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You are here >  Risk Management > CNA Risk Management Articles / Forms Sunday, December 17, 2017

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Clinical Issues

American Heart Association Updates Infective Enocarditis Guidelines

The American Heart Association (AHA) published new guidelines for the prevention of infective endocarditis (IE) in the April 2007 issue of its scientific journal, Circulation. The updated guidelines represent a significant change for many dental patients who have taken prophylactic antibiotics in the past.
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An Informed Consent Primer

During our dental risk management seminars, we often see exasperated looks on dentists' faces when the topic turns to informed consent. Their faces seem to ask why they should bother to use valuable chair time to talk about the proposed treatment or ask for an acknowledging signature. After all, they've practiced their entire careers without incident, without ever formalizing the informed consent process or using a written consent document.
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Anatomy of an Infection Claim

This claim from the CNA HealthPro claim annals demonstrates the need for thorough assessment, communication, and documentation when an infection is presented or suspected.
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Caring for the Pregnant Patient

One of the keys to successful care is good communication between the dentist and both the patient and her obstetrician. Few patients elicit a greater fear of litigation among dentists than pregnant ones. The thought of a patient alleging that a birth defect or other complication of childbirth had resulted from negligent dental care is certainly worrisome. However, the current body of knowledge suggests that most dental care presents little, if any, risk to either the mother or child.
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Claims Alleging Treatment of the Wrong Tooth

"Wrong tooth" allegations have long been a source of dental malpractice claims. Fortunately, dentists' risk management efforts have decreased the frequency of these claims from what they once represented fifteen years ago. Treatment of the wrong tooth is one of the more preventable causes of malpractice claims. The risks can be managed through careful attention to clinical needs, documentation, patient consent and communication between the primary and referral dentist.
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Dental Infection Management

Treating dental infections can be a challenging aspect of dental care. In addition to patients presenting with infections of unknown origin, infections are a potential unwelcome sequelae to almost any dental procedure. Infections often precede or exist concurrently with dental treatment, possibly compromising the treatment outcome or complicating the health status of the patient.
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Determining the Standard of Care

The dental standard of care is a moving target, changing as techniques and procedures evolve. This article looks at how the standard of care is established in court and how dentists can stay current. Standard of care is at the heart of dental malpractice claims and lawsuits. Some states require that an expert dental witness certify that there is a reasonable and meritorious cause for filing a lawsuit. The expert dental witness bases this decision on whether or not the standard of care has been followed. The following questions and answers examine some of the issues surrounding this key concept.
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Don't Be Numb to Local Anesthesia Risks

It has been estimated that American dentists administer hundreds of millions of local anesthetic injections each year.1 Because of their common occurrence and relative safety, local anesthetic injections are often overlooked as a professional liability risk. While not a significant source of professional liability claims, adverse events can occur during and in response to local anesthetic injections, sometimes with serious consequences.
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Early Detection Key to Treating Oral Cancer

Nearly 29,000 Americans will be diagnosed with oral cancer in 2002 and approximately 7,400 will die from the disease, according to estimates from the American Cancer Society (ACS). When detected early, oral cancer has a far better prognosis than most cancers. Unfortunately, many oral cancers are not diagnosed until they are relatively advanced. The current overall five-year survival rate for oral cancer stands at only 56 percent – lower than the 62 percent overall cancer survival rate, and sixth lowest among the 18 major cancer sites listed in the ACS’s “Cancer Facts & Figures 2002.”
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From the Claim Files of CNA HealthPro: Missed Cancer Diagnosis

We present a malpractice case history to educate readers about the risks faced by practitioners and the process of claims resolution. The patient, who had a history of sinusitis and nasal congestion, complained of right-side facial pain and swelling. After examining the area, Dr. X, a general dentist, told her the swelling she felt was an underlying bony projection.
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Liability Considerations in Aesthetic Dentistry

Aesthetic dentistry can turn ugly when a patient is dissatisfied with results. Managing patient expectations is the key to minimizing potential liability.
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Lightening the Risks of Vital Bleaching

As Americans retain their teeth longer and more serious dental problems become less common, the demand has risen for procedures to remove extrinsic discoloration – caused by aging and by cola, coffee, tea and tobacco stains – from vital teeth. The dental profession has responded by offering in-office vital bleaching, a relatively safe and inexpensive procedure that permits patients to brighten their teeth several shades.
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Manage Your Endodontic Risks

Few areas of dentistry have seen as many changes in recent years as the field of endodontics. Many dentists find today’s endodontic teachings and techniques very different from what they learned in dental school. It used to be the cardinal rule of endodontics to never, ever put a rotary instrument in a canal. Yet many dentists, even endodontists, now openly embrace rotary techniques for cleaning and shaping canals.
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Manage Your Extraction Risks

Of the many clinical procedures performed by dentists, more funds are paid annually for extraction malpractice claims than for any other dental procedure, according to CNA HealthPro claim data.
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Managing After-Hours Patient Calls

Dentists often receive phone calls away from the office, when they lack access to patient files. That’s when dentists most need a form to organize information and prompt the necessary questions. If problems develop afterward, a terse, cryptic note written on a scrap of paper will not impress a jury. It might even suggest that the dentists did not take a proper history or convey necessary information to the patient.
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Managing Implant Risks

Dental claims related to implants often have a high degree of severity. Careful patient selection, thorough case planning and sound clinical technique can minimize the risk to your patients and to yourself.
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Nitrous Oxide Risks Are No Laughing Matter

The use of nitrous oxide in dentistry dates all the way back to 1844, when Dr. Horace Wells first used it on his patients. Since that time, many patients have elected to have nitrous oxide analgesia during their dental appointments for its analgesic, anxiolytic and amnesic effects.
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Patient Records: Medical History

A number of malpractice lawsuits are filed each year by patients who claim the dental treatment they received led to a complication or bad result, as a consequence of an existing medical condition which contributed to the poor outcome. The patients claim that, although their dentist did not know of the condition, he or she should have been aware of it through the patient’s medical history. Finally, these patients maintain their dentist is negligent because the dentist failed to recognize the condition and prevent the complication or bad result.
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Periodontal Disease: Pitfalls and Strategies

Professional liability claims pertaining to periodontics most commonly allege failure to diagnose, failure to inform, failure to refer, or failure to treat. Adverse events during treatment and the failure of either surgical or non-surgical therapy produce few claims. The majority of periodontal claims are alleged against general dentists. This is statistically expected, considering that the majority of U.S. dentists are general practitioners. Claims against periodontists reflect the surgical nature of their practices and include claimed injuries such as postsurgical infection and paresthesia.
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Review - Antibiotic Prophylaxis for Dental Patients With Total Joint Replacements

