OSHA Inspection Gone Bad: Don't Let This Happen to You!

You're listening to the Phil Klein Dental Podcast. With no notice at all, an OSHA inspector shows up at your door and says that he's there to do a full inspection of your office and your records. Yes, this sounds like a nightmare, but unless you're fully prepared, this inspection can haunt you and your practice for a very long time. In this episode, we're going to be specifically talking about an inspection that went bad, and we're going to learn all about what not to do and what we should be doing. With us today to guide us in the right direction is our guest, Dr. Karson Carpenter, a dentist and expert in OSHA, HIPAA, and CDC guidelines. He's president and CEO of Training Compliance Partners, which specializes in compliance and dealing with dental office inspections. Dr. Carpenter will be joining us in a moment, but first, we all know that to achieve healthy, beautiful smiles, we sometimes need to align the teeth. and to do so, aligner therapy is a great option. So why not set your practice apart with 3M Clarity Aligners Flex? Designed for comfort, Clarity Aligners Flex feature a thin, flexible design, yet they deliver excellent force persistence over a two-week period. Plus, they resist scratching and stains, and they're backed by a dedicated clinician team providing support every step of the way. With a variety of affordable case type options, single or dual arch, Clarity Aligners Flex offer a great value to your patients and practice. To learn more, visit 3m.com slash clarity dash aligners dash flex. Dr. Carpenter, it's a pleasure to have you on the show. Phil, it's great to be back. Thanks for having me. You know, this is really an important topic. We're talking about an inspection that's gone bad based on the title. And we certainly don't want this to happen to anybody. But it does. The reality is that it does happen to dentists. So tell us about this particular inspection that so-called went bad. What initiated it? And give us the background so we have an idea of what actually happened. This one went bad because it led to a lot of other problems. And that's what I hope to talk about in this podcast, to let my colleagues know. why we need to be in compliance, how things can really go wrong. In this case, Phil, to answer your question, it started with an unhappy employee who basically weaponized this. In other words, they anonymously, which you're allowed to do, they anonymously called OSHA, claiming that they were being harmed in their office. This precipitated the inspection. So how do you know this? Like, how does the actual dentist that hired that person know that the complaint came from an employee? Does OSHA tell the dentist we have a complaint from an employee and we need to come in? They do. They do. They'll let you know it's an anonymous complaint from an employee. But this was on schedule, this particular inspection. Well, actually, it started out, imagine, first step, employee complains. Second, OSHA sends a letter to the doctor with the allegations. Third, they responded to it. OSHA wasn't happy with what they heard. they decided to come in unannounced. And what was the chief complaint by the employee? Well, the chief complaint was that they didn't receive training and they were being exposed to blood-borne disease. In the operatory or just in sterilization? In the operatory, in the sterilization room, even in the laboratory. They had a lot of allegations, only some of which were true and most were not nearly as bad. as they described, but nonetheless, it triggered an inspection. Was this employee fired or were they still working in the office when they sent the complaint to OSHA? Well, actually, when they sent the complaint to OSHA, they were an employee. Now, of course, the doctor was pretty sure who that employee was. In fact, they were almost 100% sure. Shortly before OSHA came in, that employee then left employment, but it didn't matter. The damage had been done. OSHA was in the office. So what was the actual information that OSHA provided the dentist where when they replied to that letter, it was inadequate? Well, here was the problem. You know, what's sad here is it quickly could have gone away if they'd had the right materials. For example, one of the first things they asked for in this allegations, the allegations that were given by OSHA were, there's no training. Send us proof of training. They had no proof. In other words, they actually are looking for dates, name of trainer, subject covered, signature of the employee. So they had none of that. It's interesting that the employee used lack of training as a complaint to OSHA. Maybe it's just me, but I don't think that's something that's typical of an employee to say, hey, I need more training. Schedule more time for someone to teach me things. I need to read more. It sounds like they weaponized this complaint as a vengeful act against the office. It really was. It really was. And as a matter of fact, this is one of the areas that I see most weaponized where the employee states that there was no training or inadequate training or that there is no written training program because they know those things are required. They know that those things can precipitate an inspection. So did the office have training? Did the office provide training? Was that a legitimate complaint by the employee? Well, you know, they did provide some training, but it was a bit random. It was hit and miss. It wasn't documented. So they never really sat down as a team and did documented required