by Sarah D. Parsons, D.D.S. Associate Executive Director of The Dentists Professional Liability Trust of Colorado and Private Practice Dentist.

As of July 1, 2026 the Code of Regulations specify that Dental Hygienist MUST have their own professional liability policy independent of the dentist’s professional liability coverage.

Colorado Dental Board now requires hygienists to maintain their own liability insurance rather than relying on coverage through the owner dentists. Under this change the minimum coverage limits are:

1. $50,000 per claim
2. $300,000 aggregate per year

Working in a Dental Office with a Dentist DOES NOT Replace Individual Coverage

A hygienist working in a dental office does not replace the new obligation to maintain their own policy. The Dentist policy with the TRUST does cover other employees working under your supervision. However, the event of a claim against your hygienists will require their own policy, the dentist professional liability coverage will be considered excess insurance over and above the applicable limit of the hygienist policy.

If it is determined your hygienist does not have their own policy in the event of a claim or Colorado Dental Board matter against them, they would be subject to discipline by the Board, and as their employer, you could be subject to discipline as well.

Currently, the Trust does not offer a policy for hygienists. The TRUST board is currently looking for options for these policies to potentially become available.  The Trust recommends contacting the Colorado Dental Hygiene Association for recommendations on carriers that offer liability coverage to hygienists.

Keep Current Documentation on File

As best practices management, we recommend that you keep a copy of the following documentation for each of your hygienists in their employee folder:

1. Copy of their current liability policy declaration page
2. Their active Colorado dental hygiene license and other applicable licenses documents
3. Current CPR/BLS certifications
4. Applicable permits, endorsements, and other professional certifications
5. Required training records and documentation such as HIPAA and OSHA
6. Necessary employment documentations
7. Required vaccinations and TB testing records

If You Use a TEMP Hygienist

Maintain the SAME documents as listed above and retain these documents in a secure file.

Review, Renew, and Document

We suggest that each licensed professional maintain their license, professional lability policy, permits, CE, professional certifications, DORA contacts, and PDMP registration and not delegate this to an employee or manager… after all this is YOUR livelihood. Set reminders on when they expire and when you are eligible to renew them. Request updated documentation at renewal and place copies of these documents in a secure file.

Requests copies of these documents and review coverage for your hygiene team whenever a hygienist employment changes or their licenses, certifications, or policies expire.

At the TRUST, we encourage members to make this review a routine part of practice management. Keeping current documentation readily available helps protect YOU, your team, your patients, and your practice.

Questions? Contact The Dentists Professional Liability Trust of Colorado at 303-357-2600

By: H. Candace DeLapp, D.D.S. is the former executive director of The Dentists Professional Liability Trust of Colorado. She has over 30 years of private practice experience.

“All things being equal people chose to do business with those they like. All things not being equal, they will still choose to do business with those they like…” Dr. Bill Blatchford.

Dentistry has changed, or has it?

I would challenge that statement that it is not only dentistry that has changed, but how we as practitioners have changed. It is no longer enough to be a good dentist, you must be a good, dare I say “great” communicator. A key foundation of any successful relationship whether it be personal, or professional is communication. Building rapport between dentist and patient is fundamental to delivering quality dental care.

So how do you build an excellent relationship?

What can you do to prevent a fractured relationship when a problem arises? It all begins at the beginning. I have often heard that a good listener spends 80 percent of the time listening and only 20 percent of the time speaking. We as dentists tend to want to “product dump”, we all know the answer we want to give and “fix” our patients. By listening more than you speak, you can get into people’s “WHY”. Take time at that first meeting and at each subsequent appointment to listen, to find out what they want, what motivates them.

“Learning to listen, that takes a lot of discipline.” Gary Cole as Coach Larry Gelwix in Forever Strong (2008).

Keep in mind that there are a lot of dentists in practice here in Colorado, the patient choose you, a tremendous compliment, take some time to get to know them.  

You only have one chance to make a Good First Impression, make it count.

