An Employee-Termination Case Study

without his knowledge or authorization. Considering the increasingly problematic behavior exhibited by the hygienist, the dentist felt it would be best to terminate her employment.

The call: After repeated safety violations, a practice owner informed a hygienist that her services would no longer be needed. When the former employee failed to pick up her final paycheck, the dentist reached out to the Risk Management Advice Line for assistance.

In this case, the dentist terminated the hygienist for repeatedly exposing the staff and providers to unnecessary radiation. The hygienist was deliberately taking radiographs in the presence of the dentist or other staff in the operatory. On one occasion, the office was short-staffed, and the dentist asked the hygienist to take radiographs on one of their patients as she had a few minutes to spare between her hygiene patients. She hastily initiated taking the radiographs while the dentist was still in the operatory, entering notes in the patient chart. The dentist tried to stop her. The disgruntled hygienist threw the X-ray holder on the instrument tray and stormed out of the operatory.

Unfortunately, this was a repeated behavior already addressed with the hygienist. As an added complication, the dentist had recently discovered that the hygienist had added her family to the group medical plan that the practice owner offered to qualifying employees,

After the hygienist’s last patient, the practice owner took her aside and told her he would no longer need her services and that her final paycheck would be ready for pickup the next day. The employee left the office in tears and did not show up the following day to pick up her check.

The dentist had decided to make deductions from the employee’s final pay to cover the unauthorized medical insurance premium she had received. Considering the various issues, the dentist reached out to the Advice Line for guidance on how to proceed prior to mailing the employee her check.

The advice: While the analyst agreed with the practice owner’s decision to terminate employment, they advised caution regarding the final check. The analyst noted that according to the employment laws within that state, an employee’s unpaid wages are due and payable to the employee immediately at discharge. The analyst advised the dentist against making any deductions. Instead, the analyst referred the dentist to a qualified employment law attorney to discuss how the dentist could be protected from wrongful-termination suit and gain compensation for the lost health care premium.

Employment Best Practices

It’s rare to meet an employer who has never had to terminate an employee. Know that there are steps you can take to ensure that employee termination is the exception in your practice, not the rule. The following best practices will also help to reduce the risk of bad hires and employment liability lawsuits.

Implement effective processes to find and hire quality employees. Creating a robust screening process is invaluable when it comes to searching ideal candidates. A carefully composed job description allows an employer to define their expectations, qualifications, necessary experience and education along with explaining key job functions. Not requiring the candidate to fill out a job application is a missed opportunity for filtering out potential bad hires, allowing you to collect information and the applicant’s signed approval for you to check their background and qualifications. When these filters are in place, you essentially refine your pool of candidates to avoid costly and timeconsuming hiring mistakes.

Invest in interviewing. After identifying candidates who can fulfill the duties of the job description and who have accurately portrayed their qualifications, an interview is the next step. Maintain consistency in the questions you ask other candidates applying for the same job as a basis for equitable comparison. It is advisable to ask for a copy of the candidate’s license (RDA, RDH, DDS) so you can verify that the license is in good standing with the state dental board. You can improve the odds of a “good hire” with attention to details and mitigating risks during the interview process manual that can be given to employees is a key step to documenting your compliance with federal, state and local employment regulations. An employee manual also simplifies the performance evaluation and corrective action process, as reference to performance — improved or needed — can be related back to your handbook and your established office policies. TDIC policyholders have access to downloadable sample employee handbooks specific to the state in which they practice.

An employee handbook is a crucial tool for communicating employment conditions and expectations. Minimize risk by documenting your practice’s employment policies within a handbook and making sure all employees are offered training on the practical implementation of and adherence to those policies. Certain employment laws require employers to notify employees of workplace rights in writing, so a well-developed

Performance evaluations should be routine. By conducting regular performance evaluations, dental practice owners can identify any issues with an employee's performance or behavior early on and address them before they escalate. Regular performance reviews establish the validity of employment decisions by creating a pattern of communication and documentation related to the employee. A well-defined job description can assist practice owners and managers as a reference when providing performance feedback and, if needed, the development of a performance improvement plan.

