From Complaints to Compliance: Mastering OSHA Inspections

But if you're not prepared, you're very vulnerable. And in this case, this particular citation was over $10,000 with six serious violations. But to me, more than the $10,000, it's the fact that now you're on OSHA's radar. You've got to correct all these violations. It may involve some downtime in the practice. And we all know every hour you close a practice, that's where the real expense comes in. Welcome to the Phil Klein Dental Podcast. Beyond keeping your patients safe, a solid infection control protocol is critical to protecting your practice. In today's episode, we'll discuss how to navigate complaints to OSHA by a disgruntled employee. We'll cover how to respond to an OSHA inspection with confidence and why highlighting your infection control compliance program to new hires can be a game changer for employee retention. Plus, we'll break down what a typical OSHA inspector is really looking for when they visit your practice and how likely an inspection really is. So hopefully by the end of this episode, we'll equip you with more information and more knowledge so that you can stay compliant, prepared, and proactive. Joining us today is Dr. Karson Carpenter, a dentist and CEO and founder of Compliance Training Partners. Dr. Carpenter is a regular contributor on VivaLearning.com. We'll be getting to our guest in a second, but first... Thanks to GC America, we're now able to incorporate all the advantages of glass ionomer into a beautifully aesthetic, strong, long-lasting restoration. That's a great reason to try GC Fuji Automix LC. You'll love the convenient automix delivery system and ergonomic dispenser. which allows precise placement into the preparation. And GC Fuji Automix LC is bioactive, allowing for a high rechargeable fluoride release, which is ideal for high caries risk patients. And because it forms a chemical bond to tooth structure, even in the presence of saliva, there's no need for etchant and adhesive bonding. This saves steps and is ideal for challenging patients where access and isolation are difficult. And the small filler particles in the material allow for superb polishability and excellent aesthetics. So when you're thinking glass ionomer for your clinical cases, think GC America, a world leader in dental materials. To learn more, visit gc.dental. Dr. Carpenter, pleasure to have you back on the show. Phil, thanks for having me back. We've talked about these issues where dental offices are reported to regulatory organizations, such as the Board of Dentistry or OSHA and so forth. And it seems like a lot of this reporting is kind of vindictive. And it's usually coming from a disgruntled employee. Tell us about your experience in... compliance training partners, which deals with a lot of these kinds of unfortunate incidents that occur when someone complains about a practice and states information that only would be available to those working in the practice. How prevalent is that, that a disgruntled employee reports an office for a violation of CDC guidelines? Well, I'll tell you, Phil, that that's absolutely... how inspections incur today. Inspections occur because of a disgruntled employee. I see it all the time. Small practices, large practices, DSOs, practices in major cities, practices in rural areas, rural Alaska, one that we were involved with. It's all about disgruntled employees. Employees today pretty much know they need to receive OSHA training. They know that there needs to be a compliance manual. And when they don't have the things that are required, you're very vulnerable. I'm going to say that every inspection I've been involved with in the last year has been from a disgruntled employee. That's what triggered it. So when it comes to the training of the office with all the other things involved with CDC guidelines, infection control, OSHA, et cetera, I think it's important to include the vulnerability, not only from the standpoint of the health and welfare of the patient and the employee, but also the vulnerability of the practice through a disgruntled employee reporting them. And by the way, even though they're called guidelines, CDC guidelines, they are enforceable as if they were laws because the office can be fined. And of course, it can be worse than that. It's not optional. In fact, today, maybe a little later, I'd love to talk with you about a recent OSHA inspection. Of course, we talked about in a previous podcast, a CDC problem. But I had very recently an OSHA inspection of a practice that resulted in a number of serious violations. Six serious violations. And again, this was triggered by a disgruntled employee. What I find, the word I use is weaponized. Employees increasingly use your lack of compliance as a way to gain retribution against you. And that's why we've got to be in compliance. You're right. It's not optional. We don't have a choice. We have a business to protect. This one situation, this one case that we talked about offline where OSHA got involved and the practice was not in compliance. It was reported to them by a disgruntled employee. How did you find out about it? And how has this all played out since then? First of all, this practice, apparently an employee. They contacted the Occupational Safety and Health Administration as part of the U.S. Department of Labor. They contacted them saying that it was an unsafe workplace. They were able to do so anonymously. Of course, OSHA knew who the person was, but they would never divulge that to the practice owner. At that point, some weeks later, the practice received a letter. It looks a bit scary, right? Citation, notification of penalty. occupational safety, health, and administration. You need to be able to defend yourself. And