Do you have the ability to communicate with different personalities? We all have patients that you’re afraid to even ask “how are you doing” because they will chatter and share their entire life, leaving little time for treatment. There are patients that are technical and want to know every step, read every MSRP, know how long it will take, how many of these have you done? Patients are not all the same and honing your ability to communicate with all of them will serve you well.

I, personally, believe that to be clear is to be kind. While doing some research for this article I came across the 7 Cs of

Communication – clear, concise, concrete, correct, coherent, complete, and courteous. (Professional Academy blog)

Taking the time to set patient expectations by providing treatment plans, financial agreements, and informed consents creates patient autonomy but more importantly, patient empowerment and trust. With the patient as your partner in making decisions about their care, you gain their loyalty and often will find fewer barriers to treatment and increased productivity, with fewer complaints.

The 7 Cs are not just verbal.  Are you in tune with your non-verbal communication? The tone of your voice, nodding of your head either in agreement or disagreement. Do you catch yourself or your team rolling eyes, being sarcastic because this must be at least the fortieth time today you have been asked the same question? Please take a moment and gather yourself. If you need to step out, do so, think how these non-verbal communication moments make another feel and what negative outcome it may lead to. 

Do you see patients with limited English proficiency (“LEP) and/or patients with hearing disabilities? What are your obligations to enable these patients to use your dental practices services? In brief, a covered dental practice must take reasonable steps to provide meaningful access to its services to people with LEP and must take appropriate steps to ensure that communications with individuals with disabilities are as effective as communications with individuals without disabilities provided that the accommodation does not pose a demonstrated undue burden on the dental practice. Wondering whether your practice is obligated to comply with Title VI of the Civil Rights Act of 1964? Broadly speaking, if the dental practice receives any federal financial assistance, the practice is obligated to comply.

The power of saying “I’m sorry”.

Did you know that Colorado is one of five full apology states? The law protects expressions of “apology, fault, sympathy, commiseration, condolence, compassion, or a general sense of benevolence” from being used against the practitioner in a lawsuit.    CRS 13-25-135:

(1) In any civil action brought by an alleged victim of an unanticipated outcome of medical care, or in any arbitration proceeding related to such civil action, any and all statements, affirmations, gestures, or conduct expressing apology, fault, sympathy, commiseration, condolence, compassion, or a general sense of benevolence which are made by a health-care provider or an employee of a health-care provider to the alleged victim, a relative of the alleged victim, or a representative of the alleged victim and which relate to the discomfort, pain, suffering, injury, or death of the alleged victim as the result of the unanticipated outcome of medical care shall be inadmissible as evidence of an admission of liability or as evidence of an admission against interest.

You can’t win an argument…

When there is a complaint, there may be a tendency to feel that patients are just complaining to avoid paying for treatment. Consider a face-to-face consultation with the patient and the dentist. Let them have their say; there may be legitimate reasons for their discontent. The key principle of The Secret of Socrates is to emphasize your agreements and avoid disagreements. Your goal is to get the other person to say “yes” or agree as much as possible to gain understanding and cooperation.

By taking the time to discover your patient’s concerns and address their expectations, patient satisfaction tends to increase. It’s okay to say, sorry you have having difficulty, here’s how we can help you. Deferring a final answer or plan at the time of this consultation may be your best immediate course of action… you don’t have to provide a solution right then. Take some time to contemplate before responding.

Your team should be well trained and knowledgeable about your practice visions and goals.

Your practice stands on your reputation.

You stand on the shoulders of your team.

They need to be great communicators too.

The most important message I can get across to you.

Don’t make it about you … it’s about the patient. In general, patients see you twice a year, so even if you’re having a bad day, it’s about the patient, not you. When they ask, you’re having a great day, how about you?

“It’s not the customer’s job to know what they want” Steve Jobs

The Dentist Professional Liability Trust of Colorado is Colorado’s most recommended professional liability carrier because we are for dentists, by dentists.

Want to know more about the TRUST and how we can help your practice. Contact executive director, David Geck D.D.S. at [email protected] or call us 303-357-2600

James A. DeLapp II, D.D.S., M.S. is an Associate Professor at the University of Colorado School of Dental Medicine.

