Transcript DH226 CH7-NC

Chapter 7
Society and the State Dental Practice Act
Objectives
 Relate the role of the state in the governing of health
care professions.
 Identify the provisions that are likely to be included in
state statutory law for the practice of dental hygiene.
 List the reasons that a dental hygiene license may be
suspended, restricted, or revoked.
 Define and describe direct supervision, indirect
supervision, and general supervision.
 Recognize the responsibility of the dental hygienist for
understanding the state statutory and regulatory
provisions.
Statutory Law
 The legislative branch of government is generally
responsible for the enactment of the state dental
practice act.
 The state dental practice act may be a single law or a
compilation of laws that regulate the practice of dentistry.
 DH must be familiar with the laws that deal specifically
with dental hygiene, as well as the general laws that protect
the well-being of the state’s citizens.
 EX: most states have enacted laws that require health care
professionals to report suspected child abuse. This law may
be found in acts that focus on child protection, rather than
the practice of dental hygiene.
Issues regulated by state laws but may not be
incorporated into a state’s dental practice act.
 Abuse reporting requirements
 Biomedical wastes and hazards management
 Consent to treatment and informed consent
 Criminal activity
 Disability accommodation
 False health claims
 Patient confidentiality
 Public health reporting requirements(contagious or
infectious diseases)
Statutory Law
 State statutory law that regulates the practice of
dental hygiene is likely to include provisions
regarding the following:
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Licensure requirements
Licensure examination requirements
Licensure eligibility requirements
Licensure by endorsement
Approval of educational programs
Examination and disciplinary authority
Scope of practice
Supervision requirements
Continuing education requirements
Rules and Regulations
 The executive branch of government is responsible for
implementing the statutory law and providing more specific
guidance and regulation regarding dental hygiene practice.
 The executive branch includes the departments and agencies of
state government (Dept. of Health, Dept. of Professional
Regulation, etc.).
 The regulation of the practice of dental hygiene may be
facilitated by an appointed board or an elected regulatory body.
 The regulatory body may be referred to as Board of Dental
Examiners, Board of Dentistry, State Dental Board, etc.
 In some states a regulatory board may be advised by a 2ndary
body, which has greater dental hygiene representation, such as a
council or dental hygiene committee.
 Enactment of the state dental
practice act.
 Laws specifically with dental
hygiene
 General laws that protect the wellbeing of the state’s citizens
 Ex: Abuse reporting, consent to tx,
informed consent, criminal activity,
disability accommodations,
confidentiality
 Implementing statutory law
 Provide more specific guidance and
regulation regarding dental hygiene
practice.
 Includes Dept of Health, Dept of
Professional Regulation
 Regulation body: Board of Dental
examiners, Board of Dentistry, State
Dental Board
The Practice of Dental Hygiene
 In the US the practice of DH is not nationally
regulated and is different in every state
 A hygienist on an annual basis should obtain and
review the applicable state dental practice act
 A good time to do this might be at your license
renewal, birth date, or other annual occurrence of
significance
 Our State Dental Practice Act can be found at
www.tsbde.state.tx.us
Types of DH Licenses
 Full license: granted on basis of examination or
endorsement of credentials.
 Temporary license: granted on the basis of licensure in
another jurisdiction, permits practice for a limited period
of time while the DH pursues full licensure status.
 Volunteer license: granted on the basis of licensure in
another jurisdiction, permits practice for the purpose of
public service.
 Faculty license: granted on prior licensure in another
jurisdiction, permits faculty member to practice within the
scope of his/her educational responsibilities.
Licensure Provisions
 In order to practice DH legally, you must have a license
in the state you are to practice.
 A condition of DH licensure is to graduate from a DH
school that is accredited by the CODA (Commission
on Dental Accreditation), as well as successful
completion of a national, regional, and/or state
licensure exam.
 An exception to these general conditions exist in
Alabama (refer to book pg 105).
Licensure Provisions
 A DH license may be issued on the basis of a review of
credentials (aka licensure by endorsement or
reciprocity).
 If you have graduated from an accredited school, are
licensed in good standing in a state with similar or
higher requirements for licensure, have practiced DH
for a minimum prescribed period may have exam
requirements waived on basis of credentials.
Licensure Provisions
 Some states provide for temporary licensure of DH who are
licensed in other jurisdictions, are relocating to that state,
and do not have the option of licensure by credentials.
 A temporary license is valid for a prescribed period of time
or until the next scheduled licensure exam.
 A volunteer license may be available to DH who hold a DH
license in good standing in another jurisdiction, have a
minimum specified years of clinical experience, and seek to
provide volunteer services.
 A limited number of states provide for a faculty license for a
DH whose practice will be limited to DH education only.
Licensure Provisions
 DH are generally required to display a copy of their
license at their place (s) of practice.
 DH licenses expire and require renewal on a
schedule (annually, bi-annually) prescribed by
state law.
 When a DH experiences a limited lapse of
licensure, the state may reinstate without exam
upon proof of continued professional competence
and payment of renewal and penalty fees.
Licensure Provisions
 The practice of DH without a valid license is a criminal
offense.
 The penalty for noncompliance with licensure
requirements may include a monetary fine and/or
imprisonment.
