Legal Responsibilities: Negligence, Records, Privacy, and Mandatory Reporting
Negligence and malpractice
Four elements must line up: a duty of care owed, breach of the standard of care, causation, and actual damages. The standard is what a reasonably prudent hygienist in similar circumstances would do. Contemporaneous documentation is the strongest defense; altered records invite an allegation of spoliation and can be worse than the original error. Incident reports are internal quality tools, not a substitute for charting.
Records and privacy
Charts must be accurate, legible, timely, signed, and retained for the period the Board requires (commonly seven years, longer for minors). Patients have a right to copies within the statutory time frame. Privacy duties under HIPAA and the CMIA include safeguarding, minimum-necessary disclosure, and breach notification.
Mandatory reporting
- Child abuse or neglect: report by phone immediately or as soon as practicably possible, followed by a written report within 36 hours.
- Elder or dependent adult abuse: report immediately or as soon as practicably possible, with a written report within two working days.
- Malpractice settlements or arbitration awards must be reported to the Board within the statutory period.
Reasonable suspicion is enough; investigation is not the reporter's job. Reporting internally to a supervisor never satisfies the legal duty.
Traps
Thinking proof is required; thinking confidentiality bars the report (it does not); mixing up the 36-hour and two-working-day timelines; charting opinion rather than observed facts.
Worked example: A child presents with injuries inconsistent with the stated history. Call the hotline immediately, file the written report within 36 hours, and chart objective findings, the child's statements verbatim, and the fact and time of the report.