The Impaired Dentist at 7:45 a.m.
At 7:45 a.m. in a Scottsbluff office, hygienist Brooke smells alcohol on the dentist’s breath and notices slurred speech and unsteady hands. The dentist is scheduled to perform a crown preparation and extract a tooth for two patients starting at 8:00 a.m. Brooke has known the dentist for 12 years. The dentist says, “I had a rough night; I’ll be fine.” There is no other dentist on site. Brooke’s own license is current. The office manager says, “Don’t make trouble; he’s the owner.” The first patient is already seated and has been given local anesthetic by the dentist. Brooke is scheduled to begin a prophylaxis on the second patient at 8:30 a.m.
1. What should Brooke do immediately to protect patients?
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Brooke should act on patient safety first. The dentist’s slurred speech, unsteady hands, and alcohol odor create a reasonable concern that the dentist cannot safely perform a crown preparation or extraction. Brooke should not proceed as if nothing is wrong. She should speak directly to the dentist, state her observations, and ask that the procedures be stopped or reassigned. If the dentist refuses, she should escalate to the office manager or another responsible person and remove the second patient from the schedule pending a safe plan.
The fact that the dentist owns the practice does not change the safety obligation. Brooke should not let the second patient receive treatment from the dentist while the concern remains unresolved. She should document her objective observations and the actions taken. If another dentist is available, the patients should be transferred; otherwise, they should be rescheduled with a clear explanation that does not disclose confidential health information about the dentist.
2. Does Brooke have a reporting duty under Nebraska law? To whom, and what should she report?
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Brooke should treat this as a potential mandatory reporting situation. Nebraska’s Uniform Credentialing Act and the credentialing regulations in 172 NAC 10 impose obligations on licensees to report certain violations and impairment-related conduct. A licensee who reasonably believes another licensee is practicing while impaired may need to report to the Department of Health and Human Services licensure unit or the appropriate board. Internal reporting to the office manager is not necessarily enough, especially when the manager is minimizing the concern.
Brooke should report objective facts, not conclusions: the time, the odor of alcohol, slurred speech, unsteady hands, the scheduled procedures, and the steps taken to protect patients. She should not speculate about the dentist’s diagnosis or private life. If she is unsure about the exact reporting form or timing, she should contact the licensure board promptly for guidance and document the contact. Reporting in good faith is protected; delaying to avoid “trouble” is not.
3. What should Brooke document, and what should she avoid writing in the patient record?
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Brooke should document her own observations and actions in a factual, contemporaneous note: “At 7:45 a.m., observed slurred speech, unsteady hands, and alcohol odor; reported concern to dentist and office manager; second patient rescheduled.” She should record the names of persons notified and the time. If she file a report with the board, she should keep a copy of what she submitted.
She should not write the dentist’s suspected diagnosis in the patient’s chart, and she should not record gossip or speculation. The patient record is for the patient’s care. If a patient asks why the appointment is being rescheduled, Brooke should give a brief, neutral explanation and avoid disclosing the dentist’s condition. Any internal incident report should be kept separate from the patient chart according to office policy and legal advice.