Dentists frequently ask what their dental license allows them to do for anxiety management and when a minimal-sedation permit is required. This blog attempts to explain that distinction. The Colorado Dental Practice Act and Colorado Code of Regulations (CCR) contain language that can be confusing, particularly regarding divided doses.

Currently the Colorado Code of Regulations and The Dental Practice Act follows the 2016 ADA guidelines regarding sedation, though the 2026 guidelines are published and considered more contemporary.

The brief distinction, under this reading, is:

• One oral dose: For anxiety management within the maximum recommended dose (MRD) for unmonitored home use = Allowed with a Colorado Dental License.
• Divided or incremental doses: Minimal Sedation License Required = Must be within the applicable MRD for the specific drug you are prescribing for unmonitored home use and/or taken in the office.

The examples below illustrate this reading of the CCR. They explain the dosing distinction; they are not patient-specific dosing instructions. The applicable maximum may be lower depending on the patient and the medication’s labeling.

A Dental License with NO minimal sedation license may:

Under a strict single-administration interpretation, a dentist may administer one dose of an anxiolytic medication, such as triazolam (Halcion) or diazepam (Valium), within the applicable MRD (maximum recommended dose) for unmonitored home use. Nitrous oxide may also be administered.

For illustration, assume an applicable MRD (maximum recommended dose) of 0.5 mg of triazolam (Halcion). A dentist may prescribe a patient one tablet of 0.25 mg or two 0.125 mg tablets for a total of 0.25 mg that must be taken at one time for a single administration of the drug.

Under this interpretation, no additional dose or doses could be administered during the appointment, even though the initial amount was below the assumed MRD of 0.5 mg.

In the CCR, the “one dose” refers here to one administration: one time event, not the number of pills.

Minimal-Sedation License:

Under the divided-administration interpretation, a dentist with a minimal-sedation license could administer the same initial amount and then provide supplemental doses when needed and appropriate.

For example:

• Initial administration: Two 0.125 mg tablets = 0.25 mg.
• First supplemental dose, if needed and appropriate: One 0.125 mg tablet, bringing the total to 0.375 mg.
• Second supplemental dose, if needed and appropriate: One additional 0.125 mg tablet, bringing the total to 0.5 mg.

This is an example of divided doses totaling 0.5 mg, the assumed MRD for unmonitored home/in office use in this illustration. It does not establish when supplemental doses should be given.

What does “divided over time” as it pertains to minimal sedation licensure mean?

The question is not simply how much medication may be administered, but whether the total may be divided over time—and what additional authority the license provides.

Rather than committing to the entire amount at the outset, the clinician begins with a smaller amount and considers additional medication based on the patient’s response. Depending on the timing and cumulative effects, this approach may also extend the duration of sedation.

Permitted minimal sedation also carries more extensive requirements for equipment, patient evaluation, monitoring, personnel, documentation, and emergency preparedness, as outlined in the CCR.

In principle, divided administration may allow the clinician to begin with less medication, assess the response, and administer additional medication only when necessary.

This may appear to be a more prudent approach. However, it comes with an important limitation.

Oral dosing is NOT equivalent to IV titration

Oral dosing is NOT equivalent to intravenous titration. Absorption and peak effects are less predictable. Additional medication given before an earlier dose has reached its full effect can accumulate, producing deeper or more prolonged sedation than intended.

Divided dosing therefore should not automatically be characterized as safer!

QUESTIONS? Call the Dentist Professional Liability Trust of Colorado for more information and learn about our Sedation Courses offered bi-annually in the Denver Metro area and The Western Slope that fulfill the initial training requirements along with continuing education requirements for continued licensure for a Minimal Sedation Permit.

303-357-2600 or email [email protected]

Regulatory language

Rule 1.14(E)(1)(c) addresses anxiety medication for non-pediatric patients. It permits “a dose of a single drug” within the maximum recommended dose for unmonitored home use, optionally combined with nitrous oxide.

Rule 1.14(F)(3) separately requires an appropriate sedation permit to administer minimal sedation.

