Infection Control and Employee Whistleblowing

Think about it. We're the CEO, but we're also on the assembly line in the dental office. We're doing both, and we just lose track of some of the priorities. I don't think they meant anybody any harm, but I don't think they knew at this point what was going on back in their sterilization area. Welcome to the Phil Klein Dental Podcast. In today's episode, we'll discuss a scenario that every dental practice owner dreads, a disgruntled employee reporting infection control violations to the Department of Health. We'll explore a real-life case that highlights just how devastating such a report can be, leading to potential fines, damaged reputation, loss of patient trust, and even shutting down the practice. And we'll also talk about actionable strategies to safeguard your practice by maintaining impeccable infection control protocols and fostering a culture of accountability. Joining us today to shed light on this topic is Dr. Karson Carpenter, a dentist and expert consultant on infection control and OSHA compliance in the dental setting. Dr. Carpenter is the founder and CEO of Compliance Training Partners, a company dedicated to helping dental practices stay compliant and navigate investigations related to infection control violations. If you want to learn more about Compliance Training Partners or talk to Dr. Carpenter, You can go to ComplianceTrainingPartners.com. Dr. Carpenter will be joining us in a second. But first, with countless dental composites on the market today, choosing the right one can be overwhelming. Yet a few products rise above the rest, and VOCO composites lead the way. For over a decade, Grandioso's tooth-like physical properties have remained unmatched by any other restorative material. With its stunning aesthetics, exceptional durability, and superior handling, Grandioso stands out as the clear choice for all of your composite needs. And if you're looking to simplify posterior restorations with a single-shade solution, check out Admira Fusion Extra, this omni-chromatic nano-hybrid cover. all 16 Vita Classical shades with a single shade. It achieves this without compromising strength, handling, or radio opacity, providing fast, strong, and aesthetic posterior fillings. Join thousands of dentists who trust VOCO for proven performance, superior aesthetics, and lasting results. Explore VOCO's full range of composite materials and request a sample at voco.dental. Dr. Carpenter, pleasure to have you on the show. Bill, thanks again for having me. So on previous episodes, Dr. Carpenter, we've talked about the disgruntled employee and how that employee unfortunately uses or weaponizes the Department of Health, OSHA, et cetera, to be vengeful against the practice, to retaliate against the practice for whatever reason. And in this particular case, the employee was terminated. They had a pretty shady track record at the office. And this doctor was faced with these problems after this person reported them. And things happened very quickly from the time the report was filed. Things unraveled very quickly. So tell us about this case, how you got involved and where we are right now. You know, it is a little scary. Yet at the same time, I don't want to scare people because, yes, this could happen to you. But if you are prepared, unlike this office wasn't. It will not be an issue. But to show you how things can go sideways, imagine if you had an employee who was documented as bipolar, had physically assaulted another employee in the office, was very profane. In fact, they had it recorded on audio, found out they had a past criminal record. They often were absent. Okay. Wouldn't you think if they contacted the state's Department of Public Health that they might take this into consideration? No. They came out within 48 hours of her complaint because she'd been fired. It doesn't fully surprise me that the Department of Public Health was fully focused on the complaint and not really that interested in what preceded it, that their job is to follow up on a complaint, but it would certainly give it some context for them to know. what was behind this complaint, at least in the mind of the doctor. But I assume the Department of Public Health eventually found out that this was a justifiable termination based on communicating with the doctor's office, right? Well, actually, in this case, when they contacted the office, the doctor called them back, explained the situation, explained how it had been weaponized, and said, look, I've got documentation of these problems, why we had to let her go. All the Department of Public Health cared about was the fact that there were purported breaches in infection control, so they came out. Yeah, that doesn't fully surprise me, Dr. Carpenter. The Department of Public Health is interested in infection control violations, and that's what they're focused on. They're not going to get into the underlying reason why there might be a complaint against the office. They're just doing their job and what's under their purview. So what was that conversation like between the doctor and the Department of Public Health, and what happened after that? Well, basically, the conversation was that, again, infection control violations have been reported by this employee, that they would be at the office the next day, and that they would review their compliance with CDC infection control guidelines. And what's really interesting about this, Phil, is I have right here in front of me the spreadsheet that they used, and they literally came