Presentation on theme: "Ethics, Jurisprudence, and Risk Management"— Presentation transcript:
1 Ethics, Jurisprudence, and Risk Management DENA 101Orientation to Dental AssistingFall 2002
2 Ethics:A discipline dealing primarily with moral duty, conduct, and judgment.These are standards of behavior which we choose to accept for ourselves – not those imposed by some other authority.
3 Jurisprudence: The philosophy of law or a system of laws. Laws are the minimum standards established by the state.
4 Dental Jurisprudence: The system of law applied to dentistry.The dentist, and the practice of dentistry are controlled by many laws on the federal, state, and local level.
5 Risk Management:The steps taken by dentists to prevent a patient from bringing legal action against them.As the dentist’s employee, you have an important role in preventing or causing a lawsuit!
6 Ethics & Jurisprudence Compared Level #1 – A system of law established by society. These represent a minimal standard of acceptable conduct.Level #2 – A professional code of ethics. These are a statement of conduct the professional organization has accepted.Level #3 – A personal code of ethics. These represent the highest standard of acceptable conduct.
7 Conduct may be unethical and still be legal Conduct may be unethical and still be legal. But it cannot be illegal and still be ethical.
8 Professional Ethics:Consistently higher than the standards required by law.Voluntary controls, however, everyone entering into the profession is expected to adhere to these professional standards.Serve as a method of self-policing, and enforcement of the code is handled within the professional organization.
9 Personal Ethics: Standards which individuals set for themselves. These are our own “inner rules” for acting responsibly.These standards are reflected in the way we act, the decisions we make and the values we hold.
10 A Decision is Ethical if: 1- It enhances integrity and self-respect.2 – It does not bring harm to others.3 – It builds understanding and dissolves unreal barriers between people.4 – It builds a core of genuine confidence in self and others.
11 A Decision is Not Ethical if: 1 – It results in an illegal action.2 – It brings harm to others.3 – A person is exploited and used as an inhuman object.4 – If human potential is belittled, damaged, or ignored.
12 One of your primary responsibilities is to treat the dentist(s), staff members, and all patients with dignity and respect.
13 The philosophy of individual worth is the belief that everyone, regardless of personal circumstances or personal qualities, has worth and is entitled to respect as a human being.
14 Law:A set of rules established and enforced by a sovereign authority such as the local, state, or federal government as a means to an ordered society.Criminal Law pertains when a person commits a wrongful act against society.Civil Law pertains when one person sues another for satisfaction of a personal wrong done to him or her.
15 Plaintiff (accuser) is a person bringing the legal action which accuses another of wrongdoing. Defendant (accused) is a person whom legal action is being brought against.
16 Reasonable (Prudent) Person A reasonable person is expected to do those things that are appropriate in a given situation.This includes the use of sound judgment, so that these actions are fair, proper, just, moderate, and suitable under the circumstances.
17 Negligence – failing to do something that a reasonable person would do, or doing something that a reasonable person would not do.Contributory negligence – failure on the part of the patient to follow the dentist’s instructions during and after treatment.
18 Malpractice – professional negligence Malpractice – professional negligence. Failure to perform one’s professional duties completely.Admission against interest – statement made by an individual which serves to defeat his or her own interests. “Oh, I’m sorry. It was my fault.”
19 Res gestae – Latin term meaning “Things done or part of the action” Statements made spontaneously at the time of the alleged negligent act are admissible as evidence.A careless word or statement by an auxiliary can be just as damaging to the dentist as his or her own admission against interest.
20 What to Do of the Dentist is Sued Say NothingBe supportiveBe cooperativeAsk before acting
21 State Dental Practice Act Controls the practice of dentistry only within that state.The primary purpose of the State Dental Practice Act is to protect the public from being mistreated or misled be incompetent practitioners.
22 Provisions of the State Dental Practice Act Eligibility for licensure.The methods and requirements for licensure.A definition of what is included in the practice of dentistry within the state.