The difficulty lies in interpreting the boundary between those provisions, particularly because the rule does not expressly explain whether “a dose” must be administered all at once.

Terminology: MRD is used here to mean the maximum recommended dose for unmonitored home use, rather than simply the maximum daily dose.

Colorado Dental Board Rules, 3 CCR 709-1, Rule 1.14

By Sarah Parsons, D.D.S. Private Practice Dentist and Associate Executive Director of The Dentist Professional Liability Trust of Colorado

An unexpected treatment outcome can be stressful for both a patient and the dentist. Patients want answers, and dentists want to address concerns with honesty and compassion. Yet the fear that a conversation could later be used in a lawsuit can make those discussions feel difficult.

Colorado’s Candor Act offers a structured path forward: an opportunity for open, protected communication after a qualifying adverse incident. Enacted in 2019, the law can help dentists and patients work toward understanding and resolution.

An opportunity to rebuild understanding

A patient who feels heard may be better able to understand an unexpected outcome.

Candor creates room to explain findings, answer questions, discuss prevention, and an appropriate path forward. Under Colorado law, the Dentist must initiate the Candor process by sending a written notice to the patient within 180 days of adverse incident. The TRUST assigns legal counsel to help our Colorado Dentist navigate and prepare for a Candor meeting. This preparation and representation allow the TRUST Dentists to have more successful Candor outcomes and hopefully deter a formal lawsuit from being filed.

Contact the Trust early

If an outcome raises concerns, contact the Trust promptly before attempting to arrange a Candor meeting. We can work with legal counsel to evaluate the circumstances, reporting implications, and required steps.

You do not have to navigate a difficult patient situation alone. The Trust is here to help you respond thoughtfully, protect your interests, and keep patient care at the center of the conversation.

For dentists. By dentists. It’s personal.

by Dr. Kami Marr, President, The Dentists Professional Liability TRUST of Colorado

As I step into the role of The Trust Board President, I am reminded of just how meaningful this organization has become to me personally and professionally. Since joining the Board in 2017, serving alongside such thoughtful and dedicated colleagues has been one of the most rewarding parts of my dental career.

In dentistry, we spend our days building relationships, earning trust, and navigating the unexpected, and we always have our plan B in the back of our minds. We know that even with the best intentions, excellent clinical skills, and careful planning, challenges can arise. And when they do, having someone in your corner who understands what it’s like to sit in the dentist’s chair—not as a patient, but as the provider—can make all the difference.

That’s what makes the Dentists Professional Liability Trust of Colorado so special.  Our motto, “It’s Personal,” isn’t just a catchy phrase. It’s the foundation of who we are and how we serve our members.  The difference is a conversation. 

One of the greatest benefits of the Trust is the ability to pick up the phone and speak directly with a local, licensed Colorado dentist. Someone who understands the realities of practicing dentistry and the concerns that can keep us awake at night.

Sometimes, that conversation is all it takes to provide reassurance, perspective, or guidance. Other times, early support can help manage a difficult situation before it escalates into a formal complaint or malpractice claim.

The Trust is also different because of how it is structured. We are a member-owned, not-for-profit organization.  Our priorities are aligned with the dentists we protect. Rather than focusing on shareholders, we focus on providing meaningful coverage, stabilizing premiums, and returning value to our members.

Equally important, the Trust is led by our peers—Colorado dentists who understand firsthand the challenges and rewards of practicing in our state. Our Board is comprised of diverse clinical backgrounds and perspectives to help ensure that the Trust remains relevant and prepared for the evolving needs of our profession.

At our recent Board Retreat in Colorado Springs, I discussed with our group about the important aspects of this very special organization and the pearls of wisdom that come with this responsibility and experience.  We don’t solve every issue at a single board meeting, but we do keep asking the right questions, listening to our members, and making thoughtful decisions that will strengthen the Trust for years to come.   

When the unexpected happens, and it will, insurance is important. But knowing who’s on the other end of the phone when your Plan B didn’t work as you had planned?  That’s personal and makes all the difference.

By Dr. David Geck

Colorado’s New Damage Caps: Why a $1M Professional Liability Policy May No Longer Be “Enough”.

