Delegation at a Rural Satellite Office
Dr. Patel owns a practice in a rural county and opens a satellite office 45 minutes away, staffed by a hygienist and two assistants. She plans to be at the satellite only one morning per week and otherwise available by phone. The hygienist, who has five years of experience, will see patients independently, including taking radiographs, applying fluoride, and doing scaling and root planing on patients with moderate periodontal disease. An assistant will place a temporary filling on a patient with a fractured cusp when Dr. Patel is not on site. A patient asks whether the hygienist can diagnose her gum disease and tell her she needs SRP.
1. Evaluate the supervision level required for the hygienist's planned services at the satellite.
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The hygienist may perform services authorized for dental hygienists, but the level of supervision required depends on the specific service and the dentist's presence or availability under the applicable rules. Prophylaxis and radiographs generally may be performed under general supervision with proper prior authorization and the dentist's availability, while more involved periodontal treatment such as SRP typically requires a higher level of supervision or a documented dentist examination and treatment plan. Dr. Patel cannot simply be "available by phone" if the rules for a given service require her physical presence or a prior exam. She should confirm the required supervision level for each service and ensure the satellite meets it, or restructure the schedule.
2. Can the hygienist tell the patient she has periodontal disease and needs SRP?
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Diagnosis and treatment planning are the dentist's responsibility. The hygienist may perform assessments, chart probing depths, and educate the patient, but she should not render a definitive diagnosis or independently prescribe a treatment plan. The appropriate flow is for the hygienist to document findings and have Dr. Patel examine and confirm the diagnosis and plan before SRP proceeds, consistent with the supervision level that service requires. Telling the patient "you have gum disease and need SRP" as an independent diagnosis oversteps the hygienist's role.
3. Can the assistant place the temporary filling while Dr. Patel is off site?
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Placing a temporary filling is a restorative procedure that generally requires direct supervision-the dentist on the premises and available-and in many cases the procedure is reserved to the dentist or delegated only under strict conditions. With Dr. Patel 45 minutes away, the assistant should not place the temporary filling. The patient should be stabilized with instructions and scheduled when the dentist is present, or referred. Allowing an assistant to perform restorative work without the required supervision is unlicensed practice exposure for the assistant and a supervision violation for Dr. Patel.