 A DH license may be suspended or revoked on the basis of
unprofessional conduct, violations of laws and regulations,
and clinical incompetence or delivery of substandard care.
 EX of unprofessional conduct- acts of fraud, conviction of
felony, sexual conduct with a patient, violation of state or
federal laws.
Dental Hygienists
breaking the law!!
 Practicing without a valid DH
license
 Unprofessional conduct, violations
of laws and regulations
 Clinical incompetence, delivery of
substandard care.
 Fraud, conviction of a felony,
sexual conduct with a patient,
violation of state or federal laws
Licensure Provisions
 DH may also have their practice restricted or suspended if they
become impaired by reason of mental illness, physical illness, or
habitual or excessive use or abuse of alcohol or controlled
substance.
 Many states have CE requirements for maintaining licensure.
 Documentation or certification of compliance is generally
necessary when renewing the license. License renewal requires
payment of a licensing fee.
 If you are not currently practicing DH some states have the
option to make your license inactive, but still maintain
professional status and reactivate when ready. Some states like
Arkansas requires a DH to be practicing in order to maintain
active license status.
License Restriction
or Suspension
 Impaired for mental illness
 Physical illness
 Habitual or excessive use of
alcohol and drugs
Scope of Practice
 Varies among the states.
 Includes educational, assessment, preventive, clinical, and
other therapeutic services.
 Each specific function is defined by state law.
 Some routine functions that are allowed are removal of
deposits and stains from supra and subgingival surfaces by
SRP, polishing, applying pit and fissure sealants, fluoride,
charting of oral conditions and exposing, developing and
referring to oral radiographs.
 Some states allow for DHs to administer local anesthesia
and perform restorative procedures (Expanded Functions).
Scope of Practice
 In some states (Arkansas) you are required to have a
separate certification from your hygiene license to
administer local anesthetics.
 DH can also perform, if competent, any procedure that can
legally be delegated to a non-licensed provider, such as a
dental assistant.
 General preclusions of practice include diagnosis for dental
treatments, cutting or removing of hard or soft tissues, and
prescribing of drugs or medications.
 It is the DH legal responsibility to stay within the scope of
practice for that state; if asked to do something outside
your scope, you are obligated to decline that request.
Supervision Requirements
 Level of supervision varies by state, scope of practice, and
location of practice.
 Direct supervision generally requires prior diagnosis of the
patient’s condition and authorization of a procedure by a
dentist, presence of dentist on premises, and dentist
approval of work prior to patient dismissal.
 Indirect supervision requires prior diagnosis of the
patient’s condition and authorization of a procedure by a
dentist, and the presence of the dentist on the premises.
 General supervision requires that the services to be
delivered are authorized by the dentist, however, the
presence of the dentist in the treatment facility is not
required.
Other Selected Statutory Provisions
 Not all laws governing the practice of DH are
encompassed in the state dental practice act.
 This does not negate the DHs obligation to comply
with such laws like:
 Abuse Reporting
 Most states have enacted laws that mandate the
reporting of child abuse.
 In addition, several states have enacted legislation that
mandates or encourages the reporting of abuse of
vulnerable, dependent, and disabled adults.
Other Selected Statutory Provisions
 Patient Records
 Although maintenance of a patient record is
professionally prudent, it may also be mandated
statutorily.
 Some states have incorporated patient record
requirements within the state dental practice act.
 Health care records are generally recognized to be
confidential and protected against disclosure to
unauthorized third parties.
Other Selected Statutory Provisions
 Professional Liability Insurance
 DH in some states are mandated to maintain
professional liability insurance or other indemnity
against liability for professional malpractice.
 When mandated, the law may prescribe the level of
insurance that must be maintained per incident as well
as in the aggregate (collection of particulars into a whole
mass or sum; a total or gross amount).
Other Selected Statutory Provisions
 CPR Certification
 It is professionally prudent to maintain current
cardiopulmonary resuscitation (CPR) certification.
 Some states have enacted legislation that mandates
that dental professionals be currently certified in
CPR.
Other Selected Statutory Provisions
 Self-Referral and Kickbacks
 State and local self-referral statutes have been enacted
to avoid the conflict of interest that may be inherent in
the referral of a patient by a health care provider to a
provider that the referring provider has an investment
in.
 Prohibitions on kickbacks, or remuneration or payment
back as an incentive or inducement to refer or solicit
patients, have also been enacted at the federal and state
levels.
Due Process
 In the event of threatened adverse reactions
against licensure status, DH should become
familiar with the available administrative
procedures.
 General due process provisions include notice and
an opportunity to be heard.
 Notice generally includes a statement of the
proposed action to be taken, the available evidence
supporting the proposed action, and the
opportunity for a hearing.
Due Process
 The proposed action can be taken within the time and
manner specified in the notice.
 If a hearing is requested the DH will be notified of the
time and place and who is conducting the hearing.
Summary
 Dental hygiene is a state regulated health profession
because of society’s concern for its citizens.
 It is the DH responsibility to be intimately familiar
with the statutory and regulatory provisions of the
practice of dental hygiene.
 Noncompliance with these provisions is not an excuse
for failure or to understand the hygienist’s
responsibilities.
THE END