You have built a thriving practice.  Your patients trust you, your team respects you, and your reputation is “solid”.  Then the unthinkable happens.  A surgical complication, an adverse outcome.  You’ve always believed your $1 million professional liability policy would protect you. But under Colorado’s new legislation increasing tort damage caps, that assumption may leave you at personal financial risk.

As of January 1, 2025, Colorado enacted sweeping changes to its damage cap laws through House Bill 24-1472, dramatically increasing the maximum recoverable damages in civil and dental/medical malpractice lawsuits. For dental professionals, this isn’t just a subtle “tweak” to the law, it is a significant shift that could leave dentists underinsured with inadequate professional liability insurance coverage.

Many dentists in Colorado carry a $1 million per occurrence liability policy, long considered sufficient. However, under the new law, that coverage may no longer protect you against the full financial risk of a claim, whether it be a nuisance or a serious claim. It is time to address the key changes, their implications for dental practices, and the steps dentists should take to safeguard their professional and personal assets.

Colorado’s updated damage caps significantly increase the financial exposure for healthcare providers, including dentists. The most relevant changes include:

Noneconomic Damages in Civil Actions (General negligence)

• Old Cap: $250,000 – Adjusted to $729,790 as of 2024
• New Cap: $1,500,000
• Adjustment: Indexed for inflation every two years starting in 2028

Wrongful Death (General negligence)

• Old Cap: $250,00  — Adjusted to $729,790 as of 2024
• New Cap: $2,125,000
• Adjustment: Indexed for inflation every two years starting in 2028

Medical Malpractice – Wrongful Death

• Old Cap: $300,000
• New Cap: $810,000 (cases filed in 2026)
• New Cap: Phased increase to $1,575,000 over three years
• Adjusted for inflation effective 2030

Medical Malpractice – Noneconomic Damages

• Old Cap: $300,000
• New Cap: $530,000 (cases filed in 2026)
• New Cap: Phased increase to $875,000 over three years
• Adjusted for inflation effective 2030

Medical Malpractice Overall Damages Cap – Economic and Noneconomic Damages

• New Cap: $1,012,500:  The greater of $1,000,000 or 125% of the Medical malpractice and Wrongful Death noneconomic damages cap in effect at the time the acts or omissions occurred.
• Increases to $1,968,750 over next three years
• Adjusted for inflation effective 2030

These increases reflect a broader national trend toward expanding patient rights and compensation. Colorado’s biennial inflation adjustments mean these caps will continue to rise, further increasing liability exposure over time.

 For example, consider the following hypothetical claims:

A patient suffers severe infection and permanent facial nerve damage from a dental procedure, resulting in extensive follow-up care, chronic pain and loss of function. Economic damages alone, such as medical or surgical expenses, lost wages and future care, could quickly eclipse $1 million. This is especially true if the patient has a difficult medical course, is a substantial wage earner, or the future treatment is likely to be extensive. Then, the noneconomic damages for pain and lost enjoyment of life could easily add up from there, leaving a six- or even seven-figure gap in coverage. 

A patient experiences post-treatment complications alleged to have been caused by dental/medical care, and sadly the patient dies. Numerous factors can drive exposure in wrongful death claims filed under a dental/medical malpractice theory. Before the recent changes to the damage caps, most such claims were subject to a $300,000 exposure. The new wrongful death caps, especially as they grow in the future, can make settlement or verdict amounts exceed the historically common $1 million policy limit.

If your coverage stops at $1 million, you’re personally responsible for the rest.

In each case, if a judgment exceeds your insurance coverage, plaintiffs may pursue your personal assets, including savings, property, and future earnings.  This could bring considerations about additional legal challenges, liquidating assets, facing wage garnishment, or enduring long-term financial hardship.  As damage caps rise, insurers may adjust premiums, policy structures, and underwriting criteria. Dentists should expect potentially higher costs for enhanced coverage.

So, what’s your plan moving forward?

Start with a review of your current coverage.  Contact your professionally liability provider and confirm your per-occurrence and aggregate limits. Understand the scope of your coverage and any exclusions.

