The Dentist's Instruction That Exceeds Delegation
At a Mesa practice, Dr. Ruiz tells Priya, RDH, to administer a local anesthetic block for a restorative appointment. Priya holds a current local anesthesia certificate and has done blocks before. Dr. Ruiz then asks her to also place a temporary filling in a tooth he has already prepared, because he is running late for a meeting. Priya has never placed a temporary filling and is unsure whether Arizona law permits it. The practice's written protocols are silent on both procedures. A dental assistant offers to "sign off" on the temporary filling so Priya can get started.
1. Analyze the local anesthesia request: what must Priya confirm before administering the block?
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Priya must confirm that her local anesthesia certificate is current, that the specific block is within the scope authorized by her certificate and the Board's rules, that the required supervision level is satisfied by Dr. Ruiz's presence or availability as the statute defines it, and that the patient has been appropriately evaluated and consented. A certificate does not authorize every technique in every setting; the Board's rules define which injections are permitted and under what supervision. She should also confirm that emergency equipment and protocols are in place. If any element is missing, she should decline until it is satisfied. The fact that she has done blocks before does not cure a supervision or scope defect.
2. Analyze the temporary filling request and the assistant's offer to "sign off."
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Priya should not place the temporary filling unless Arizona law and the Board's rules clearly authorize it for a hygienist and the required supervision is satisfied. Placing a restoration, even temporary, may fall outside hygienist scope or require a specific delegation that is not established here. The assistant cannot "sign off" because a dental assistant lacks authority to authorize a hygienist's procedure; only the supervising dentist can delegate within legal limits. Priya should ask Dr. Ruiz to confirm in writing the legal basis for the delegation, or decline and let Dr. Ruiz complete the filling. Proceeding on an assistant's assurance would be practicing outside scope and could expose both Priya and the assistant to discipline.
3. What should Priya do if Dr. Ruiz insists and threatens her job?
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She should decline to perform the procedure outside her scope, document the request and her refusal contemporaneously, and preserve any written communications. She should not alter records or perform the procedure under protest. She may seek guidance from the Board, consult counsel, or use the practice's compliance channels. Retaliation for refusing an unlawful delegation may itself raise legal issues, but her immediate obligation is to protect the patient and her license. If she is terminated, the documentation will support any later claim or Board inquiry. She should also consider whether the practice's protocols need updating to prevent recurrence.