When Patients or Employees File Complaints: What Dentists Need to Know

Almost every inspection I've been involved with in the last couple of years, rather than being a programmed inspection or a random inspection of any type, it's based on an employee or patient complaint. And that's why we need to build this impregnable law. We need to make sure we're in compliance. It's not that hard to do. And then we can sleep at night and we're not vulnerable to employee weaponization or patient weaponization. Welcome to the Phil Klein Dental Podcast. As healthcare professionals, we understand the critical importance of maintaining strict infection control and prevention protocols in our offices. Beyond our primary goal of protecting patients and employees, there's another crucial consideration, the potential for patients or employees to weaponize agencies like the Department of Public Health, OSHA, or your state board as a form of retaliation against you and your practice. While this is thankfully rare, it's essential to be prepared for the potential challenges such situations might bring. 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. Dr. Carpenter will be joining us in a second, but first, when it comes to digital workflow equipment, it's important to partner with companies that provide premium products with unparalleled service, all at an affordable price. That's why you should check out Shining 3D Dental. a company that offers a complete and integrated suite of high-quality and easy-to-use digital dental equipment. Their local offices are based in California and Florida, so you get in-time comprehensive support. In fact, Shining 3D Dental can furnish your office with an entire suite of digital equipment for under $27,000. This includes their AoralScan 3 wireless intraoral scanner, Metasmile 3D facial scanner, and the AccuFab 3D printer with its post-price. So whether you're taking your first step into digital dentistry or you're looking to add additional equipment, check out Shining 3D Dental's complete digital dental portfolio. To learn more, visit shining3ddental.com. Dr. Carpenter, it's a pleasure to have you on the show. Phil, it's great to be back. So this is an interesting case. We have a patient who had treatment at a doctor's office and that patient for some reason was not happy with something and they went ahead and reported the office to the state board, the state dental board. And that state dental board sent that complaint. up the chain to the attorney general's office, which I would think that the attorney general has bigger fish to fry at that level, but that's not what happened. And the attorney general actually got involved. A letter was written to the office and then an inspection followed after that. So tell us what happened there with this patient and how it got this far and where are we at this point? Sure. I'd be glad to. This is somewhat of an unusual one. But maybe not so much because this is the second one I've seen like this referred to the Attorney General's office from the State Board of Dentistry in two different states. This is the second one I've seen in about four months. And basically, here's what I believe happened. Disgruntled patient. And maybe they had a good reason. Maybe the office wasn't clean. Maybe it's because they didn't want to pay their bill. Who knows? But they contacted the State Board of Dentistry. At that point, The State Board of Dentistry went to the state's attorney general's office. And I believe the reason they did this was because they wanted the force of law behind it. Because once it goes to the attorney general's office, now we're talking about a subpoena. I have here in my hand a copy of a subpoena sent from the state's attorney general to this doctor, to this dentist, asking, not asking, demanding certain things like copies of their compliance manual, documents relating to training, proof of training of all staff members, even things like their contract that they have a waste management service picking up their biomedical waste. So I believe that this is a tactic to really get the doctor's attention by having a subpoena appear on their desk. This patient that reported the doctor in the first place to the Dental State Board. Is this an anonymous? Was this an anonymous complaint or does the dentist get information on who placed this complaint so they have an idea of what's really behind it? Well, it could be anonymous. In this case, the office told me they knew who it was. The patient was very vocal that they were going to do this, but they could have done it anonymously. And when you talk to the dentist that's involved with this, did the dentist tell you? exactly what he or she believes was the reason for this report? They do. And it's very typical. They believe the reason for this report is that the patient did not want to pay their bill. There was a, we've all had to deal with this. The patient thought insurance would pay more. They had a bigger copay than they thought. And they weaponized this complaint is what they did. But did they have any justification to report this to the state board? as an office that's violating OSHA guidelines? I mean, on what grounds do they report this? Well, here's the problem. Unless we're very diligent, unless we have put somebody in charge of infection control and compliance, it's very easy to miss some things. I'm telling you that in my estimation, without a little bit of work, about 95% of offices aren't fully in compliance. So I'm going to tell you that the odds are very high that they're going to find something. In this case, this office was very weak. There was many things they hadn't done, and this really created great problems for them. Maybe I'm off base here, Dr. Carpenter, but it seems unusual to me for a patient to recognize that an office is not following OSHA guidelines as a way of being vengeful to the office, unless they're in the healthcare business where they are aware of what should and shouldn't be done, because OSHA, you know, obviously is there to protect the employee. not the patient. So perhaps the person was in the healthcare field and they realized that they had an opportunity to be vengeful against, retaliate against the office. No, you're right. It is unusual. Maybe it