Brace for Impact: Buying a Practice that's not OSHA Compliant

I wrote his letter of contest to OSHA. The inspector he worked with was not willing to give an inch. But I told this young doctor, I said, look, let's write a letter. Let's talk about the trajectory this practice is on. This is something that you're already putting a lot of money and a lot of time to make a safer workplace. And I'm glad to say that even though he was not in compliance at all, we're able to take this fine down to $5,000. Welcome to the Phil Klein Dental Podcast. Imagine this scenario. A dentist's office recently purchased by a new owner finds itself facing a surprise OSHA inspection due to a disgruntled employee. With the previous owner neglecting OSHA regulations and the new owner strapped for time in the transition, the practice is now grappling with the repercussions of noncompliance. So in today's episode, we're going to be discussing potential fines and penalties, the impact on the practice owner, as well as the staff morale. We'll also discuss strategies for navigating through the situation, including steps to lower the fine and swiftly bring the practice up to code and establish a culture of safety and compliance. Our guest is Dr. Karson Carpenter, a dentist and founder and president of Compliance Training Partners. He is truly an expert in these kinds of unfortunate mishaps in the office. Dr. Carpenter, thanks for joining us. You're welcome. Good to be here, Phil. Yeah, so you are always an exciting guest to interview. Every time we have a conversation on a podcast, you're telling me about these horror stories that are involved with inspections and dentists that have disgruntled employees. And this particular conversation we're about to have is about a surprise inspection by OSHA to a new owner of a dental practice. I'm just going to give the audience a little bit of an intro. So apparently a dentist in his late 30s, early 40s, was an associate at a dental practice, ended up purchasing the practice. And shortly thereafter, there was an employee there that he apparently did not feel was a good fit for the practice. So that employee was terminated. And then shortly after that, he was surprised, the office was, with an OSHA inspection. it was revealed to the practice that the reason for the inspection was a complaint from a former employee. And it seemed like things went downhill after that. So you were contacted, Dr. Carpenter, because I know you have a company, Compliance Training Partners, which we'll talk about later, that specializes in handling these kinds of, I would call them nightmares in a way. It's a nightmare. So tell us about this incident and how it progressed. I'd be glad to, Phil. And as you know, we had originally intended to do a different topic, but this inspection has come up since we last visited with each other. And I thought it was so appropriate for my colleagues to know how things can go sideways, how you can prevent this. And quite honestly, I have a lot of empathy for this young guy who bought his first business and had this happen. Basically, here's what happened, Phil. He had worked there as an associate. He knew that the office was out of compliance, but he had an opportunity to purchase it. He wanted to turn that ship around. And of course, as you can imagine, by the way, this inspection occurred within two months of him buying the practice. As you can imagine, there's priorities. It's an older practice. It was owned by an older gentleman. He needed new equipment. He needed a new autoclave. into equipment, started to do some compliance things, had it on the radar that over the next year he would have that part of the puzzle solved. Too bad he waited. He should have made that first. It really wouldn't have taken that much time. It really wouldn't have cost that much money. And he was vulnerable. And he suffered for the sins of the guy who he bought the practice from. That guy's off scot-free. Now, how long was he an associate working at that practice? knowing that, or at least I hope he knew, that the infection control protocol was not up to par? He'd been there about three years, so he realized that there was a lot of improvements that needed to be made. Okay, so he bought the practice with full understanding of that the office was not in compliance. Where was the practice deficient in complying with OSHA protocol when he took the practice over? And by the way, I'll start to go into that, but I thought you'd find it interesting that the fine was approximately $21,000. Now, here is a guy who told me he's not taking a salary. He's got a young family. He's putting money into the office. He's got a big loan. This is major. I mean, it's not good for anybody. But if you've been out there a while, I guess a $20,000 fine is not going to end your career. He's really, this is a hardship on him. Not to mention the time it's taken away from clinical dentistry to solve this, which is probably going to cost him more than that. But the way it started was, again, an unannounced inspection. They came through and one of the first things they asked for was, let's see your written training program. Specifically, they asked for a written hazard communication plan, which that's the plan that talks about chemical safety, labeling, safety data sheets, personal protective equipment. He didn't have a written plan. So that was a big part of the citation, lack of a written hazard communication plan. The next thing