Valid licenses: How much more important can it get?

Sept. 1, 2010
Do you have employees who are required to have certain licenses and/or certifications? If so, are those licenses and/or certifications current?

For more on this topic, go to www.dentaleconomics.com and search using the following key words: licensure, professional credentials, staff issues, Tim Twigg, Rebecca Crane.

Do you have employees who are required to have certain licenses and/or certifications? If so, are those licenses and/or certifications current? When was the last time you checked?

Recently, a dentist checked the Web site of his local State Board of Dentistry and discovered that his full-time hygienist’s license had not been renewed for two years! His other part-time hygienist’s license had expired in February 2009.

Another dentist had a temp fill in during his hygienist’s three-week vacation. When the full-time hygienist returned, she noticed her license was missing from the wall and a fake one placed in the frame! The practice investigated and found the temp was, in fact, a clinical assistant from another state posing as a hygienist. The doctor had to call back all 73 patients seen by this woman for another visit and exam and explain to them what happened. Thankfully, none of the patients followed up with legal action against him.

Who would have thought of these potential problems? In today’s litigious society and amid the ever-growing problems of identity theft and high unemployment, dentists need to be particularly vigilant. Without documentation, don’t make the mistake of assuming applicants and employees are certified or licensed.

Nothing is more important than maintaining the license to practice dentistry. Likewise, maintaining licensure of the practice’s licensed and certified staff members is critical. For example, registered dental hygienists are licensed to provide care to patients under the direct or indirect supervision of the dentist. And their licenses must be current. There are a myriad of reasons – some intentional, some unintentional – that a license might not be valid, including a name change, incorrect proper legal name, or a change of address. Employers must be careful to ensure that employees do indeed have the necessary credentials to perform as expected. The good news is that most states now have the ability to verify licenses online. Check your dental association, Board of Dental Examiners, or State Health Department for the appropriate Web site.

Practicing without a valid license can be considered a felony and can result in legal proceedings as well as disciplinary actions – not only against the clinical staff member, but also the employing dentist for negligence or failure to safeguard patients. Are you willing to stake your own license and practice on the assumption that the required licenses or certifications are still valid?

While it is the responsibility of the licensee to make sure his or her license/registration is current and valid, be aware that the State Board of Dentistry can hold the doctor accountable for having an unlicensed clinical staff member and apply the same penalties to the doctor as to the offending employee – meaning it could cost the dentist his or her license along with fines and/or other potential legal consequences.

Don’t make the mistake of thinking your liability insurance will cover or protect you. According to a representative for leading dental liability insurance companies: "Board action against a dentist or hygienist is not considered a ‘malpractice’ claim. Consequently, there is typically no coverage for a dentist/hygienist under the Professional Liability Insurance policy – the dentist/hygienist is on their own."

An exception that may provide insurance coverage for a dentist or hygienist is if the Board action results from a patient bringing the action, in which case the insurance company may investigate the action and, with a "Reservation of Rights" letter, pay the patient’s claim if it constitutes neglect of the patient.

If you discover that you are employing an unlicensed hygienist or an expanded duty dental assistant, whether they forgot to renew their license or failed to procure a license initially, he or she should be relieved of duty immediately.

To prevent this from happening to you requires having an effective protocol requiring licensed clinical staff (regular and temporary) to produce their current license and more importantly, verifying their credentials on an annual basis.

Personnel Policy Manual

This protocol begins with an up-to-date Personnel Policy Manual. A comprehensive manual will stipulate that, when applicable, a current and valid license and/or certification is a requirement for continued employment. This policy would also describe the expectations for ongoing confirmation of validation, and that any continuing education required for the maintenance of licensure/certification can be the responsibility of the licensee. Here is an example ...

"Positions within the practice may require licensure or certification. In such cases, maintaining valid and current licensure or certification is a condition of employment and is your responsibility.

