Professional Responsibility in Dentistry

Joseph P. Graskemper, DDS, JD, DABLM, FAGD, FACD, FAES, FICOI, FASO, FCLM, is Associate Clinical Professor at Stony Brook School of Dental Medicine in Stony Brook, New York, USA.

Contents

Preface xi

Acknowledgments xiii

About the Author xiv

Part I Legal Concepts 1

1 The Lawsuit 3

True Case 1: Miscarriage due to endodontics 3

The Complaint 3

True Case 2: Changing the chart 4

True Case 3: Saving the case for trial 5

Examination before Trial 5

The Results 6

References 7

2 The Regulation of Dentistry 8

True Case 4: Dental state board case of fractured porcelain 9

Federal Oversight 10

OSHA 10

True Case 5: OSHA 12

FDA/DEA/EPA 12

NPDB 13

HIPAA 13

True Case 6: Ransomware 15

TCPA 16

True Case 7: Unsolicited texts 16

Licensure 17

Continuing Education 17

I-Stop (Internet System for Tracking Over-Prescribing) 18

Permits 18

Professional Misconduct and Unprofessional Conduct 19

True Case 8: Forfeit of license 20

True Case 9: Lost his license 20

Auxiliary Personnel 20

True Case 10: Assistant extracted tooth 21

Advertising 22

True Case 11: Dental society denial 23

Federal False Claims Act 23

True Case 12: Fraudulent billing 24

References 25

3 Definitions and Legal Concepts 27

Negligence 27

True Case 13: Amalgam tattoo – melanoma 28

True Case 14: Divorce due to paresthesia 29

True Case 15 (True Case 1 Revisited): Lawsuit due to dentist’s criticism 29

Definitions 29

True Case 16: Tennessee case Tolliver v. Gamble 32

References 32

Part II The Practice of Dentistry 33

4 The Doctor–Patient Relationship 35

Basis for Relationship 35

True Case 17: Food for fillings 35

Fiduciary Duty 36

Types of Realtionships 36

When Does It Begin 37

Duties of Doctor and Patient 37

Patient Relationships 38

When Does It End 39

True Case 18: No pay, no crown 39

References 39

5 May You Refuse to Treat? 40

Pandemics (COVID-19) 41

True Case 19: Patient demand 41

References 41

6 The Medical–Dental History 42

True Case 20: Only Boniva 42

Other Needed Information 43

True Case 21: Only heart surgery 44

Barriers 44

Reference 44

7 Patient Abuse 45

Definitions 45

Reporting Child Abuse 46

True Case 22: Child neglect 47

Elder Abuse 47

Signs of Abuse 48

Failure to Report Patient Abuse 48

Domestic Partner Abuse 49

References 49

8 Informed Consent 50

What Needs to Be Done 50

True Case 23: Implants include the teeth 51

Information Needed 51

Consent 52

True Case 24: Signed consent? Forgery 53

Competency 53

True Case 25: Two for one 54

Exceptions 55

True Case 26: Teenage pregnancy 55

Types of Consent 55

True Case 27: Lawyer threatens: write off patient’s balance or be sued 56

References 57

9 Records 58

True Case 28: $300,000 Night Guard 58

Record Entries 59

Electronic Records 60

True Case 29: Corporate greed 61

Release of Records 62

Texting 63

Teledentistry 64

HIPAA 64

Retention of Records 65

References 65

10 Statute of Limitations 67

When to Tell the Patient 67

Exceptions 68

True Case 30: Never fitting denture 68

Reference 69

11 Abandonment 70

Types of Abandonment 70

Avoiding Abandonment 71

True Case 31: No Money – No Teeth 71

Proper Termination 72

Release of All Claims/Anti-defamation Clauses 73

True Case 32: Patient outsmarts dentist 73

References 73

12 Standard of Care 75

How It Began 75

Challenges 81

References 81

13 Peer Review 83

True Case 33: Peer review 84

References 84

14 Risk Management 85

True Case 34: Too many “near misses” 86

The Dos and Don’ts of Risk Management 87

Collections 90

If You Are Sued 91

True Case 35: (True Case 6 revisited): Dentist leaves state 91

True Case 36: (True Case 2 revisited): Changing the chart 92

Practice Enhancement Through Risk Management 93

True Case 37: Who knows what is going on? 94

The Examination 94

References 97

15 Employees and Associates 98

Hiring and Firing 99

True Case 38: Extra-long vacation 99

Unemployment 100

True Case 39: Just eight hours count 100

Staff Snafus/Problems 101

True Case 40: Embezzlement 101

Harassment 102

True Case 41: Looks too good 102

References 102

Part III Professionalism and Ethics 103

16 Professionalism 105

Professional Obligations 105

Learning Professionalism 107

Professionalism Boundaries 108

Leadership 109

References 110

17 Ethics 112

Code of Ethics 113

True Case 42: Patient doesn’t want referral 114

True Case 43: I don’t want my teeth 114

True Case 44: Fractured porcelain 117

Teaching Dental Ethics 117

True Case 45: No pay, no treatment 118

Ethical Challenges 118

Decision Making 119

References 119

18 Professional Ethical Situations Based on True Cases 121

Part IV New Dentist Issues 125

19 Associateships 127

Noncompete/Restrictive Convenants 128

True Case 46: Dentist reopened next door 129

True Case 47: Dentist takes all patient records to new office 129

Trade Secrets 129

Compensation 130

True Case 48: Buy what you built? 131

True Case 49: Earn your pay 131

Dental Service Organization (DSO) 132

References 133

20 Starting or Buying a Practice 134

True Case 50: Do you see me now? 134

Location 134

True Case 51: You can run but you can’t hide 135

Transfer/Setup Considerations 135

True Case 52: Poof! You’re moving 137

Show Me the Money 137

True Case 53: Bankrupt 138

Balance Sheet and Profit and Loss 139

Insurance Needed 141

References 143

21 Marketing for a Successful Practice 144

Ethical Advertising 145

Competition for Patients 148

Fee Splitting 149

True Case 54: Keeping it in the family 149

The Logo 150

True Case 55: Keep the patients coming 150

Preferred Provider Organization (PPO) 150

True Case 56: Insurance company approves treatment but then doesn’t pay 152

Collections 153

References 154

22 Social Media 156

Types and Characterizations of Social Media 156

You Posted It, You Own It 157

True Case 57: Can’t stop you from posting it 158

True Case 58: Oh yes I can stop you from posting it 158

Is It Working? 158

References 159

23 Co-diagnosing and Gaining the Patient’s Trust 160

Types of Patients 160

Making the Appointment 161

Patient Motivation 161

True case 59: Denture time 162

Co-diagnosing With the Patient 162

Reference 164

24 Employee Management 165

True Case 60: Please believe me 166

Testing the Waters 166

Office Culture Integration 166

The Paperwork 168

True Case 61: Dr. Chadwick v. Board of Registration in Dentistry (MASS) 168

Evaluation and Appreciation 168

Reference 171

25 Multispecialty Practice 172

The Set Up 172

Who’s Next 173

True Case 62: I want to pay more 174

Show Me the Money 174

26 Forms 177

General Release for Dental Treatment 177

Consent for Pulpal Debridement and Endodontic Treatment 178

Consent for Oral Surgery 179

Consent for Periodontal Surgery 180

General Consent for Surgical and Invasive Procedures 181

Refusal of Treatment / Referral 182

Termination Letter 183

What You Should Know about Financing Your Dental Treatment 184

Authorization for Release of Dental Records 185

Photography Authorization 186

Release of All Claims 187

Anti-defamation Clause 188

Epidemic/Pandemic Dental Treatment Information Form 189

Index 190