patient is also expected to cooperate and follow instructions regarding treatment and home care

29. Malpractice • The “four D’s” must all be present for a malpractice lawsuit to be successful: • Duty: A dentist-patient relationship must exist to establish the duty • Derelict: Negligence occurred because the standard of care was not met • Direct cause: The negligent act was the direct cause of the injury • Damages: May include pain and suffering, loss of income, and medical bills, among other things

30. Acts of Omission and Commission • In dentistry, the two types of malpractice are acts of omission and commission • Act of omission • Example: A dentist fails to diagnose periodontal disease because he does not take x-rays or perform periodontal probing • Act of commission • Example: A dentist administers 15 cartridges of local anesthetic to a very small child, resulting in serious overdose and the death of the child

31. Doctrine of Res ipsa loquitur • Meaning the “thing speaks for itself” • For example, a dentist extracts the wrong tooth or breaks an instrument in the tooth and leaves it there • The proof—the instrument itself—is clear

32. Risk Management In this age of increasing litigiousness (readiness to engage in lawsuits) the dental team must constantly be aware of the need to avoid malpractice risks in the dental practice. Risk management refers to the procedures and practices that are used to avoid lawsuits.

33. Risk Management (2) • Major areas of risk management include: • 1. excellent communication with patients • 2. maintaining accurate and complete records • 3. receiving informed consent • 4. doing everything possible to maintain the highest standards of clinical excellence. • Legal authorities note that legal problems with patients are best avoided by maintain a climate of good rapport and open communication.

34. Avoiding Malpractice Lawsuits • Prevention and good communication between provider and patient are the best defenses against malpractice. Patients are less likely to initiate a lawsuit when they have a clear understanding of the following: • Planned treatment • Reasonable treatment results • Potential treatment complications • Their own financial obligations

35. Silence is Golden • The dental assistant must never make critical remarks about the dental treatment rendered by an employer or another dentist. • The dental assistant should never discuss other patients and should avoid discussing the dentist’s professional liability insurance. • Under the concept res gestae, statements made spontaneously by anyone (including the dental assistant) at the time of an alleged negligent act are admissible as evidence and may be damaging to the dentist and dental assistant.

36. Guidelines for informed Consent • The concept of informed consent is based on the idea that it is the patient who must pay the bill and endure the pain and suffering that may result from treatment. Therefore, the patient has the right to know all important facts about the proposed treatment.

37. Informed Consent • Based on information provided by the dentist. • Implied consent-when a patient enters the dental office they have given implied consent by showing up for the scheduled appointment. • Written consent-The preferred means of obtaining and documenting the patient’s consent to and understanding of the procedure.

38. Exceptions to disclosure • The dentist does not have a duty to disclose information about proposed treatment in the following situations: • The patients asks not to be advised. • The procure is simple and straightforward and life-threatening risks are remote. • Treatment risk is minor, and treatment rarely results in serious adverse effects. • Information would be so upsetting that the patient would be unable to weigh risks and benefits rationally.

39. Informed consent for minors • The parent, custodial parent, or legal guardian must give consent for minor children. • When parents live separately, the child’s personal information from should indicate which parent is the custodial parent. • When separated parents share custody, the child's record should contain letters from both parents providing consent and authorization.

40. Documenting Informed Consent At minimum, the patient’s record should indicate that patient received information about risks, benefits and treatment alternatives and consented to or refused the proposed treatment. When treatment is extensive, invasive or risky, or written informed consent document is recommended.

41. Content of informed consent forms • Informed consent forms is a process, not just a form. It involves face to face discussion between the dentist and the patient. • Enough time should be made available to answer all of the patients questions and concerns.

42. Content of informed consent cont. • Many types of commercial informed consent forms are available form .