05/01/2012

Understand legal issues when using CBCT scans

by Stuart J. Oberman, USA

Dentists are legally and ethically obligated to do no harm to their patients. Improper diagnosis after using a CBCT (cone-beam computed tomography) does not align with this standard because delay of diagnosis leads to delay of treatment. This is not in the best interest of the patient because it can lead to an inferior prognosis. Also, not every patient requires a CBCT scan; therefore, it is the dentist’s responsibility to determine whether a CBCT scan is necessary by using reasonable, careful judgment in light of the patient’s medical and dental history and thorough examination. The dentist should do a cost-benefit analysis before requesting a CBCT scan. When doing so, the dentist should consider whether the likely benefit to the patient exceeds the ionizing radiation risk and the financial cost.

Dentists’ scope of legal responsibility to diagnose

When using CBCT, as with other diagnostic tools, the dentist’s responsibility is not limited to the area of interest being diagnosed or treated. The treating dentist is legally responsible for diagnosing any disease that falls within the scope of the dentist’s license, which is normally broad in scope, encompassing all diseases and lesions of the jaw and related structures. As for a dentist’s responsibility for diagnosing a disease that falls outside the scope of the dentist’s license, the answer is not clear. Thus, it is always a good idea to be cautious and assume the responsibility to recognize any abnormality that appears anywhere on the CBCT scan. If ... ART 1 ... dentist is unsure of ...ART 2... scan results, he or she should consult with ...ART 3... specialists in the field or refer ...ART 4... patient to ...ART 5... specialist.

Patient Confidentiality and Recordkeeping

Privacy is a patient right. Dentists have an ethical and legal responsibility to safeguard patient information. Patient information includes such information as personal data, medical history, diagnosis, treatment, and financial situation.

Patient information should be shared only on a need-to-know basis with those who participate in the care of the patient. ....CONECTIVO... disclosure is required or permitted by law, patient information should not be shared with anyone without the patient's written permission. Court orders, subpoenas and investigations by the Office of Professional Discipline are examples of disclosures that may be required even in the absence of the patient's consent.

Health professionals are required to maintain records for each patient that accurately reflect the evaluation and treatment of the patient according to section 29.2(a)(3) of the Rules of the Board of Regents. All patient records must be retained for at least six years, with the exception of records for minor patients, which must be maintained for at least six years and for one year after the minor patient reaches the age of 21.

(Adapted from NY State Education Department − Office of the Professions: http://www.op.nysed.gov/prof/dent/ dentpracticeguide.htm)