Hygienist sued for periodontal treatment

April 1, 2002
Although the hygienist provided periodontal therapy to the patient, the billing code she used was for a prophylaxis, a fee that is far less than that charged for periodontal therapy.

Editor's Note: The article below originally appeared as a column called "Thinking Sharply" in the April 2002 issue of RDH. As such, it was not an article discussing actual litigation. The author was depicted a scenario to illustrate the vagueness of dental terminology related to the diagnosis of oral diseases.

By Shirley Gutkowski, RDH, BSDH

Although the hygienist provided periodontal therapy to the patient, the billing code she used was for a prophylaxis, a fee that is far less than that charged for periodontal therapy.

Dateline: Anytown, USA…Heidi Doe, RDH, was fined $10,000 for battery to her client, Patty Jones, and sentenced to six months in jail.

Doe was charged with battery to the patient for performing an unauthorized procedure.

Jones arrived for her dental hygiene appointment at Compass Dental on January 4. She was on the hygienist's schedule for a routine prophylaxis.

Jones asserted that Doe was told only to clean her teeth, but that Doe … without authorization from the dentist overseeing Jones' treatment …proceeded to perform periodontal therapy.

"I love Dr. Parker," Jones said. "When the hygienist told me that I had gum disease and what it would take to get rid of it, I told her I did not want the treatment. I told her it was too expensive, but she did it anyway," Jones added.

Periodontal disease is a multifactorial disease characterized by clinical bleeding when instruments are placed between the gums and the tooth.

"When I put the probe into the pocket, the patient was bleeding profusely," Doe explained in an exclusive interview with this reporter for Nearly News Weekly. "I thought to myself, "Oh, no! Not again."

Doe went on to say, "She [the patient] had so much bleeding and so much calculus, I could not stop. I just kept going deeper and deeper until I got the majority of it off. Periodontal disease is an indicator of heart problems and more things, too.

"I explained that to Jones when I expressed my concerns about the state of her oral health. The doctor was busy on the phone, unavailable for consultation. I just could not do what she asked; I just could not ignore it!

"I know that conservative treatment works. In cases like this, I usually just do the therapy, and charge for a regular cleaning. It makes the patients happy because they aren't charged a lot, and I feel good about the treatment I'm providing. It also helps the doctor keep his reputation for not being 'money-grubbing.' I never dreamed it would come to this. Dr. Parker is squeamish about recommending treatment for periodontal disease. I'm not sure why. It puts me in a terrible position."

Although Doe provided periodontal therapy to Jones, the billing code she used was for a prophylaxis, a fee that is far less than that charged for periodontal therapy.

"I feel as if I've been violated," said Dr. Parker, Doe's employer. "I don't know how much Heidi has stolen from me by undercharging for periodontal therapy or how many clients she's done this with. It will be a long time before I can trust again."

Dr. Parker retained legal counsel and sued Doe for fraud and grand larceny. "She took money directly from my pocket," he said. "I support five families, other than my own, with this practice," Dr. Parker said, referring to other staff employed at Compass Dental.

The charges by Dr. Parker, added to those brought by the patient, resulted in a guilty judgment with a sentence of six months in jail for Doe. Judge Magistrate said, "I'm livid! These hygienists are highly skilled, highly paid, and educated individuals. The employer in this case is inept. We must change the laws to allow more autonomy for hygienists. I know several legislators that will hear from me within the next week."

Axel Knight, representing the Hygiene Association, explained that, while dental hygienists learn to recognize periodontal disease in college, most states do not allow them to perform a diagnosis. "Sure, they know how to recognize it [periodontal disease] and treat it, but they need the doctor's prescription in order to proceed. Hygienists also need the patient's permission to treat them. The association is very supportive of a client's right to decide on treatment," said Knight.

In a statement, the insurance company, Big Bad Insurance Co., said: "It became clear that Dr. Parker was not providing treatment for periodontal disease, as evidenced by a code audit. The doctor also was not providing referrals to any periodontal disease specialist, although one was located in the same building. This raised a red flag during the audit, resulting in the charges."

"I can't believe the lack of support around me," Doe said. "I know this to be standard practice."

As the law stands now, our state does not allow hygienists autonomy. The dentist must prescribe all procedures done by hygienists. In this case, periodontal disease was evident to the hygienist, who treated the patient for the disease. However, no prescription for treatment was written.

Protect yourself from legal actions .

Does this scenario seem farfetched to you? If it does, review the glossary of terms below These broad definitions cover a lot of territory … territory that you don't want to find yourself in! Make sure you have written authorization from the dentist and the patient before proceeding with periodontal treatment and that you use the correct code for billing purposes.

Glossary of terms

Battery: Unlawful touching of one person by another.
Larceny: Unlawful taking of valuables
Grand Larceny: Unlawful taking of valuables in excess of an amount established by each state
Fraud: A piece of trickery, unlawful representation of person or thing.

Shirley Gutkowski, RDH, BSDH, has been a full time practicing dental hygienist in Madison, Wis., since 1986. Ms. Gutkowski is published in print and on Internet sites, and speaks to groups through Cross Links Presentations. She can be contacted at [email protected].