1 The Dentist’s Legal Responsibilities to the Patient Dental Law and Ethics

2 R esponsibilities of the Dentist and the Assistant: Proper licensure: –All legal requirements have been met for the dentist to practice –If required by state law, the assistant must be registered or certified in radiation health and safety Exercising reasonable judgment and skill: –Skill: refers to knowledge plus the ability to use such knowledge –Care: relates to the manner in which skill is used –Judgment: refers to the decision making process in the choice of procedural methods Proper licensure: –All legal requirements have been met for the dentist to practice –If required by state law, the assistant must be registered or certified in radiation health and safety Exercising reasonable judgment and skill: –Skill: refers to knowledge plus the ability to use such knowledge –Care: relates to the manner in which skill is used –Judgment: refers to the decision making process in the choice of procedural methods

3 Legal Responsibilities Dentist’s responsibilities to patient Properly licensed Skill, care, judgment Patient autonomy Do not abandon patient Refer to specialist Standard techniques, materials, drugs Reasonable results within reasonable time Patient privacy Adequate instructions Reasonable fees Patient’s responsibilities to dentist All instructions will be followed, e.g., postoperative instructions; home-care instructions; cooperation with treatment such as wearing elastics, controlling diet, conducting oral hygiene, etc. Appointments will be kept. Fees for services will be paid. Patients will conform to generally accepted modes of behavior. Patients will be truthful regarding their health history and other administrative inquiries.

4 Responsibilities of the DA: Develop and maintain skills through CEU’s Maintain current CPR certification Perform duties to best of ability each time Exercise good judgment Think before you say or do anything Use reasonable care at all times Develop and maintain skills through CEU’s Maintain current CPR certification Perform duties to best of ability each time Exercise good judgment Think before you say or do anything Use reasonable care at all times

5 Skill, Care, Judgment Knowledge plus ability to use such knowledge Manner in which the skill is used Decision-making process in making choice of procedural methods Knowledge plus ability to use such knowledge Manner in which the skill is used Decision-making process in making choice of procedural methods

6 Patient must give consent for doctor to provide any treatment Patient autonomy and informed consent Patient must give consent for doctor to provide any treatment Patient autonomy and informed consent

7 Consent requires: – Patient must be legally competent –It must be an informed consent –The consent is only for a specific treatment –The act consented to must be legal –The consent is not established by a fraudulent means – Patient must be legally competent –It must be an informed consent –The consent is only for a specific treatment –The act consented to must be legal –The consent is not established by a fraudulent means

8 Consent: Informed consent given after the patient has been given reasonable information to make an educated choice of treatment –Nature of condition –Proposed treatment –Risks involved –Chances of failure –Likely results if patient remains untreated –Alternative procedures that could be employed Implied consent refers to the consent that is presumed by the actions of the patient Patient enters office and sits in dental chair, indicates implied consent for dentist to examine, diagnose, and consult Further treatment requires informed consent from patient

9 What happens to consent during an emergency? implied consent

10 What happens to consent during an emergency? Implied consent is used in an emergency when immediate care is necessary –Emergency = patient is in danger of death or serious bodily harm and is unable to give consent verbally or in writing Implied consent would also be used in an emergency when a parent cannot be reached to give consent for a minor Implied consent is used in an emergency when immediate care is necessary –Emergency = patient is in danger of death or serious bodily harm and is unable to give consent verbally or in writing Implied consent would also be used in an emergency when a parent cannot be reached to give consent for a minor

11 Written Consent Required: –When new drugs are used –Experimental clinical testing is involved –Whenever a patient photograph may be used –For the use of general anesthesia –When minors are being treated in a public program –When treatment will take more than one year to complete –When new drugs are used –Experimental clinical testing is involved –Whenever a patient photograph may be used –For the use of general anesthesia –When minors are being treated in a public program –When treatment will take more than one year to complete

