1. Copyright © 2007 by Saunders, an imprint of Elsevier Inc. All rights reserved. Essentials of Dental Assisting, 4e Professional & Legal Aspects of Dental Assisting Chapter 2

2. Copyright © 2007 by Saunders, an imprint of Elsevier Inc. All rights reserved. Introduction Dentistry is a profession different from general businesses. As a professional dental assistant, you are bound by an ethical code of conduct.

3. Copyright © 2007 by Saunders, an imprint of Elsevier Inc. All rights reserved. Introduction-cont’d  Ethics deals with moral conduct (right and wrong behavior), and good and evil.  Ethics includes the values, high standards of conduct, and professional and personal obligations in interacting with each other.  As dental healthcare professionals, these qualities are important to us as we provide dental care to our patients.

4. Copyright © 2007 by Saunders, an imprint of Elsevier Inc. All rights reserved. Introduction-cont’d  Ethics seeks to answer two basic questions: – What should I do? – Why should I do it?  Ethics refers to what you should do, not what you must do. The law deals with what you must do.

5. Copyright © 2007 by Saunders, an imprint of Elsevier Inc. All rights reserved. Professional Code of Ethics All the major professions (e.g., dental, medical, legal) have a written code of ethics. These are voluntary standards of behavior, not laws, and serve as a method of self-policing within a profession. The code of ethics of most professions has been revised on several occasions to keep it consistent with the times, but there has never been a change in the moral intent or overall idealism.

6. Copyright © 2007 by Saunders, an imprint of Elsevier Inc. All rights reserved. Reasons for a Code of Ethics  To demonstrate to the public the standard of conduct it can expect from its members.  To increase the ethical consciousness and ethical responsibility of its members.  To guide its members in making informed ethical decisions.  To establish a standard for professional judgment and conduct.

7. Copyright © 2007 by Saunders, an imprint of Elsevier Inc. All rights reserved. Difference Between Ethics and Law Legal issues are settled by using laws and court decisions. Ethical issues are subject to individual interpretation as to the right or wrong of particular situations.

8. Copyright © 2007 by Saunders, an imprint of Elsevier Inc. All rights reserved. Difference Between Ethics and Law-cont’d Laws are very specific and are written by people authorized to write them. The law is often referred to as being “black and white” or “right or wrong.” Ethics are less specific and have more gray areas. Ethics are the conscience of the profession. Laws set the minimum standard of behavior; ethics set the highest standard of behavior.

9. Copyright © 2007 by Saunders, an imprint of Elsevier Inc. All rights reserved. Introduction Regulations regarding dental auxiliaries vary greatly from state to state, and the roles and the responsibilities of the dental auxiliaries also vary from state to state.

10. Copyright © 2007 by Saunders, an imprint of Elsevier Inc. All rights reserved. State Dental Practice Act  Primary Purpose  To protect the public from incompetent practitioners  The dental practice act 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.

11. Copyright © 2007 by Saunders, an imprint of Elsevier Inc. All rights reserved. State 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.

12. Copyright © 2007 by Saunders, an imprint of Elsevier Inc. All rights reserved. Licensure  The purpose of licensure is 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.

13. Copyright © 2007 by Saunders, an imprint of Elsevier Inc. All rights reserved. Types of Supervision: Direct  Direct supervision means that the dentist has delegated a specific procedure to be performed for a patient of record by a legally qualified dental auxiliary. The dentist must examine the patient before delegating the procedure and again when the procedure is complete.  The dentist must be physically present in the office at the time the procedures are being performed.

14. Copyright © 2007 by Saunders, an imprint of Elsevier Inc. All rights reserved. Types of Supervision: General  General supervision (indirect supervision) means that the dentist has authorized and delegated specific procedures that may be performed by a legally qualified dental auxiliary for a patient of record.  Exposing radiographs and recementing a temporary crown that has become dislodged are examples of functions that are often delegated under general supervision.  The dentist need not be physically present in the office at the time the procedures are being performed.

15. Copyright © 2007 by Saunders, an imprint of Elsevier Inc. All rights reserved. Unlicensed Practice of Dentistry  A dental assistant or dental hygienist may legally perform only functions delegated under the dental practice act of the state.  Performing procedures that are not legal is practicing dentistry without a license and this is a criminal act. Ignorance of the dental practice act is no excuse for illegally practicing dentistry.  This means that 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.

16. Copyright © 2007 by Saunders, an imprint of Elsevier Inc. All rights reserved. Dentist’s Responsibility to the Patient  Duty of care  Licensed  Use reasonable skill, care, and judgment  Use standard drugs, materials, and techniques  Abandonment  The dentist may refuse to treat a patient; however, this action must not be based on the patient’s race, color, or creed.

17. Copyright © 2007 by Saunders, an imprint of Elsevier Inc. All rights reserved. Patient’s 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.

18. Copyright © 2007 by Saunders, an imprint of Elsevier Inc. All rights reserved. Fig. 2-4 An important role of the dental assistant is to help maintain good communication with the patient. (Courtesy Pamela Landry, RDA.)