 If you are a member of the Dentists Professional Liability Trust, you are already have a $2M/$6M policy.  If you have a $1M/$3M policy, you should consider raising your limits.  The cost difference is minimal compared to the risk of underinsurance.  And as always, do your due diligence and consider which policy is the best fit for you.

Be proactive to reduce your risk.  Invest in continuing education, review and update patient hand-off and inter-office protocols.  And remember that detailed, accurate documentation and thorough informed consents (not just a signed form, but a true communication about risks, benefits, and alternatives) are pivotal in defending a claim against you. 

Prioritize communication and trust.  Establish rapport and trust with each patient and with your team.  Most lawsuits start with a breakdown in communication or a loss of trust.  When complications arise, speak directly with your patient.  They feel more reassured and valued when the dentist personally reaches out, offering clarity and a compassionate touch.  Often, a kind and empathetic face-to-face conversation (not just a text message) can go a long way toward de-escalating a matter.

 Colorado’s new damage caps mark a turning point in malpractice liability. For dentists, the message is clear; the old standard of a $1 million policy is no longer enough. By taking proactive steps, reviewing coverage, increasing limits, and enhancing risk management, you can protect yourself, your practice and your future.

Don’t wait for a claim to test your limits. Prepare today for tomorrow’s risks.

Contact the Dentists Professional Liability Trust of Colorado Today at ask about our 2million/6 million claims made policy to make sure you are protected. It’s Personal to us and your protection matters.

Dismissing a Patient

By H. Candace DeLapp, D.D.S.

It’s Monday morning- morning huddle time. There’s a patient’s name on the schedule that makes everyone in the office cringe! You know who I am referring to: the person who won’t let you take radiographs, won’t let you do an exam but once every three years, and refuses routine dental care. Basically, it’s that patient who makes threats if you are not willing to treat them or not treated them based on their demands or is out-right abusive.

The Dentist-patient relationship is based on mutual trust and respect. This is commonly termed, rapport- defined by Webster’s Dictionary as “a close and harmonious relationship in which the people or groups concerned understand each other’s feelings or ideas and communicate well. ” Occasionally, there comes a time when this relationship becomes strained or no longer exists and you now have concerns about continuing dental treatment on this patient.

Some other behaviors or actions that breach this relationship are: frequent no shows or last minute cancellations, non-compliance on referrals, ignoring treatment recommendations, refusal to obtain full and timely records for treatment planning, not following directions on medications prescribed, breaching financial arrangements (written and signed), as well as being rude, threatening or abusive to your team and yourself. There are many other examples.

Have you found yourself asking “should I dismiss this patient from my practice?” and/or “when should I dismiss this patient?” Not all patients are the perfect fit for your practice. You are allowed and might need to dismiss patients from your practice- and once you find yourself asking these questions seriously, it’s time to take appropriate action.

Ending the relationship must be done properly. The Dental Practice Law of Colorado addresses grounds for disciplinary actions as “Failing to provide reasonably necessary referral of a patient to another licensed dentist or licensed health care professionals for consultation or treatment when the failure to provided referral does not meet generally accepted standards of dental care;” (C.R.S. 12-220-130 (1) (W)). Failing to dismiss a patient from your practice properly could put you in violation of this provision.

Here are some recommendations to include in a dismissal letter to a patient

• Advise the patient to immediately seek the services of another dentist (you may refer them to an appropriate dentist or dentists for treatment).
• Advise the patient of the reasons for dismissal (i.e. Failure to follow through with recommended treatment).
• Advise the patient of conditions that require follow up or evaluation.
• Advise the patient that you will be available for any dental emergency for the next 30 days.
• Advise the patient that you will provide a copy of their records upon recieved a Release of Information request and attach a copy of a release to the letter (this can be obtained from the ADA or tdplt.com).

Remember, the patient is entitiled to a copy of their records. Although you may charge for a copy of the rcords, in this case it is probalby best to provide a copy at no charge.

