Ask the Expert: The Disappearing Dental Hygienist

One of the dental hygienists in the private practice where I work took a lunch break and never returned, even though she had several patients scheduled for the afternoon. Is this considered patient abandonment?

By Michele P. Carr, RDH, MA, EdD On Jan 18, 2017 0

QUESTION: One of the dental hygienists in the private practice where I work took a lunch break and never returned, even though she had several patients scheduled for the afternoon. Is this considered patient abandonment?

ANSWER:

I assume this dental hygienist did not have a valid reason, such as illness, for not returning to the practice. With this in mind, most dental hygienists are at-will employees. This means the employer or employee can terminate employment without cause.¹ Unless a signed contract was in place that specified a fixed term of employment, a dental hygienist has the right to quit at any time. The existence of a written contract may not have prevented the dental hygienist from leaving the office for the rest of the day without warning, but certain ramifications could be specified in writing. These might include no pay for the day or a deduction in salary to cover the cost of a temporary service or the income lost due to the cancellation of patient appointments. Ensuring employees sign a written contract is beneficial to both employers and employees, as it alleviates miscommunication of expectations and clearly defines the details of employment.

Regarding the concept of patient abandonment, the American Dental Association’s Principles of Ethics and Code of Professional Conduct states: “Once the dentist has undertaken a course of treatment, the dentist should not discontinue that treatment without giving the patient adequate notice and the opportunity to obtain the services of another dentist. Care should be taken that the patient’s oral health is not jeopardized in the process.”²

In most states, a dental hygienist is an employee of the practice. As such, patients are legally patients of the practice with a legal dentist-patient relationship. When a dental hygienist leaves the practice, the patients remain with the practice, receiving care from other providers in the office, so abandonment is not an issue. All patient information belongs to the dentist/owner; therefore, if a dental hygienist leaves the practice—even suddenly—he or she is not committing patient abandonment.

With the variety of supervision levels available in dental hygiene today, some clinicians are no longer practice employees. For instance, California registered dental hygienists in alternative practice (RDHAPs) must follow laws specific to independent practice. If an RDHAP did not return to his or her practice, he or she could be disciplined by the state board for unprofessional conduct.

On a more philosophical note, dental hygienists take an oath to abide by the code of ethics set forth by the profession. The American Dental Hygienists’ Association (ADHA) updated its Bylaws and Code of Ethics in June 2016. The above scenario violates the ADHA’s code of ethics. As stated in its purpose: “The code establishes concise standards of behavior to guide the public’s expectations of the profession and supports dental hygiene practice, laws, and regulations. By holding dental hygienists accountable to meeting the standards stated in the code, we enhance the public’s trust on which our professional privilege and status are founded.”³ By not returning to see his or her afternoon patients, the dental hygienist violated both the patients’ and the dentist’s trust. Even if the dental hygienist had workplace conflicts that prompted leaving for the afternoon, these should have been handled in a professional manner that did not interrupt patient care.

The consequences of the dental hygienist’s behavior may include termination and a negative impact on future employment. Dental professionals need to behave appropriately in all situations and remember that holding a license is a privilege.

REFERENCES

Kimbrough-Walls VJ, Lautar CJ. Ethics, Jurisprudence, and Practice Management in Dental Hygiene. 3rd ed. Upper Saddle River, New Jersey: Prentice Hall; 2011.
American Dental Association. Principles of Ethics and Code of Professional Conduct. Available at: ada.org/en/about-the-ada/principles-of-ethics-code-of-professional-conduct. Accessed December 6, 2016.
American Dental Hygienists’ Association. Bylaws and Code of Ethics. Available at: adha.org/resources-docs/ 7611_Bylaws_ and_Code of Ethics.pdf. Accessed December 6, 2016.

The Ask the Expert column features answers to your most pressing clinical questions provided by Dimensions of Dental Hygiene’s online panel of key opinion leaders, including: Jacqueline J. Freudenthal, RDH, MHE, on anesthesia; Nancy K. Mann, RDH, MSEd, on cultural competency; Claudia Turcotte, CDA, RDH, MSDH, MSOSH, on ergonomics; Van B. Haywood, DMD, and Erin S. Boyleston, RDH, MS, on esthetic dentistry; Michele Carr, RDH, MA, and Rachel Kearney, RDH, MS, on ethics and risk management; Durinda Mattana, RDH, MS, on fluoride use; Kandis V. Garland, RDH, MS, on infection control; Mary Kaye Scaramucci, RDH, MS, on instrument sharpening; Stacy A. Matsuda, RDH, BS, MS, on instrumentation; Karen Davis, RDH, BSDH, on insurance coding; Cynthia Stegeman, EdD, RDH, RD, LD, CDE, on nutrition; Olga A.C. Ibsen, RDH, MS, on oral pathology; Jessica Y. Lee, DDS, MPH, PhD, on pediatric dentistry; Bryan J. Frantz, DMD, MS, and Timothy J. Hempton, DDS, on periodontal therapy; Ann Eshenaur Spolarich, RDH, PhD, on pharmacology; and Caren M. Barnes, RDH, MS, on polishing. Log on to dimensionsofdentalhygiene.com/asktheexpert to submit your question.

From Dimensions of Dental Hygiene. January 2017;15(1):54.