in with all the CDC guidelines. It's an Excel spreadsheet, and it says, CDC recommendations and another column that says observations in this office. Now, many times people think, well, they're CDC guidelines. That's what they're called, right? CDC guidelines. I'm not that worried about that. I'm worried about OSHA because OSHA is a law. OSHA has the threat of fine. But this goes to show you this particular inspection, why you've got to be in compliance with CDC because the Department of Public Health can close down your facility. So after the call was over, the inspection followed soon after. Was that a surprise inspection or was that a scheduled time? Well, they said it, told it, gave them a time, a window that they would be out there. And they told them, in fact, I have right here, that their objectives were they were going to review their infection control practices. They wanted to observe them while they were working. They wanted to determine whether any past or current deficiencies existed. They wanted to interview employees. So with only two days notice, they had a full inspection. Did you get involved with this prior to the inspection or after it was complete? Actually, I got involved with it after the inspection. And this one has not been settled yet. This is a current one. So I can't tell you what the final outcome will be. But I will tell you that at least we have here a doctor and staff who are not argumentative. want to do the right thing and are working with us because they have quite a list of breaches that I'll go over with you a little bit later that they admit that there's some problems here. And I want the people listening to this podcast, if this happens to you, because we can never stop this from happening to you, I want there to not be any violations. And it's not hard to do. And we'll talk about just how you can do that. So the phone call came in. Let's go back to the phone call for a second from the Department of Public Health. not the inspector, but an administrator, is there any way to ask for an extension on that two-day period? Because, I mean, you could be doing implant surgery that whole day, or you could be involved going to an off-site CE course for the whole day. So is there any play there, or do they have complete authoritative power? to come to your office with such little notice on their terms? Well, they do have the power to come in because, you know, as the name deploys, Department of Public Health, if they feel the public's health is in jeopardy, they can come in. That being said, I've seen many times where if you talk to them in a reasonable manner, they will give you an extension. In this case, it wasn't asked for. They came in quickly. And if you're busy that day and they want to interview your staff, they can basically destroy the whole workflow of the day, right? They really can. And in this case, they wanted to observe. I mean, they specifically, this is what was unusual, is normally they're not that comfortable having patients around. But in this case, they specifically wanted to observe their protocols, hand washing, processing. of infection or processing of instruments, cleaning of rooms. And they have massive notes on all the things they saw that day. It seems kind of unusual that after two days, just two days, they're in the office observing live patients being treated by the practice after a complaint by an employee. Seems rather quick, almost like they are looking to catch them on something without time to prepare. Is this something that's typical for all the states in the country? Or is this something unique to California, perhaps? Well, you know, I find that this can happen in any state. In this case, this was on the East Coast. And I will tell you that when they came in and spent the day in this office, this letter that they sent, which came within a week, it says this. We found practices inconsistent with the recommendations of the Centers for Disease Control. And then it goes on to say, collectively, these breaches constitute an unacceptable infection control risk to your patients. In response, the department expects you to immediately implement best practices recommendations as outlined in the enclosed table. And this is a very extensive table that basically bullet points every CDC infection control recommendation for dentistry. In reality, was this office just a mess? Did you get to see the office yourself or you just talked to them? You know, from talking to the doctor, it was not unlike many offices. And listen, I practiced dentistry for many years myself. So I have empathy for my colleagues. I'm not an ivory tower guy who never practiced. I know it's easy to forget some of these things. You get busy. You're trying to run a business. But... That being said, there were a number of things that they weren't doing. Let me just give you a couple examples, Phil. The office had no written infection control guidelines, okay? Even if they were doing things right, they're in violation if they don't have written protocol. Here's another one. The dental assistant that processes instruments was not in the office that day. The people who were there said no training logs were provided to show that anybody else had been trained. Here's another. We observed alcohol-based hand rub in three out of five operatories, but many of the bottles were expired. So they're looking at the dates on the bottles. All right, so you can see that once they got in there, in fact, I would tell you, Phil, they found some things that had expired in 2008. So here's