Alcohol, Substance Use and the Dental Team

TDIC’s Risk Management Advice Line occasionally takes calls from dentists who have concerns about signs of substance abuse in employees. The analysts remind dentists to help support high standards of behavior by clearly defining office policies and professional boundaries.

Within the dental practice

Your practice needs the entire team to be sharp and focused for the schedule to run smoothly. The impact of an employee’s substance abuse on a practice extends beyond impaired performance and productivity. Substance abuse leads to higher rates of absenteeism, workplace accidents and patient injuries — all of which impede safety and increase practice liability.

Since every situation is unique, it is best to exercise an abundance of caution when dealing with employees who appear to be intoxicated or under the influence. TDIC’s Risk Management team advises dentists to contact their human resources specialists or an employment attorney for counsel specific to their situations. Having a drug-free workplace policy detailed in your employee manual is also recommended.

In addition to a documented policy, both the practice owner and the individual who performs human resources duties should be trained in handling these types of sensitive situations. The U.S. Office of Personnel Management (OPM) publishes the guide Alcoholism in the Workplace: A Handbook for Supervisors, which can be a helpful training tool.

The impact of an employee’s substance abuse on a practice extends beyond impaired performance and productivity.

In a case reported to TDIC, a dental assistant presented to work on more than one occasion smelling of alcohol. Her performance and interactions with colleagues and patients were declining, and she was using language and a tone inappropriate for the workplace. During a verbal altercation with another staff member, the employee became highly

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emotional and erratic. The dentist had to stop patient care and intervene to address the unacceptable behavior.

The employee shared with the dentist some personal issues and admitted to having an occasional drink to help her cope with the crisis she was dealing with at home. The dentist sent the employee home, with pay, for the remainder of the day, allowing her time to take care of personal issues. The next day, the employee returned to work, with the same attitude, being rude to staff and patients. The situation escalated as the employee continued to demonstrate unprofessional behavior, absenteeism and declining performance over the next few months, making it difficult for others to work with her. To make matters worse, the office did not have a drug and alcohol policy in place. Not knowing how to handle the situation, the dentist contacted TDIC for guidance.

If an employee in your practice exhibits unusual behavior, document your observation in an objective manner and note only the observable facts in the employee’s file. Making a diagnosis or accusation can heighten an already stressful situation and open the practice up to liability. Rather, express concern for patient and coworker safety and state the facts in a manner such as “I am concerned. I have observed you slurring your speech.” As there are situations in which an employee behaves erratically due to a prescription medication or a health issue, addressing the underlying behavior and workplace safety is prudent.

If your drug policy includes fitness for duty testing, and the employee refuses to comply, the employee’s refusal may lead to a finding that they are being insubordinate. But regardless of an employee’s willingness to comply with the testing, you should help provide them with a safe ride home. Document the interaction and its outcome in the employee’s file, along with the employee’s behaviors that led to the reasonable suspicion and all actions and outcomes that follow.

Outside the dental practice

Often, employers and employees mistakenly believe events and activities that take place outside of the place of employment absolve them of the rules that exist in the workplace. This is not the case. Once an employer invites most or all employees to a hosted social event or party, that event is considered an employment function. The same standard applies to off-site training or conferences that an employer pays for employees to attend.

If an employee in your practice exhibits unusual behavior, document your observation in an objective manner and note only the observable facts in the employee’s file.

Risk Management analysts remind practice owners that standard harassment, antidiscrimination and workers’ compensation factors apply at company-sponsored events. Employers can and have been held liable for their employees’ behavior regardless of when or where it occurred. Celebrating off-site or after hours does not negate the responsibilities of an employer and poses risks. For example, if an employee drives under

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the influence and causes an accident, the employer can also be held liable.

Risk Management analysts remind practice owners that standard harassment, antidiscrimination and workers’ compensation factors apply at companysponsored events.

Another consideration is maintaining the professional reputation of the practice. In one call received by the Advice Line, a practice leader

In this situation, the TDIC analyst recommended having an honest, transparent conversation with the employees right away. The practice leader should clearly identify what behavior is expected of staff members when attending professional meetings and events.

While employees should be held accountable for their actions at employer-sponsored functions, establishing and maintaining boundaries creates a structure for employees to follow and know what is expected of them, regardless of the setting.

invited and covered the expenses for several members of their team to attend a weekend dental conference. During the day, the conference offered educational workshops, lectures and panel discussions, along with opportunities to explore new products and technology. In the evening, there were events for staff to attend that encouraged socializing and networking.

Two of the members of this practice team were seen overindulging in alcohol during the evening events, and their attendance at daytime lectures was sporadic. The practice leader was frustrated and embarrassed by the behavior of these employees, feeling it reflected poorly on the practice and showed a disregard for the educational opportunities. However, the practice leader was uncomfortable addressing the employees’ behavior since it occurred outside of their place of employment.

Communicating expectations

The best action practice owners can take to prevent issues with impaired employees is to communicate and document expectations of employee

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behavior through the policies detailed in their employee manual. TDIC Risk Management analysts provide the following direction for including behavioral expectations in an employee manual: • Have a detailed drug-free workplace policy. The policy should cover rehabilitation/counseling options and disciplinary actions, including grounds for dismissal. If you intend to conduct reasonable suspicion fitness for duty testing, this should be detailed as well. • A proper policy will cover what substances are not allowed and outline risks including termination if substances are brought onto the premises. Contact your attorney for advice specific to your practice. • Never assume that everyone has the same definition of “professional behavior.” Cite specific examples of unprofessional and unacceptable behavior and of respectful behavior and professional conduct. • Specify the circumstances in which professional conduct is expected. If there is a reasonable expectation that employees will be included in employer-sponsored gatherings or represent the employer at professional events, make sure to outline the expected rules of professional conduct outside of the office.

Maintaining an employee manual is a critical point of documentation. Require staff to sign an acknowledgment for every employee manual or policy change and keep these acknowledgments in employee records.

It is also appropriate to provide staff members with friendly reminders of company policies for appropriate professional behavior before off-site events or in-office celebrations.

The practice leader should clearly identify what behavior is expected of staff members when attending professional meetings and events.

Practice owners must be mindful that their individual style and personality dictate the office environment in which they and their staff work. They should model the same behaviors they expect from their staff members, abiding by the rules for conduct outlined in the employee manual. With acceptable and unacceptable actions clearly defined, everyone in the office will be less likely to cross the line.