The legal obligations in the dental office rest principally with the dentist. However, assistants must be aware of state dental practice acts and any rulings which could involve the assistant. In many states current CPR status for auxiliaries is required. Always remember-ignorance of the law does not constitute immunity from liability.13
In addition to familiarity with state dental practice acts, the dentist should also be aware of accepted treatments and protocols for medical emergencies which often become the basis for a legal standard of care. The standard of care can be defined as “what the reasonable, prudent person with the same level of training and experience would have done in the same or similar circumstances.”
The first component is a duty to act. There is no doubt that a health care provider is required to render necessary emergency care to an individual in an office, whether that individual is a patient, family member, or an employee. The expectation of the general public is that they are in a health care facility and that its employees should be trained for such emergencies.
The second part is an act of omission or commission. An act of omission would be failing to carry out some task that the “reasonable, prudent person” would have performed under the circumstances. An act of commission would be an attempt to provide care beyond what was normally accepted under the circumstances or by failing to have taken an action that would have prevented an emergency.
The third point that would have to be proven is that the patient was actually injured in some way. In most cases, this would be some type of physical injury, but it could also include emotional or economic damages.
The fourth point-that the assistant’s failure to act as a reasonable, prudent person was the proximate cause of the patient’s injuries-ties everything together.
This cycle of potential malpractice can be avoided by safeguarding the patient’s interests, performing as expected in an emergency, and acting within the scope of your practice.
Taking into consideration these legal aspects concerning emergency treatment, always keep in mind the following points:
- When an emergency arises call for EMS (911) immediately. There are cases on record in which dentists have been sued for not calling an ambulance in a timely manner. In handling an office emergency, the goal should always be to maintain the patient and provide appropriate treatment until the rescue squad arrives. Rescue squad personnel will not mind if they arrive at the scene only to find a patient not requiring further treatment or transport. Once the rescue squad arrives, however, they and their medical control physician (via radio) are in charge of the patient’s medical treatment.
- If there is a problem, such as a dental dam clamp falling into a patient’s throat, be honest with patients as to the nature of the problem.
- Refer patients to medical professionals when necessary. Never attempt to treat situations which require physician or hospital management.
- Be knowledgeable about state dental practice acts and your requirements for dealing with emergencies.
- Take a complete health history for new patients and update it at each visit. Maintain adequate records. Document emergency treatment rendered; generally, courts have maintained that if it wasn’t written down, it wasn’t done.
- Take vital signs, especially if an anesthetic is to be administered.
- Having an emergency kit in the office does not prevent liability unless you know how to use it properly.
|Figure 31. Elements of Malpractice
|Four elements must be proven in malpractice (negligence) cases:
- Duty to act or render care in the situation
- Acts of omission or commission
- The patient was injured in some manner
- The health care providers’ failure to act was the proximate cause of the patient’s injury