to defend yourself, you need to have, really, it's very simple, but you need to have certain basic items, certain written documents, certain training, certain safety items. Not hard to defend against, but if you're not prepared, you're very vulnerable. And in this case, this particular citation was over $10,000 with six serious violations. But to me, more than the $10,000, it's the fact that now you're on OSHA's radar. You've got to correct all these violations. It may involve some downtime in the practice. And we all know every hour you close the practice, that's where the real expense comes in. So in the letter from OSHA, there were six itemized violations detailed exactly what the violations were. They were detailed in the letter. How did they know exactly what was happening at that level so that they can put that in the letter and send it to the office? Well, in this case, The employee accurately laid out where the problems were, and an inspector actually came out. So first a letter alleging this, second an inspector came out, and certainly, unfortunately, the employee was right. The violations were there. I'll give you an example. The first one, very easy to have been in compliance, but... particular violation said there were no required safety data sheets. They literally had no safety data sheets. If an employee alleged you didn't have data sheets and you had them, it goes away. Instead, that resulted in a serious fine. The next thing that they asked for was training records. The employee clearly knew they'd never been trained. They could produce no training records. So you can see the violations that they have here. They're not difficult to abate, but why not do it ahead of time? Why not prevent that employee from getting a leg up on you and being able to do this? When a letter like that comes in and you want to prove that you do have it, what do you send back? Do you send a letter saying that I have this and you list it out or do you copy your document or do you print your digital document and send it out or you send your digital file? How is that information substantiated and validated that you do have all this to the authority? Normally, OSHA will request that you respond in a written form. Email is preferred. And what you want to do is line item by line item address the alleged violations with, of course, written response, but also photographs. copies of documents. I always say it's the government. They love paper. Give them a lot of paper. We like to send pictures of eyewash, safety data sheets, training manuals, training records. So if you can produce the items that they say it's been alleged that you do not have, they probably won't even visit your office. But we can't lie. Because I'll tell you, there's a spot in this particular citation. In fact, I have it here in front of me, Phil. And here's what it says. The law requires that a copy of this citation and penalty be posted in a prominent place at or near the location of violations where all employees can see. So we've got to be very honest. If we don't have a manual, we can't say we do. If we didn't have training, we can't say that we did. So that's why I implore all of you, all of my colleagues out there to do this ahead of time. Do it before you get a letter like this. So they want you to post a sign stating that you're deficient in that area, in the area, in the office where the deficiency exists. And that's for the employees to see. Now the patients won't have access to see that or they might? They would not. It could be in an employee only area, but you can imagine. That creates a lot of talk over coffee or over the water cooler in the morning among employees. And in fact, it can create a hornet's nest, which is, again, why I don't want to see it get to this point for anybody. There's no question in my mind, Dr. Carpenter, most dentists are very, very focused on infection control. They don't want their employees or their patients to get sick, and they try to comply as closely as possible. with CDC guidelines, and so forth. But I think it's important during the onboarding process of a new employee to make that really clear, because number one, it gives the employee confidence that he or she is working in the right place, with the right culture, and it's safe, and so forth. And I think it's less likely in the long run that that employee will weaponize a small breach in CDC guideline protocol, whatever, in infection control. against the practice. Do you agree with that, Dr. Carpenter? And are you seeing dentists emphasize it enough when they hire a new person, how important infection control and prevention is to their practice? You know, that's a great question, Phil, because, and again, that's what I like about this podcast. We're talking to our colleagues. I can kind of let my hair down and tell you just exactly what I do. If we're doing training to your whole office and staff, We're certainly not going to talk about, well, you know, it's your right as a disgruntled employee to call OSHA anonymously. We want to make everybody feel good. And on day one, you're the new employee in the office. I want you, besides fulfilling the requirement I have to provide training as part of onboarding, I want you to think, wow, this is the safest, most compliant office I've ever been. What a great office. They don't have any weaknesses. I want you to build this insurmountable barrier where they would never think of calling OSHA or the Department of Public Health on you. And to me, that would start with, first of all, I'd like you to watch this training session, this online training session. At the end of it, you'll be taking a post-test, printing a certificate of completion. We need a copy of that on our desk by next week. Secondly, we