Episode 816: The OSHA Inspection That Shut Down an Ortho Practice

What this OSHA inspector seemed to feel was, okay, I'm here as OSHA. OSHA only cares about one
thing, the safety of employees. But from what I'm seeing, this practitioner is also not protecting
the public. I'm going to contact my connections at the Department of Public Health. Now you have a
tag team on you. You have two inspectors from different governing bodies. Welcome to Austin,
Texas, and welcome to the Dr. Phil Klein Dental Podcast. Before we jump into today's conversation,
we've got a quick favor to ask. If you're enjoying the show, hit that follow button, whether it's
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review. It only takes a minute, but it makes a big difference. It helps us reach more dental
professionals, bring you more incredible guests, and keep the conversations coming. We really do
appreciate it. Today's episode is a cautionary tale every dental specialty practice needs to hear.
were unpacking a real OSHA and public health department inspection in an orthodontic practice,
triggered by an employee complaint and driven by the belief that ortho practices really don't have
hazards. What followed was a cascade of citations, fines, mandatory office closure for two weeks,
and intense oversight that no practice wants to experience. This case is a powerful reminder that
OSHA and infection control requirements apply to every dental practice, and that the real cost of
noncompliance isn't just the fines, it's the downtime, disruption, and damage to a practice's
reputation. Our guest today is Dr. Carson Carpenter. Many of you have heard him before on our show,
as he is one of our regular contributors. He is a general dentist and president and CEO of
Compliance Training Partners. He is considered one of the top educators in the dental industry on
infection control, HIPAA, and OSHA. He is no doubt one of the most respected advisors to dental
offices related to handling inspections of the practice by either OSHA, Department of Health,
or even the Attorney General's office. Dr. Carpenter, welcome to the show. Thank you for having me
back, Phil. Yeah, we're very happy to have you on the show, Dr. Carpenter. There's no question our
listeners are highly engaged with your content. I don't know if it's out of fear or whatever
reason. They want to be in the know about what it's like to be surprised by an OSHA inspector,
what to say, how to manage it, and even more important, to be prepared so that if something like
that does happen, they have nothing to worry about. And of course, our main concern is to keep our
employees and our patients safe. And that's what this is all about. In this particular episode,
we're going to be talking about an employee who felt unprotected. Apparently this employee
understood OSHA requirements to the nth degree. That person was extremely knowledgeable on all of
what is expected of a dental office regarding the safety of their employees. So how often do you
see situations where staff recognize compliance gaps before the doctor does?
And then of course, that's an opportunity for that employee to weaponize it against the office.
if they feel they have a reason to do so. And in the case we're going to be talking about today,
this particular employee came from another practice, as you'll explain, and she went to an
orthodontic practice. And after working there for a little while, she realized, hey, this office
ain't up to speed. And that led to what we're going to be talking about today. Well, you know,
first of all, I see employees who often know maybe more than the practice owner does about OSHA and
safety and requirements. More often than you would think. And this was a typical scenario.
I've run into it so many times. Imagine that this particular employee left a general practice,
happened to be a very good general practice, a very OSHA aware and infection control aware
practitioner. She just thought that's the way the world was. She took a new job. She moved,
happened to be in an orthodontic office, could have been in any office, could have been in any
specialty. She was shocked to find out that they weren't taking many of the precautions that she
was used to. And of course, the answer to her, the response was, well,
this is an orthodontic office. We don't have those kind of hazards. But in fact, every specialty
office, including orthodontics, still has hazards, still has to comply with all the same rules and
regulations. And this particular woman openly. contacted OSHA.
Many times an employee will contact OSHA anonymously. They can do it anonymously.
In her case, she was very open about it. Hey, you won't work with me. You won't help. I've
contacted OSHA. So one of the first citations was for having no written OSHA hazard communication
program. They didn't have any documentation on that. They didn't have any documentation to prove
that they've done hazard communication training for the staff. So tell us why these foundational
requirements are so commonly missing in dental practices, especially some specialty practices.
And again, I'm going to address this as an orthodontic practice, but keep in mind this could easily
have been any other specialty. But in this case, the practitioner, the orthodontist,
actually seemed to be a pretty quality guy. trying to do the right thing. I think he sounded like
someone who's a very, very good clinician. But what he didn't realize, he seemed to think that
orthodontics was immune to this. For example, his response to the employee and when we talked to
him was this, we're an orthodontic practice. We don't have hazardous materials like a general
practice. We don't do procedures where you're exposed to blood-borne pathogens like an oral
surgery office. But here's the problem. An orthodontic office. You have phosphoric acid to X teeth.