another one. We observed assistants and hygienists. not washing hands before and after gloving. We observed dental health care workers wearing masks and gloves while providing patient care and walking down the hallway with those same gloves. Hand hygiene was often not observed. Dental health care personnel not wearing puncture resistant utility gloves. So these are all things that are in our training, the training that we provide, the training that's required to do every year. Not difficult to comply with these things. And if they had had these items, I don't believe the inspectors even would have come in. Yeah, but in this case, Dr. Carpenter, the Department of Health didn't even ask for anything. They just said, hey, we're coming in. They didn't. But I guess what I should say is this employee, although she appeared to be mentally unstable, a person who turned them in, she saw their weak underbelly. She would not have challenged them in this area if she had seen annual training. if she'd seen training when she was onboarded, if she'd seen an infection control manual, she wouldn't have challenged them, but she saw weakness and she jumped on it. We'll be getting right back to Dr. Carpenter in a second. But first, for many years now, we've recognized that buffering local anesthetics can reduce injection pain, speed up onset, and decrease the overall volume of anesthesia needed. However, the process of buffering has always been complex, time-consuming, and expensive until now. Introducing BufferPro, a single-use, sterile, self-contained capsule that delivers 0.1 mils of sodium bicarbonate into a dental anesthetic cartridge, raising the solution's pH to near physiologic levels. No measuring, no mixing, and no hassle. Join the growing number of dentists introducing BufferPro into their practices. To learn more, visit septodontusa.com. So, based on your experience with your company, Compliance Training Partners, Do you see these kinds of violations that you just enumerated fairly frequently among offices? I really do. I really do. And without training, without somebody being put in charge of OSHA infection control, any one of our offices, I mean, I'm not going to tell you that these are bad offices with doctors who don't care. These are good offices that care about their patients and care about their staff, but they're so caught up in the day-to-day. that they didn't take the time to either do the training themselves or engage a company like ours to give them the written materials they need, to provide the training modules that they need online or a webinar. So these are not bad offices, but I'm going to tell you, these are quite typical because we're all busy. What's new to me, Dr. Carpenter, in this case is that I always assumed that the inspector would be from OSHA, but that's not the case here. The inspector came directly from the Department of Public Health. This was the Department of Public Health inspector, and when I talked with the doctor yesterday, one of the things I counseled him on is we need to make this go right. Again, we need to provide a response that's accurate, honest, humble, because the Department of Public Health, if they really get a sense that you're not doing things the right way, they're going to call in OSHA also. The Department of Public Health is going to say, look, We're concerned about the public health safety, about infection control, but we see a lot of other violations. We want to bring OSHA in to look at other things like lighting, noise, ventilation, electrical, hazard communication. So I said, there are a lot of ways this could go south if we don't make our response go well here. Yeah, I mean, I don't want to belabor the point, but it just seems interesting to me that... this employee went to the Department of Public Health when OSHA has so many resources on their website where you just go to OSHA's website and you can get a phone number where you can make a complaint or even a local office based on your zip code and you can go right there in person and make the complaint. And that's typically where an employee would go. So I just found it a little unusual. Do you have any thoughts on why they went directly to the Department of Public Health rather than OSHA? You know, that's a good question. I don't know the answer. I don't think they realized they could do that because they could have easily picked up the phone, called the Department of Public Health, called also OSHA. And I've seen cases where the same person then called the Department of Health and Human Services and reported a HIPAA violation. Can you imagine three different entities attacking that office at once? Now, again, I want to preface all that. I should have prefaced all that by saying you don't have to be scared about this. If you have your written policies and your annual training, you're going to be bulletproof. That inspector that came in from the Department of Public Health itemized some very specific violations or what they perceived as violations. Is there some sort of system that's in place during these inspections where you have major infractions and minor infractions? And if you have all the major stuff handled, in which I'd like you to clarify what you think those are, and then you have some minor infractions, or do they not do it that way? I mean, everything can't be weighted the same, right? It's true. You're right. There are some things that they would consider more of a threat to the public health. For example. As I look on this Excel spreadsheet that the inspectors