Your letter should be sent both registered/certified mail and first-class mail. Retain a copy for the patient chart. Do not send a TEXT dismissing the patient. This places you at risk for a HIPAA violation.

What if the patient has a balance on their account? While sometimes hard to do, consider giving yourself the “gift” of writing off the balance and leaving a clean slate. Trying to collect at this point will most likely only prove to be a source of frustration and additional cost. Allow yourself to move on, let go, and be happy.

What if the roles are reversed and you find yourself being dismissed by the patient? If this occurs, put your pride aside and follow the previously mentioned steps to ensure that the patient is aware of their continued need for dental treatment so there is no risk of abandonment on your part. Send a letter reinforcing that the patient has informed you of the change in practitioners and remember to make the patient records available upon request.

Finally, breaking up doesn’t have to be hard to do. Communicate well and you can have harmonious outcome.

Contact Dr. Geck at the Dentists Professional Liability Trust of Colorado for more guidance on a dismissal letter [email protected]

By Sarah D. Parsons, D.D.S., Private Practice Dentist and Associate Executive Director of The Dentists Professional Liability Trust of Colorado.

Dr. Candace DeLapp, the former executive director of the Trust use to say:

“Your clinical notes are like a fire- they can either keep you warm on a cold night or burn your house down.”

It’s a simple statement, but it captures one of the most important principles of professional liability: your clinical records can become either your greatest asset or your worst enemy.

Your memory isn’t a defense, your records are.

Imagine receiving a board complaint or request for records on a pending lawsuit about a patient you treated several years ago. You may think you remember the patient, the procedure, the conversation had, the details… but truth is if isn’t written in your records… it didn’t happen.

You won’t remember every detail. That is why throughout documentation in your clinical notes are imperative. You can review it line by line, detailing the encounter.

When a complaint arises, your clinical notes can help tell that story of what really happened. What you diagnosed, what you recommended (alternative treatment and risk of no treatment), what you discussed with the patient, ultimately what the patient chose, what treatment was completed, complications or adverse outcomes, follow up, referrals, and patient’s demeanor.

If it isn’t documented… it didn’t happen. It’s that simple

If you don’t document details then it didn’t happen. It becomes a simple she said vs he said.

Good notes tell a story of the patient’s care.

“Crown placed. Patient tolerated procedure well.” Is not a good story and will often be that fire that burns your house down should a complaint arise.

A good clinical note should provide enough meaningful information that another dentist, attorney, investigator, or licensing board, can understand the whole scope of care.

A good documentation could include the following:

• Patient’s presenting cheif complaint
• Clinical and radiographic findings
• Your diagnosis and differential diagnosis
• Treatment recommendations, alternatives, and risk of no treatment
• Risks, benefits, and potential complications
• Patients questions and concerns
• Patients decision to accept, delay, or decline treatment
• Informed consent for procedure both verbal and written
• Relevant medical history and medical history changes
• Blood Pressure
• Detailed Anesthetic amounts administered including amounts of epi
• Details of procedures performed
• Post op instructions given
• Risks post operatively
• Referrals or consultations
• Follow up recommendations
• Significant communications with the patient

Avoid a “CYA” note. Good documentation includes “just the facts”. Avoid judgmental, inflammatory, or emotional language.

NEVER ALTER THE STORY AFTER THE FACT.

If you realize you forgot something or want to add to your clinical notes at a later date, follow your electronic health records proper procedure for adding an addendum to the note. DO NOT go back and rewrite the original note as though it had been entered contemporaneously.

The integrity of your notes matter. A transparent late entry can help clarify the record. An altered record can create an entirely different and worse problem.

Keep your fire burning for you.

Dr. DeLapp’s famous words are worth remembering every time you sit down to finish your notes:

Your clinical records can keep you warm at night or burn your house down.

Take a few extra minutes. Document the findings, recommendations, conversations, patient decisions, care, and any communication that is relevant.

Because years from now, when you may or may not remember exactly what happened, your notes will be there to protect you.

QUESTIONS? Contact The Dentists Professional Liability Trust of Colorado at 303-357-2600 or email Dr. Sarah Parsons directly at [email protected]