Helpful Information

DENTAL BOARD COMPLAINTS

Have you ever received a letter from the Board of Registration in Dentistry- and it wasn’t time to renew your license? After you open it, you find that one of your patients, often a former patient, has complained to the Board about you, your work, your professional conduct, your business, your staff, or all of the above.

If this is your first time receiving such a complaint, it is quite normal for you to feel shocked, then angry, and eventually worried. You may have difficulty concentrating or you may have trouble sleeping. Your professional reputation has been challenged. Even if you are certain that you acted completely within the standards of acceptable dental practice, it is natural to be concerned about what this complaint may mean to your future. After all, the Board holds your livelihood in its grasp. It allows you to practice your profession. And it has the power to take it all away.

This article will provide you with valuable information so that you can know how to proceed, should you receive a complaint letter. It will provide you with tools to protect yourself and your practice from unwarranted disciplinary action in the future.

PREVENTIVE STRATEGIES

If we are to put ourselves in the patient’s shoes, it affords us a view into what makes a person file a complaint. Almost universally, a patient who doesn’t know you very well is more likely to file a complaint than one who has been treating with you for years. Conversely, a patient who knows you and has been a loyal patient will choose not to take action against you, even when others would find it reasonable to do so. Second, if a patient feels slighted in any way, she may find reason to complain about your practice to the Board. For example, if she feels that you rushed her out of the office, or if she has not received satisfactory explanations about her treatment or her bill, she may take action against you. A good number of patients are unhappy or unable to pay their dental bills and decide that if they file a complaint with the Board, they will not have to pay for their dental treatment. There are no filing fees, unlike civil actions that are filed with the Courts. However, what patients don’t necessarily know is that the Board does not consider what the dentist has charged a patient when investigating dental complaints. The Board’s sole responsibility is to make certain that you are practicing within the standards of your profession.

Unfortunately, it is virtually impossible to accurately predict what a patient is thinking or feeling about you and your practice. So it is not feasible to direct any of your time attempting to identify potential patients who might take action against you. Instead, you can make it a policy to always ask each patient before they leave the chair if they understand your directions or your explanations. This also necessitates that you make a notation in the patient’s record indicating that they understood.

If a patient doesn’t understand, or if she wants more time with you than you can give her, you can make an additional appointment to discuss her concerns, or you can have your staff assist her. While you may not be able to know what a patient thinks about you and your practice, you can be sure that every patient wants to feel respected. One of the simplest ways to show your respect is to make the patient feel welcome at every visit, give the patient eye contact when talking to her, and give her a small amount of extra time. You would be surprised how little actual time this can take. It can be as little as 30 seconds. If you establish an unhurried approach, and if you ask if the patient has any questions or concerns, you will be showing your respect for her. To recap:

RESPONDING TO A COMPLAINT

Despite your best efforts, you may receive a notice from the Board, requiring you to respond to the allegations within a patient’s complaint, which the Board normally will include. Often the grounds for the complaint will be based on the patient’s idea that your dental treatment was inappropriate, or that you performed treatment that was not expected, and therefore without consent. A patient who thinks that the dental charges were excessive may couch his complaint by finding fault with the treatment in question. Other, more serious allegations such as misconduct, fraud, practice beyond the scope of your profession, practicing while impaired, have also been filed by unhappy patients.

While many of the complaints against your license are brought by patients, the Board is entitled to raise an inquiry about your practice on its own accord if notice is given by another source; for example, a report submitted by the Massachusetts Department of Public Health for an incident involving care provided at a hospital. Regardless of the source of the complaint, a compliance officer at the Board sends a letter to you, identifying the general issue or issues of concern. The compliance officer requires your response to the complaint within a short period of time, usually 15 days. In addition, the compliance officer will provide you with a list of information needed which you must supply within the same 15-day period. While the Board requires documents from you depending on the nature of the complaint, most likely you will be required to produce the following information:

  1. Current residential address and telephone number
  2. Updated Curriculum Vitae
  3. Copies of all licenses in-state, or out-of-state
  4. Controlled Substance Registrations, both state and Federal
  5. Copies of attendance records at educational seminars and conferences, indicating the number of Continuing Education Units (CEU’s) earned in the last complete license period before the treatment at issue.
  6. The complete patient records, including x-ray films
  7. Patient financial statements
  8. Prescription slips and laboratory orders
  9. Duplicates of casts or models used for diagnosis or treatment.