23 Provisions of the State Dental Practice Act Grounds for suspension or revocation of a license.Provisions for establishing and maintaining an administrative board to supervise the practice of dentistry.A means of controlling the assignment of duties, including extended functions, to auxiliaries.
24 Grounds for suspension or revocation of a license. Provisions for establishing and maintaining an administrative board to supervise the practice of dentistry.A means of controlling the assignment of duties, including extended functions, to auxiliaries.
25 State Board of Dentistry Also known as the State Board of Dental Examiners.Primary functions include:Examine applicants and grant licenses.Deal with misconduct, incompetence, and related matters.Establish and regulate the functions assigned to other related professionals in dentistry.
26 ReciprocityA mutual agreement between two or more states to allow an individual who is licensed in one state to receive, without further examination, a license in the other state entering into that reciprocity agreement.
27 Grounds for Suspension or Revocation Conviction of a CrimeUnprofessional ConductPersonal or Professional Incapacity
28 Specific Grounds for Discipline Permitting unlicensed personnel to perform dental procedures normally restricted to dentists.Failure to supervise personnel properly.Sexual advances toward or involvement with patients.False or inaccurate patient recordsFraud involving reimbursement of patient expenses by insurance companies of government programs.
29 Giving or receiving rebates related to patient fees. Transmission of disease by improper sterilization procedures.Improper communication of confidential patient information.Improperly prescribing, handling, or selling controlled substances.Patient neglect or abandonment.
30 Respondeat superior “Let the master answer” In addition to being held responsible for his or her own acts, under the doctrine of respondeat superior, the dentist/employer is also held responsible for the acts of his or her employees – if that wrongdoing was committed within the scope of their employment.
31 Who may be sued?A dental assistant who is guilty of negligence is responsible for his or her own actions, and the injured party may sue both the dentist and the assistant.The dentist’s liability insurance will not cover the auxiliary if they are sued for negligence!!
32 Levels of SupervisionDirect supervision – a licensed dentist is present in the room.Indirect supervision – a licensed dentist is present in the office.General supervision – under the direction of a licensed dentist though not present in the office.Undefined supervision – under the direction of a licensed dentist, but supervision id not defined.
33 Civil LawContract Law – division of civil law covering specific agreements between people and violations of same.Tort Law – division of civil law covering the rights and duties of people toward each other and wrongs committed in violation of these rights and duties.
34 Contract Law Those entering the agreement must be legally competent. The act covered by the agreement must be a lawful one.There must be a consideration involved in the contract.
35 Types of ContractsImplied – A contract is made by certain actions on the part of the parties concerned, even though the essentials for a legally binding contract have not be discussed.Expressed – A contract in which there is oral or written agreement as to the terms of the contract.
36 When Written Consent is Required: New drugs are being usedExperimentation or clinical testing is involvedA patient’s photograph is being usedGeneral anesthesia is being usedMinor children are being treated in a public programTreatment will require more than one year to complete
37 Breach of ContractBreach of contract occurs if either party fails to keep their part of an expressed contract, either written or oral. When this happens the other party may sue for breach of contract.
38 Four “D’s” of Tort LawDuty – a legal duty must be owed by someone to anotherDereliction – the duty owed must have been breached by the accusedDamage – the plaintiff must have been hurt in some wayDue to – the plaintiff must be able to prove that the defendant’s action, or lack of, were the proximate cause of the damage
39 Establishing a Legal Duty A dentist-patient relationship (legal duty) does not exist in law until the patient seeks service from the dentist, and the dentist, by some words or action, accepts the patient.
40 Patient of RecordA patient of record is someone the dentist has already accepted as a patient.The dentist is not legally compelled to accept or treat a new patient just because an emergency exists, however, the dentist is obligated to provide emergency treatment for a patient of record.
