The Impaired Colleague and the Duty to Act
During a busy clinic day, a hygienist, Tara, notices that Dr. Silva smells of alcohol, is slurring words, and has just started a crown prep on a patient under local anesthesia. Tara reports it to the office manager, who says, "He's the owner; there's nothing we can do - just keep an eye on him." Dr. Silva completes the prep and leaves early. The next morning he calls in sick. Tara is unsure whether she has any obligation to report, and the office manager tells her to "stay out of it."
1. Does Tara have a reporting obligation, and to whom? Analyze the duty to report an impaired practitioner.
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Duty to report: Arizona law and Board rules impose reporting obligations on licensees who have knowledge of a practitioner practicing while impaired or incompetent. A hygienist is a licensee; the duty is not limited to dentists or employers. "He's the owner" is not an exception.
To whom: Reports generally go to the Board (and, where applicable, a peer-review or diversion program). The office manager's instruction to "stay out of it" does not override the legal duty.
Timing: The obligation arises when the licensee has knowledge; waiting to see if it happens again is not a defense. The report should be factual: what was observed, when, and the patient safety concern.
Conclusion: Tara likely has a duty to report. She should document her observations contemporaneously and report to the Board, not merely to the office manager.
2. What should have happened in the moment to protect the patient, and what should happen now?
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In the moment: Patient safety comes first. The procedure should have been stopped, the patient stabilized and cared for, and Dr. Silva removed from patient contact. A second dentist or the practice's emergency protocol should have been invoked. Letting an apparently impaired dentist finish a prep is not acceptable.
Now:
- Document the observations and the patient's status.
- Ensure patient follow-up - contact the patient, verify the restoration, and document.
- Report to the Board.
- Do not retaliate against Tara for reporting; retaliation is itself a problem.
Reasoning: The exam tests the priority order: patient safety, then documentation, then reporting. The office manager's "keep an eye on him" is the wrong answer because it defers action while a patient is at risk.
3. What are the consequences for the office manager's instruction and for Dr. Silva if the conduct is confirmed?
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Office manager: Instructing staff to conceal or ignore impairment can expose the practice and the individuals involved to discipline for failure to report or for aiding concealment. Non-licensees may not be subject to Board discipline directly, but the instruction is evidence of a culture problem and may affect the dentist's own case.
Dr. Silva: If confirmed, practicing while impaired is unprofessional conduct and grounds for discipline ranging from reprimand and monitoring to suspension or revocation, often with conditions such as treatment, monitoring, and random testing. The Board may impose interim action to protect the public pending resolution.
Reasoning: The exam wants you to recognize that impairment is both a patient-safety event and a reportable regulatory event, and that "he's the owner" and "stay out of it" are not lawful defenses.