The Board always includes a statement that you are entitled to legal representation to assist you in responding to the complaint and defending your position. At first, you may think that if you have done nothing wrong, you are capable of handling an adequate response on your own. However, nothing could be farther from the truth. Because the Board has the power to revoke or suspend your license, levy a fine, issue a reprimand or place you on probation, it is unwise to try to go it alone. Most professional liability insurers will cover your defense to a Board complaint, and since you pay dearly for such coverage, it does not cost you to take advantage of what your insurance coverage provides. You may request a particular attorney or your insurer may assign an attorney to represent you. Therefore, once you receive a complaint letter from the Board, your first step is to call your insurance carrier. The next step is to consult with an attorney.

Your next task will be to gather the documents requested by the Board. Bring all requested documents with you when you meet with your attorney. Some attorneys will request that you write down a draft of your response to the Board. Others will interview you, write a draft response, and ask you to edit it. Whatever the method, it is essential that you understand that the letter to the Board will be signed by you, on your business stationery. In other words, you and your attorney will develop the letter together, but your signature will indicate that you have attested to the truth of its contents once it is signed by you. To summarize, if you receive a complaint from the Board:

  1. Immediately call your insurance carrier
  2. Call the attorney assigned to your case
  3. Copy the dental records, x-rays, casts and molds
  4. Copy all correspondence to/from the patient, phone messages, inter-office memos or notes
  5. Gather all documents needed to respond to the Board, including CEU certificates, an updated C.V., business papers, licenses, etc.
  6. Bring all data with you to meet with your attorney
  7. Review final draft of response letter carefully for accuracy, then sign it.
  8. WAIT

Your attorney may seek out an expert in your specialty in consultation before a response is completed to the Board. A fellow provider can provide valuable insights into the appropriate standards and how you met them.

Once your response is submitted to the Board, the waiting begins. It may be several weeks before you receive any further correspondence from the Board. Your attorney will continue to represent you during this time and will call the Board on your behalf to determine the status of your case. The compliance officer will review all the information submitted by you, including the patient’s dental records, and will present this information before the full Board at an open meeting. It is here that an initial decision is made on the merits of the complaint. The good news is the vast majority of complaints are dismissed at this level. Normally the Board finds that the explanations in your response letter, if consistent with the documentation in the patient’s record, will be sufficient to close the case. However, occasionally, the Board will continue the case if its investigation suggests any possible misconduct. They may propose remedial courses, a probation period, or possible discipline. If this occurs, you have the right to be heard, as a matter of law. The Board will notify you of the hearing and it is important to be represented by an attorney.

HEARING OR NO HEARING

Often the Board will determine that an informal hearing is the appropriate next step. The informal hearing is like an interview. Both you and the patient who filed the complaint will be present to explain the circumstances of the complaint to the Board members. After hearing from both parties, the Board will notify you in writing whether it finds grounds for a formal hearing or whether any further action will be taken.

In many cases the Board may attempt to meet with you and your attorney and the person who issued the complaint against you in an effort to resolve the case without a formal hearing. If this occurs, your attorney is best suited to assist you in negotiating a reasonable settlement. If the Board offers you this option, it most likely means that the action you will be required will be something less punitive than the loss of your license. If the Board determines that a formal hearing is warranted, it will issue you an “Order to Show Cause” why the Board should not revoke or suspend your license.

The formal hearing is for your protection. You are entitled by law to a formal hearing before any discipline is levied that will impact your license, your practice, your career. The formal hearing is like a trial in many aspects. You and your attorney may call witnesses, you may testify on your own behalf and you may provide additional evidence.

DISCIPLINE

Disciplinary action will be taken only if the Board finds that the evidence presented at the formal hearing proves misconduct on your part. Discipline may be as mild as a reprimand, or an order to comply with Board regulations. If the offense is serious, a suspension or a revocation of your license is a possibility, but only after the evidence presented proves the allegations of the complaint and only if the misconduct is deemed sufficiently serious or dangerous. Disciplinary actions vary and may include one or a number of the following:

A FEW LAST WORDS

Because the Board is responsible for the safety of the consumers of health care, it is the Board’s prerogative to request all relevant documents from you. Because you are never certain who may find fault with you or your practice, it behooves you to be prepared at all times. You can be best prepared to respond to a Board complaint if you follow the principles listed below:

This article is designed to provide you with helpful information about the complaint process carried out by the Division of Health Professions Licensure. Because a complaint has the potential to place your career at risk, all complaints, no matter how frivolous they may appear to you, should be handled with the utmost care and seriousness. In order to proceed in defending yourself against any complaint, it is the wise professional who consults with an attorney who is knowledgeable and experienced in representing professionals like you and who can provide you with the best defense possible.

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