annual OSHA training. And that was the problem. That was the first area that triggered this problem with OSHA. So what is the actual training requirement annually for an office to be in compliance with OSHA? The training requirement is that all employees receive annual training. There's no way around it. Is it an hour? You're talking about an hour of training, two hours in-person training? Could it be done online? You know, it can be done online. It can be done in person. For example, Compliance Training Partners, my company, we do it both ways. Most people train online. But at the same time, And training also must occur for that new employee. So you have to have training as part of onboarding and then training once a year for all employees. Those are the requirements. So in an ideal world, what should have that office return back to OSHA in response to that complaint? And you know, again, what's sad is when you look at this complaint, and a little bit later on, we'll talk about all the things that... came, negative things for the doctor that came because of this inspection, it could have all gone away quickly because if they had had, first of all, documentation of training, in other words, written documents from each employee signed that they'd been trained on a date, what was covered? The second thing they asked for, a written exposure control plan. Now the exposure control plan, that's the written plan that describes how you handle prevention. of exposure to blood-borne pathogens. They didn't have a written program. So there was the second thing. The third, they didn't have a written hazard communication plan. They had talked about all these things. I believe that the office was reasonably safe, but they didn't have those three things that you must be able to produce in a written form. Documentation of training, documentation of a written hazard communication plan. and also a written exposure control plan. Once OSHA saw those weren't in place, that opened the doors. And did they contact the office again and say, were coming in for an inspection and they set up a date or they just showed up? I'll tell you, Phil, that normally that's what they do. They do give you the courtesy of calling, at least letting you know when they're going to come in. In this case, they just showed up. It was unannounced. And what happened when they knocked on the door and said, here we are? Well, of course, they showed their credentials, said they needed to inspect the office. The results that they received from the office showed that the office may not be in compliance. And of course, they had to let them in. They could have refused entry, but they could have quickly got a warrant and come back in. So they did do the right thing in letting them in. But they came in and they started to interview employees, physically inspect the office. And worse yet, although they were OSHA inspectors, they felt that the public was also not being protected. So they called the State Board of Dentistry and... State Department of Public Health. So apparently this quickly escalated into something much bigger with those state groups contacted. Oh, absolutely. Absolutely. And that's where things went really bad. Because imagine that OSHA is designed for one thing, to protect employee health, to make it safe for employees in an office. They literally don't care about patients. But now you've got OSHA in there. OSHA contacts the Department of Public Health. And the board of dentistry, they're all about protecting patients. So you can imagine having literally three different bodies after you. So different things. When they had that unannounced inspection, should the dentist have stopped working on the patient that he or she was working on and greet the inspector or inspectors and take them through the practice and say, what could I show you? Or did the dentist just continue working as they were? team of inspectors? Were there more than one? There was one, just one from OSHA. Later, there were two from the Department of Public Health and one from the Board of Dentistry. Okay, but the first one with OSHA, should the dentist have spent time directly with that inspector and just excused themselves from the operatory and said, I have to take care of something and I'll be back? What actually did happen and what do you suggest? Dr. Carpenter will be right back to answer that question. But first, if you're looking to raise the bar with your adhesive dental procedures, you should definitely be looking into Bisco. Bisco is a great company that has an unparalleled track record. I can unequivocally say adhesion is their passion. They are genuinely dedicated to understanding and improving the ability to bond dental restorations. Bisco is a company that places tremendous value on research and scientific knowledge to benefit you and your practice. Being an endodontist myself, my favorite Bisco product is Theracal LC, which hands down is one of the best materials to use for direct and indirect pulp capping procedures. It not only seals the dentin, but offers significant calcium release, which stimulates hydroxyapatite and secondary bridge formation, which is exactly what we're looking for in these kind of procedures. So check out their entire product line of premium adhesive products at bisco.com. Well, here's what I suggest. And I base this on the fact I and my company have been involved in more inspections, OSHA inspections in dental. And although I'm trained as a dentist in dental, medical and veterinary facilities than anybody in the U.S. And what I