Surviving the Unplanned OSHA Visit

As dental professionals, we understand the importance of providing quality care to our patients. But what happens when the spotlight turns to our workplace safety protocols? In this episode, we'll uncover the untold story of a dentist who faced the unexpected challenge of a surprised OSHA inspection of his newly purchased office. And unfortunately, his office was clearly not in compliance with OSHA regulations. From tense moments during the walkthrough with the inspector to dealing with a significant OSHA fine, this young dentist was way over his head. So what is the best way to proceed if something like this happens to you? To help us answer that question and navigate through this kind of nightmare is our guest, Dr. Karson Carpenter. Dr. Carpenter is a dentist and expert in OSHA and infection control compliance. and is founder and president of Compliance Training Partners. 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So we had a previous podcast. We've had several podcasts actually in the past, but the previous one that kind of goes with this is the unfortunate situation of a dentist, young 40s, has a young family, worked in a practice for three years, bought the practice, and shortly thereafter was surprised with an OSHA inspection. And this dentist was informed that the reason for the inspection was because a disgruntled employee reported the office to OSHA. And then, of course, the inspector showed up unannounced and things started going to hell in a handbasket. So brief overview I just gave. Tell us exactly what happened. I'd be glad to because it's a cautionary tale for all of us, either young practitioners who want to buy a practice or experienced practitioners who maybe are even at the end of their career. Basically, this was the most stressful thing he's ever dealt with in his life. Imagine he never owned a business. He bought it. Shortly after he bought it and he was trying to do the right thing, turning it around, he was inspected by OSHA. OSHA at that point, in the beginning anyway, did not care that he just bought it. They didn't care that someone else owned it for 40 years and was not in compliance and that this guy was trying to turn it around. All they cared about was that day that they went in there, it was not in compliance. So this turned out to be stressful and expensive for him. and made him question if he even wanted to be a dentist. He's turned it around. There's a pleasant outcome to the story, but it was a rough road. There are certainly very important lessons learned from this, and we'll get into that as we get further into the podcast. But tell us what happened when the inspector came into the office. The inspector came in, showed their credentials, said they were there to inspect the facility for workplace safety, that they needed to talk to the owner. And of course, this was the receptionist that first met this person, went to the back, got the dentist. They were working on a patient, came up front, and the dentist did invite them in, which really you should do. Now, technically, he could have said, I don't want you in my facility without a warrant. Well, that just creates animosity. they can quickly get a warrant from a judge and be right back in that day or the next day. So to me, there's no use doing that. Better to be prepared. And even if you weren't completely prepared, I still maintain he did the right thing inviting them in. So you're saying that even if the dentist is unprepared, and in this case did not have proper OSHA documentation, which was the first thing the inspector asked for, asking for a warrant to at least buy some time so that the dentist could get prepared. You don't think that's a wise move based on you saying that the inspector could come back in a few hours. You think it's more valuable, obviously, to create a better tone between the dentist and the inspector from the get-go with the hope of possibly getting some more leniency with the inspection. I've typically seen it happen within 24 hours. They consider workplace safety a priority. And when someone won't let them in, they consider that the public may be at risk. Judges consider that a priority. And you know, when you think about it, not a whole lot you can do in 24 hours anyway, which is why the theme of our conversation today is going to be, be prepared. It's not that hard. This could happen to you. Okay, so let's get back to the inspector. The doctor walked from his operatory to the front, met the inspector, said, okay, fine, you're here. What did he do? Like offer him a cup of coffee and say, you want a tour? Or what actually happened? Well, basically he did. He did. He said, I'm going to have my manager give you a tour. I have to finish up a patient. She'll seat you in the kitchen at a table. We'll give you a workspace and we'll sit down and talk. Came back after the tour. And of course, the first thing, and this usually happens in any inspection, let's see your records. And they're going to ask for specific records. In this case, they wanted to see training records. They wanted to see the written OSHA manual that contained the written hazard communication plan, the written exposure control plan, and the written general safety plan. And this particular doctor had none of that? He had none of that. They also asked for safety data sheets. He had a