Board Complaint After a Scope-of-Practice Allegation
A Missouri dental hygienist with 12 years of experience is named in a board complaint filed by a patient. The patient alleges that during a recall visit, the hygienist 'diagnosed' two cavities, told the patient a crown was needed, and then wrote in the chart 'mesial caries #14; crown recommended.' The hygienist says she only told the patient that the dentist 'would probably want to look at a dark spot' and that the chart note was dictated by the dentist but entered under her login. The board opens an investigation and sends a letter requesting a written response and copies of the chart. The hygienist's employer tells her to ignore the letter because 'the board has no jurisdiction over hygienists, only dentists.' She is also worried that if she responds, she may incriminate herself.
1. Is the employer correct that the board has no jurisdiction over hygienists? Explain the statutory basis for board authority over hygienists.
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No. Missouri's dental practice act licenses dental hygienists and gives the board authority over their licensure and conduct. The board can investigate complaints, and hygienists are subject to discipline for unprofessional conduct, practicing beyond scope, fraud or misrepresentation, and failure to cooperate. The fact that the employer is a dentist does not shield the hygienist. If the chart note was entered under her login, she is responsible for its accuracy even if the dentist dictated it. The employer's advice to ignore the board is risky; ignoring a lawful board inquiry can itself become a separate ground for discipline.
2. Describe the Missouri disciplinary process from complaint to final sanction, including the role of the Administrative Hearing Commission.
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The board receives and investigates the complaint. If it finds cause, it files a complaint with the Administrative Hearing Commission. The AHC conducts a contested-case hearing, receives evidence, and issues findings on whether cause exists. The board then decides the sanction, which may include reprimand, probation, suspension, revocation, fine, or CE. The licensee has the right to counsel, to present evidence, to cross-examine witnesses, and to appeal the final decision to the appropriate circuit court. The AHC does not impose the license sanction itself; it determines the facts and cause. This split matters because the hygienist should prepare for a formal hearing, not just an informal board meeting.
3. What should the hygienist do about the board letter and the chart note? Discuss self-incrimination and record alteration.
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She should not ignore the letter. She should retain counsel, request an extension if needed, and provide a truthful written response. In an administrative case, she may assert constitutional rights, but a blanket refusal to answer can be treated as noncooperation. She should not delete or rewrite the chart. If the note is wrong, she should add a dated addendum explaining who dictated it, who entered it, and what she actually said. The original entry must remain visible. She should explain that the dentist dictated the note but that entering it under her login made it her record; she must not blame the dentist without documentation. Candor and correction are more protective than silence or alteration.