By Kathleen Marcus, J.D.
In these times of increased violence and vulnerability, it is critical that dentists play their role as healthcare providers who are obligated both to identify possible abuse of all patients, and also to report suspected abuse of children to the state or local authorities. Always be sure you know the phone number to call to make a report, and the language of your state’s mandatory reporter law.
In every state, healthcare providers are legally and ethically required to report suspected physical abuse of a child. This applies, of course, to dentists who treat a pediatric (under 18) population. The obligation is quite different from an ethical or moral obligation to assist adults who are possibly abused.
Trauma-informed dentistry is a necessary practice for dentists treating the particular population of people who require sedation because of dental fear or previous negative experiences in or out of a dentist’s office. It can be as simple as leaving cards from the local domestic violence shelter in the restrooms or other private place where someone at risk can safely and privately take the information.
Always remember that if abuse is suspected of either an adult or a child, never question the patient about the abuse in front of anyone who might possibly be the abuser. Not only will the patient be unlikely to report honestly, but these discussions can also put the patient in greater danger of retribution from the abuser.
The ADA Council on Ethics, Bylaws and Judicial Affairs has addressed this difficult issue in Advisory Opinion 3.E.1: REPORTING ABUSE AND NEGLECT. Section 3.E of the ADA Principles of Ethics and Code of Professional Conduct ADA Code states:
Dentists shall be obliged to become familiar with the signs of abuse and neglect and to report suspected cases to the proper authorities, consistent with state laws.
The Council also draws the distinction between the dentist’s obligation toward a child and the dentist’s obligation to their adult patients:
Dentists must respect adult patients' rights to self-determination and confidentiality. If a dentist suspects an adult patient has been abused or neglected—but the dentist is not a mandated reporter [of adult abuse] and the patient does not want the dentist to report the suspected mistreatment—the dentist should respect the patient's wishes.
However, the ADA Advisory Opinion issued in 2000 clarifies:
A dentist’s ethical obligation to identify and report the signs of abuse and neglect is, at a minimum, to be consistent with a dentist’s legal obligation in the jurisdiction where the dentist practices. Dentists, therefore, are ethically obliged to identify and report suspected cases of abuse and neglect to the same extent as they are legally obliged to do so in the jurisdiction where they practice.
Failure to report suspected abuse of a child can lead to civil and criminal liability, as well as the worst of outcomes for your patients.
Remember, if you are a DOCS member, you have access to DOCS Regulatory Counsel who also happens to be a trained domestic violence counselor. She can assist you in confirming the specific mandated reporting requirements in your jurisdiction, and to talk through any questions you may have about your legal position in situations when you suspect a patient is being abused.
Author: Kathleen Marcus, J.D., is DOCS Education's Regulatory Counsel. Uniquely qualified to advise and advocate for sedation dentistry, she draws on a healthcare law background that started from her first big court case right out of law school, over three decades ago. A 1988 graduate of Temple University School of Law, she was Research Editor of the Temple Law Review; she previously attended Bennington College, and has a B.A. in Philosophy. Kate is Pennsylvania licensed, with extensive experience in civil and criminal litigation at the state and federal levels. Her specialties include compliance, healthcare law, contract negotiation, contract drafting, commercial litigation, small business, health insurance and regulation, and URAC; she has demonstrated excellence in persuasive writing and editing, public speaking, and compliance (EEOC, HIPAA, HITECH, Title IX).