Establish checks and balances. Within the setting of a dental practice, checks and balances ensure that no one person has absolute control over decisions, clearly define the assigned duties, and enforce cooperation in completing tasks. They help reduce mistakes and prevent improper behavior in organizations. In the case study cited previously, the terminated hygienist’s unauthorized use of health benefits could have been prevented by a regular check of the office’s plan by two or more employees.

Maintain personnel files. A personnel file is just as important as a patient chart. Documentation in a personnel file can provide important supportive data. For example, to show an employee’s discipline history in support of a termination and any subsequent litigation. Include the employee’s signed acknowledgement that they have received, read and understood the employee handbook, as well as copies of performance reviews and improvement plans. It is essential to keep certain employee records and information in a confidential file, separate from the personnel file, such as their medical records, workers' compensation claims information, their I-9 form and background checks.

Ethical and Lawful Reasons for Termination

Employee termination can be a tricky and sensitive matter, but there are several ethical and lawful reasons for termination. The following are some of the most common reasons for employee termination:

• Poor performance or misconduct: Inferior performance can be a valid reason for termination if an employee consistently fails to meet the expectations of the dental practice owner as stated in the employee handbook. Misconduct, such as theft, harassment or discrimination, can also be grounds for termination.

• Violation of company policies: If an employee violates company policies, such as repeatedly showing up late for work or failing to follow safety procedures, this can be a reason for termination.

• Poor attendance or punctuality: Consistent absenteeism or tardiness can disrupt the workflow of a dental practice and can be a valid reason for termination.

• Loss of necessary qualifications: An employee losing the necessary qualifications to perform their job, such as losing their dental license, can be a valid reason for termination.

• Position elimination: If a dental practice owner needs to downsize or restructure their practice, they may need to eliminate certain positions, which may result in justified employee termination.

Steps to Ensure Appropriate Termination

When it comes to employee termination, dental practice owners must take certain steps to ensure that the process is handled appropriately. TDIC’s analysts urge practice owners facing challenging employment issues to contact them before initiating a termination. Advice Line analysts offer expertise and can assist you to complete the following steps:

• Provide documentation: Keep a record of any performance issues or policy violations, including any attempts to correct the behavior, in case of future legal action.

• Communicate clearly: Communicate the reason for termination clearly to the employee and make sure they understand why they are being terminated. If the employee was hired on an at-will basis, in the absence of a contract, both employee and employer are free to end employment at any time, so long as the decision is not based on any discriminatory issues or protected classes. Employers must be careful that their decision to terminate at will does not violate or appear to violate state or federal law. The termination should also be consistent with employee policies (including the Employee Handbook, if there is one), practices and any other implied or actual agreements.

• Be respectful: Terminating an employee can be a difficult and emotional experience for both parties. Show respect and compassion to the employee during the process.

• Provide final pay: You are legally obligated to provide the final paycheck to the terminated employee, including any unused vacation time or sick leave. The timing of final pay varies by state, so check your state’s employment laws to make sure you will comply.

• Collect company property: Collect any company property, such as keys or uniforms, from the terminated employee. Remember to disable the terminated employee’s passwords and email access and change alarm codes and locks to the office or building, if necessary.

Additionally, be sure to remove check-writing authorization if applicable and update your practice’s website to reflect the staffing change.

TDIC offers Employment Practices Liability Insurance (EPLI) to dental practice owners in several states. EPLI provides coverage for claims made by current or former employees, such as claims of discrimination, harassment or wrongful termination. This insurance can protect dental practice owners from the monetary impact of these types of claims, including legal fees and settlement costs.

Employee termination can be a difficult and sensitive matter, but there are times when it becomes necessary to preserve the safety, integrity and reputation of your practice.