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Balance and Boundaries: Ethical and Legal Considerations When Terminating Dental Practice Employees

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. TDIC’s risk management analysts caution dental practice owners to take steps to ensure that the process is handled appropriately.

Employee termination is one of the most difficult tasks that any dental practice owner may have to face. However, there are times when it becomes necessary to let go of an employee due to ethical or lawful reasons. While employment laws differ by state, The Dentist’s Insurance Company’s Risk Management Advice Line analysts can guide practice owners on the best path to take when navigating this sensitive issue.

An Employee Termination Case Study

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, 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.

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 pick up 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 healthcare premium.

Ethical and Lawful Reasons for Termination

Employee termination can be a tricky and sensitive issue, but there are several ethical and lawful reasons for termination to be aware of. 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 should take certain steps to ensure that the process is handled appropriately. As a reminder, the best time to reduce potential risks of termination is before the employee is notified. TDIC’s analysts urge practice owners facing challenging employment issues to contact the Risk Management Advice Line before initiating a termination. Advice Line analysts have special 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, 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. You can talk to an agent to learn more about EPLI.

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. If you have questions about any employment or practice management issue, TDIC’s Risk Management Advice Line is available to assist you.

TDIC’s Risk Management Advice Line is a benefit to TDIC policyholders. To schedule a consultation with an experienced risk management analyst, visit or call 1.877.269.8844.

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