have... compliance manual here with all the written documents in. I'd like you to look through it. Sally here is in charge of OSHA. After you look through this manual, I want you to ask her any questions you have because we want you to be safe here at XYZ Dental Center. Right away, I fulfilled my obligation, but I've also sent a message. This isn't the office to mess with if you want to call OSHA, if you want to... to sue me for an unsafe workplace. So send that message on day one as part of onboarding. Training, written documents, ask any questions you have. And that employee will fall right into line. And again, with the shortage of workforce that's going on right now in the dental space, there's a shortage of assistants, there's a shortage of hygienists. You want to keep the people that you have, especially the good people, and having a really tight... infection control and prevention program is part of that, a big part of it. You know, that is a great point, Phil, and that's something I talk about all the time. That's why any anger you have towards compliance, towards this over-regulation we have, you might as well just get over it. We want to own a business. We want to be successful. By doing the type of onboarding we're talking about, employees not only see us as someone who they wouldn't attack legally. but they see us as a safe place to work. In other words, compliance is a powerful HR tool. And I've learned that from particularly, let's face it, we have a lot of young women, childbearing age, out there in the dental profession. And let me tell you, these ladies really, really appreciate a safe office, an office that does infection control training, that does OSHA training. that provides quality PPE. This means a lot to keeping those hard to find dental auxiliaries that you're describing that nobody can find. We think it's a wonderful HR tool, an understated HR tool to use compliance. And that's why we want to sell them on what we're doing. We want to promote it on day one. This is a safe place to be because, you know, dentistry actually is a very safe place to be. We all saw those headlines. Number one, most dangerous occupation during COVID. That all proved to be untrue. Dentistry is a safe place to be. We'll be getting back to our guest in a second. But first, are you looking for an air-driven handpiece that rivals the power and torque of electric? Well, I have good news. It's finally here. It's called the TMAC-Z and it's from NSK, a company we all know and trust as a world leader in dental handpieces. In addition to being lightweight and ergonomic, this revolutionary air-driven handpiece delivers unprecedented 44 watts of power, allowing it to cut through tough zirconia smoothly and quickly. In fact, the TMAC-Z reduces overall cutting time by 30%. That means less chair time, reducing the burden on you and your patient. Take a test drive of the TMAC-Z air-driven handpiece from NSK. For a free 10-day trial, go to nskdental.com and find your local rep to inquire. Experience the power and excitement of the TMAX Z series. I want to ask this question just because I'm curious. Have you found in your experience working at Compliance Training Partners with a lot of different dental practices, do you see a difference, generally speaking, in... compliance when you compare a small practice to a larger group practice where the dental team is much larger. There's multiple hygienists, assistants, staff members, front desk, lots of chairs. Do you see any noticeable difference when you contrast one to the other? You know, you would think, Phil, that the smaller practices might be less likely to be in compliance, but I have found it's all over the board. I find small one-doctor practices that are incredibly compliant in every way. I've worked with fairly large DSOs, multi-site facilities, maybe some names you might even know, that weren't doing a good job at all. So I find that compliance doesn't seem to be related to the size of the practice at all. That being said, one thing I like about teaching compliance is I've had so many doctors come up to me and say, you know what? I think I can do this. I've been tempted to work for somebody else because I just didn't think I could deal with compliance. If you're a small business owner, a one, two doctor practice, you can do this. You don't need to work for a DSO or sell your practice if you want to have your own business. Compliance isn't that hard. You just have to check the boxes. So tell us what the absolute essentials are for a dental practice to have in place where if they were inspected, they could provide all this, information to the inspector and then the inspector say, wow, you're doing a great job. Thank you very much. Have a great day. And never hear from them until the next inspection. Hopefully they won't have another one. What are those critical components that a practice absolutely must have to be compliant? You know, Phil, I'm going to give you the key things that I see, the key violations that I see that you could easily avoid. But let me just preface that by saying, Every now and then you'll see an inspection where they look at something you just wouldn't think they'd look at, like exit signs or your eye wash, or do you have a spill kit? One thing I would really encourage you to do, go to the ComplianceTrainingPartners.com website, download the OSHA audit app, download the infection control audit app. That way you'll get a real thorough coverage of all points of compliance. But in terms of what are the main things you need to do? First of all, OSHA looks for, when they come in, written documents. Do you have a OSHA manual with a written hazard communication plan for chemical safety, a written exposure control plan for bloodborne