For the purposes of recertification, any continuing education requirement must be managed (planned and scheduled) by you. If possible, please arrange to attend courses during hours you are not scheduled to work. Provide at least two weeks’ notice of courses you wish to attend during your regularly scheduled working hours so that arrangements can be made for substitute personnel.

Since licensure or certification is a condition of the job, compensation is not required and will generally not be paid for hours spent traveling or attending continuing-education courses. However, the employer maintains the discretion to make alternative financial arrangements deemed appropriate at the time your courses are taken.

In addition, reimbursement for any expenses incurred (tuition, gas, hotel, etc.) during such continuing-education events are at the employer’s discretion.

Prior to attending a continuing-education event, the Continuing Education for Recertification Agreement must be completed and signed. Upon completion of recertification, please provide us with a copy of the renewed license. The employer assumes no responsibility for employees who become delinquent in the number of units needed for recertification and who, consequently, lose their license. Failure to maintain a required license or certification may lead to termination of employment."

By having a good Personnel Policy Manual in place, you will have, in writing, policies critical to the management of staff and be a guide for the administration of a consistent and fair personnel program. This manual will assure uniformity and fairness throughout the practice and communicate to everyone within the employment relationship the rights and responsibilities of all. A signed "Acknowledgment Notice" should be maintained within each employee’s personnel file. Contact our office for a complimentary copy of Form No. 203.

Well-written job descriptions

A second key aspect of an effective protocol is having well written job descriptions – ones that clearly outline the job requirements, including the need for specific and valid licenses and certifications. These requirements should be clearly stated in each employee’s job description.

A dentist may choose to pay for license renewal or the CE required to maintain an employee’s license or certification, which are a requirement of the job. The dentist also has the prerogative to make the costs (fees, travel, tuition, etc.) for license renewal or the CE required to maintain licensure/certification, which are requirements of the job, the sole responsibility of the employee. Whichever option is chosen, the policy should be in writing and acknowledged by all employees.

Choosing to pay (or not) for license renewal and/or CE does not affect the "at-will" prerogative or create any unique type of liability or contractual relationship. Paying is simply a benefit, typically viewed positively by employees, and can help ensure employees follow through, since someone else is paying! Obviously, whatever choice is made should be applied consistently for all similar employees to avoid the risk of discrimination claims or a violation or breach of covenant of good faith and fair dealing claim.

For the well-being of your practice and patients

In conclusion, for the health and well-being of your practice, as well as the health and well-being of your patients, you should check on the status of the licensure of every one of your employees where a license or certificate is required. You should, as part of the annual performance review, obtain a copy of the hygienist’s or clinical assistant’s license/ certification and verify its validity.

A new team member should never be hired without the dentist first confirming his or her current and valid licensure through the use of a third-party background checking service. Call us for more information.

The dentist should record the expiration date of that license and require the hygienist or clinical assistant to provide a copy of his or her renewal license prior to the expiration date, maintain a signed copy in the employee’s personnel file, and have all required employees’ licenses posted in plain view.

As the leader of the practice, you are the one to determine what is necessary for the safe, efficient, and economic operation of the business. Make an informed decision. "No license – No renewal license – No job!"

Reprinted with the permission of Trojan Professional Services; originally printed March 2010.

Tim Twigg is the president of Bent Ericksen & Associates, and Rebecca Crane is a human resource compliance consultant with Bent Ericksen & Associates. For 30 years, the company has been a leading authority in human resource and personnel issues, helping dentists successfully deal with the ever-changing and complex labor laws. To receive a complimentary copy of the company’s quarterly newsletter or to learn more about its services, call (800) 679-2760 or visit the Web site at www.bentericksen.com.

Special note of acknowledgement: This article was a collaborative effort with the authors and Kathy Asted of Asted Consulting Associates, Andover, Minn.; Donna Rosebush of the DBS Companies, Bay City, Mich; and Flossie Riesner, Riesner Consulting, Lansdale, Penn.

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