Ethics, Jurisprudence, and

Risk Management

DENA 101
Orientation to Dental Assisting
Fall 2002
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.
Jurisprudence:
 The philosophy of law or a system of laws.

 Laws are the minimum standards

established by the state.
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.
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!
 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.
 Conduct may be unethical and
still be legal. But it cannot be
illegal and still be ethical.
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.
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.
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.
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.
 One of your primary
responsibilities is to treat the
dentist(s), staff members, and all
patients with dignity and respect.
 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.
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.
 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.
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.
 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.
 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.”
 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.
What to Do of the Dentist is Sued
1. Say Nothing
2. Be supportive
3. Be cooperative
4. Ask before acting
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.
Provisions of the State Dental
Practice Act
1. Eligibility for licensure.
2. The methods and requirements for
licensure.
3. A definition of what is included in the
practice of dentistry within the state.
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.
 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.
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.
Reciprocity
A 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.
Grounds for Suspension or
Revocation
 Conviction of a Crime

 Unprofessional Conduct

 Personal or Professional Incapacity

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 records
 Fraud involving reimbursement of patient
expenses by insurance companies of government
programs.
 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.
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.
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!!
Levels of Supervision
 Direct 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.
Civil Law
 Contract 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.
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.
Types of Contracts
 Implied – 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.
When Written Consent is
Required:
 New drugs are being used
 Experimentation or clinical testing is involved
 A patient’s photograph is being used
 General anesthesia is being used
 Minor children are being treated in a public
program
 Treatment will require more than one year to
complete
Breach of Contract

Breach 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.
Four “D’s” of Tort Law
 Duty – a legal duty must be owed by someone to
another
 Dereliction – the duty owed must have been
breached by the accused
 Damage – the plaintiff must have been hurt in
some way
 Due to – the plaintiff must be able to prove that
the defendant’s action, or lack of, were the
proximate cause of the damage
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.
Patient of Record
 A 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.
Liabilities in Dentistry
The dentist may be held liable in the
following ways:
1. Breach of contract
2. Maligning a patient
3. Permitting a hazard in the dental office
4. Technical assault
5. Malpractice
Malpractice
1. Professional misconduct
2. Any unreasonable lack of skill
3. Lack of fidelity (faithfulness) in
performance of professional duties
4. Practice contrary to established rules
Malpractice May Be Do To:
1. Ignorance or neglect

2. Lack of skill

3. Neglect in applying these skills

Dentist’s Responsibilities to the
Patient
 Must be properly licensed
 Must exercise reasonable skill, care, and
judgment
 Must do only those things consented to by
the patient
 Must refer unusual cases to a specialist
 Must use standard drugs, materials, and
techniques
 Must complete agreed upon treatment
within a reasonable time
 Must hold inviolate the patient’s privacy
 Must give adequate instructions to the
patient.
 Must make a reasonable charge for the
services rendered
Patient’s Responsibilities to the
Dentist
 Must follow instructions during and after
treatment
 Must pay a reasonable fee or a fee agreed
upon between dentist and patient
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.
“Happy patients
don’t sue
their doctors.”
Ten Rules of Risk Management
 When in doubt say nothing
 If there is a problem or conflict with a patient,
refer the matter to the doctor
 Never say anything that implies a guarantee or
that will give the patient unrealistic expectations
as to the result which the dentist can achieve
 Never comment on the quality of care provided
by your employer or any other dentist
 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-date
 Always perform all of your duties to the
best of your ability
 Be prepared to assist in any kind of
emergency
 Do not start collection measures without
the doctor’s permission
Patient Records
The 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.
Part of the Patient’s Clinical
Record
 Medical and dental histories
 Examination findings and treatment plans
 X-rays (properly identified and dated)
 Any letters from, or about, the patient regarding
treatment
 Copies of prescriptions
 Written consent or refusal of treatment forms
 Notation of broken appointments or any failure to
follow the treatment or advise of the dentist
Not Part of the Patient’s Clinical
Record
 Any records that are kept for financial
reasons only
 Financial information such as the record of
charges, payments and the current balance
 Insurance claim forms
 Irrelevant materials, such as post cards
from the patient
Guidelines For Clinical Record
Entries
 Use the next available line
 Make the entry as soon as possible after the
patient’s visit
 Date the entry
 Sign or initial the entry to clearly identify who
made the entry
 Make the entry clear, concise, and complete
 The entry must be typed or in ink (blue or black)
 Handwritten entries must be legible
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 discovered
 Draw 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)
 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.
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 it
 Always lock file cabinets and/or rooms
containing files at the end of the day
 Refrain from answering queries regarding
patients from third parties such as a lawyer.
Refer all third party inquiries to the doctor
 Do not allow original patient charts to
leave the practice.
 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
Professionalism
 No 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