The April 2007 American Heart Association (AHA) guidelines for the prevention of infective endocarditis are specific to patients with cardiac conditions and do not directly affect the previously published advisory statement from the American Dental Association (ADA) and the American Academy of Orthopaedic Surgeons (AAOS) regarding patients with prosthetic joints. However, patients who present with a medical history that includes both cardiac and total joint considerations will necessitate a greater degree of investigation, communication, and documentation by the treating dentist.
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The Importance of Follow-up

Proper follow-up is a critical phase of clinical dentistry as well as an excellent patient management and risk management technique. Good follow-up procedures enhance both patient care and patient satisfaction by identifying clinical problems early and addressing patient concerns and complaints quickly.
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The Importance of Follow-up - Claim Handling Issues

The quality of patient records always affects the defensibility of a malpractice claim. A good dental record speaks for itself and is often the key to a successful defense. In the case of Dr. Taylor, less than adequate records may hurt his attempt to prove that he gave Mr. Carroll sufficient follow-up instructions, which Mr. Carroll apparently chose to ignore.
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The Refusal of Periodontal Treatment and Periodontal Referrals

A patient who refuses either your periodontal treatment recommendation or your periodontal referral presents you with two choices. You can continue to treat the patient – within the outline of the parameters to follow – or you may dismiss the patient from your practice due to noncompliance. There is no right or wrong decision, simply a matter of preference.
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Treating the Older Patient

The number of older patients seen in dental practices continues to grow for two primary reasons: the aging of the U.S. population coupled with advances in health care. Individuals over 65 represent a growing demographic segment, constituting about one-eighth of the population. And seniors are retaining more of their teeth than ever before, with the proportion of edentulous older people dropping from approximately 60 percent in 1957 to roughly 40 percent today.
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Updating the Medical History

An accurate and current medical history is an essential tool in providing quality dental care. It also protects both the patient and you from unnecessary risks. Failure to obtain, update, and investigate the patient’s medical history have all been alleged in professional liability claims against dentists.
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When Your Patient Refuses

It happens to every dentist from time to time. You provide your patient with a thorough explanation of the treatment he needs and how it will benefit him, only to have him refuse to accept or follow your recommendation. Most refusals are based on finances or fear, although other factors may also be involved.
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Written Treatment Plans Benefit All

You know that patients don’t remember everything you tell them. Whatever the issue – the need for treatment, postoperative instructions or your rationale for a referral – if the message is relayed orally, the likelihood of total recall on the patient’s part is remote. Treatment plan discussions are no different. From the necessity for treatment to the sequence to the cost, people forget what you tell them.
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FAQ's - Automatic External Defibrillators

Q. The American Dental Association’s Council on Scientific Affairs recently announced the awarding of its first Seal of Acceptance for a defibrillator. Although I was considering one before, does this now mean I am required to have one in my office in order to meet the standard of care?
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FAQ's - Drug Interactions

Q. I've heard that some over-the-counter allergy remedies can react with common dental anesthetics and antibiotic drugs. How can I protect my patients against harmful drug interactions?
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FAQ's - Extractions

Q. I perform several third molar extractions each week. Before each extraction, I sit down with the patient and explain that, if desired, a referral can be made to an oral surgeon for the extraction. Next, we discuss any available alternatives and the risks and complications of the procedure, including the risks of paresthesia. I then have the patient read and sign an informed consent form covering these issues. I have had a couple of instances of post-extraction paresthesia; when they occurred, I called and conferred with an oral surgeon. My question: Am I doing everything I can to avoid a claim of negligence?
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FAQ's - Fen-Phen

Q. What exactly is Fen-Phen? A. The term "Fen-Phen" has come up in many news reports describing cardiac valvular damage caused by appetite suppression drugs. The "Fen" can be either fenfluramine (Pondimin®) or the dex-isomer of fenfluramine, dexfenfluramine (Redux®). "Phen" is the drug phentermine (Adipex®, Fastin® or Ionamin®).
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FAQ's - Office Medications

Q. I keep some medications in the office to dispense to patients when needed. How can I best manage the risk of theft and other potential problems?
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FAQ's - Patient Misuse of Dentist's Drug License

Q. I recently received a call from a local pharmacy regarding a patient I last saw about a year ago. The pharmacist inquired about a recent prescription for narcotics that had been phoned in using my DEA number, purportedly by one of my staff. It became apparent during the conversation that it had been the patient herself who called in the prescription, as well as others attributed to area physicians. I am concerned about the potential consequences I may confront because this patient used my personal information to obtain controlled substances. Is there anything I can do at this point to minimize my risk?
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FAQ's - Poor Quality Duplicate Radiographs

Q. I am a specialist, and I often receive duplicate radiographs from referring dentists that are so poor in quality I feel uneasy using the films to treat the patient. Naturally, patients balk at the prospect of having to pay for additional films. How might I go about getting the originals from the referring dentist? And if I can’t get the use of the originals and the patient does not consent to additional films, am I obligated to treat that person anyway?
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FAQ's - Pro Bono Dentistry and the Standard of Care

Q. Some residents of my town need dental care but cannot afford it. Does the standard of care dictate that I treat their problems definitively, even if they are unlikely to pay a fee, or is it acceptable to treat their problems palliatively and defer definitive care? If I provide care on a pro bono basis, does that limit my obligation or my potential liability, and have I “accepted” them as patients?
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FAQ's - Swallowed Object

Q. Recently, a finished crown that I was attempting to cement disappeared down a patient’s throat. The patient coughed for a few minutes, but she seemed all right after that. She said she thought she had swallowed the crown, which sounded reasonable considering that her coughing had stopped. I suggested that she check her stools for the next few days to verify the passage of the crown. Was there anything else I should have said or done?
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FAQ's - Vacationing or Transient Patients

Q. Where I practice, dentists see a lot of “snow birds” – people who live up north most of the year but spend their winters here, where it’s warmer. It is very common for these individuals to call my office and say they “only want a cleaning,” and that their dentist back home will take care of the exam. Am I placing myself at a greater risk by allowing them to have prophys without insisting on exams?
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Patient Management Issues


An Informed Consent Primer

During our dental risk management seminars, we often see exasperated looks on dentists' faces when the topic turns to informed consent. Their faces seem to ask why they should bother to use valuable chair time to talk about the proposed treatment or ask for an acknowledging signature. After all, they've practiced their entire careers without incident, without ever formalizing the informed consent process or using a written consent document.
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Anyone Can Learn to Communicate Better

Communication is a vital element in every successful dental practice, fostering the relationships that tie patients and dental practices together. Dental communication issues pervade risk management and include contact between dentist and patient, dentist and staff, staff and patient, and between dentists. By properly managing these issues, you can improve patient care and increase patient satisfaction levels – and also help reduce the risk of a malpractice claim arising from a communication breakdown.
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Can I Be Held Responsible For a Negligent Referral?