find works best is when OSHA comes in for the owner, the doctor in this case, to get up from the patient, greet them, say, look, we'd be glad to show you around. Glad to do this. Can we delay it till, you know, a couple days from now? Give them a date because right now we have patients in the office. I'm treating a patient right now. We're concerned about patient privacy. I will tell you that in most cases, I find OSHA to be reasonable and they'll take you up on that. The next best thing, if they won't do that, you can at least ask if they will not tour the clinical facility. presently because, again, privacy concerns. But instead, we can say in the lunchroom, you can start to take a look at our paper records, logs of training, written documents, safety data sheets, etc. That's the best way I find to handle it. If we want to tell them, look, you can't come in, they're going to be back in short order and they will have the legal documents to allow them to come in. In this particular case, what did the dentist do? In this case, the dentist actually did not get up, continued seeing the patient, which I think was a mistake, told the office manager to let them in. At that point, they were in the office. I think it could have gone a lot better if the owner had talked to them. We can't guarantee that, but that's what my experience has been. So what were the main infractions that they found on the OSHA side? Well, on the OSHA side, of course, I'll just mention again because they were so important. No documentation or no training and no documentation of training. No, let's call it an OSHA manual with written hazard communication plans, with written bloodborne pathogens exposure control plans. Also, they found that there were, although there was an eyewash, It hadn't been tested weekly as it should be. They found out that several members of the team had not signed a declination form saying that they did not want the hepatitis B immunization. A number of paperwork violations, missing safety data sheets. In fact, probably missing about half the safety data sheets that they should have had. Yeah, so it sounds like there was a whole lot of things. So in your experience, how many dental practices, out of everything you just mentioned, would be in compliance with all those components that were inspected there? Well, you know, I guess I have a personal bias here because, again, we have thousands of clients around the United States, and I feel that almost all of those are in compliance. It's not that hard to do, but I will say that unless somebody has made a concerted effort to do this, is working with a company that knows how to assist them, to help them, I would say... probably less than 10% are truly in compliance. Again, that being said, it's not that hard to do, but you have to have a plan. Generally speaking, if you get audited by the IRS for tax purposes, there's always something they could find. I mean, every little line item can't be perfect. And you don't have a receipt for every little thing. So obviously, if they dig deep enough, they'll find something. But in a case like this, where this inspector came in unannounced, and OSHA knew there were problems based on the response that the dentist provided initially, this dentist had no chance without forewarning of that inspection. You know, that's true. And one thing I would like to emphasize, I definitely don't like to scare my colleagues. As a matter of fact, I'm the guy who's going to tell you that actually most OSHA inspectors are quite fair and quite reasonable. Having been involved... with inspections in almost all 50 states and U.S. territories like U.S. Virgin Islands, Puerto Rico. I was involved, we were involved in an inspection in rural Alaska where the inspector came in on a flow plane. So, but they're all the same. The inspector actually is quite fair, quite reasonable. They'll cuck you a lot of slack, I find, if you've done the basic things. You've got records of training. You've got a quality OSHA manual with the written documents you need. They're very reasonable at that point. don't want to scare people. I do want to scare you if you haven't done anything because you're very vulnerable. But if you want to put a little time in doing this, it's not that hard to make OSHA happy. So how has this affected the practice, Dr. Carpenter, the one that we're talking about here, where this inspector came in well aware that the practice was certainly not tip-top shape regarding all the compliance that needed to be taken care of to meet OSHA guidelines. How long after the inspection? Did the dentist hear back from OSHA with the results and the next steps? Well, I'll tell you, this inspection is the perfect case study of why we need to be in compliance, because the implications here are many, and the time period, it's still going on. It still hasn't stopped, and it's about six months later. When you have OSHA, the Board of Dentistry, the Department of Public Health, all involved. It is a nightmare. And that's why I really, I don't want to debate, are these laws right? Are they just? Are they correct? We've all got to follow them because here's what's happened to this fellow. First of all, you can imagine his mental state over this, incredibly depressing, wishes he wasn't practicing, would like to sell his practice, lost half of his staff over it. The Board of Dentistry is still putting certain requirements on him and, in fact, has even said that, quote, the respondent must permit a consultant appointed by the board to conduct a random and unannounced