couple from the previous doctor that was there. Maybe he said he had a dozen of them out of... you know, 60, 70 products. So sadly lacking in SDS sheets as well. So at that meeting, when he's sitting in the break room with the inspector and the inspector is asking for this documentation and he's going, no, I don't have it. No, I don't have it. How long was that whole ordeal? How long did that go on? He said that was about a half an hour, 45 minutes. And of course he did try to explain that he had, this was a newly purchased business. that the practice was not in compliance before him, and he was working towards that goal. And how long did he have the practice before that inspection that he owned it? Two months? About two months. Very short time. Right. And after he explained it to the inspector that he just bought the practice and he's in the process of trying to comply, that wasn't acceptable. Apparently, he got an inspector who wasn't particularly empathetic. Well, he said that the inspector was, first of all, very polite. Very professional. But he said, it doesn't matter how long you've owned the business. That's not an excuse. As a business owner, you have to have a business with a proper safety and health plan. And you don't. So when the inspector realized that the office did not have the right documentation, what happened after that? Well, I'll tell you what he did was once he realized there were not many records, he asked them to go around and do some specific things. Number one, he wanted to spend... hour, which he did looking for very specific things like signage, eyewash, spill kits, fire extinguishers, things of that nature, personal protective equipment. He also then spent some time individually interviewing employees, not trying to get this guy, not trying to create problems, but to find out. Do you know where your safety plan is? Do you know where safety data sheets? Have you ever been trained? That's a little unnerving when that happens, when they take an employee in one at a time and talk to them. But that's exactly what happened. A tour, an interview, a request for records, then a closing conference where they describe that we'll see how this goes. You should see something in the mail within 30 days. So they would have to, I assume, ask permission. to interview your employees. If you have a busy practice and you have patients in the waiting room, patients in the operateurs, things are being sterilized and there's movement in the practice. It's amazing to me that an inspector can come in and disrupt all that unannounced. And the practice just lets these employees go in there and sit down with this inspector in the break room while they should be working. How does that happen? I mean, that's crazy. See, Phil, and there is the difference between someone like yourself who practiced a long time, who's experienced. and his owned businesses versus a young guy who does not, it would have been perfectly within his right, or I shouldn't say his right, but it would have been perfectly reasonable to say, Mr. Inspector, the person you want to interview next is my hygienist and the other one is my assistant. We have patients booked. Could we have you come back and do the interview process tomorrow at three o'clock? We'll make sure we block out some time. I find Phil that almost every time, A practitioner is reasonable and requests that. OSHA is willing to do that. They're actually quite reasonable, but this fellow didn't even know to ask that. That's something that we teach in our courses, right? How to deal with an OSHA inspector. What some of your rights are, what some of your requests could be, he didn't know. We'll be right back with Dr. Carpenter 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. Yeah, because I certainly would like to talk to my employees as a team before... individually sit down with this inspector and they are completely surprised off guard. They may say things that they may not even mean just because they're half in shock that they're being talked to by an ocean inspector and they're just not prepared for it. I would much rather gather the troops up and say, listen, we're going to have an inspector come in tomorrow, like you mentioned, at three o'clock. And I just spoke to an expert in this. Maybe they would call someone like you and find out the best way to proceed. And I assume that's part of your training, Dr. Carpenter, in your program, Compliance Training Partners, to prepare the team for an unannounced inspection, specifically what to say and how to handle the whole situation. Of course, the ideal situation is to be prepared with all the documentation and everything else. But there's also a way of dealing with the inspector regarding the situation that happened to this doctor. You're right. That's an important part of it. We teach compliance. But we also teach protocol for dealing with inspectors. Again, I find almost all of them are reasonable. They believe in health and safety. They are upset when they come into a business and see that nobody seems to care. But I find that if you're reasonable to them, respectful of them, you've made an attempt to be in compliance. You don't have to be perfect, but you've made a good attempt. They will cut you a lot of slack. They're really quite fair. In this case, we had a practitioner who was very nice, very polite, very