Social Media Photos, an Altered Chart, and a Potentially Impaired Dentist
The Board receives a complaint from a former patient of Dr. S. The patient says Dr. S posted before-and-after photographs of her smile on the practice’s public Instagram account with the caption “fixed this disaster.” The patient’s signed form authorized treatment and payment, not marketing. After learning of the complaint, the office manager adds a note to the electronic chart: “Patient gave verbal consent for photos.” The patient also reports that Dr. S smelled of alcohol during a 4 p.m. extraction and that his hands shook while giving an injection. Two staff members tell the investigator that Dr. S has been drinking at lunch since his divorce and has missed two days of work. Dr. S asks the office manager to delete the Instagram post and the original photo files before responding to the Board.
1. What professional-conduct issues arise from the Instagram post and the chart note?
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The post raises privacy and consent issues. A treatment consent is not the same as authorization to use identifiable photographs for marketing. The practice needs a valid authorization that explains the use, and the patient must be able to revoke it. The caption “fixed this disaster” is also demeaning and unprofessional, even if the image were otherwise permissible. The chart note is more serious: adding “verbal consent” after the complaint, if untrue, creates a false record. A dentist is responsible for the office’s recordkeeping and cannot let staff manufacture consent to defend a complaint. The Board may view an inaccurate record as unprofessional conduct and as an aggravating factor because it impairs the investigation. The original chart entry, metadata, and the patient’s actual authorization should be preserved. The dentist should not characterize the note as a clarification unless there is independent evidence that the conversation occurred.
2. How should Dr. S respond to the Board’s request for records and information, including the request to delete the post and photos?
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He should preserve evidence, not destroy it. Removing a public post to limit further disclosure may be reasonable, but he should first save a copy of the post, its metadata, and the original images, and document when and why it was removed. Deleting the original files after notice of a complaint can look like spoliation. He should provide the Board with the complete chart, including the original and any later entries, and explain who made each entry and when. He should not alter the chart further. He should respond to the subpoena or request through counsel if he wishes, but he cannot refuse to produce required records or direct staff to give false statements. He should identify the patient’s authorization documents and the practice’s social-media policy. A truthful explanation that the consent note was added after the complaint is better than a cover-up; the Board will compare metadata and staff interviews.
3. What should Dr. S do about the reported alcohol use and tremors, and how does that affect patient safety and Board disposition?
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Dr. S should not practice while impaired or while his ability to provide safe care is in doubt. He should arrange coverage, seek a confidential health evaluation, and follow any treatment or monitoring recommendations. Many licensing boards have a health-professional program that allows self-referral; the availability and protections depend on Oklahoma law and Board rules, so he should ask the Board or counsel rather than assume. He should not ask staff to lie about his condition or attribute the tremors to something else without evaluation. The Board will consider patient safety first: the 4 p.m. extraction and injection are specific safety concerns, not private matters. A prompt self-report, compliance with treatment, and a monitored return-to-work plan are mitigating. Denial, continued practice, or retaliation against staff who reported is aggravating. The Board may impose practice restrictions, evaluation, or monitoring even if no patient was injured.