Standards of care, supervision, and delegation to auxiliaries
Standards of care, supervision, and delegation to auxiliaries
This domain tests the chain of responsibility: the dentist owns the outcome of every service delivered in the office, and delegation is lawful only when the task, the licensee, the training, and the supervision level all line up at the same time.
The dentist's non-delegable core
Diagnosis, treatment planning, prognosis, prescribing, surgical procedures, and the final judgment about a patient's condition stay with the dentist. The dentist must personally examine the patient where the rules require an examination as the basis for treatment, and must be available at the level of supervision the rule demands. Responsibility itself cannot be delegated.
The delegation test
Ask four questions in order: (1) Is the task on the list the rule permits for that auxiliary? (2) Does the auxiliary hold the license or permit required for it? (3) Has the auxiliary completed the Board-required training or certification? (4) Is the required supervision level in place for this patient today? Three yeses out of four is still a violation.
Supervision in practice
Direct supervision generally means the dentist is physically present in the office and has examined the patient. Indirect supervision means the dentist is on the premises and available but not necessarily in the operatory. General supervision means the dentist has authorized the service but is not on the premises, and it applies only where the rules say it does. The most tested errors are assuming general supervision covers hygiene services in private practice, or assuming a dentist somewhere in the building satisfies a rule that calls for direct supervision. Public-health and institutional settings are where general supervision most often appears.
Documenting delegation
Records must show who performed each service and under whose supervision, plus evidence that the auxiliary's training is current. If the chart does not identify the supervising dentist and the procedure, the Board and a plaintiff's expert will treat the delegation as unsupported.
Worked example
An expanded-duty assistant is asked to administer local anesthesia so the schedule stays on time. Local anesthesia is not an assistant function in Georgia; it is limited to dentists and to hygienists who hold the applicable Board permit after the required training. The correct response is that the task cannot be delegated at any supervision level, and performing it would be unlicensed practice as well as a delegation violation for the dentist.
Traps
- Treating "expanded duty" as unlimited scope.
- Assuming a dentist in the building satisfies a rule requiring prior examination by the dentist.
- Delegating to unlicensed staff "just this once."
- Failing to keep documentation of auxiliary training and supervision.