they looked at was, well, let's see now your written exposure control plan. And of course, an exposure control plan is the written plan for prevention of bloodborne disease. He didn't have a written plan. Again, had the best intentions. A very nice guy, by the way, very agreeable, very easy to work with. Had a great attitude with OSHA, but it didn't matter. They didn't care that he planned to do it. They didn't care that he just bought this practice. All they cared about was he owned it and he didn't have written plans. So that was the first. infraction. And of course, you can imagine there are more. We'll be getting back to Dr. Carpenter in a second. But first, for the optimal bond between zirconia and your resin cement, check out Bisco's Z' Plus. Rated best in class by thousands of top clinicians, Z' Plus, featuring MDP, creates a strong, reliable bond to zirconia, metal, and alumina substrates. And nothing could be simpler. It comes in a single bottle, and it's 100% compatible with both light-cured and dual-cured resin-luting cements. It's time you get the most out of your zirconia restorations. To learn more about Z-Prime Plus and the entire Bisco adhesive product line, visit bisco.com. So it sounds like to me that the primary concern for the inspector was for the doctor to demonstrate or show him or her that... documentation was present in the office. You mentioned specifically training and hazardous materials. Aren't these templates that can just be accessed or purchased somewhere, pretty much your company or other places online, and then they just kind of customize it? I mean, it's basically a template that every office should have. It doesn't seem like a lot of heavy lifting there. Well, a template is acceptable. You can imagine our compliance system. I'm realistic. Having practiced dentistry myself, I'm realistic. We don't have time to write plans. I'm also realistic that most offices are basically the same, but there are certain fill in the blanks things. For example, your address, the name of your employees, the name of the disinfectant that you use. So it has to be customized somewhat, but a template is the way to go. A template, for example, our program makes it easy. And what's really a shame is if he had spent probably for all the infractions he had. I bet if he... less than $1,000 and put in maybe about 10 hours, I don't think there would have been a fine at all. And believe me, this guy's not sleeping at night. This has been really a tough deal for him. You know, the first thing that came into my mind when you said that he purchased the practice and he had other priorities, it seems to me having a template for these written plans that he knows is essential to be OSHA compliant doesn't seem like a big deal compared to the downside of being caught not being compliant in exactly the case that happened to him. So it just seems crazy to, it's like not buying fire insurance on a $2 million home because you want to save $4,000 a year. I mean, nobody likes paying the fire insurance, but if your house burns down, you're out $2 million plus. It doesn't seem like it makes a lot of sense to me that he neglected that, but of course he did. Another thing that surprises me is that the doctor knew that he was terminating an employee. So there was ill will there and there was a potential for, you know, a disgruntled employee to retaliate by reporting him to the state board or for whatever reason or OSHA, which this person did. So that is another thing to keep in mind, right? I mean, you're taking over practice, you're terminating an employee. If you know that you're not compliant and you're doing those things, you certainly should get compliant. What are your thoughts on that? You're right, Phil. And I guess it's easy for me to say, having practiced for many years, having been experienced, and probably for you as well, you practiced a long time, to realize that, yes, and by the way, it's a great analogy. You would want to buy the house insurance on day one you bought the house, even if you're going to fix it up and put a lot of money into it. But I can understand a young practitioner, never owned a business, had no business training like none of us did in dental school. Thought to himself, you know what? Room one has a chair that's leaking fluid, hydraulic fluid. I need to, first of all, get operational so I can see my patients. The x-ray, he told me, it had a terrible old x-ray that didn't work right. So he put his money into what he thought were productive things. He is the first to admit now, he said, you know, compliance should have come first. It wasn't that expensive. It wasn't that hard. That's the mistake he made. It's easy for any one of us to make that mistake, I guess, if you're not experienced. So when the inspection occurred, did the doctor explain to the inspector about some possibility of a grace period saying, hey, I just bought this practice. I'm trying to get it going. Within a few months of purchasing it, here you show up at my door. There is no grace period where they have a little bit of sympathy and say, okay, you just took the practice over. You have six months to get compliant, no fines. No major deal. We'll be back in six months. That's not the case, I assume. Well, you know, you've heard me say before when we've done these talks that actually, in my experience, OSHA is usually pretty fair, pretty reasonable. I mean, it could be said that what they were asking for, a written