1

The Dentist’s Legal Responsibilities to the Patient

Dental Law and Ethics

2

Responsibilities 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

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

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

6

Patient AutonomyPatient 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

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

10What 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

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

12If 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

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

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

15

Standard of Care

• 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

17

Provide adequate instructions

• 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