Expanded Duties,
Expanded Risk?
Author: Julie Goldberg, DDS, Sr. Dental Risk Specialist at PMIG
What Dentists Should Know About
Delegation, Scope of Practice, and Professional Liability
Across the country, states continue to explore expanded duties for dental
hygienists and dental assistants as a way to improve access to care, address
workforce shortages, and increase practice efficiency. While these changes
create opportunities for dental practices, they also introduce important
considerations related to patient safety, documentation, supervision, professional
liability, and insurance coverage.
As scopes of practice evolve, dentists may benefit from periodically
evaluating not only what duties can be delegated, but how those duties are
implemented, supervised, documented, and communicated within the practice.
Delegation Is Not the Same as Transfer of Responsibility
One of the most common misunderstandings surrounding expanded-duty
personnel is the belief that delegation transfers responsibility. In most
situations, even when a procedure is legally delegated, the dentist retains
responsibility for patient assessment, diagnosis, treatment planning, and the
clinical decisions that support patient care.
When an adverse event occurs, allegations often focus not only on the
delegated procedure itself, but also on questions such as:
- Was the
individual properly trained and credentialed?
- Was the
procedure within the individual's authorized scope of practice?
- Was supervision
provided as required by state law?
- Was the patient
appropriately evaluated before treatment?
- Was adequate
documentation maintained?
In many malpractice cases, the issue is not whether delegation occurred.
Rather, the issue becomes whether the delegation process was reasonable and
appropriately managed.
Scope of Practice Varies Significantly by State
Expanded-duty laws differ substantially across jurisdictions.
A procedure that may be permitted for a dental assistant in one state
could be prohibited in another. Similarly, levels of supervision may vary from
direct supervision to indirect supervision, general supervision, or independent
authority, depending on the provider type and the state.
For practices with multiple locations or providers licensed in different
states, periodically reviewing current regulations can help reduce confusion
and promote consistency.
Questions worth considering include:
- Have state
regulations changed since our protocols were developed?
- Are job
descriptions aligned with current state requirements?
- Have newly
hired team members received state-specific training?
- Are supervision
requirements clearly understood by all providers?
Documentation Remains a Critical Defense Tool
Expanded-duty models often create additional handoffs during patient
care. More handoffs mean more opportunities for communication breakdowns.
Documentation may become especially important when treatment involves
multiple providers participating in the patient's care.
Areas frequently reviewed during an investigation include:
- Treatment
planning documentation
- Supervision
records
- Informed
consent discussions
- Training and
credentialing records
- Clinical notes
related to delegated procedures
- Follow-up and
postoperative instructions
A well-documented process often provides stronger support for the
clinical decisions made by the practice.
Consider the Impact on Professional Liability Exposure
As practices expand services and delegation models, their risk profile
may evolve as well.
Examples include:
- Expanded
function restorative procedures
- Interim
therapeutic restorations
- Local
anesthesia administration by hygienists where permitted
- Expanded
periodontal services
- Community-based
or public health programs
- Teledentistry-supported
preventive care
These activities may be entirely appropriate and permissible, but they
can create new questions regarding supervision, training, documentation, and
liability allocation.
Dentists may wish to discuss significant operational changes with their
insurance professional, particularly when adding new services, locations,
provider types, or delegation models.
What About Board Complaints?
Many dentists associate risk primarily with malpractice lawsuits.
However, board investigations can arise independently of litigation.
A patient complaint involving a delegated procedure may prompt questions
regarding:
- Scope of
practice
- Supervision
requirements
- Documentation
- Credential
verification
- Patient safety
protocols
In some cases, a board matter may create greater concern for a provider
than the underlying malpractice allegation because of the potential impact on
licensure.
For this reason, dentists may find it worthwhile to understand whether
their professional liability policy includes defense coverage related to board
investigations and what limits or conditions apply.
A Practical Opportunity for Practices
Expanded duties continue to play an important role in modern dentistry.
When implemented thoughtfully, they can improve efficiency, support access to
care, and allow practices to maximize team capabilities.
As regulations continue to evolve, practices may benefit from
periodically reviewing:
- State-specific
delegation requirements
- Supervision
protocols
- Training
records
- Credential
verification processes
- Documentation
practices
- Professional
liability and board defense provisions
The goal is not to avoid delegation. The goal is to ensure that
delegation occurs within a framework that supports patient safety, regulatory
compliance, and defensible clinical decision-making.
Key Takeaway
As dentistry continues to expand the responsibilities of hygienists and
dental assistants, dentists may wish to view delegation not only as a workforce
strategy, but also as a risk management strategy. The strongest programs
combine appropriate training, clear supervision, thorough documentation, and an
understanding of how evolving practice models may affect professional liability
and board-related exposures.
For questions
related to dental risk management, contact Dr. Julie Goldberg, Professional
Dental Risk Specialist with PM Dental Protect, PMIG. julie.goldberg@phmic.com.
This information is intended to provide general
information only on specific risk management topics. It is not intended to
provide coverage determinations or coverage positions, nor is it to be
construed as legal, medical, or professional advice in any form whatsoever.