plan, safety data sheets, training of employees. I mean, everything's written down. Everybody knows what it is. It could be said that that's pretty reasonable. It's not that expensive. It's your responsibility, even on day one, to do that. But you're right. OSHA does have some empathy, some compassion. This young guy was ready to pay the fine when he was introduced to us. I immediately stopped him. I wrote his letter of contest to OSHA because the inspector he worked with, the guy who had the boots on the ground, was not willing to give an inch. But I told this young doctor, I said, look, let's write a letter. Let's talk about the trajectory this practice is on. This is a practice owned by an older practitioner. It wasn't safe. This is something that you're already putting a lot of money and a lot of time to make a safer workplace. So that's the type of letter I wrote, Phil. And I'm glad to say that even though he was not in compliance at all, we were able to take this fine down to $5,000. You might say $5,000, that's a lot of money. But compared to $21,000, not only that, he was able to do the things that he needed to do and get OSHA off his back. So they're not going to be back in there again. So to answer your question, yes, they do have some compassion. They do have some empathy. But this was a special case. And that's what I outlined in the letter. Look, a very unsafe business, bought by a young guy, carrying a lot of debt, trying to do the right thing. has plans to make it completely compliant and make the workplace safer for everybody. We don't want to put a financial hardship on him. That saved him about $15,000. Yeah, so that's a success story. But when you think about it, perhaps the inspector felt that the doctor was working in that practice you mentioned for three years. So even though he bought the practice, he was well aware or should have been well aware that there was no written documentation as required by OSHA to comply. So I think that hurt him. I may be wrong. If he had just bought the practice and was new, didn't have time to even find out where the men's room was, that would be something different. But he was working there for three years. So maybe that had some influence on the inspector. We'll be right back with Dr. Carpenter. 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 from Solventum, formerly 3M Healthcare. 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. So we talked about this doctor's nightmare, so there's lessons learned from this, obviously. So what do you suggest a dentist do when it comes to due diligence before buying a practice specifically related to where that office is regarding OSHA compliance? Well, you know, that's a great question. And the first part of it you had mentioned kind of plays into that. Namely, did it hurt him the fact that the inspector said, look, you worked here for three years. You knew what you were getting. Yes, it did hurt him. was, how would I use the word, upset about it and did use that against him. I, on the other hand, when I wrote the letter, I used that for him. To me, the feeling is this. When you can take an unsafe workplace that nobody would have known about, that could cause harm to people, someone else buys it and upgrades it and makes it safer. You've done a great service to dentistry, to society. I basically wrote in this letter, he knew very well what he was getting and felt he could turn it around and was in the process of turning this ship around. While that didn't appeal to the inspector, it appealed to the inspector's boss. It appealed to the OSHA regional director who said, yeah, look at here. We got a taxpaying citizen, a guy who's carrying a lot of debt, a young guy. He doesn't have a criminal record. I mean, he's a quality citizen. Let's cut him. break that being said your next part of your question would i buy a practice that was knowing out of compliance. Well, let me tell you, I look at it two different ways. If I'm a young doctor, I'm looking to buy a practice. And let's just say the doctor's asking $500,000 for this practice. Older doctor, it's clearly not in compliance. I'm going to use that as a negotiating tool. Dr. Smith, I'd love to buy this practice, but I can see that just to get it in compliance with OSHA, with CDC, with our state's public health department, we need a new autoclave. We need OSHA compliance manuals. We need eyewash. We need training. I'm willing to take this on, but I need a $25,000 discount. Truly, Phil, I think this should be a negotiating tool. On the other hand, if you're an experienced practitioner, trust me, a practice that's in compliance is worth a premium. When I sold my practice, that was a key thing that fixed a premium, that this had state-of-the-art infection control, OSHA compliance, trained employees, records. I would go to say that that put another $100,000 in my pocket. So compliance pays for itself on both ends when you look at it. Would I, as a young practitioner, be scared away from a practice that wasn't in compliance? Not at all. But I would sure get it in compliance on week one. And you would negotiate the price to make up for any additional costs that would be required for you to bring it up to compliance. No doubt. That makes a lot of sense. So getting back to that particular office that we're talking about here, what was the state of their training? Did they have any training whatsoever, these employees that were working there? Now, here is something