ethics, jurisprudence, and

8/13/2019 Ethics, Jurisprudence, And

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Ethics, Jurisprudence, and

Risk Management

DENA 101Orientation to Dental Assisting

Fall 2002


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Ethics: A discipline dealing primarily with moral

duty, conduct, and judgment.

These are standards of behavior which we

choose to accept for ourselvesnot those

imposed by some other authority.


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Jurisprudence: The philosophy of law or a system of laws.

Laws are the minimum standards

established by the state.


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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.


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Risk Management: The steps taken by dentists to prevent a

patient from bringing legal action against

them.

As the dentists employee, you have an

important role in preventing or causing a

lawsuit!


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Ethics & Jurisprudence

Compared Level #1A system of law established by

society. These represent a minimal standard of

acceptable conduct. Level #2A professional code of ethics. These

are a statement of conduct the professional

organization has accepted.

Level #3A personal code of ethics. These

represent the highest standard of acceptable

conduct.


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Conduct may be unethical and

still be legal. But it cannot beillegal and still be ethical.


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Professional Ethics: Consistently higher than the standards

required by law.

Voluntary controls, however, everyoneentering into the profession is expected toadhere to these professional standards.

Serve as a method of self-policing, andenforcement of the code is handled withinthe professional organization.


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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.


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A Decision is Ethical if: 1- It enhances integrity and self-respect.

2It does not bring harm to others.

3It builds understanding and dissolves

unreal barriers between people.

4It builds a core of genuine confidencein self and others.


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A Decision is NotEthical if: 1It results in an illegal action.

2It brings harm to others.

3A person is exploited and used as an

inhuman object.

4If human potential is belittled,damaged, or ignored.


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One of your primary

responsibilities is to treat thedentist(s), staff members,and all

patients with dignity and respect.


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The philosophy of individual

worthis the belief that everyone,regardless of personal

circumstances or personal

qualities, has worth and is entitledto respect as a human being.


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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 orderedsociety.

Criminal Lawpertains when a person commits a

wrongful act against society.

Civil Lawpertains when one person sues another

for satisfaction of a personal wrong done to him

or her.


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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.


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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 thecircumstances.


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Negligencefailing to do something that a

reasonable person would do, or doing

something that a reasonable person would

not do.

Contributory negligencefailure on the

part of the patient to follow the dentistsinstructions during and after treatment.


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Malpracticeprofessional negligence.

Failure to perform ones professional duties

completely.

Admission against intereststatement

made by an individual which serves to

defeat his or her own interests. Oh, Imsorry. It was my fault.


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Res gestaeLatin term meaning Things done

or part of the action Statements made

spontaneously at the time of the alleged negligentact 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.


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What to Do of the Dentist is Sued1. Say Nothing

2. Be supportive

3. Be cooperative

4. Ask before acting


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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.


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Provisions of the State Dental

Practice Act1. 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.


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Provisions of the State Dental

Practice Act Grounds for suspension or revocation of a

license.

Provisions for establishing and maintainingan administrative board to supervise thepractice of dentistry.

A means of controlling the assignment ofduties, including extended functions, toauxiliaries.


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Grounds for suspension or revocation of alicense.

Provisions for establishing andmaintaining an administrative board tosupervise the practice of dentistry.

A means of controlling the assignment ofduties, including extended functions, toauxiliaries.


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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.


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ReciprocityA mutual agreement between two or more

states to allow an individual who is

licensed in one state to receive, withoutfurther examination, a license in the other

state entering into that reciprocity

agreement.


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Grounds for Suspension or

Revocation Conviction of a Crime

Unprofessional Conduct

Personal or Professional Incapacity


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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 patientexpenses by insurance companies of government

programs.


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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 sellingcontrolled substances.

Patient neglect or abandonment.


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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 employeesif that wrongdoing wascommitted within the scope of their

employment.


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Who may be sued?A dental assistant who is guilty ofnegligence is responsible for his or her own

actions, and the injured party may sue boththe dentist and the assistant.

The dentists liability insurance will notcover the auxiliary if they are sued fornegligence!!


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Levels of Supervision Direct supervisiona licensed dentist is present

in the room.

Indirect supervision

a licensed dentist ispresent in the office.

General supervisionunder the direction of a

licensed dentist though not present in the office.

Undefined supervisionunder the direction of a

licensed dentist, but supervision id not defined.


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Civil Law Contract Lawdivision of civil law

covering specific agreements between

people and violations of same.

Tort Lawdivision of civil law covering

the rights and duties of people toward each

other and wrongs committed in violation ofthese rights and duties.


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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.


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Types of Contracts ImpliedA contract is made by certain

actions on the part of the parties concerned,

even though the essentials for a legallybinding contract have not be discussed.

ExpressedA contract in which there is

oral or written agreement as to the terms ofthe contract.


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When Written Consent is

Required: New drugs are being used

Experimentation or clinical testing is involved

A patients 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


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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.


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Four Ds of Tort Law Dutya legal duty must be owed by someone to

another

Derelictionthe duty owed must have beenbreached by the accused

Damagethe plaintiff must have been hurt insome way

Due tothe plaintiff must be able to prove thatthe defendants action, or lack of, were the

proximate cause of the damage


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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.


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Patient of Record A patient of record is someone the dentist

has already accepted as a patient.

The dentist is not legally compelled toaccept or treat a new patient just because

an emergency exists, however, the dentistis obligatedto provide emergencytreatment for a patient of record.


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Liabilities in DentistryThe 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


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Malpractice1. Professional misconduct

2. Any unreasonable lack of skill

3. Lack of fidelity (faithfulness) in

performance of professional duties

4. Practice contrary to established rules


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Malpractice May Be Do To:1. Ignorance or neglect

2. Lack of skill

3. Neglect in applying these skills


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Dentists 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


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Must complete agreed upon treatment

within a reasonable time

Must hold inviolate the patients privacy

Must give adequate instructions to the

patient.

Must make a reasonable charge for the

services rendered


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Patients 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


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Withdrawal from a Case

or Patient Written notificationcontaining the reason, the

withdrawal date, the need for further care, an

offer of help or assistance, and signature. Proof of mailingletter must be sent certified

mail with a return receipt requested.

Documentation on filea copy of the letter and

the signed postal receipt are kept with the

patients record.


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Happy patients

dont suetheir doctors.


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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


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Establish a rapport with the patients

Maintain accurate, complete and legible

records (they are the dentists best

defense!)

Keep all of your skills up-to-date

Always perform all of your duties to the

best of your ability


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Be prepared to assist in any kind of

emergency

Do not start collection measures without

the doctors permission


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Part of the Patients 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 tofollow the treatment or advise of the dentist


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NotPart of the Patients 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


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Guidelines For Clinical Record

Entries Use the next available line

Make the entry as soon as possible after the

patients visit Date the entry

Sign or initial the entry to clearly identify whomade 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


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Changes to the Clinical Record Never change a chart entry without the doctors

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)


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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.


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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 couldread it

Always lock file cabinets and/or roomscontaining files at the end of the day


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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.


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The patient chart is created by the dentist

for his or her own use. Under law, these

records are considered to be the dentistsproperty. What the patient pays for is the

dentists professional skill in interpreting

these records


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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

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