Yes, you can! Although referrals generally improve the quality of care patients receive, it sometimes happens that a patient claims injury while under the care of the referral dentist. The claimant may cast a wide net in such an instance, alleging not only that the treating dentist committed malpractice but that you, the referring dentist, made a negligent referral that put the patient in harm’s way.
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Decision Making and the Patient of Questionable Mental Capacity

Dentists confront many dental, medical, ethical and legal questions when dealing with mentally incapacitated patients and those with questionable mental capacity. Health care decisions are valid only when patients have the capacity to comprehend and consent to treatment – and patient capacity can be difficult to assess. As the number of older Americans continues to grow, this issue will affect greater numbers of dentists and patients.
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Effective Physician Consultations

Consultations with physicians and other health care professionals are an important part of treating and protecting the health of patients with special medical conditions. Dentists have both an ethical and legal duty to be knowledgeable about the non-dental consequences of the treatment they perform as well as the medications they prescribe, as ignorance is not a valid defense to a malpractice action. Effective management of these cases depends on gathering the necessary information prior to treatment.
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Good Telephone Technique Keeps Patients Connected

The success of your practice depends on relationships and patient confidence. This process often begins with good telephone skills. The following ideas, culled from a variety of sources, can help you and your staff deal more effectively with patients and create a more positive image of your practice.
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How Patients Perceive Your Practice

A patient’s perception of your practice is based on much more than the dental care you provide. It includes many seemingly minor details, from the tone of the receptionist’s voice to the currency of reception area magazines. A positive perception increases patient loyalty and encourages patients to recommend your practice to their acquaintances, while a negative perception can be a major detriment to your practice and could potentially increase the risk of patient dissatisfaction and malpractice claims.
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Informed Consent and the Minor Patient

Most dentists are aware that, as a general rule, an unemancipated minor’s consent to treatment is not valid, and that the consent of a parent or legal guardian must be obtained before treatment is rendered. Yet dentists frequently provide “routine” dental treatment to their minor patients withoutsuch consent.
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Looking at Your Practice From the Patient's Point of View

Experience teaches us that the success of a practice does not depend entirely on the clinical skill of the dentist. Most patients lack the training and experience to objectively evaluate a dentist’s clinical skills. Instead, they gather information and form impressions based on their own subjective criteria, which may be very different from the standards dentists apply to themselves. To make your practice more successful, first determine how it and you are perceived by patients.
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Make Patient Records Work For You

Dentists often consider record keeping as time-consuming drudgery. But effective record keeping is one of the most powerful risk management tools available. Comprehensive, thorough records reduce the likelihood of treatment errors, communication problems and patient dissatisfaction.
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Managing After-Hours Patient Calls

Dentists often receive phone calls away from the office, when they lack access to patient files. That’s when dentists most need a form to organize information and prompt the necessary questions. If problems develop afterward, a terse, cryptic note written on a scrap of paper will not impress a jury. It might even suggest that the dentists did not take a proper history or convey necessary information to the patient.
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Managing Patient Expectations

Many risk management problems and their subsequent solutions have their roots in how well a dental team can assess and actively manage patient expectations. Unfortunately, failure to meet patient expectations continues to be a major cause of professional liability actions. Through careful communication with patients and staff, you can discover and understand what patients know about dentistry and what they expect from you and your practice. Only then can you assess what you learn about your patients to determine whether or not their expectations are reasonable.
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Medical Emergencies

Medical emergencies in the dental office can take many forms, ranging from the common and relatively benign syncope to rare but serious sudden cardiac arrest. In between those extents of severity, we have received claims involving hematomas, burns, respiratory arrest, asthma attacks, excessive bleeding, allergies, and diabetic shock, to name but a few emergency medical events.
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Patient Referral Letter Template

Proper Termination Procedures Reduce Abandonment Risks
The standard of care for dentists includes the legal duty to continue caring for patients of record. If an irreconcilable doctor-patient conflict results in a determination that you cannot continue to care for the patient at or above the required standard of care, you have an obligation to end the relationship in an appropriate manner. Improper termination of the dentist-patient relationship may lead to allegations of abandonment, failure to recall or failure to treat.
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Reducing Referral Risks

The referral of patients is a daily event in dentistry. Whether the referral is for specific treatment or a second opinion, to a specialist or another general dentist, referrals permit you to offer patients the best possible care.
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Referral: The Specialist's Perspective

Regardless of the treatment requested by the referring dentist, dental specialists have an independent professional duty to assess the patient and determine an appropriate treatment plan. Occasionally, a referring dentist or his or her staff member will request inappropriate treatment, such as endodontic therapy on a non-restorable tooth, or indicate treatment for the wrong tooth. By taking the time to verify the need for care, you can help avoid errors and resultant patient injuries that could expose both you and the referring dentist to liability.
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Sample Patient Termination Letters

The following fictitious scenarios discuss why a patient might be terminated and provide examples of letters that might be used to effect the termination. Please keep in mind that situations and information needs vary from patient to patient and dentist to dentist.
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The Managed Care Referral Dilemma

The scenario: your longstanding patient, Mr. Franklin, needs a periodontal referral. He has recently switched jobs and dental insurance plans as well. Although he previously had a benefit available for treatment by any periodontist, he now receives a benefit only if he sees a periodontist who participates in the plan. Unfortunately, you do not know any of the periodontists listed – or perhaps you know one, but feel uncomfortable referring Mr. Franklin to him.
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Treating the Older Patient

The number of older patients seen in dental practices continues to grow for two primary reasons: the aging of the U.S. population coupled with advances in health care. Individuals over 65 represent a growing demographic segment, constituting about one-eighth of the population. And seniors are retaining more of their teeth than ever before, with the proportion of edentulous older people dropping from approximately 60 percent in 1957 to roughly 40 percent today.
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Using Technology to Enhance Communication

Dentists are increasingly taking advantage of high-tech tools such as patient education systems, intraoral cameras and computer imaging systems to explain their diagnoses and treatment recommendations in a more graphic, compelling and efficient way. While these devices can often demonstrate certain conditions and objectives that spoken and written descriptions cannot, they are not a substitute for dialogue, documentation and informed consent.
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Using Written Informed Consent Forms

Written informed consent forms are used to supplement, but not replace, informed consent discussions. Most patients do not remember all that they were told during the informed consent discussion, making written forms a valuable reminder to both the patient and the dentist. When used, they should have uncomplicated language that the patient will understand.
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When Your Patient Refuses

It happens to every dentist from time to time. You provide your patient with a thorough explanation of the treatment he needs and how it will benefit him, only to have him refuse to accept or follow your recommendation. Most refusals are based on finances or fear, although other factors may also be involved.
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FAQ's - Consent for Minors