that he had begun. The practice previous to him, no training at all. One thing he did do that was absolutely right in the first couple of weeks. He purchased an online training program. It happened to be ours, actually, as a matter of fact. He purchased an online training program. The staff was trained. There was documentation of training. And I will tell you, that was a key thing that swayed that inspector's boss, the regional director, that he saw that he had done training. The problem was, was, of course, many of the things taught in that training weren't being done because they didn't have them. They didn't have the SDS sheets. They didn't have the eyewash. They didn't have the spill kit, et cetera. But he had made an attempt that did make him look good. So you're involved with a lot of these cases where there's OSHA inspections and violations and all sorts of things, and you're obviously helping dentists get through it. If you would, share with us a little bit more specifically on what happened with this inspector that came to this doctor's office. Sure. Sure. Glad to tell you this. And this is often how it happens. In this case, came in unannounced, showed identification to the lady at the front desk. The doctor was with the patient. He came up front. Again, a bit naive in business, a good guy, an honest guy. He said, come on in, take a look. Which was the right thing to do, by the way. And we'll go into that in the next episode about should you ask for a warrant or not. But he naively let them in, thinking that they would understand that he just bought this business and is trying to do the right thing. But they didn't. So at what point did the doctor reach out to you for help regarding this situation? Was it right after the inspection was completed? did not reach out to me when the inspection occurred. He reached out to me on the first day when he received his letter, his citation from OSHA stating he owed $21,000. He was, as you can imagine, very upset. In this case, he reached out to his sales representative who happened to work with us and suggested he contact us. I wish he'd contacted us even earlier, but he did have at that point almost, well, a little over two weeks to respond. And that's what we helped him with. How do they come up with these fines? Where do they get the number $21,000? Well, you know, there's actually a schedule of fines for serious, less than serious fines. And basically... fine could have been a lot more than that. That fine could have been $120,000. So actually, believe it or not, $21,000 for having nothing. Actually, the inspector was reasonably generous. But they do have a public schedule of OSHA citations, and they go up every year according to the Consumer Price Index. So you mentioned that he basically had nothing when the inspector came in. But I mean, he had an autoclave. He has some sort of sterilization protocol. autoclave testing. Hopefully he had an eyewash. Actually, maybe he didn't because you mentioned that was a violation. But he was basically dead to rights without that documentation from the get -go. He was guilty. Well, he did have those things. But you see, when it comes to OSHA, sometimes the OSHA inspector knows very little about the function of an autoclave. Or for example, that an autoclave needs to be tested every week. OSHA is really focused on one thing, employee safety. So OSHA wanted to know where are the safety data sheets to protect the employees? Where's the training to protect the employees? Where's the PPE to protect the employees? Now, often that does lead to an inspector contacting the public health department. They then do an infection control inspection. In this case, this guy focused almost entirely on employee safety. In the next episode, too, I'll talk about some of the very unusual things that he cited him for that are very easy to prevent. So in your experience, Dr. Carpenter, once there's an OSHA inspection, I assume there's also risk of the state board getting involved and possibly doing an inspection as well based on violating CDC guidelines. Tell us about that. Unlike OSHA, which actually... It's the OSHA Act of 1970, federal law. They have a cadre of inspectors. CDC has a list of infection control guidelines. They don't actually have inspectors, but the CDC is the gold standard. The CDC is what a state public health department inspector will use as his or her guideline for an inspection. individual will use as their guidelines. And CDC guidelines are what a court of law would hold us to should it go that far. So as we wrap up this podcast, tell us what actually happens after the inspection. So the inspector's done. What are the final words that usually takes place between the inspector and the doctor? Do they even say whether the inspection was a pass or fail? Or do they just say, you know, you'll be hearing from us? They won't even say that there'll be a citation. they'll say there will be a letter sent your way describing any violations we found and a possible citation. Even if they know in their own mind there's going to be a citation, they won't state that. When you open that letter, that's when you find out if it's simply a recommendation or if there's a fine. All right, Dr. Carpenter, very interesting and looking forward to hearing exactly what happened on that inspection in another podcast. Until then, have a great evening. Thank you so much. Thank you, Phil. Thank you for listening. See you in the next episode.