respectful, but very naive and very unprepared. That was the problem. So how were you able to successfully reduce the fine of $21,000 to $5,000? Did you basically say that the violations would be corrected within a certain time frame and that the practice was only owned by this doctor for a short time? And what was your strategy to reduce that fine? In that letter, we talked about the dates of training that were scheduled. We even sent then a summary of the contents of training, which you can imagine were quite extensive. They were sent the invoice showing the new eyewash that was purchased, exit signs, glow-in-the-dark exit signs, because they had several missing exit signs, and they had at least one or two. that were exit signs, but they weren't glow in the dark or battery backup. So again, invoices were shown for that. Again, these inspectors are quite reasonable if you give them a plan. I find that too many times practitioners are aggressive towards these guys. Worse yet, they get an attorney. The attorney can hold everything up, but now you make the inspector angry. You can't really gain a lot by doing that. And it's hard to find an attorney that really understands these OSHA laws. I mean, the law is the law. If it says you have to have an eye wash and you have to test it once a week, no attorney, I don't care who it is, can negotiate anything for you. You have to have it. I've been involved in many inspections, post-inspections, where someone did get an attorney, had spent thousands of dollars, was getting nowhere, and just simple common sense. writing a letter like you're talking about. I'm willing to do this. These are the dates I'm going to do it. Please come back and inspect. I mean, reasonable human behavior can make this go away. Did the citation that the doctor received, which you got a copy of, did that delineate timeframes and say, okay, your fine is $21,000. We'll be back in two weeks and it's going to be another 20,000 if we don't see any changes. Was there anything like that? gave you some timeframe where they expected the office to be in compliance or else there'd be additional fines? Yes. As a matter of fact, they actually had a form in this inspection. It needed to be posted. And there's another thing. It's a bit embarrassing. This citation must be posted by law for all employees to look at, to comment on anonymously. There's a form that includes every violation with then a blank box, date, of abatement. Basically, in this case, they gave him approximately, I think it was 15 business days, 14 or 15 business days to abate these things. Again, that has to be posted for all employees to review. You can't lie about it. You can't fake it. Everybody's reading it. So you can imagine the pressure he was under. As he told me, he said, Carson, he said, I haven't drawn a salary since I bought this practice. And now I just got this fine. You can imagine he wasn't sleeping well at night. It shows you that you have to be very careful. And you have to do your due diligence when you purchase a practice. Now, he did work there for several years. So he should have known that this office was deficient and not up to speed with. OSHA compliance. Here's a really crazy story. I had dinner with a periodontist friend in Austin a week ago, and he's retired now, but he told me about a practice that he bought 35 years ago from an older dentist, a perio practice. That doctor, that periodontist had one employee. So he went into the practice the first week, never working there before. And the one employee was a front desk person, but also assisted chair side. He did a prophy on a patient, took the prophy cup and threw it away. And she looked at him and said, oh, Dr. So-and-so uses that for a whole day. He gets a whole day out of that. And that was the way this doctor was practicing. And he must have had to practice for 25, 30 years before my friend bought it. And I said, how did they sterilize the prophy cups? And he said, they just dropped it in some blue fluid. which was some soapy. The blue killed it, right? Yeah, the blue killed it, yeah. Yeah, you know, it's funny. It's interesting, Phil, but after this story is like the one you're just telling and this inspection that I helped this young doctor with, if I were a young doctor and I were negotiating to buy a practice, I would actually insist that as part of the closing before I become the owner, I mean, I'll be glad to help supervise it, but I want this practice to be in compliance. I want, before my name is on that line, I want that OSHA compliance manual with those written documents, with records of training. I want to see that you have at least a month where you're showing that you've tested the autoclave every week. You stop and think about it. What happened to this young guy shows me that it may not be good enough to get it in compliance, even on week one. Consider getting it when it's still not under your ownership. You know, that's exactly what happens when you buy a house. You have an inspector come in and they look at the entire property and they say, okay, you know, my inspector did this with me in my house in Austin. This deck looks great, but underneath there's rotting wood. You can either have it torn out and replaced by the existing owner or adjust the price, the asking price for the house to you know, make up for the amount of money that you're