Q. I have a 16-year-old patient who needs her wisdom teeth extracted. She is living with her boyfriend’s family, as her mother is deceased and her father, with whom she has virtually no contact, lives in another town 100 miles away. Can her boyfriend’s mother sign the consent form?
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FAQ's - Inadequate Patient Funds

Q. I just completed a root canal on tooth #30. Unfortunately, the patient now claims I never informed him of the costs associated with the build-up and crown and that he cannot afford to continue with treatment. He said that if he knew it would cost this much, he would have had the tooth extracted. What should I do to avoid a problem going forward?
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FAQ's - Informed Consent Protection

Q. Does having obtained informed consent provide any protection for a true instance of malpractice?
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FAQ's - Referral Refusal

Q. I am a general dentist in a rural area. There is no specialist of any kind within 30 miles of my office. Because of the travel distance, it is not unusual for my patients to balk when I suggest a referral to a specialist. Trying to keep patients happy, I have gone ahead and treated cases of all kinds that I originally thought best to refer, including third molar extractions, molar endo and perio surgery. Fortunately, I haven’t encountered any major problems so far. But how much risk am I accepting by attempting the treatment after the referral is refused?
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FAQ's - Unaccompanied Minors

Q. I feel very uncomfortable when a parent drops off a young child and leaves, telling us we can treat the child and to call their cell phone if we have any questions. Other issues also arise that customarily require discussion with a parent, such as fees, insurance matters, and various treatment and post-operative issues. Should I be concerned that the parent is not physically present in the office?
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FAQ's - Weight Loss Management

Q. I recently read about a removable intraoral appliance that is being marketed by dental practices as a behavior modification device for the sole purpose of patient weight loss. What are the risks I need to consider before deciding whether or not to offer this treatment option in my practice?
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Practice Management Issues


A Confidentiality Primer for Dentists

Confidentiality is central to the dentist-patient relationship. This article examines the rules governing disclosure of patient information in normal circumstances and after a claim has been filed.
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A Safety Checklist for Your Office

As a dentist, your responsibility for patient safety extends beyond the provision of care. You also have an ethical and legal duty to make your premises as safe as possible for all visitors. To protect your patients and yourself, it is necessary to establish an effective accident prevention and emergency preparedness program. Such a program involves identifying risks, preparing for possible emergencies and implementing appropriate practice policies. And, as even the best precautions cannot always prevent adverse events, it is also necessary to maintain adequate general liability insurance coverage.
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Assess Your Records Management Practices

Sound risk management practices can aid dentists in two ways: first, by reducing the chances that an untoward patient care event will occur, and second, by helping protect the practitioner if a liability claim is filed.
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Be Cautious About Collection Actions

In an ideal world, every patient would pay his or her bill, in full, at the end of each appointment. In the real world of dentistry, however, some accounts go unpaid for a variety of reasons. Efforts to obtain outstanding receivables may result in disputes that destroy the dentist-patient relationship, especially if the dentist has forwarded the patient's account for collection action.
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Be Prepared for a Slip-and-Fall Incident

It might be a visitor. It might be a patient. But, chances are, you won't be there to witness it should someone slip and fall in your office or in a building you own.
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Can You Be a Better Insurance "Patient"?

Every dental practice is familiar with the patient who gives an incomplete health history update, who doubts the need for regular bitewing or panoramic x-rays, who is too busy for six-month recalls and who wonders if the whole process is just about selling more dentistry. It’s usually the uninformed, non-compliant patient who develops oral health problems that could have been avoided or minimized.
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Conducting Effective Performance Evaluations

Regular performance evaluations are an essential tool for monitoring performance and determining promotions and wage increases. They can also serve an important risk management function: protecting employers, including dentists, from accusations of unfair labor practices.
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Coping With a Malpractice Suit: A Defense Attorney's Perspective

Being sued for malpractice is a traumatic experience for any dentist. Dentists are highly self-motivated professionals who are used to being in control of their destinies. As defendants, though, dentists often feel swept along by events, lacking the ability to direct the outcome of the legal process.
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Correcting and Amending Dental Records

Accurate and complete records are one of the most powerful risk management tools and a foundation for quality patient care. In the event that you do become a defendant in a malpractice action, a comprehensive dental record is your chief defense weapon. It is difficult for a plaintiff to challenge an accurate and organized dental record written at the time of treatment.
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Creating an Emergency Plan

Creating an emergency response plan requires some time and effort. However, resources are available to assist you in your task. To get you started in the creation of an emergency response plan, we have outlined the essential steps below.
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Dental Advertising - Risks and Liabilities

Once banned, dental advertising is now a part of mainstream society. Whether in electronic media such as radio and television, or print ads in local newspapers, telephone directories, and coupon mailers, dental advertising is more pervasive than ever.
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Do You Have an Office Emergency Plan?

Without an emergency plan, you could be increasing the risks to patients and staff. Here are some tips on planning for the unexpected. As a dentist, you are responsible for the safety of your staff and patients while in your office. This includes times of unexpected emergency, such as a loss of power, fire or explosion. It is important that you plan for emergency situations and the challenges they bring. For example, who would assist patients during an evacuation? If, in the middle of treatment, the electricity went out or a fire alarm sounded, how would you handle your patients?
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Easing the Concerns of Retirement

The decision to retire from practice is often a difficult one, involving many personal and professional considerations – including potential liabilities. The fact is that retiring from dental practice does not necessarily end all associated liabilities. Fortunately, with a little time and effort, you can protect yourself against many of these risks.
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Hired Contractors and Insurance

Dentists most often think about insurance in the context of patient care benefits or malpractice claims. While both these insurance products are important to dental professionals, other forms of insurance can be equally vital.
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Improving Documentation Through Self-Assessment

While most dentists readily admit that their record keeping practices could be improved, they also admit that they are often too pressed for time to write as much as they should. One aspect of managing risk is to recognize those instances when additional measures are warranted. In the realm of documentation, this means writing more comprehensive entries for those patients and clinical procedures that you believe present a heightened risk. The risk may be an adverse outcome or simply patient dissatisfaction. Both of these matters may trigger dental professional liability claims.
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Make Sure Hired Contractors are Insured

Dentists most often think about insurance in the context of patient care benefits or malpractice claims. While both these insurance products are important to dental professionals, other forms of insurance can be equally vital.
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Managing the Risk of Repetitive Stress Injuries

RSIs can cut short the careers of dentists and staff members. To combat this threat, dentists may need to make ergonomic adjustments to the work environment. Chronic work-related musculoskeletal disorders are becoming more prevalent in the American workplace. The Bureau of Labor Statistics estimates that more than 60 percent of new workplace ailments reported in 1995 were repetitive stress injuries (RSIs). The costs are staggering: in 1997, workers’ compensation for RSI and back injuries claims amounted to an estimated $20 billion, while the indirect costs (including lost work time, reduced productivity and rehabilitation expenses) added an additional $100 billion.
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Must Dentists Provide Maternity Leave?