pathogens? Do you have records of training that you're showing you're training all your people every year? And do you have safety data sheets? Those are the big four when it comes to records. do an inspection, do a walk around. They're looking for pretty basic things like, is the OSHA poster up? Do you have an eyewash? Are people wearing protective equipment, particularly safety glasses with side shields, long sleeve clothing, masks? That is 80% of it right there. Is the actual inspection somewhat subjective, even though they're all focused on OSHA compliance? Is it typical for one inspector to focus on one specific thing where another inspector would come in and look for something completely different? I mean, is there some subjectivity to this? You know, it is subjective. Here's what I find. In general, if you ask me what is the one thing that it seems that every OSHA inspector looks at, it's violations of bloodborne pathogen standards. That being said, often when they come in, if there's been a specific complaint by a disgruntled employee, they focus on that. for example a recent inspection i was involved with the employee was upset because they had no safety data sheets for products in the office now they came from an office that they'd worked at before where they knew they had a log of all the safety data sheets for every product in the office so this inspector as you would expect focused almost entirely on hazard communication chemical safety safety data sheets labeling Whereas other inspectors will come in and they'll focus on everything. But it is dependent on the inspector. They have a lot of latitude to focus on the areas they would like. So what's the typical flow, Dr. Carpenter, when a disgruntled employee contacts OSHA, for instance, and reports a violation? What typically happens after that? Well, here's the flow that I normally see. Step one. Well, unknown to us, an employee files a complaint. We receive a letter from OSHA stating the following has been alleged. Number one, number two, number three. Please respond within 10 business days. Basically, they're saying we're giving you a chance to defend yourself. Maybe this is untrue. If you can't produce those documents or the items or proof that they request. They will then schedule an inspection. In fact, even if you send them things, they will tell you right in this letter, we may decide to do an inspection. I find is if you can give them good solid proof in the form of copies, photographs, et cetera, proof of training, they probably won't come out. It'll go away. In this case, the case that I was talking about, they couldn't produce those things. They couldn't lie in front of the employees because they had to post a citation where everybody could see it. OSHA said, you don't have these things. Maybe these allegations are true. We're going to come out. At that point, they came out. They inspected. They found the six serious violations. So the posting of the violations in the area where the employees are, that's something that you have to do, correct? You must, by law. And does an inspector come out to check to see if that's posted? That's the question they'll ask employees. They'll interview employees individually. or as a group, wanting to know if they were aware that this office was going to be inspected, that there was alleged violations and was this posted. So I always tell people, don't try to lie about this. Better to tell an uncomfortable truth than to try to lie because they will find out. Unless you're the only employee in the practice, and you're probably not. Yeah, no, of course, you have to do it. I was just wondering whether it was followed up with an inspection for them to see the posting. of the violations. And then how long does that sign have to stay up in the area for the employees to look at? I assume once the violations are mitigated and corrected, you can take the sign down. How long does that have to stay up there? Exactly. You're right. They allow you to take that down when those violations have been abated. You have to get a sign off on that. You do. And again, I find that if you seem to be a reasonable person, You can show historical records. I mean, it's one thing if they're saying there's been no training and you send them a document showing, well, training occurred last week, as opposed to if you're in an office that can show them three, four, five years of training records, documents from several years, copies of your OSHA manual that show different dates. They can pretty quickly tell. if you're just getting in compliance today or yesterday versus if you're a long-term player. And the long-term players, the people who are trying to do it right, they normally don't even come out to visit. They have their hands full because there are so many disgruntled employees filing anonymous complaints. They hardly have time to do any what are called programmed inspections anymore. In other words, just going out and doing a random inspection, almost never done anymore, at least not in healthcare. Oh, is that right? A dentist shouldn't be concerned about an unannounced inspection at this point. So unlikely, so unlikely because OSHA has its hands full. Yeah, no, I would assume that. So in the event that a dentist gets involved with this and gets wrapped up and entangled in some sort of incident where they have to deal with OSHA and they have to prove that they're compliant now, they may have been deficient on a few things, but it's been corrected. Should they bring somebody like you in? to the communication and saying, you know, we've hired a training company for years that provides us with these things. Does that help the dentist to have someone like you involved with the communication? I'll tell you what really