going to have to put in to replace this deck. And that's the negotiation that should go on for a dental practice. Of course, they do that with equipment. They'll say, you know, I need to replace this x-ray unit or the chair is on its last year. This thing is not worth keeping more than a year. I'm going to have to replace the patient chairs. I'm going to have to replace, I have to update the waiting room. And of course, you know, it comes down to what are you actually buying, which is patients on record is what. the value of the practice at that point might be. But still, there's negotiation to everything. So I don't know whether this doctor in this particular case talked with the owner of the practice and said, listen, you're not compliant. That's one of the things you're deficient. I'm going to have to get there and that's going to cost me. I mean, how much does it cost? A couple of thousand dollars to get compliant with written documentation? You know, when you think of the price of everything we buy in dentistry, it's really cheap to get in compliance. I'm telling you, for a couple thousand dollars, you can do a lot. For a couple thousand dollars, we're talking about online training for everybody, a complete compliance manual that covers everything, eyewash, spill kit, wall guides that you need up. I mean, that's not even if you recovered one ADEC share, I believe the vinyl on there would cost you about $2,500. It's not expensive to get in compliance. And if you assign somebody in the office, a key clinical person, so a trusted hygienist, a trusted assistant, it doesn't take that long. And as you said, let's not even talk about compliance. This is an insurance policy. You need an insurance policy. So in my mind, I'm always going to put that insurance policy before I am fixing up that practice. Yeah, none of this is taught in dental school. The priority, the importance, the significance of being OSHA compliant and purchasing a practice that is OSHA compliant, or you need to get it OSHA compliant before you actually put it in your name, where now you're taking on the responsibility of an OSHA inspection and you have to pay the fines, you need to get it there before you actually put your name on the door as an owner. So that's a priority. It is. Yeah, that's as important or more important than updating the equipment. Of course, the equipment has to work. A sad situation for this dentist who brought upon a tremendous amount of stress into his life, into his family's life. And I'm sure the issue with posting this for the employees to see wasn't particularly great, to have the employees walk by and see that they got a slap on the wrist for not being an OSHA compliant office. What about infection control? What do you do at Compliance Training Partners with Infection Control? Is that part of your services or is it strictly OSHA? No, it really is a major part of our services because when you think about it, bloodborne pathogens is, of course, is one of the major OSHA laws, safety for employees with bloodborne pathogens. That rolls right into infection control, which is really simply safety with bloodborne pathogens for patients. So that's part of the training. And we clearly delineate what part is CDC guidelines for patients, what part is OSHA law for employees. And many of the requirements are the same. Many of them blend together. For a typical example, the PPE that we wear, we all learn so much during COVID that that mask that we wear to protect us, that protects those around us, including the patients. So CDC and OSHA blend harmoniously together. Yeah, and I think that one of the great advantages of owning your own practice is having the ability to determine your future. not to report to anybody the freedom of making your own decisions versus working in a DSO. And for some people, DSOs work out very well also. But for those that want to take control of their life and be a dental entrepreneur and run their own show, there's great advantages to that. But they have to keep in mind that when it comes to OSHA and infection control, it's on them. Well, you know, the one thing I want to say, and I'm really listening to what you just said about owning a business. I guess I'm biased. All the years, I've always owned my own dental practice, owned my own business. In my opinion, it's the only way to really gain wealth. Obviously, if you don't want to own a business, you're really happy working with the DSO. That's great. But if you want to own a dental practice, a dental business, Don't let compliance stop you. Don't let that be the reason you'd work for a DSO. It's not that hard. All you have to do is, quite honestly, work with a company like ours, do some planning, delegate it to a key person. It's not difficult. Don't let that ever stop you from owning your own business. Absolutely. Thank you very much, Dr. Carpenter. We appreciate your input. And it's always good to hear from an expert. You've been doing this for decades. You've handled many, many inspections. It's been a real pleasure learning from you over the years, and we look forward to having you on future webinars and podcasts coming up with Viva Learning. Thank you so much. Thank you, Phil. See you next time. If you're enjoying this podcast, please leave a review or follow us on your Facebook. Thanks so much for listening. See you in the next episode.