Maternity leave can be a complex issue for dentists and other small employers. Dentists want to keep valued employees happy by allowing a reasonable amount of time off after the birth of a child, yet they must consider how an extended absence could affect their practice. At the same time, federal, state and local laws create a variety of obligations for employers. Dentists must carefully balance these factors to maintain morale and productivity while avoiding potential liability.
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New Legal Standard Increases Risk of Harassment Claims

In two recent opinions, the U.S. Supreme Court established a new standard of liability for employers in sexual harassment cases. The new standard not only affects sexual harassment liability, but it may well foreshadow changes in other areas of employment discrimination law. These changes could have a major impact on all employers, large and small — including dental practices.
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Patient Financial Management

Malpractice allegations against dentists may result from a combination of a poor treatment result and a breakdown in the doctor-patient relationship. However, often such allegations arise due to a patient’s financial problems rather than a bad result. For example, a patient may assert a defense of negligent treatment in response to a collection action.
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Plan in Advance for Emergency Events

Regardless where you live, planning for potential emergencies should be an important aspect of your practice management plan. The need to plan is vital, whether the event is a medical emergency involving a patient's health or a non-medical emergency that affects your practice. This article will address nonmedical emergencies.
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Protecting Accounts Receivable Records

Should an event such as a fire or flood destroy your accounts receivable (A/R) records, you would be unable to identify those patients with an outstanding balance on their account, making collection of the fees difficult.
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Record keeping Self-Assessment Checklist

Record keeping Organization

  • Do you maintain a record keeping system that allows you to locate a patient's record quickly?
  • Do you maintain a record keeping system that facilitates finding misplaced patient records?
  • If you keep computerized records, do you make a back-up regularly and store it off-site?
  • Do you have an established office protocol for record handling and record access?
  • Do you have a record keeping system that deters your staff from making unauthorized entries in patient records?
  • Do you have a method for training new employees in the record keeping methods of the office?


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The Importance of Staff in Managing Risk

 

Dentistry is a team business. No matter how or where you look in a dental practice, dental staff are vitally important to every aspect of it. That importance includes their ability, whether directly or indirectly, to manage risk.
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The National Practitioner Data Bank

The following is a review of the National Practitioner Data Bank’s (NPDB) purpose and its mandatory reporting requirements. The NPDB was created through legislation because Congress perceived the increasing occurrence of medical malpractice litigation and the need to improve the quality of medical care to be two problems that had become nationwide in scope and too large for states to address individually. When the Health Care Quality Improvement Act of 1986 became law, dentists found themselves included in the legislation alongside physicians, nurses, dietitians, optometrists, pharmacists and other licensed healthcare practitioners. The NPDB actually began collecting and disseminating information on September 1, 1990.
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The Paperless Record

One of the most significant changes in healthcare over the past decade has been the increasing ability to move toward a “paperless” practice. What began with relatively simple billing and financial bookkeeping programs has evolved into integrated patient record and practice management systems with a wide range of capabilities, such as electronic scheduling, clinical progress notes and diagnostic imaging. In fact, many hospitals at the cutting edge of the technology curve have already converted their patient charts to entirely computer-based systems in an effort to reduce communication and medication errors.
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Useful Tools to Manage Employment-Related Risks

CNA HealthPro is pleased to introduce H.R. Web Training, an interactive, web based tool that helps dentists insured through the Professional Protector Plan for Dentists to develop recognized and current employment practices and procedures. CNA is offering this service through The AGOS Group, LLC, a nationally recognized human resources consulting and training company. The system features a menu of training and best practice tools designed to empower organizations in their efforts to manage their workplace and help minimize incidents and litigation.
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Vicarious Liability

Vicarious liability is based in part on the legal concept of respondent superior, which holds the “master” (employer) responsible for the acts or omissions of its “servant” (employee). When a person employs another for his or her own profit, fairness demands that the person also take responsibility for managing the risks and paying for the damages associated with the employee’s work. Dentists, as employers, are vicariously liable for the negligent actions of staff members acting within the scope of their employment.
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Volunteer Dentistry Is Not Risk-Free

Many dentists volunteer their time and talents to patients who might otherwise not receive care, delivering free or significantly discounted treatment in their office or a community clinic. The vast majority of such patients are grateful for the services they receive. However, charitable intentions do not negate potential liability. It is necessary to understand the risks posed by volunteer dentistry in order to manage them successfully.
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When Working with Temporary Staffing Agencies, Sound Practices Mitigate Risk

Temporary staffing and locum tenens agencies have come to play an important role in dentistry. Temporary personnel provide an important measure of flexibility, allowing dental practices to adjust quickly to employee absences as well as longer leaves and departures. Dentists also benefit from the ability to fill critical openings and to evaluate candidates for possible permanent employment. Hired on a short-term basis, temporary workers can help a practice maintain adequate staffing levels, reduce its human resources burden and strengthen its bottom line.
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FAQ's - Adding a Dentist

Q. I’m considering adding a dentist to my growing practice. What factors would a court consider in determining whether the new dentist is an employee or an independent contractor?
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FAQ's - Attorney's Request for Records

Q. I recently received a letter from an attorney representing a new patient. In it, he requests that I prepare a report describing my examination findings as well as my personal thoughts regarding the patient’s prior care. He included an authorization signed by the patient to release dental records. I am guessing that the patient plans to bring an allegation of malpractice against his former dentist. I feel uncomfortable about the whole thing and would really prefer not to respond at all, let alone put my comments in writing. What am I legally required to do?
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FAQ's - Employee Theft

Q. I’ve been as busy as ever lately, but my practice income is lower than in past years. I’m beginning to wonder if my longtime receptionist/bookkeeper has been stealing from me. What are the signs of employee theft and what can a dentist do to prevent it?
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FAQ's - Evacuation Plans

Q. What does OSHA require in terms of office fire safety and emergency plans?
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FAQ's - Hygienist Liability

Q. Does my dental hygienist need her own professional liability policy? Does my PPP policy cover me for the actions of a hygienist working in my office?
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FAQ's - Independent Contractor Liability

Q. I am a dentist working as an independent contractor in a dental practice owned by another practitioner. I do not have any employees of my own, but I use the practice’s front office staff, dental assistants and dental hygienists. In this situation, am I still at risk for claims alleging discrimination or other employment-related liability?
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FAQ's - Office Medications

Q. I keep some medications in the office to dispense to patients when needed. How can I prevent theft and other problems?
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FAQ's - Refund Requests

Q. A patient recently requested a refund of fees for a crown I placed two months ago on tooth #7. Although the crown looks great to me, with closed margins and very natural esthetics, I’m inclined to comply with her request just to appease her and get the issue past me. If I go ahead and give her the refund, am I in some way admitting wrongdoing or negligence?
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FAQ's - Request for Records