You have hydrofluoric acid to X porcelain. You have plaster.
You have stone. You have alginate. And those materials, Dr. Carpenter, are certainly considered
respiratory hazards. Obviously, the dust can be inhaled into the lungs.
And also, the bloodborne pathogen argument doesn't hold because, obviously,
orthodontists are not doing as aggressive surgery as an oral surgeon, for sure.
But manipulating... brackets and wires easily can cause bleeding of the gums.
And that could lead to the spread of bloodborne pathogens in a number of different ways in a dental
practice, for sure. Exactly. You're right on with that, Phil, in that, okay, yes,
there's more blood in an oral surgery or a perio office or a general office, but there's still
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There's still saliva. For example, OSHA states that saliva in a dental setting is always considered
what's OPIM, other potentially infectious material. So all the same rules applied,
and this practitioner truly didn't think that they did. Yeah, it kind of surprises me that an ortho
practice would feel that they're not held to the same standard regarding OSHA requirements as any
other dental practice. Would you consider this an exception to the rule? More of an... for an ortho
practice to think this way? No, it's something we've run into quite often. Sometimes people feel
that their particular specialty is immune to these problems. And you know something in this case,
this orthodontist was a great guy. He really wanted to do the right thing.
But you stop and think about it. He went to dental school. Think about it. In dental school, you
never even run an autoclave. You go out, you have a license, you can start a business,
but yet you probably have very little infection control training now you go into a specialty an
orthodontic specialty training program a residency of some type and and of course you learn to be
an excellent clinician and i think you're told along the way the great thing about this particular
specialty you don't have nearly the hazards that you do in a general practice they're never really
taught about osha this practitioner once we told him uh what he should be doing it was more than
willing to do it it's it's it's too bad he he just he said you know i just never attended courses
on osha i attended courses on straight wire orthodontics and functional appliances and and i just
wasn't aware we got him turned around but it did cost him some money some time and a lot of
embarrassment so do you think in your experience dr carpenter that when it comes to orthodontic
practices and we're not targeting orthodontists here It's just that this episode is about a
practice that happens to be an orthodontic specialty practice that ran into all sorts of trouble
with OSHA because of his employee who felt that they were not following guidelines tight enough
where the employee felt protected. I assume that this mindset of being lax with CDC guidelines
doesn't happen very often in an ortho practice. You know, more common than you would think.
For example, let's take CDC guidelines. They say, Any handpiece connected to air or water,
the motor must be sterilized. Well, you'd be surprised just how many orthodontic offices are not
sterilizing the low-speed motor. But they're connected to air or they're connected to water.
The same rules apply. And again, I don't think, in this case particularly,
this orthodontist was not trying to cheat the rules. He simply didn't know. But the same rules
apply. Once he understood it, he was more than willing to turn things around. So in this case, the
inspection, the OSHA inspection escalated to the public health department.
And this probably happened, correct me if I'm wrong, because the office had no infection control
training in the practice. So in essence, in the absence of infection control training,
that's almost a guarantee that another agency will typically get involved. Is that what happened
here? Well, here's how it typically happens. Imagine again, we've even mentioned in a previous
podcast that the inspector comes in. The OSHA inspector has been alerted to a possible safety
violation by a disgruntled or unhappy employee, either anonymously if they want or openly,
but anyway, they come in. And it started out in this office the way you don't want it to start. can
we see your written training program for hazard communication? We don't have them. We don't have
hazardous chemicals. Well, okay. Can we see your bloodborne pathogens written program,
your exposure control plan? They didn't have that. Can we see a written infection control plan?