12 If the doctor is not available: Abandonment = desertion, or the dentist’s not being accessible to a patient under treatment (patient of record) at any time the patient may reasonably require assistance –Arrange for coverage from another dentist –Arrange “on call” coverage when office is closed –Arrange schedule so that patients can get appointments without unreasonable delays Daily “buffer time” for emergency calls –Failure to pay does not allow dentist to refuse to complete patient of record treatment –The dentist must address the patient when they call, and be available to address their questions Abandonment = desertion, or the dentist’s not being accessible to a patient under treatment (patient of record) at any time the patient may reasonably require assistance –Arrange for coverage from another dentist –Arrange “on call” coverage when office is closed –Arrange schedule so that patients can get appointments without unreasonable delays Daily “buffer time” for emergency calls –Failure to pay does not allow dentist to refuse to complete patient of record treatment –The dentist must address the patient when they call, and be available to address their questions

13 Withdrawing from a Case: The dentist’s intentional withdrawal from treatment of a patient prior to completion of current treatment plan –A written notification must be sent –The letter must be sent by certified mail, return receipt requested (documented proof that letter was sent and received) –Copy of letter and signed postal receipt kept with patient chart –Letter must include Notification of intent to withdraw and the reason –Failure to follow advice or to keep appointments are often the case The withdrawal date (allow about 30 days) –Dentist must continue to provide care if patient seeks it, for this time The need for further care and results of not receiving that care An offer to help (transfer dental records to another dentist or suggesting another dentist) The doctor’s signature The dentist’s intentional withdrawal from treatment of a patient prior to completion of current treatment plan –A written notification must be sent –The letter must be sent by certified mail, return receipt requested (documented proof that letter was sent and received) –Copy of letter and signed postal receipt kept with patient chart –Letter must include Notification of intent to withdraw and the reason –Failure to follow advice or to keep appointments are often the case The withdrawal date (allow about 30 days) –Dentist must continue to provide care if patient seeks it, for this time The need for further care and results of not receiving that care An offer to help (transfer dental records to another dentist or suggesting another dentist) The doctor’s signature

14 Referrals: General dentists may perform all dental treatments –Good judgment must be made in regard to the dentist’s level of abilities Dentist should refer to specialist –when he/she does not possess required knowledge or skill to treat the condition –Failing to refer patient in timely manner = malpractice Documentation in patient chart: –Date of referral and name of recommended specialist –Copy of consultation report and any other correspondence from specialist –Signed informed refusal form if patient refuses doctor’s recommendations General dentists may perform all dental treatments –Good judgment must be made in regard to the dentist’s level of abilities Dentist should refer to specialist –when he/she does not possess required knowledge or skill to treat the condition –Failing to refer patient in timely manner = malpractice Documentation in patient chart: –Date of referral and name of recommended specialist –Copy of consultation report and any other correspondence from specialist –Signed informed refusal form if patient refuses doctor’s recommendations

15 Standard of Care responsibility to use current techniques used by other dentists in the area proper use of drugs requires responsibility to use current techniques used by other dentists in the area proper use of drugs requires

16 Achieving a Reasonable Result Law = dentist fulfill a legal duty to exercise the standard of care Unrealistic expectations can lead to lawsuits Treatment should be completed within a reasonable amount of time, and should not extend beyond one year HIPAA laws protect patient’s privacy Law = dentist fulfill a legal duty to exercise the standard of care Unrealistic expectations can lead to lawsuits Treatment should be completed within a reasonable amount of time, and should not extend beyond one year HIPAA laws protect patient’s privacy

17 Provide adequate instructions Written and verbal instructions to patient for post- operative care Explained in language and manner that patient can understand Written and verbal instructions to patient for post- operative care Explained in language and manner that patient can understand

18 Reasonable fees Reasonable = fee that dentist and patient have agreed upon Completed dental work becomes personal property of patient Reasonable = fee that dentist and patient have agreed upon Completed dental work becomes personal property of patient