would take a patient that had some education in healthcare. In this case, we know for a fact that the patient was a nurse. So she did have some medical background. She claimed that people were not washing their hands before they put on gloves. They weren't washing their hands after they took off their gloves. Maybe that was true. Maybe it wasn't. But the big problem is now it exposed the fact that they're asking for things like, let's see your written infection control protocols. Let's see your written exposure control plan. And they don't have these things. So it opened up Pandora's box for this office, creating many problems. So is that typical, Dr. Carpenter, when a complaint is made or a report is filed, the office is typically subjected to a full examination or a full investigation or full inspection of all their OSHA documentation and everything else where they have to be completely transparent on everything because of a complaint about possibly... an employee not washing their hands before donning their gloves. You know, it is because you just can't hide anything here. Because under penalty of law, if you lie to them, now you've got some serious problems. So it can expose many inadequacies in the office, things that you haven't done. And for all of us, you know, we're running a business, we're busy. We know there's things that we should do. But the good news is this is not meant to scare anybody. What this is meant to do is to warn you. It's not that difficult to be in compliance, but we do need to make it a priority. We need to put somebody in charge. The things they were asking for here were very reasonable, would have normally been very easy to comply with, but this office just hadn't taken the time. So the office gets the letter from the attorney general, and then, of course, you got involved. What are they expected to do with the demands in the subpoena? Are they supposed to send copies? through the mail to the Attorney General Office with an explanation defending what happened? Or can they scan it and just send a digital copy of their documentation? What's the typical protocol there? Well, they're very exacting in what they're asking for. In fact, they say specifically, I have it right here in front of me, submit these documents by mail, not by email, by the way, by hard mail, to a particular person. in a particular department at this address, and it has to be done within 30 days. And again, it ends with failure to comply with the subpoena may render you liable for contempt of court and other penalties as provided by law. That would really ruin your day to get a letter like that, wouldn't it? Yeah. So they have 30 days to comply, and they had no documentation at all on any of the things they were being asked to provide? Very little. And what's a shame is they really, in describing their infection control and safety program, they were really trying to do the right thing. But they didn't have written documentation and they didn't have written documentation of training and they didn't have written protocols. So even though they were doing things in a pretty safe manner, they were not in compliance. So during that 30-day window, during which time they're supposed to gather their documentation, do you suggest to them to... create documents they're deficient in and obviously make it clear when those documents were created, but at least they're trying to mitigate the damages here. Or is that something that's fraud if you make documents from the date in which the report was received, the complaint was received by the office? Well, absolutely. I suggest that they do that, but they need to be very honest about it. I've been involved with a lot of inspections in almost all 50 states and some U.S. territories. And I always advise our clients, never lie, always be honest. And the letter might start out at XYZ Dental Center, we believe and have established a culture of safety, but have been lacking in some written documents. Over the past several weeks, we have now in place a written infection control program, a written hazard communication program. So we want to be very honest, but they do look very favorably on the fact that you're trying. So you've been quite a help to this doctor as far as advising him on all the steps from the time he was surprised with this AG letter. How did he find you? In this case, they found out through one of the major distributors, national distributors that they work with who often refer clients to us. So once you saw the letter, what did you instruct the dentist to do then? Well, you know, the first thing you have to do is kind of talk them off the ledge. It's very scary. Most doctors say, you know, geez, I didn't go to dental school for this. I wasn't expecting this. Some sleepless nights, particularly when you could be threatened with pulling your license and not being able to practice. And the first thing we do, we really try to calm them down and say, look, you need to comply. You need to appear as reasonable. We'll help you write the letter. But you need to do these things. You can't lie. You need to do these things. And it should go quite well. And really, Phil, it ends up costing some time and money, of course, and some sleepless nights. But I think that this makes them realize this is important. This is a priority. 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Explore VOCO's full range of composite materials and request a sample at voco.dental. So when you saw the letter from the Attorney General and you met with the dentist and spoke with him about what should be done, what were your main concerns? And do you expect the office to be fined because in reality they are out of compliance? Well, a couple of concerns here. One thing that we tell them is many of the things that you don't have, they really come on the OSHA end, which is safety for workers. We need to make sure we make the attorney general's office happy because they could very easily now pull OSHA in to look at workplace violations. The Attorney General at this point is just concerned with infection control violations that concern the safety of the patient. But we need to do this promptly. We need to do it right. And there is nothing that stops them from saying, this letter looks great. It