The Dental Spa Owner
A non-dentist businesswoman owns Bright Smile Spa, LLC. She hires Dr. Cole as an "independent contractor," sets all fees, requires him to use a particular dental laboratory, and directs him to perform same-day crowns on every patient who can finance $4,500. She also instructs a front-desk employee to perform "power whitening" using a 35% hydrogen peroxide gel and a curing light. Dr. Cole is paid 40% of collections and has no ownership interest. A patient suffers a chemical burn and a poorly fitting crown. The owner tells Dr. Cole to "handle it quietly" and offers the patient a refund in exchange for a release. Dr. Cole is unsure whether he can be disciplined because the owner, not he, controls the practice.
1. Does the owner's arrangement constitute unlicensed or corporate practice of dentistry? Explain.
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Pennsylvania's Dental Law limits the practice of dentistry to licensed dentists and prohibits unlicensed persons from owning or controlling a dental practice or splitting fees with a dentist. The owner's control over clinical decisions, fees, and laboratory choice, combined with paying Dr. Cole a percentage of collections, suggests fee splitting and corporate control. The front-desk "power whitening" with a high-concentration gel and curing light is likely the unlicensed practice of dentistry; bleaching with a dental curing light and potent peroxide is not a clerical or cosmetic task. The LLC label does not insulate the arrangement. The key question is who exercises professional judgment and who shares in dental fees. If the owner directs treatment or profits from dental services in a prohibited way, the Board may treat it as unlicensed practice or aiding unlicensed practice.
2. What is Dr. Cole's exposure before the Board?
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Dr. Cole can be disciplined even though he does not own the practice. He is the licensed dentist responsible for the care. Allowing a non-dentist to direct treatment, participating in fee splitting, permitting an unlicensed person to perform clinical services, and providing substandard crowns are grounds for discipline. His "independent contractor" status does not transfer professional responsibility. He also may not use a patient release to conceal a reportable event; that could be obstruction or unprofessional conduct. The Board will look at whether he exercised independent professional judgment, whether he documented appropriately, and whether he allowed financial incentives to compromise care.
3. What enforcement tools can the Board use against the owner and Dr. Cole?
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The Board may issue a cease-and-desist order, impose civil penalties, suspend or revoke Dr. Cole's license, restrict practice, require remedial education, and refer the unlicensed practice for criminal prosecution. The Board can also seek injunctive relief. Dr. Cole should separate from the arrangement, ensure patients receive appropriate follow-up, and report the unlicensed activity. Ownership must be restructured so that licensed dentists control clinical care. A refund and release do not cure the statutory violations or erase the Board's authority to investigate. The patient's burn and poor crown also create malpractice exposure independent of the licensing issues.