41 Liabilities in Dentistry The dentist may be held liable in the following ways:Breach of contractMaligning a patientPermitting a hazard in the dental officeTechnical assaultMalpractice
42 Malpractice Professional misconduct Any unreasonable lack of skill Lack of fidelity (faithfulness) in performance of professional dutiesPractice contrary to established rules
43 Malpractice May Be Do To: Ignorance or neglectLack of skillNeglect in applying these skills
44 Dentist’s Responsibilities to the Patient Must be properly licensedMust exercise reasonable skill, care, and judgmentMust do only those things consented to by the patientMust refer unusual cases to a specialistMust use standard drugs, materials, and techniques
45 Must complete agreed upon treatment within a reasonable time Must hold inviolate the patient’s privacyMust give adequate instructions to the patient.Must make a reasonable charge for the services rendered
46 Patient’s Responsibilities to the Dentist Must follow instructions during and after treatmentMust pay a reasonable fee or a fee agreed upon between dentist and patient
47 Withdrawal from a Case or Patient Written notification – containing the reason, the withdrawal date, the need for further care, an offer of help or assistance, and signature.Proof of mailing – letter must be sent certified mail with a return receipt requested.Documentation on file – a copy of the letter and the signed postal receipt are kept with the patient’s record.
49 Ten Rules of Risk Management When in doubt say nothingIf there is a problem or conflict with a patient, refer the matter to the doctorNever say anything that implies a guarantee or that will give the patient unrealistic expectations as to the result which the dentist can achieveNever comment on the quality of care provided by your employer or any other dentist
50 Establish a rapport with the patients Maintain accurate, complete and legible records (they are the dentist’s best defense!)Keep all of your skills up-to-dateAlways perform all of your duties to the best of your ability
51 Be prepared to assist in any kind of emergency Do not start collection measures without the doctor’s permission
52 Patient RecordsThe patient’s dental record, commonly referred to as “the chart”, provides a chronological record of, the clinical justification for, treatment received by the patient.These records are important legal documents.
53 Part of the Patient’s Clinical Record Medical and dental historiesExamination findings and treatment plansX-rays (properly identified and dated)Any letters from, or about, the patient regarding treatmentCopies of prescriptionsWritten consent or refusal of treatment formsNotation of broken appointments or any failure to follow the treatment or advise of the dentist
54 Not Part of the Patient’s Clinical Record Any records that are kept for financial reasons onlyFinancial information such as the record of charges, payments and the current balanceInsurance claim formsIrrelevant materials, such as post cards from the patient
55 Guidelines For Clinical Record Entries Use the next available lineMake the entry as soon as possible after the patient’s visitDate the entrySign or initial the entry to clearly identify who made the entryMake the entry clear, concise, and completeThe entry must be typed or in ink (blue or black)Handwritten entries must be legible
56 Changes to the Clinical Record Never change a chart entry without the doctor’s permission; however, an error should be corrected as soon as possible after it is discoveredDraw a single line through incorrect material. The original entry must still remain readable.Add your initials (to show who made the correction) and the date (to show when the correction was made)
57 On the next available line, explain the reason for the change On the next available line, explain the reason for the change. Initial and date this entry.On the following line, enter the correct data. Initial and date this entry.
58 Five Rules for Safeguarding Patient Records Do not allow any unauthorized person to remove, read copy, or otherwise tamper with any record at any time.Never leave an open file folder on your desk when an unauthorized person could read itAlways lock file cabinets and/or rooms containing files at the end of the day
59 Refrain from answering queries regarding patients from third parties such as a lawyer. Refer all third party inquiries to the doctorDo not allow original patient charts to leave the practice.
60 The patient chart is created by the dentist for his or her own use The patient chart is created by the dentist for his or her own use. Under law, these records are considered to be the dentist’s property. What the patient pays for is the dentist’s professional skill in interpreting these records
61 ProfessionalismNo matter what your relationship with the doctor, always address him or her as “doctor”Adult patients are always addresses using the more formal, courteous form of address such as Mr., Mrs., or Ms.Always introduce yourself to someone new