inspection on a date and time chosen by the consultant. So he is still under threat of them coming in again. Should I use the word ruined his life? It's certainly ruined his professional life. We don't want to let this happen to us. So in this case, it's pretty clear this doctor's in a real mess. What do we do to fix it? Well, you know, one thing that our company does is, of course, we help doctors like this who either were or are our clients or going to become our clients get through these things. And I think a big part of it is, as I say, talking them off the ledge. Right. This is going to go away. This is going to pass. We've got to fix these things. It's difficult right now. But, you know, you're going to get your professional life back here. Once you've got your practice into compliance, you're not going to have to worry about this again. You'll you'll sleep better. So I think he's doing better already. But it's been six months of hell. It really has. But typically when you have this happen, I would assume. All the boards that were involved, OSHA and so forth, they're going to come back and say, this is what you need to do, and then we'll re-inspect. And if you can meet these requirements and get your office back into shape, they probably throw a fine at him. But once he's in compliance, everything should be back to normal. Am I being over-optimistic? Well, you're correct. They have put his license, although they haven't taken it away. They've threatened to. They have put him on probation. So that is hanging over his head. But you're correct, Phil. In a certain amount of time, that may be a year, he'll come off from probation. They'll feel that he's in compliance. And I think he'll be treated like any other practice. But in the meantime, it's a very tough time. Is there a financial fine involved with this? There is. There is. That would be from OSHA. How much money are we talking about typically for something like this? You know, again, I don't like to scare people because you can look at the OSHA penalties and see that it's possibly possible to be fined, you know, six figures. But what do I find in something like this? Probably that five to 30, $40,000, probably the average being seven, $8,000 is what I see in my experience. But to me, what's far more costly than that is the downtime. the stress, the anguish over this, that's what really costs you a lot of money. And again, if time is money, you can imagine the time that he's putting into this almost every night after work. So your company, Compliance Training Partners, you have a mixture of customers. You have a mixture of dental offices that use you partly to stay in compliance and get the materials they need to stay in compliance and then partly to deal with issues like this? You know, I think we probably have some of our best and most loyal clients where we have helped them after the fact. They were not clients. We helped them afterwards when no one would. That being said, it's just like practicing dentistry, right? What makes you feel best, what you want to do most is preventative. And I get no, I guess I get joy out of helping people like this, my colleagues out of a bind. But I get a whole lot more satisfaction out of getting them prepared, having the written programs, having the training, and the fact that they can sleep at night. They know if OSHA comes in, they're not going to have a problem. And in fact, when you're prepared, that staff sees this, I'll call it an impenetrable barrier. Wow, I've never been in an office where they do training every year. It's scheduled. Onboarding and new employees immediately train. we've got an eyewash, we've got a spill kit, we've got somebody in charge of OSHA. That's not the person who's going to call OSHA. They feel you're bulletproof. And it is important in an office to have somebody that's held accountable to making sure that the office is compliant in all these areas, right? Isn't it better to have someone like an infection control coordinator, an ICC, that that might be the person that would be involved with this? Is that typically what you find one person held accountable to making sure that that office doesn't run into the issue that this gentleman did? I'm glad you mentioned that, Phil, because to me, that is one of the most important things. Every office I've ever seen that's in compliance has somebody in charge, somebody held accountable. Now, when it comes to ocean infection control, I say pick a quality, organized clinical person. In other words, somebody who knows the back, a quality, trusted assistant. or hygienist. If we were talking HIPAA, I would say for HIPAA compliance, of course, pick a quality organized business office person. But if you pick an organized assistant who knows the back, even if they've never done OSHA compliance before, they can work with, say, a company like ours with the audit checklist that we provide. It's not difficult to go through, check the boxes, and make sure you're in compliance. Doctors, I can say this because I'm a doctor too. If we leave it up to us, it's never going to quite get done. Great podcast, Dr. Carpenter. For those of you who want to reach Dr. Carpenter's company, simply visit trainingcompliancepartners.com. Dr. Carpenter, thank you and have a great evening. And Phil, I always appreciate you having me on this. And I hope everybody in the audience finds this beneficial. And if you do some of the things we talked about, you're going to be able to sleep nights. It's not that hard. Thanks so much for listening. See you in the next episode.