helps. OSHA really wants to talk to the employer, to the owner. What works really well and has proven itself over 25 years of helping doctors who've been inspected is if you're coaching behind the scenes, if you're helping to write that letter, if you're giving advice on what photographs to take and show them, what things not to show, what things to say. That's the way that it works most effectively. OSHA wants to talk to the business owner. They don't want to talk to a hired gun. Okay, but it's good to get advice from someone like you, I would assume. Absolutely. And again, not because we're so smart, Phil, but we've been through so many of these. We've been involved in inspections in almost all 50 states and also in territories like U.S. Virgin Islands, Puerto Rico. And we kind of know what these inspectors are looking for, what type of responses seem to work. And obviously things that you don't want to say as well. So we talked about in a previous episode, a dentist who purchased a practice, was excited to get started, jumped in full force. The office that they purchased was very, very negligent on their protocols for CDC guidelines. And they kind of inherited all this. What do you say to those people that are... involved with a purchase of a practice from an old timer or somebody who just didn't take it seriously. They don't have any records as such that we talked about. What do you recommend to that person? They want to get in and start working. And the situation is, as I described. That's a great question. I'm glad you asked that. I'm glad you remembered that because we did talk at length about that doctor, didn't we? A great young guy bought this practice, but talk about bad luck. Here's what I learned from that. I really learned a lot from that one too. If I'm a young doctor, and in this case, he had been an associate in this practice. He knew this practice was non -compliant. He absolutely knew it. And his intention was to immediately after he purchased it, get it turned around. Well, you know how sometimes when you buy a business, there's maybe a little disharmony for a while. All of a sudden, it's a new doctor, some new policies, different personalities. It's really a very vulnerable time for the owner, right? Because a couple of employees were unhappy with some of his new policies. If I had any advice to give to that doctor or a young doctor, again, it would be this. Before you buy that practice, you need to get that practice in compliance before it's in your name. I want to see that be in compliance on day one. It's not that expensive to do. But to me, you're very vulnerable. And what a shame. This poor kid came in. to a practice that was totally non-compliant, that never had a problem. And within the first month, he was inspected. He paid for all the older doctors since. And the other thing I want to mention is to me, if a practice is compliant, and this is encouraging our listeners here to get in compliance, think how much more your practice is worth. A practice that is compliant is worth considerably more than one that's not. I mean, wouldn't you want to buy a practice where you say we follow all CDC guidelines? We're in full compliance with OSHA. Everybody's trained. Here's the training records. That practice has a value of maybe, Phil, maybe it could be 5%, 10%. It's a valuable thing. As we wrap up this podcast, Dr. Carpenter, what is your recommendation for updating all the documentation that you talked about today? And I assume the safety data sheets are updated as the new products and materials come in. They're dropped into a binder or they're scanned or whatever. major documents, how often do they need to be updated? I would say that for the most part, an update needs to be done about every five years. I wouldn't let your OSHA compliance manual go more than five years just because subtle changes that occur in the law. Not only that, I'll give you an example of our manual, our manual from my particular company. Many of the exchanges we make each year are based on inspections we've been involved with. We see trends. We see things that OSHA is looking for. We see, I guess, different interpretations of the law. And so a manual needs to reflect that. I would say roughly every five years. But one of the key things that will keep you out of trouble, the key thing, is making sure you do an annual training. for all employees. And the other nice thing about that is if there is exchange in the law, if there is an update, that's going to be featured in the training. So the way to keep yourself out of trouble, have a manual that's complete, that's less than five years old and annual training for all staff. And that will create a very safe and compliant workplace and keep you out of trouble. Yeah. And these manuals can be purchased like a template where you can just fill in the details for your practice. Yes, the program from Compliance Training Partners is available both in a written template, a complete manual where you would literally fill in the blanks with the names of your people, the names of your practice. It's also available in an electronic form. In fact, that's one that we call our comply. And, you know, even if you're not a client, I would really encourage you to download. at our website, the audit app, because there you'll find maybe you're completely in compliance already, but you need to go through this checklist and see where you're in compliance, where you're not in your areas of vulnerability. See if you can't mitigate those in a hurry. Dr. Carpenter, thanks so much for your regular feedback on this show. Invaluable stuff based on your experience you have related to OSHA and CDC. Thank you so much. We'll talk to you soon. You're welcome, Phil. See you next time.