gency; he may also have a gun and be intent on robbing Dr. Smith. In order to address this situation, Dr. Smith may prefer to offer to meet the patient at a nearby Emergency Department where the basics of emergency care can be imple mented and follow-up treatment scheduled. .:. Most dentists agree that pa tients who do not have a personal dentist are at higher risk for oral health problems. Many of these individuals are sporadic in their oral hygiene, rarely have their teeth cleaned or their dental status assessed, and often have significant problems before they seek dental care. Dr. Smith will have greater difficulty achieving a satisfactory outcome for this patient. His efforts may be fur ther hampered by the necessity to provide aggressive care for a patient whose health history and whose ability/willingness to be compliant may be problematic. • An individual calls or visits Dr. Smith's office. He is not Dr. Smith's patient. Neither is he a patient of one of Dr. Smith's colleagues. The individual reports that he has a dental emer gency and that, although he does not currently have the time/money/insur ance approval to initiate care, none theless he would like to obtain pain relief and then schedule the actual treatment for a later date. Risk is sues that Dr. Smith should consider include: ·:·This person may be a perfectly in nocent individual, but this scenario is often reported by law enforce ment officials as indicative of drug seeking activity. Scam artists are often "new to town," currently not under the care of a dentist, unwill ing to authorize treatment (other than pain medication), and they promise to return in a day or two to commence the actual treatment. Police and drug enforcement offic ers note that these persons often name a particular drug that "works best" for them and they may be come belligerent and threatening if the doctor offers emergency treat
50 Virginia Dental Journal
ment, but will not write a prescrip tion for a painkiller. .:.Dentists are frequently advised by law enforcement experts to refuse to treat unknown persons without an up-front agreement that treat ment will be initiated before pre scriptions (in very limited amounts) will be given to unknown parties. In general, dentists who implement this type of policy soon discover that the "walk in emergency" or the "late at night" emergency trade has sud denly disappeared. While it is true that dentists do have an obligation to try to provide emergency care for patients, this is an instance in which charity begins at home. Individu als who have the greatest right to a dentist's concern and emergency inter vention, are that doctors own patients. When dentists agree to provide emer gency coverage for each other's pa tients, it would be best if these arrange ments are made within a formal con text so that each participant is laboring under the same set of expectations and promises. Kentucky has been reported as a state that has a high risk for drug-seeking activity from individuals ostensibly try ing to obtain health care services. The prevalence of drug theftand relatedcrime
(especially related to oxycontin) in creases the risk of physical injury to health care workers who have access to high value street drugs. The mere possession of a DEA number and a pre scription pad, dictates that dentists should not allow themselves to be duped because of their ethical concern for pa tients. State or local dental associations and study groups may be able to provide guidance for dentists who want to en sure that patients do indeed have ac cess to after-hours emergency care but who also don't want to be put into the awkward position of having to pro vide care for a person who will not com ply with standard treatment protocols, who may be engaging in unlawful activi ties, and who will either inadvertently or intentionally place the dentist at risk. Cooperative efforts with DEA officials, hospital Emergency Departments, phy sicians who treat drug addicts, and a consistent local approach to the design of after-hours emergency services poli cies will help dentists: a) ensure that legitimate and compliant patients ac cess needed care; b) restrict the emer gency care for some individuals to envi ronments that are safe for the doctor as well as for the patient; and c) make it more difficult for persons with hidden agendas to engage in illegal activity.
2003 VA BOARD OF DENTISTRY The Virginia Board of Dentistry is appointed by the Governor and is composed of seven dentists, two hygienists and one citizen representative. Contact the Board office or a member of the Board on questions on rules and regulations. MEMBERS
Michael J. Link, D.D.S. GaryTaylor, D.D.S. STAFF Nora M. French, D.MD. Sandra K. Reen, Executive Director Darryl Lefcoe, D.D.S. Senita Bookes, Admin. Assistant Gopal S. Pal, D.D.S. Kathy Lackey, Administrative Assistant Harold S. Seigel, D.D.S. Brenda Duncan, Office Services Specialist James D. Watkins, D.D.S. Sheila Lester-Mitchell, Records Manager Trudy Levitin, R.D.H. Cheri Emma-Leigh, Operations Manager Deborah Southall, R.D.H. Robert Winters, Esquire (Citizen Member) Virginia Board of Dentistry
6606 W. Broad Street, #401
Richmond, VA 23230-1717
(804)662-9906 FAX(804)662-7246