looks like you're doing the right thing. We're going to come in and inspect in person. We're trying to make that not happen, right? We don't really want them in our office. So OSHA makes it pretty easy for employees to submit a complaint. There's a website. The OSHA website has phone numbers. It has local offices based on zip code. You could find the office in your area if you want to do it in person. But when it comes to the patient making a complaint, is it typically the dental state board they go to to do that? It normally would go to the State Board or State Department of Public Health because the CDC per se doesn't have inspectors. The CDC writes the guidelines that the Public Health Department then enforces. Okay, so typically the patient would make a complaint to the Dental State Board or the Department of Public Health. Is that right? Yes, they could. Okay. So after you responded to the Attorney General's office, their subpoena, did you hear back from them? We did, and I'm pleased to say... this one went well. Although it did cost them some money in terms of products they had to purchase. How much money was spent? You know, really not that much. They probably spent less than $1,500 for the different products they needed. But then they had to spend some time making sure that the employees had documented training. And fortunately, because the response letter included training certificates, pictures and copies of their infection control and OSHA manual, pictures throughout the office, and really a good, solid letter that didn't act as if they were being singled out, that simply said, we want to comply, we want to be safe. In this case, I'm glad to tell you the Attorney General's office. And public health department decided to not even come back out. They took them at their word. Although we have seen many of these where it does create an on-site inspection. Right. So when you say they didn't come back out, they never had an inspection in the first place. They just sent a letter. Yes. Okay. So there was no, there was no inspection. There was no inspection. Okay. That's good. Had this not gone right, there would have been, had it not gone right, they would have pulled OSHA into it where there would be another inspection. and the possibility of some pretty large fines. So the moral of the story is, if something like this happens, you want to respond fairly quickly. You want to be honest, of course. That goes without saying. And you want to show the attorney general that although you weren't up to speed at the time the report was filed, you are now. The office is compliant now. Here's the proof of where we are now. We didn't have these things at the time the report was made. We're trying to mitigate. this as best we can. And we're on the road to working with a company, maybe like Compliance Training Partners, for instance, which is your company, to maintain all the things we need to do to be compliant. And then they're pretty good with that. I actually find it goes quite well. And I say we need to, I always say we need to respond quickly, accurately, and humbly. And you know, like anybody, people seem to do pretty well when you act like that. So what happened in the other case, Dr. Carpenter, where we did an episode, you talked about the attorney general also getting involved from a different state, and there was an inspection, I believe. And that didn't go so well. So what went wrong there where the house of cards kind of collapsed? Well, here's what happened there. First of all, we got involved late in the game. We didn't find out about this until things were falling apart. And they didn't respond quickly. They certainly didn't respond humbly and they didn't respond honestly. That created a real problem. In fact, what they decided to do was hire an attorney and go on the offensive. That just doesn't work. And I don't know about you, but I'm really not going to go on the attack when somebody holds my license in their hand. They can stop the way I practice. And how can you argue? If you're not following CDC guidelines, if you're not following OSHA laws, you don't really have any claim to make. So they got angry. They fought. They had an inside inspection. It didn't go well. It led to OSHA coming in as well. And that's what we want to avoid. It would have been so easy to avoid. Was that a scheduled inspection by OSHA or they just showed up as a surprise to the office? Well, basically, the public health department referred. this problem to OSHA. And OSHA came in. They did give advance notice, but not much. They gave a few days advance notice. And was that a complaint by a disgruntled employee or a disgruntled patient? That was a disgruntled employee, that particular one. And what a shame because it didn't have to go that way. All they had to do was get into compliance. It's not that hard to do. It's not that expensive. It takes a little bit of time. And I find when you do that, These inspectors are quite reasonable. Yeah, it seems to me a little bit surprising that a dentist would hire an attorney and try to fight this when there's obvious records or lack of records of compliance. Like, what are they fighting? The reality is the reality. They were deficient in some of the things they had to do to stay compliant. Yeah, that's unfortunate. It's unfortunate that patients weaponize. these types of things to get back at the dental office. Have you seen that a lot, this kind of weaponization? I have. I have. I've seen that. In fact, I will tell you that almost every inspection I've been involved with in the last couple of years, rather than being a programmed inspection or a random inspection of any type, it's based on an employee or patient complaint. And that's why we need to build this impregnable law. We need to make sure we're in compliance. It's not that hard to do. And then we can sleep at night and we're not vulnerable to employee weaponization or patient weaponization. So no office is 100% compliant on every single nuance. There's always a gotcha somewhere. But tell our audience, if you would, Dr. Carpenter, what the must-haves are. What do we absolutely have to have in place so that if something like this happens where a patient or an employee puts a complaint in and we are approached by