Legal Issues and the Dental Radiographer

Laws exist that govern the use of ionizing radiation in dentistry​

• The dental auxiliary must be informed of and comply with these regulations​

• The possibility of negligent care exists when dental images are not properly exposed or used​

• Federal and state regulations govern the use of dental x-ray equipment.​

• The federal law controls who can take dental images and proper training and certification standards.​

Federal government

• Requirements include safety precautions affecting the use of dental x-ray machines made and sold in the United States​

• All dental x-ray machines sold in the United States after 1974 must meet federal regulations which include safety specifications for minimum filtration and accuracy of milliamperage and kilovoltage settings

State, county, and city laws

• Many states require x-ray machines to be registered and charge a fee for this registration.​

• Most states require that dental x-ray equipment be inspected every 5 years.

Licensure Requirements

• May include:​

  • Obtaining additional certification in dental imaging​

  • Performing dental imaging procedures only under the direct supervision of the dentist​

  • Following restrictions concerning the types of dental images that may be legally exposed​

The Consumer Patient Radiation Health and Safety Act is a federal law that requires persons who take dental images to be properly trained and certified.

Legal Issues and the Dental Patient

• Risk management​

• Malpractice issues​

• Patient records​

• Patients who refuse images​

Risk Management

The policies and procedures that should be followed by the dental radiographer to reduce the chances that a patient will file legal action against the dental radiographer or the supervising dentist

• Policies are designed to reduce the likelihood of a malpractice lawsuit against the dentist.​

• The dental radiographer must be careful never to say anything negative about the x-ray equipment or how it is working.​

• Statements made by anyone at the time of an alleged negligent act are admissible as evidence in court.​

Self-determination (Informed Consent)

• Persons seeking health care services have the legal right to make choices about the care they receive, including the opportunity to consent to or to refuse treatment

• It is the dentist’s responsibility to discuss the need for images and treatment procedures with the patient.

Information presented to the patient should include the following (Informed consent

• Purpose and potential benefits of the images​

• Person responsible for exposing the images​

• Number of and type of images​

• Possible harm that may result if the images are not exposed​

• Risks associated with x-ray exposure​

• Alternative diagnostic aids that may serve the same purpose as the images

Disclosure (Informed Consent)

• The process of informing the patient about the particulars of exposing dental images​

• The dental radiographer must be very careful to use lay terms in a way that patients understand.​

• Dental radiographers should not oversimplify an explanation.​

• Calling radiation harmful might make a patient uneasy. Explain to the patient that many common things are harmful in excess. Radiation is something patients are exposed to everyday from the sun.

Informed consent

• Defined as consent given by the patient following complete disclosure ​

  • Purpose of the procedure and who will perform it​

  • Potential benefits of receiving the procedure​

  • Possible risks​

  • Opportunity to ask questions

Liability

• Dentists are legally accountable or liable to supervise the performance of dental auxiliaries​

• Dentist and dental auxiliary may both be sued for the actions of the dental auxiliary

• Anything done maliciously makes the radiographer liable

Malpractice

Results when the dental practitioner is negligent in the delivery of dental care

Negligence

When the diagnosis is made or the dental treatment delivered falls below the standard of care

Care may result from the action or lack of action of either the dentist or dental auxiliary

Standard of care

• The quality of care that is provided by dental practitioners in a similar locality under the same or similar conditions

• The number of films exposed, as well as the quality of the images may be an important issue in a malpractice suit.

Statue of limitations

• The time period during which a patient may bring a malpractice action against the dentist or auxiliary​

• It is the responsibility of the dentist to review and report all information presented on dental images and acquired data sets

• States govern the duration of time within which a patient may bring a malpractice action against the dentist or the auxiliary.​

• Frequently, it’s not until a patient seeks care from another dental professional that they find out that their previous dental treatment may have been negligent

Documentation

• Informed consent​

• Number and type of images exposed​

• Rationale for these dental images​

• An imaging report including diagnostic information obtained from the interpretation of images​

Confidentiality

• State confidentiality laws protect information​

• Nondiagnostic images are sometimes unavoidable, but a competent technician can keep these to a minimum.​

• It is very important to document the exposure of dental images.​

• Images that are of poor quality and are nondiagnostic reflect poorly on the dentist.​

Nonprivileged person

An individual who is not directly involved in the treatment of the patient.

Ownership and retention of dental images

• Legally, dental images are the property of the dentist​

  • Patients do have the right of reasonable access to their records​

  • Dental records and dental images should be retained indefinitely

• Some patients may have trouble understanding that they do not own the images.​

• Explain to them they are paying for the interpretation or diagnosis of those images.​

• Never give or send the original images to a patient.​

• Patients have a right to reasonable access to their records.

Patients who refuse exposure of dental images

• The situation must be carefully considered by the dentist​

  • The dentist must decide whether an accurate diagnosis can be made and whether treatment can be provided

• A dentist should never work without a current image of the problem area.​

• Patients who refuse x-rays need to understand that the risk from radiation is minute compared to the risk of working without an image.​

• The use of the dental images is now the accepted standard of care.