used, here's the type of details that they went into. We observed a statum 2000 being used for sterilization. Dental health care workers stated dental hand pieces, extra instruments, air, water, syringes were placed in unwrapped conditions and that when things were wrapped, that many of the packages were torn. So you see, they're going into great detail. They would consider I believe, to see a breach in the actual sterilization room where someone might have instruments that are contaminated, of more of a serious nature than not having a training log. Both are important, but you're right, Phil, I think there are some things that are more likely to get an office shut down. If they come in and one new person wasn't trained yet, everybody else was trained, they appear to have done anything right, they're not going to shut them down. They're trying to triage things when they come in and inspect. So one of the key things to keep in mind here is that if your main person, maybe your ICC, your infection control coordinator is out for the day, whoever's in there should absolutely have training equivalent to what the ICC has to some extent, maybe not exactly the same amount of training, but at least have the minimum training, I should say. where they would be looked at as someone who has adequate knowledge and competency in handling uh instrument sterilization right from from the use of the instrument to the transport of the instrument to the sterilization room to the cleaning of the instrument and then to the uh packaging of the instrument and then sterilization of it and so forth and making sure that the instruments are dry because you handling you know wet instruments or um Wet packaging or damp packaging obviously transmits microbes directly into the instrument itself through the moisture of the packaging. So all that stuff we know is important. You just can't have the ICC person take a day off and then not have somebody that's fully trained that's taking over. I mean, that's critically important, is it not? Today's episode is sponsored by Sunstar, makers of gum products. You're absolutely right. You've got to have some backup. You've got to have some cross-trained people. Certainly in every office that's under 25 employees, there's probably only... one person, probably a hygienist or assistant, in charge of ocean infection control. But you've got to have some cross-training. He or she has to have some backup. Let me show you further on this spreadsheet, exactly to the point you're talking about. It says, the dental health care workers confirmed that spore testing was performed every week. However, no spore testing logs could be found. No results were provided to us. Nobody knew where they were. The employee stated that the person in charge was off this week. Exactly what you just said. You've got to say, okay, let's go over a worst case scenario. Sally's in charge of this. What do we do when Sally's on vacation? Well, Tom needs to understand this too. Everybody needs to understand their safety program. So you can imagine at this point, you're an inspector, you're a public health department inspector, and you're in an office. Nobody knows what's going on. They can't even find records that this autoclave works. All of a sudden, they see a real threat to the public health, which is why I'm really concerned about this inspection, that it could create great problems for this doctor. In this particular case, is this a single dentist owner, or are there more than one dentist owning the practice? More than one. And what you've seen so far, in your opinion, Does it seem like this dental office is more concerned about the business end of it rather than the infection control protocol? You know, I've talked to the guys. They're not bad guys at all. They're like so many of us out there practicing dentistry, caught up in the busyness, the day-to-day. I mean, think about it. We're the CEO. But we're also on the assembly line in Dell office. We're doing both. And we just lose track of some of the priorities. I don't think they meant anybody any harm, but I don't think they knew at this point what was going on back in their sterilization area. I don't think that they realized just how badly things were going. Well, I mean, like you mentioned, the CEO, the buck stops with the CEO. So they, especially if they own the practice, they have a lot on the line there. If I was owning a practice, I certainly would want to make sure that the sterilization process was top-notch and complied with all the guidelines that are on the books right now, because otherwise the vulnerabilities on the downside are immeasurable. What's going to happen now, do you think, based on your experience handling many of these kinds of cases to that practice? I think because there were so many violations. For example, one of the really big ones that I see here is that they have no water testing records at all. They're not testing their dental unit water. They said that the dental unit water had a foul smell. I'm worried about what the bacterial level there can be. I think that with all the violations I see here, I think they're not only going to tell them. that they have to come into compliance, that they're going to come back and they're going to continue to monitor them maybe over a year or two period. So let's not let this happen to us. It's not that hard to do, but we've got to get somebody in charge in the office and hold them accountable. Now, if someone got sick from that practice, God forbid, someone got seriously ill from that practice