19. Copyright © 2007 by Saunders, an imprint of Elsevier Inc. All rights reserved. Categories of Law  Criminal Law  Felony  Misdemeanor  Infraction  Civil Law  Contract law  Administrative law

20. Copyright © 2007 by Saunders, an imprint of Elsevier Inc. All rights reserved. Contract Law  Expressed contracts  Implied contracts: Most dental contracts are implied contracts. For example, if a patient comes to the dentist with a toothache and allows the dentist to examine him, it is implied that he wants treatment.

21. Copyright © 2007 by Saunders, an imprint of Elsevier Inc. All rights reserved. Torts  A tort is a wrongful act that results in injury to one person by another. It may be done accidentally (negligence) or intentionally.  Example: A dental auxiliary mounted x-rays on the wrong side of the mount. The dentist noticed the error and turned the films over, and no harm was done to the patient. No tort occurred. However, if the dentist did not notice the error and extracted the tooth on the wrong side of the mouth because of the error in film mounting, a tort did occur.

22. Copyright © 2007 by Saunders, an imprint of Elsevier Inc. All rights reserved. “Four Ds”  Must all be present for a malpractice lawsuit to be successful:  Duty: There must be a dentist/patient relationship to establish the duty.  Derelict: Negligence occurred as a result of not meeting the standard of care.  Direct Cause: The negligent act was the direct cause of the injury.  Damages: May include pain and suffering, loss of income, medical bills, and so on.

23. Copyright © 2007 by Saunders, an imprint of Elsevier Inc. All rights reserved. Types of Malpractice  Act of omission: Example, A dentist failed to diagnose periodontal disease because he did not take x-rays or do a periodontal probing.)  Act of commission: Example, A dentist administered 15 cartridges of a local anesthetic to a very small child, and a serious overdose resulted in the death of the child.

24. Copyright © 2007 by Saunders, an imprint of Elsevier Inc. All rights reserved. Risk Management  The major areas of risk management (prevention of lawsuits) involve:  maintaining accurate and complete records  gaining informed consent  Legal authorities have noted that the primary factor in avoiding legal problems with patients is maintaining a climate of good rapport and open communication with all patients.

25. Copyright © 2007 by Saunders, an imprint of Elsevier Inc. All rights reserved. Avoiding Malpractice Suits  Prevention and good communication with the patient are the best defenses against malpractice. Patients are less likely to initiate a lawsuit when they have a clear understanding of: What is the planned treatment? What is the planned treatment? What are the reasonable results? What are the reasonable results? What are the potential complications? What are the potential complications? What are the patients’ financial obligations? What are the patients’ financial obligations?

26. Copyright © 2007 by Saunders, an imprint of Elsevier Inc. All rights reserved. Res Gestae: “Part of the Action”  The dental assistant or dental hygienist must never make critical remarks about dental treatment rendered by his or her employer or any other dentist.  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 in a court of law.

27. Copyright © 2007 by Saunders, an imprint of Elsevier Inc. All rights reserved. Types of Patient Consent  Implied Consent – Is given when the patient agrees to treatment, or at least does not object. Implied consent is a less reliable form of consent in a court of law should there be a malpractice suit.  Written Consent – Written consent is a preferred means of obtaining and documenting the patient’s consent and understanding of the procedure.

28. Copyright © 2007 by Saunders, an imprint of Elsevier Inc. All rights reserved. Guidelines for Informed Consent  To assist the patient in making an informed decision about having the proposed treatment, the dentist should explain:  The nature of the proposed treatment.  The benefits of the proposed treatment, and the consequences of not having the proposed treatment.  The most common and severe risks associated with the proposed treatment.  Reasonable alternatives to the proposed treatment, including the risks and benefits of each.

29. Copyright © 2007 by Saunders, an imprint of Elsevier Inc. All rights reserved. Informed Refusal  If a patient refuses the proposed treatment, the dentist must inform the patient about the likely consequences and obtain the patient’s informed refusal.  An informed refusal does not release the dentist from the responsibility of providing the standard of care. A patient may not consent to substandard care, nor may the dentist ethically or legally agree to provide it.

30. Copyright © 2007 by Saunders, an imprint of Elsevier Inc. All rights reserved. Informed Consent for Minors  For minor children, the parent, custodial parent, or legal guardian must give consent.  When parents live separately, the child’s personal information form should indicate which parent is the custodial parent.  Where separated parents share custody, the child’s record should contain letters from each providing consent and authorization to treat.

31. Copyright © 2007 by Saunders, an imprint of Elsevier Inc. All rights reserved. Patient Clinic Records  These records are important legal documents that must be protected and handled with care.  All examination records, diagnoses, radiographs, consent forms, updated medical histories, copies of medical and laboratory prescriptions, and correspondence to or about a patient are filed together in the patient’s record.  Financial information is not included in the patient’s chart.

32. Copyright © 2007 by Saunders, an imprint of Elsevier Inc. All rights reserved. Ownership of Dental Records  The dentist technically “owns” all patient records and radiographs.  Patients have the right to access (review) and retrieve (remove) their records and radiographs.  Original records and radiographs are never allowed to leave the practice without the dentist’s permission.  In most situations, duplicate radiographs and a photocopy of the record will satisfy the patient’s needs.