the attorney general or OSHA or whatever, we can sleep at night. We have peace of mind knowing that we have these major things in place and what possibly could be an infraction is a small nuance which we could correct very quickly. Well, I really divide it into two areas. There's two areas we need to have for compliance. One is training. One is actual products or things, physical things we have to have to be in compliance. So let's talk about training first. You say, what are the things that we have to have to make sure we're not going to have a problem? We need to have annual proof of annual training. So documentation of annual OSHA and infection control training. And I really prefer to see it by a third party where you have an actual certificate that shows who the trainer was, what the content of training was, written proof. That goes a long way in an inspection. And I should add to that, besides the requirement for annual training, Training needs to be done as part of the onboarding process. So on day one, that new employee needs to be trained. And it can be with online programs like we have. It could be from a webinar. But you must have training. And how many hours of training is expected to be delivered to an employee regarding OSHA and infection control each year? I'm going to say, although they don't set the exact number of hours to cover OSHA and infection control, we're looking at approximately two and a half, three hours a year. I know we have a lot of listeners out there from California, and California is a kind of a bureaucratic state, as we all know. Tell us, Dr. Carpenter, what you know about California regarding minimum training required, especially for those that don't have a formal assisting education. It's a rough place to do business. And what they have done in California is this. It's not OSHA. The OSHA requirement is still annual training. But what they have said for dental assistants that have not come from a formal program. I mean, there's so many on-the-job trained assistants that a dental assistant needs to have eight hours of infection control training. Now, of course, if they've come from a RDA program. a CDA program. They've come out of school with that. When you have somebody who is maybe working in a hair salon yesterday, they're in a dental office today and they're expected to disinfect rooms, sterilize instruments, run an autoclave. I think that's what California is looking at. But you're right, that's not OSHA. That's purely their infection control requirements. And in most states, Dr. Carpenter, the annual training can be taken online. Yes. We provide training. We provide our online training in all states, including California. where we're a California provider. And again, as I mentioned in the introduction, folks, Compliance Training Partners is the company that Dr. Carpenter has founded. He's run the company for years, a very reputable organization, and they have all sorts of things that you need to look at to stay compliant, both on OSHA side and infection control. Yeah, so the moral of the story is be prepared, like we learned in the Boy Scouts when I was a kid. It's a lot easier to address a patient. disgruntled or an employee who's disgruntled, who uses the Department of Dentistry, the State Board or OSHA or the Public Health Department as a way of getting back at the office. If you're fully in compliance for the most part, you're pretty safe. If you're violating some small things here and there, I'm sure that's not going to be a big deal. But if you're completely out of compliance and you've made no effort to comply and you're hiring an attorney to try to fight something that you'll never have a chance to win. you're going down the wrong road, as you've seen in real life. What did that person have to pay as a fine on that other case? That OSHA fine ended up being, I mean, it wasn't a life-changing fine. It was about $18,000. But the time that it took, OSHA being in the office, I mean, we all know what a dental office with two doctors and four hygienists needs to be producing. They lost far more than that in production time. That was what was costly. They probably lost a lot of standing and respect among their staff. Yeah, and I meant to ask you about that. When a letter comes in from the attorney general with this kind of complaint, accusing the office of not complying, is this something that you recommend the dentist talks about with their staff from the get-go at a morning huddle, for instance? Should the dental owners inform the staff right off the bat that Mrs. Smith reported our office? for the following violations and share all that with the team. Absolutely. They need to be part of it. There needs to be full transparency because there's a good chance staff is going to have to get involved. There's a good chance that the staff may be questioned by the Department of Public Health if the State Attorney General's office asks the Public Health Department to come in. So the staff has to be on board with this. They're a big part of it. So in closing, Dr. Carpenter, as we wrap up this podcast, any closing thoughts you want to convey to our audience about this kind of situation where a patient or an employee weaponizes these departments retaliating against the office? What is your final thoughts on this? Well, you know, the first thing I want to say is I always worry that a podcast like this is that the doctors get scared when they hear this. I don't want you to be scared or intimidated. This stuff is not that hard. It's just something we have to do. And we have to do it in an orderly manner. So don't be scared. Don't be threatened by this. Don't think, I don't want to practice dentistry anymore. I can't stand to do all this compliance stuff. Trust me, it's not hard. Quite honestly, a good start, whether you work with us or someone else, if you go to our website at compliancetrainingpartners.com, there are actually OSHA and infection control. audit checklist electronic they're free it's no cost that you can go through to see where am i in compliance and where am i not i think that would be a great start for you thanks again Dr. Carpenter great discussion we appreciate your time and we'll see you on another program soon have a good evening thank you phil