Q. I just received a request for a patient’s dental records. How should I respond?
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FAQ's - Responsibility of Associates

Q. A dentist who formerly worked in my office as an independent contractor did a bridge for a patient last year. He left to start his own practice four months ago. The patient recently returned to my practice, complaining about the bridge and wanting it remade. I examined her and found an open margin on one of the abutments. Since I had not made the bridge myself, I suggested she see my former associate. Later, I received a phone call from the patient, informing me that my former associate told her to pursue the matter with me, since the payment check was made out to my practice. What can I do to make my former associate accept responsibility for his work?
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FAQ's - Restrictions of PPO Plans

Q. I signed up with a new PPO plan a few months ago. Since joining, I’ve begun to wonder whether the plan’s service restraints and reimbursement limitations might create potential liability for me. What do I need to know to properly handle the differences between what I would like to do and what I’m allowed to do?
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FAQ's - Sale of Oral Hygiene Products

Q. I sell to my patients a variety of dental hygiene products that are not readily available in the stores in my community. Does this practice pose a legal risk?
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FAQ's - You as an Expert Witness

Q. I have been asked by a defense attorney to give a deposition in a dental malpractice lawsuit. Before I decide to participate, I would like to know if I am exposing myself to significant legal risk as an expert witness, and how can I protect myself against these risks?
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Sample Forms


Informed Consent: Discussion and Consent
Discussion and Consent for Crown Restorations
Discussion and Consent for Extraction
Discussion and Consent for Root Canal Treatment
Discussion and Refusal of Periodontal (Gum) Treatment
Informed Refusal: Discussion and Refusal of Treatment
Authorization to Release Confidential Patient Information
Patient Referral Letter Template
Sample Patient Termination Letters


Property


Assessing the Risk of Property Loss Due to Fire

 

The risk of a fire loss depends greatly on the ability to prevent, detect, and suppress a fire. However, there are additional factors that influence the likelihood that a structure can be saved before it is completely consumed. These factors influence the insurability as well as the insurance rates for a given structure in a given location.
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Protect Your Office Against Fire

Few events are as devastating to a dental practice as a fire. In addition to the threat of bodily injury, fire can result in a range of financial losses and decreased cash flow. Dentists should carefully assess their vulnerability to fire and implement strategies to protect their practice, patients and employees.
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FAQ's - Guarding Against Flood Damage

Q. My practice is in a flood-prone area, and I fear for the safety of my patient files. What practice information should I keep off-site for safekeeping, and how can I reduce potential flood damage?
A. To protect against such perils as flood, fire and tornado, we strongly advise all dentists to keep updated copies of the following lists in a secure, off-site location:
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Claims


A Legal Perspective on Claims Outcomes

CNA HealthPro claims specialists are frequently asked questions about malpractice claims outcomes. Usually, these questions arise after a dentist has heard through the grapevine that a case has been resolved, either by settlement or verdict, at what seems an unreasonable cost. They are asked why CNA HealthPro settled such a case, or why it went to trial, or why we agreed to pay such a sum for a particular injury.
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Dental Malpractice at the End of the Century

“As long as we have human error, we will have malpractice.”
— William Otis Morris
While this statement may be true in some instances, it would be wrong to imply that all human error has been, or presently is, considered malpractice. Malpractice, whether applicable to dentists or other healthcare providers, primarily revolves around the issue of reasonableness. This includes both the information provided to the patient making a treatment decision, and the appropriateness and technical proficiency of the procedure ultimately performed.
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The Basics of Claim Assessment and Valuation

The outcome of any malpractice allegation is affected by a variety of factors, both clinical and nonclinical. The claim specialist is responsible for assessing and managing these factors to effect the most desirable claim outcome for the dentist whose professional services have become the subject of a claim.
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Why are Malpractice Claims Alleged?

Dentists and other health care providers against whom malpractice has been alleged can’t help but ask themselves – why? Why did this patient think I did something wrong? Why did this patient turn on me? Why didn’t the patient pay his bill on time? Why doesn’t the patient remember my instructions? The list could go on forever.
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FAQ's - Deposition Attendance

Q. I’m involved in a malpractice lawsuit and am now in the deposition phase. Am I required to attend all the deposition sessions? My practice is busy and I’d like to keep time away to a minimum.
A. While you are not required to attend all depositions, you have the legal right to do so – and it’s a good idea. While depositions can be time-consuming, we strongly recommend attending at least the plaintiff’s and expert witness sessions.
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FAQ's - Donated Services

Q. If I treat a patient palliatively as a humanitarian gesture and don't charge a fee for the service, does that limit my obligation and/or my potential liability?
A. Regardless of how much or how little dental care you provide for a patient, you always have the duty to practice at or above the standard of care. It doesn't matter if it's palliative care, definitive care, free care or just an examination. Whatever you do must meet or exceed the standard of care at all times. This includes free dentistry you provide to friends, relatives or indigent patients. The fact that you provided free care does not alter or waive your professional duty.
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FAQ's - Understanding Court Actions

Q. I am a dentist who was named as a defendant in a lawsuit. Recently, I was advised that summary judgment was entered by the court in my favor. What exactly does this mean? Is the lawsuit over as far as I am concerned?
A. Summary judgment is a favorable outcome for you. Lawsuits that do not make it to trial are generally resolved in one of three ways:
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Coverage


Claims-made Coverage: Today's Limits for Last Year's Incidents

The primary benefit of the claims made policy is the ability to reevaluate both your limits and your insurance company on an annual basis. While we can help you purchase adequate coverage for today based on the current claims climate in your area, we have no way of predicting the liability climate of the
future. Only a claims made policy allows you to increase your limits for prior events effective immediately and, should you change carriers, to have your new carrier provide coverage for past incidents.
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Insuring Your Leased Equipment

Perhaps you, like many dentists, have leased new equipment and financed it through a leasing company. These companies almost always require you to provide proof of property coverage for the leased equipment, and to name the leasing company as a loss payee on your insurance policy. If you do not provide proof of coverage within approximately 30 days, the leasing company will often provide it for you, which can be a costly proposition.
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Liability Insurance: Rational Protection in an Irrational World

A Professional Protector Plan (PPP) package policy includes several types of liability insurance protection, including professional liability and general liability. In addition, the policy provides protection against products liability and vicarious liability under both of these coverage parts. Why is it so important to insure against all of these forms of potential liability? First, because liability is unpredictable, and second, because insurance is the best means of protecting your assets in the event of a court’s finding of
liability.
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Name that Professional Corporation

If you are like most dentists, you have organized your business as a sole proprietorship, a professional association, a corporation or some combination of these entities. It is very important that these business structures be named in your professional liability policy.
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Practice Changes? Keep Your Agent in the Loop

Check your calendar – chances are good that your Professional Protector Plan (PPP) policy renewal date is coming up soon. As in the past, not long before you receive your policy and invoice, your PPP agent will likely contact you either by telephone or through the mail with a short renewal application. This prerenewal process is not just a formality: it allows your agent to assist you in assessing your practice and obtaining adequate protection.
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Understanding First Aid Coverage

If a patient suffers an injury while under your care or on your premises, the Professional Protector Plan for Dentists (PPP) can protect you in a number of ways: Professional liability coverage, Medical payment, First aid supplement...
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Valued Practice Interruption: Have you Selected the Right Limit?

