by Dianne Glasscoe-Watterson
I recently had an 85-year-old man on my schedule who was in poor health. He was formerly indicated for antibiotic premedication for a knee replacement. The patient stated that he had forgotten to take his premedication. At first he said he would reschedule, but the doctor I work with interjected that he did not think the patient needed any premedication. Knowing how the patient was prone to bleeding due to his periodontal condition, I stated that maybe it would be prudent to call the patient's physician. The doctor stated rather firmly that no such call was necessary and for me to proceed as scheduled.
The patient asked me about the consequences of not premedicating, and I told him that he could become very ill. The patient then asked me to do just a "light cleaning." I recommended that he take his medication and call his doctor when he got home, and I noted the conversation in the patient's chart.
When the doctor read my chart notes, he came into my room and yelled at me in front of my co-workers and other patients in the office. He asked me to give him one good reason why he should not fire me. He asked me why I did not follow the new guidelines, and I replied that I felt I was. My patient's health was compromised. The doctor was upset that I did not do a "periodontal prophy" and became very abusive and hostile. I became very upset and asked to talk with him in private. He said he wanted me to finish the afternoon, and we would talk after work.
He was very rude to me the rest of the day. When I went into his office to talk to him after work, rather than discuss the issue rationally, he led me out of his office and fired me in front of all my co-workers. He said I embarrassed him in front of the patient and that I was insubordinate and practicing beyond the scope of my license. I was speechless! I had worked in that office full time for seven years and had never had any confrontations with the doctor. His anger and subsequent firing cut me to the bone!
My desire to notify the patient's physician was based on my concern that, due to the patient's compromised health, the physician probably felt premedication was prudent. I did not feel I was out of line, nor did I have any intention of overstepping my boundaries. I was simply concerned about my patient.
To make matters worse, it has now been over six months, and I have been unable to find a full-time position due to the abundance of hygienists in my area. My question is this: Was this firing justified? Should I have just blindly accepted what the doctor said, even though my own professional judgment felt compromised?
Still Hurting in CA
Dear Still Hurting,
What a sad state of affairs. I can only imagine how difficult these months have been since your termination.
By "light cleaning," I'm assuming the patient meant for you to tip toe around the sulcus to avoid bleeding. What would that accomplish? Exactly nothing, as there is no therapeutic advantage to supragingival scaling and polishing for a patient with periodontal disease. The patient wasted his money.
There are a variety of state and federal laws that protect employees from "wrongful termination." There are several categories of wrongful termination, such as discrimination, defamation of character, breach of contract, constructive discharge, retaliation, and breach of good faith and fair dealing. I feel the last two categories are pertinent to your situation.
First, termination for retaliatory reasons can be considered wrongful termination under certain conditions. Employers cannot rightfully terminate employees for reporting their illegal actions to the proper authorities, commonly known as whistle-blowing. They also cannot fire employees in retaliation for something they legally or illegally did, or because someone refused to do something that was contrary to public policy and sound morality, such as breaking the law. According to Niznick, "Values, principles, and basic rules that the courts and legislatures consider to be in the best interest of individuals and the general public" are considered public policy. Public policy may be written or implied and can vary among states. Given that the patient was elderly and had compromised health, and had formerly been indicated for premedication, interfacing with the patient's physician seems prudent and in the patient's best interest. The dentist's expressed concern that you embarrassed him adds fuel to his actions being retaliatory.
Additionally, some states recognize the covenant of good faith and fair dealing. This means that employers have the burden to deal with employees, especially dedicated and long-term employees, with fairness and good faith. Your employer seems to have violated this principle not only with the termination itself, but also in the way he terminated you in front of your co-workers. The only positive note here is that your co-workers were witnesses to his rudeness.
Does your former employer have an office manual that describes a graduated discipline or termination process? If so, he may have violated his own policy, which also could be deemed wrongful termination. Most employers hire employees "at-will," meaning that both the employer and employee may terminate the employment relationship at any time. However, employers cannot legally terminate employees for illegal reasons.
Depending upon the situation, damages available to wrongfully discharged employees can include back pay, promotion, reinstatement, front pay, compensatory damages, required reasonable accommodations, injunctive relief, punitive damages, and attorneys' fees.
Hygienists are taught to be diligent about all aspects of patient care, including contacting a patient's physician regarding medical issues that may influence the course of treatment. In my opinion, your concern is warranted in this case, and in most offices, it would have been the standard of care to contact the patient's physician to ask about the necessity for premedication. Calling the physician would have been a simple step to set everyone's mind at ease and would have shown the patient that the practice considers patient safety a number one priority. The doctor's mandate to proceed with scheduled treatment without contacting the physician could erode the patient's confidence in the doctor. Patients are not stupid. It is possible the physician might have said, "No, this patient does not need premedication," and everyone would have been relieved.
If the doctor had acted rationally by talking with you in private, it is possible things could have been settled amicably. However, it appears he felt he needed to make an example of you by treating you so harshly. When it comes to patient care, there is no room for egos.
Considering your months of lost pay and earning potential, my advice would be to find an attorney who is willing to take your case on a contingency basis. There is no guarantee of victory, but given that you did nothing that deserved firing, you may be able to put closure on this unfortunate chapter of your life through the legal system.
About the Author
Dianne D. Glasscoe-Watterson, RDH, BS, is a professional speaker, writer, and consultant to dental practices across the United States. She is CEO of Professional Dental Management, based in Frederick, Md. To contact Glasscoe for speaking or consulting, call (301) 874-5240 or e-mail [email protected]. Visit her Web site at www.professionaldentalmgmt.com.
Hodges, Kathleen. (1998). Concepts in Nonsurgical Periodontal Therapy. Albany, NY: Delmar Publishing.