or even died from that practice from some bloodborne pathogen. And then there was an immediate inspection and they found what they found on this inspection. That's it for that office, right? I mean, they're done. Oh, I have seen offices closed, go out of business because of this. It can happen. And you stop and think about it. Let's just say that somebody got hepatitis B, hepatitis C, not in the dental office. They got it somewhere in their past life. But if you go in and you have... unwrapped instrument pouches, no record of sterilization, no record that your autoclaves are even working. How can you prove that it didn't come from your office? So you're right, Phil, that creates a terrible liability and a chance of losing the business. So using this case, Dr. Carpenter, as an example, if you had a crystal ball two years ago and you knew that this was coming down the road, that some disgruntled employee was going to report this office and this office was going to have to go through all sorts of problems dealing with the complaint and the violations and the inspections and the fines and everything else and the stress. So you have this crystal ball. What would you do two years ago as the owners of this practice to prevent this from happening? You know, that's a great question. And I think I have a simple answer. What I would do is this. First of all, Think about somebody in your office who works in the back office, either a trusted, organized hygienist, trusted, organized assistant. Put them in charge of OSHA compliance and infection control. And the first thing I would have them do, I guess I'll toot my own horn a little bit here. Whether you work with us or not, I would go to our website, ComplianceTrainingPartners.com, and you are able to there electronically do an audit. For OSHA, there's a detailed audit checklist. Then there is a detailed audit checklist for infection control. Complete both of those. Now you'll have a record of where you're in compliance and where you're not. The areas you're not in compliance, give that person authority to make this happen. Maybe they need a written infection control program. Maybe they need a spill kit, an eyewash. Maybe they need to purchase online training. Trust somebody to do this. But as I always say, well, I didn't say it originally, but trust, but verify. Occasionally, you're going to have to check to make sure that they are doing this. And let's face it, if someone doesn't think you're at least checking on it, they may not do a good job. But put somebody in charge, follow the checklist. It will not take you that long and it won't cost you that much to get into compliance. It's not that difficult. I think it's a mindset. thing i think the dental practice that's involved with this horrific situation where they're basically failed on all items uh probably didn't do things up to par on certain things for a while and then more things started to slip through the cracks and it became a way of practicing where it was just they were getting too deep into it and they didn't have any nobody got sick nobody complained they didn't have any inspections And things just went on swimmingly for the longest period of time. And then until suddenly, boom, it hits you right in the face. And then you're so far behind the eight ball, it's really difficult to recover. What is this office going to do now? Now that they've had this inspection, they're going to probably have to pay a fine, right? And like you said, they may be monitored for a while with multiple inspections. They need to hire somebody to get in there to get the place up to par because they're too busy doing dentistry and they probably don't have the knowledge. to do it themselves. You're right, Phil. And the doctors, to their credit, they said, look, we feel really bad about this. We're embarrassed. We meant to do it. We've talked about it really for years. But it's always going to be tomorrow. It's always going to be next week. And that's why I think a great place to start is with a checklist, something that shows you, something that gives you some guidance as to where you need to be in compliance and where you don't have to be, don't have to do anything. Maybe there's... Probably 80% of these areas they're in compliance with, but it's that 20% that can get you. So it's so important to do this. It's not only better for our staff, for our patients, but the liability for our business is greatly mitigated by doing this. We've got to get in compliance. Yeah. I mean, for the sake of the patient and for the sake of the employees, it's important, but it's also a gamble if you don't. You're gambling your business. And that's a gamble I don't think any practice owner wants to take. And you know, Phil, one thing I want to say in closing too is that we're all business people. All of us, we own practices. Keep in mind that the time and money, which is not that much money that you're going to put into compliance, do you realize how much more valuable it makes your practice? People want to join a compliant practice. People want to buy a compliant practice. what you're going to put into compliance. I've seen that time and time again. And you'll sleep at night. You'll sleep at night. That's right. Peace of mind. I'm telling you, there's something to be said for peace of mind. Listen, dentistry is hard enough. We don't need to worry about this. We can fix this easily. Yeah. Stay ahead of the curve. All right, Dr. Carpenter, great to have you on the show. Thank you so much and have a good evening. Thank you, Phil.