Practice Interruption coverage is one of the most commonly used features in the Professional Protector Plan policy, yet it is widely misunderstood by insureds. Practice Interruption comes into play when your office suffers physical damage by a covered cause of loss that causes you to cancel patients.
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FAQ's - Changing Carriers

Q. I’m considering changing my malpractice insurance carrier. Could this create a coverage gap?
A. It’s quite possible, depending on what type of insurance you have and what type you’re considering purchasing. Claims-made policies cover claims that are first made against you while the insurance is in force, based on incidents that occur after the prior acts date.
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FAQ's - Hygienist Liability Insurance Issues

Q. My dental hygienist has asked me if she needs to have her own professional liability policy. What considerations are important, and what does my PPP policy cover with respect to the actions of a hygienist working in my office?
A. Whether your hygienist needs her own liability policy is a personal decision and depends on a variety of factors. Fortunately, malpractice claims against hygienists are uncommon. Here are seven issues for hygienists to consider.
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FAQ's - Limits of Employee Dentist Coverage

Q. I am employed as an associate dentist in a multi-office practice. The practice owner recently asked me and all other employee dentists to sign a new contract which differs from the previous contract under which we
have all worked. The differences are that the owner has asked each of us to increase our professional liability insurance limits from $1 million (per occurrence)/$3 million (policy aggregate) to $3 million/$5 million, as well as
to add his practice entity (“ABC Dental”) as an additional named insured under our policies. I feel uneasy about his request and am hesitant to comply, although I’m not certain I understand exactly why. Is there any
real risk to me, or am I being unreasonably concerned about this?
Read More...

FAQ's - Recommended Coverages

Q. My previous employer recently retired, and I have purchased his practice. I already have professional liability insurance. What other insurance policies and coverage levels do I need from a business point of view?
Read More...


Frequently Asked Questions


FAQ's - Adding a Dentist

Q. I'm considering adding a dentist to my growing practice. What factors would a court consider in determining whether the new dentist is an employee or an independent contractor?
Read More...

FAQ's - Attorney's Request for Records

Q. I recently received a letter from an attorney representing a new patient. In it, he requests that I prepare a report describing my examination findings as well as my personal thoughts regarding the patient’s prior care. He included an authorization signed by the patient to release dental records. I am guessing that the patient plans to bring an allegation of malpractice against his former dentist. I feel uncomfortable about the whole thing and would really prefer not to respond at all, let alone put my comments in writing. What am I legally required to do?
Read More...

FAQ's - Automatic External Defibrillators

Q. The American Dental Association’s Council on Scientific Affairs recently announced the awarding of its first Seal of Acceptance for a defibrillator. Although I was considering one before, does this now mean I am required to have one in my office in order to meet the standard of care?
Read More...

FAQ's - Changing Carriers

Q. I’m considering changing my malpractice insurance carrier. Could this create a coverage gap?
A. It’s quite possible, depending on what type of insurance you have and what type you’re considering purchasing. Claims-made policies cover claims that are first made against you while the insurance is in force, based on incidents that occur after the prior acts date.
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FAQ's - Consent for Minors

Q. I have a 16-year-old patient who needs her wisdom teeth extracted. She is living with her boyfriend’s family, as her mother is deceased and her father, with whom she has virtually no contact, lives in another town 100 miles away. Can her boyfriend’s mother sign the consent form?
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FAQ's - Deposition Attendance

Q. I’m involved in a malpractice lawsuit and am now in the deposition phase. Am I required to attend all the deposition sessions? My practice is busy and I’d like to keep time away to a minimum.
A. While you are not required to attend all depositions, you have the legal right to do so – and it’s a good idea. While depositions can be time-consuming, we strongly recommend attending at least the plaintiff’s and expert witness sessions.
Read More...

FAQ's - Donated Services

Q. If I treat a patient palliatively as a humanitarian gesture and don't charge a fee for the service, does that limit my obligation and/or my potential liability?
A. Regardless of how much or how little dental care you provide for a patient, you always have the duty to practice at or above the standard of care. It doesn't matter if it's palliative care, definitive care, free care or just an examination. Whatever you do must meet or exceed the standard of care at all times. This includes free dentistry you provide to friends, relatives or indigent patients. The fact that you provided free care does not alter or waive your professional duty.
Read More...

FAQ's - Drug Interactions

Q. I've heard that some over-the-counter allergy remedies can react with common dental anesthetics and antibiotic drugs. How can I protect my patients against harmful drug interactions?
Read More...

FAQ's - Employee Theft

Q. I’ve been as busy as ever lately, but my practice income is lower than in past years. I’m beginning to wonder if my longtime receptionist/bookkeeper has been stealing from me. What are the signs of employee theft and what can a dentist do to prevent it?
Read More...

FAQ's - Evacuation Plans

Q. What does OSHA require in terms of office fire safety and evacuation plans?
A. OSHA requires that every place of business identify hazards and develop an office emergency evacuation plan. The first step is to analyze and correct such problems as blocked exits and passageways, and to make sure that exits are sufficiently wide to accommodate wheelchairs. All exits should be clearly marked, and doorways and passages that are not fire escapes should be so labeled to minimize confusion during an emergency evacuation.
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FAQ's - Extractions

Q. I perform several third molar extractions each week. Before each extraction, I sit down with the patient and explain that, if desired, a referral can be made to an oral surgeon for the extraction. Next, we discuss any available alternatives and the risks and complications of the procedure, including the risks of paresthesia. I then have the patient read and sign an informed consent form covering these issues. I have had a couple of instances of post-extraction paresthesia; when they occurred, I called and conferred with an oral surgeon. My question: Am I doing everything I can to avoid a claim of negligence?
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FAQ's - Fen-Phen

Q. What exactly is Fen-Phen? A. The term "Fen-Phen" has come up in many news reports describing cardiac valvular damage caused by appetite suppression drugs. The "Fen" can be either fenfluramine (Pondimin®) or the dex-isomer of fenfluramine, dexfenfluramine (Redux®). "Phen" is the drug phentermine (Adipex®, Fastin® or Ionamin®).
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FAQ's - Guarding Against Flood Damage

Q. My practice is in a flood-prone area, and I fear for the safety of my patient files. What practice information should I keep off-site for safekeeping, and how can I reduce potential flood damage?
A. To protect against such perils as flood, fire and tornado, we strongly advise all dentists to keep updated copies of the following lists in a secure, off-site location:
Read More...

