Legal Issues in Dental Radiography

# Legal Issues in Dental Radiography

Course Information

  • Course Code: DEHY 123

  • Instructor: Lindsey Farris, RDH, MA

Importance of Radiographs in Dentistry

  • Radiographs are needed for comprehensive patient care.

  • Essential for diagnosis and identifying conditions that may be clinically undetected.

Uses of Radiographs

Detection

  • Purpose: Confirm suspicions regarding patient health.

  • Localization: Identify the precise location of dental issues.

  • Changes: Acknowledge alterations due to trauma or disease.

  • Incorporate them as part of the patient record, serving as a baseline for future assessments.

Professional Goals for Radiographers

  • Patient Protection: Practice ALARA (As Low As Reasonably Achievable) principles.

  • Operator Protection: Duty to protect staff members.

  • Patient Education: Provide clear and effective patient education.

  • Operator Competence: Engage in continuing education to enhance skills.

  • Operator Efficiency: Maximize operational effectiveness.

  • Quality Radiographs: Strive for high-quality radiographic images.

Communication Skills for Radiographers

Effective Communication

  • Promotes trust and builds patient confidence.

  • Relying solely on skill without effective communication is insufficient.

Verbal Considerations

  • Use understandable yet non-alarming language.

  • Avoid phrases like “pull,” “yank,” “fix,” “zap,” “shot,” and “hurt.”

  • Use professional and reassuring terms: “extract,” “repair,” “expose,” “view,” “uncomfortable,” and “scale.”

Building Trust

  • Ensure verbal communication matches nonverbal cues.

  • Greet with a smile and maintain good eye contact.

  • Strive to be pleasant, relaxed, and use a soft tone of voice.

  • Avoid appearing rushed, loud, or tense.

Listening Skills

  • Maintain proper posture.

  • Nod to show understanding and engagement.

  • Paraphrase and summarize feelings communicated by the patient.

Patient Education

  • Provide accurate information and emphasize its importance to health.

  • Ensure safety protocols are strictly followed.

  • Be available to answer questions, reinforcing understanding.

Use of Radiographs in Education

  • Show patients their x-rays to help reinforce the importance of the radiographic process.

Legal Issues in Dental Radiography

Relevant Legal Considerations

  • Awareness of state laws regarding dental radiography.

  • Risks of negligence include:

    • Not taking necessary radiographs.

    • Taking an excess of radiographs.

    • Failure to diagnose conditions leading to harm.

  • Importance of comprehensive documentation, adhering to standard care protocols.

  • Maintain rigorous infection control standards.

Key Regulations

  • Consumer-Patient Radiation Health and Safety Act: Establishes safe use and maintenance of dental x-ray equipment.

  • State of Michigan Regulations:

    • Dental assistants must complete a CODA-approved training course.

    • Regular state inspections enforce strict safety rules, including collimation.

    • Operators must utilize beam-limiting devices to reduce radiation exposure.

    • Staff shall not be required to hold film or restrain patients during exposures.

    • Mandatory approved shielding is required for radiographic rooms or portable units.

Radiation Safety Guidelines

  • Patient Safety: Only essential personnel allowed in the radiographic room, prohibiting unnecessary exposures.

  • Radiation Machine Registration Certificate:

    • A certificate must be displayed, listing all radiation machines in use.

    • Dosimetry Badges: Optional for employees.

    • Females must inform employers in writing about pregnancy to enforce lower radiation limits.

    • Option to wear dosimeter badges and protocols for maintaining distance (minimum 6 feet and at angles from 90-135 degrees).

    • Staff should never hold units or film during radiographic procedures.

Informed Consent

Key Elements

  • Must explain the purpose and benefits of radiography before treatment.

  • Record details including number and type of radiographs taken and alternative diagnostic aids considered when possible.

  • For patients under 18 or deemed incompetent, consent must be obtained from a guardian.

Risk Management Considerations

  • Understanding and addressing the risks associated with procedures improves patient understanding and compliance.

Malpractice Considerations

  • Actions or inactions by dental professionals leading to negligent care, including:

    • Diagnosis or treatment below the standard of care, resulting in patient harm.

    • Issues related to improper radiography practices:

    • Careless technique leading to repeated, unnecessary exposures.

    • Conducting radiographs without a Direct Dentist's (DDS) prescription.

    • Inadequate infection control protocols.

    • Failure to gain informed consent from the patient.

Standard of Care

  • The quality of care provided, ensuring it meets professional benchmarks.

Statute of Limitations

Important Aspects

  • Begins when the patient discovers or should have discovered an injury occurred.

  • Defines the time period during which a patient may bring a lawsuit against healthcare providers.

Records Keeping

Essential Practices

  • Document informed consent accurately.

  • Records should include the number and type of radiographs taken, along with the rationale for exposures and the diagnostic information gleaned from them.

  • Never erase or black out records; rather, add additional documentation if necessary.

Confidentiality

  • Maintain confidentiality of all information in patients' records, including x-rays.

  • Information must not be transferred to non-privileged individuals, defined as those not directly involved in the patient's care.

Ownership and Retention of Records

  • Radiographs and records are the property of the DDS.

  • Patients have the right to reasonable access to view their records, in accordance with HIPAA regulations.

  • Written requests are required to forward copies.

  • Records should be retained indefinitely, or for a minimum of 10 years in the state of Michigan.

Patient Refusal of Treatment

Considerations

  • Patients have the right to refuse treatment.

  • The DDS must assess whether accurate diagnoses and treatment can occur without the necessary radiographs.

  • If refusal compromises diagnosis and treatment, the provider cannot treat the patient.

Documentation of Refusal

  • Important for releasing liability associated with patient consent to negligent care, as it is considered invalid if proper procedures are not followed.

Practice Questions

Example Case

  • A dental hygienist repeatedly exposes radiographs due to overlapping contacts caused by incorrect horizontal angulation. What legal concept may apply?

    • Options:

    • Assault

    • Battery

    • Negligence

    • Defamation

Another Example

  • A patient refuses bitewing radiographs even after the hygienist explains their necessity for diagnosis. The most appropriate response is:

    • Options:

    • Refuse to treat the patient

    • Respect the patient’s decision and document the refusal

    • Take the radiographs anyway

    • Ask another staff member to convince the patient

Ethical Principle Violated Scenario

  • A patient inquires if a procedure will hurt, and the hygienist omits the truth about potential mild discomfort by saying, “You won’t feel anything at all.” Identify the ethical principle violated.

    • Options:

    • Autonomy

    • Veracity

    • Beneficence

    • Justice

Additional Ethical Violations

  • Negligence Case: A dental hygienist notices a sharp edge on an ultrasonic tip but continues using it. What ethical principle is most likely violated?

  • Confidentiality Case: The hygienist discusses a patient’s periodontal status with a friend outside of work. Which ethical principle is violated?

Record Alteration Inquiry

  • A dentist requests the hygienist to alter a chart entry to avoid legal issues. What is the best response?

    • Options:

    • Change the record as requested

    • Refuse and explain that altering records is unethical and illegal

    • Ignore the request

    • Delete the entire record

Risks of Insufficient Information

  • A periodontally invasive treatment begins without explaining risks. Identify the violated ethical principle.

    • Options:

    • Autonomy

    • Justice

    • Ignore the request

    • Delete the entire record