FAQ's - Hygienist Liability

Q. Does my dental hygienist need her own professional liability policy? Does my PPP policy cover me for the actions of a hygienist working in my office?
Read More...

FAQ's - Inadequate Patient Funds

Q. I just completed a root canal on tooth #30. Unfortunately, the patient now claims I never informed him of the costs associated with the build-up and crown and that he cannot afford to continue with treatment. He said that if he knew it would cost this much, he would have had the tooth extracted. What should I do to avoid a problem going forward?
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FAQ's - Independent Contractor Liability

Q. I am a dentist working as an independent contractor in a dental practice owned by another practitioner. I do not have any employees of my own, but I use the practice’s front office staff, dental assistants and dental hygienists. In this situation, am I still at risk for claims alleging discrimination or other employment-related liability?
Read More...

FAQ's - Limits of Employee Dentist Coverage

Q. I am employed as an associate dentist in a multi-office practice. The practice owner recently asked me and all other employee dentists to sign a new contract which differs from the previous contract under which we have all worked. The differences are that the owner has asked each of us to increase our professional liability insurance limits from $1 million (per occurrence)/$3 million (policy aggregate) to $3 million/$5 million, as well as
to add his practice entity (“ABC Dental”) as an additional named insured under our policies. I feel uneasy about his request and am hesitant to comply, although I’m not certain I understand exactly why. Is there any
real risk to me, or am I being unreasonably concerned about this?
Read More...

FAQ's - Office Medications

Q. I keep some medications in the office to dispense to patients when needed. How can I prevent theft and other problems?
Read More...

FAQ's - Patient Misuse of Dentist's Drug License

Q. I recently received a call from a local pharmacy regarding a patient I last saw about a year ago. The pharmacist inquired about a recent prescription for narcotics that had been phoned in using my DEA number, purportedly by one of my staff. It became apparent during the conversation that it had been the patient herself who called in the prescription, as well as others attributed to area physicians. I am concerned about the potential consequences I may confront because this patient used my personal information to obtain controlled substances. Is there anything I can do at this point to minimize my risk?
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FAQ's - Poor Quality Duplicate Radiographs

Q. I am a specialist, and I often receive duplicate radiographs from referring dentists that are so poor in quality I feel uneasy using the films to treat the patient. Naturally, patients balk at the prospect of having to pay for additional films. How might I go about getting the originals from the referring dentist? And if I can’t get the use of the originals and the patient does not consent to additional films, am I obligated to treat that person anyway?
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FAQ's - Pro Bono Dentistry and the Standard of Care

Q. Some residents of my town need dental care but cannot afford it. Does the standard of care dictate that I treat their problems definitively, even if they are unlikely to pay a fee, or is it acceptable to treat their problems palliatively and defer definitive care? If I provide care on a pro bono basis, does that limit my obligation or my potential liability, and have I “accepted” them as patients?
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FAQ's - Recommended Coverages

Q. My previous employer recently retired, and I have purchased his practice. I already have professional liability insurance. What other insurance policies and coverage levels do I need from a business point of view?
Read More...

FAQ's - Referral Refusal

Q. I am a general dentist in a rural area. There is no specialist of any kind within 30 miles of my office. Because of the travel distance, it is not unusual for my patients to balk when I suggest a referral to a specialist. Trying to keep patients happy, I have gone ahead and treated cases of all kinds that I originally thought best to refer, including third molar extractions, molar endo and perio surgery. Fortunately, I haven’t encountered any major problems so far. But how much risk am I accepting by attempting the treatment after the referral is refused?
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FAQ's - Refund Requests

Q. A patient recently requested a refund of fees for a crown I placed two months ago on tooth #7. Although the crown looks great to me, with closed margins and very natural esthetics, I’m inclined to comply with her request just to appease her and get the issue past me. If I go ahead and give her the refund, am I in some way admitting wrong-doing or negligence?
Read More...

FAQ's - Request for Records

Q. I just received a request for a patient’s dental records. How should I respond?
A. Most states have laws addressing patient record confidentiality, which detail some of the basic requirements that must be fulfilled when releasing such records. Many of these state laws have certain features and legal concepts in common, which are addressed in the patient record disclosure guidelines below. However, state laws do vary, and an inappropriate response to a records request can exacerbate a potential claim situation. Whenever you are unsure of how to respond to a request, consult with an attorney knowledgeable of the laws of your state.
Read More...

FAQ's - Restrictions of PPO Plans

Q. I signed up with a new PPO plan a few months ago. Since joining, I’ve begun to wonder whether the plan’s service restraints and reimbursement limitations might create potential liability for me. What do I need to know to properly handle the differences between what I would like to do and what I’m allowed to do?
Read More...

FAQ's - Sale of Oral Hygiene Products

Q. I sell to my patients a variety of dental hygiene products that are not readily available in the stores in my community. Does this practice pose a legal risk?
Read More...

FAQ's - Swallowed Object

Q. Recently, a finished crown that I was attempting to cement disappeared down a patient’s throat. The patient coughed for a few minutes, but she seemed all right after that. She said she thought she had swallowed the crown, which sounded reasonable considering that her coughing had stopped. I suggested that she check her stools for the next few days to verify the passage of the crown. Was there anything else I should have said or done?
Read More...

FAQ's - Understanding Court Actions

Q. I am a dentist who was named as a defendant in a lawsuit. Recently, I was advised that summary judgment was entered by the court in my favor. What exactly does this mean? Is the lawsuit over as far as I am concerned?
A. Summary judgment is a favorable outcome for you. Lawsuits that do not make it to trial are generally resolved in one of three ways:
Read More...

FAQ's - Vacationing or Transient Patients

Q. Where I practice, dentists see a lot of “snow birds” – people who live up north most of the year but spend their winters here, where it’s warmer. It is very common for these individuals to call my office and say they “only want a cleaning,” and that their dentist back home will take care of the exam. Am I placing myself at a greater risk by allowing them to have prophys without insisting on exams?
Read More...

FAQ's - Weight Loss Management

Q. I recently read about a removable intraoral appliance that is being marketed by dental practices as a behavior modification device for the sole purpose of patient weight loss. What are the risks I need to consider before deciding whether or not to offer this treatment option in my practice?
Read More...

FAQ's - You as an Expert Witness
Q. I have been asked by a defense attorney to give a deposition in a dental malpractice lawsuit. Before I decide to participate, I would like to know if I am exposing myself to significant legal risk as an expert witness, and how can I protect myself against these risks?

Read More...



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