They didn't have it. So right away, what this OSHA inspector seemed to feel was, okay,
I'm here as OSHA. OSHA only cares about one thing, the safety of employees. But from what I'm
seeing, This practitioner is also not protecting the public. I'm going to contact my connections at
the Department of Public Health. Now you have a tag team on you. You have two inspectors from
different governing bodies. And I do want to mention, Dr. Carpenter, that this particular ortho
practice, the owner, told the OSHA inspector that they did have annual training for infection
control in the practice. But apparently there was no documentation of that. And of course,
we know what that means. You're right on with that, Phil. It's much like much like our records,
right? Our patient records. If it's not written down, doesn't matter if it really happened. If it's
not written down, it didn't occur in the same way. We need to do this to protect our business. And
that's why you can tell I'm really passionate about this because our colleagues. can protect
themselves so easily. It doesn't take that much time. It doesn't take that much expense. And if
we're going to run a business, we need to do this to protect ourselves. Otherwise, we're vulnerable
to our employees turning us in, to the public health department getting involved, to OSHA getting
involved. It's embarrassing. It's time consuming. It's expensive. It's easily remedied.
In this particular inspection, OSHA cited multiple violations related to day-to-day clinical
activities. And one of them was film processing chemicals. I was really surprised to hear that an
orthodontic practice today is even using the old film processing chemicals. Is this because the
orthodontist has been practicing so long that they're still using chemicals to develop their film?
And this may correlate to the fact that it wasn't particularly up to par on current CDC guidelines.
Well, first of all, I think you'd find it interesting that actually The practitioner wasn't that
long out of residency, only about five years, but he had purchased the practice. This practice came
with film-based radiography, hadn't yet upgraded to digital, was on the plan,
on the agenda to do. But that's right away when I saw film-based processing, you don't run into
that too often. Right now in this country, the statistics I see show about 85 to 90% of x-rays
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using NSK handpieces, you'll never look back. You know, this brings me back to a previous episode
that you did, Dr. Carpenter, episode 633. It was titled Brace for Impact,
Buying a Practice That's Not OSHA Compliant. And it really highlights... liability that comes with
buying a practice that's not compliant with OSHA and infection control guidelines.
Because as you mentioned in that episode, from the time you take ownership of the practice, you are
responsible for anything that went on there that's going on there currently,
actually. And you can't just tell the OSHA inspector, hey, I just bought that practice six months
ago. I'm working on it. You are responsible as if you owned it for forever. So that's something to
be really concerned about when you are doing your due diligence to buy a practice. And again,
this is an example of it with this orthodontist who was there actually not such a short time. Five
years is not really defensible to an OSHA inspector saying, I just got here. You know, I wasn't
aware that we didn't have systems in place. You know, I think there was a lot of that going on. You
buy a practice, you're spending a lot of money for it. you try to decide what things should i
upgrade in this case they had put a lot of money into new practice management system some
renovations to the building When really all they had to do in terms of OSHA compliance,
if they would have spent $1,500 and dedicated a little bit of time to it, it would have been easy
to be in compliance. But I see this often where younger practitioner buys an older practitioner.
And you know yourself, when you have a new regime, sometimes people aren't happy. To me,
it's a point that a young doctor is very vulnerable. You've got a staff that's been with Dr.
Smith. For 20 years, you're the new guy in town or the new girl in town. All of a sudden,
they're angry at you. They turn you in. And as this doctor asked me, well, it seems to me that the
former practitioner should have some liability here. What day did I assume the responsibility? I
said, the minute you signed the documents in that business was yours. It needs to be moved up to
priority number one, because I think you're at one of the most vulnerable times ever in your career
when you first buy a practice and are trying to take on a new staff and make them happy. So I want
to ask you this, Dr. Carpenter. When the public health department stepped in, they uncovered some
serious infection control failures. Autoclave monitoring is an example,
improper disinfection, and so forth. And they found that these breakdowns,
that they discovered when they did their inspection, suggest that the office does not have adequate
training. And that systemic problem of not having adequate training in the office is a big deal to
the Department of Health. It's a big deal to OSHA. And that got the office deeper into trouble.
Well, you know, I always say that compliance, you know, really begins and ends with training. And
the good thing about training, and this is why I'm a real believer in third party,
training whether it's a company like ours or another company or you've got someone who is got the
time to keep current with the laws who's providing the latest training the latest information from
osha from cdc from public health departments because training will help alert not only the
employees but the doctor to what things they should be doing like sterilizing all low-speed
motors, like getting rid of so-called cold sterile and heat sterilizing everything that can
possibly be heat sterilized, how to use barrier covers, how to use the right type of disinfectant
in the right situation. So to me, it all starts with training. Good training would have kept this
office out of trouble because, again, you take what I consider a quality clinician. A decent human
being like this particular orthodontist was, he even said to me, you know, if I'd had this training
in the beginning, I would have done all these things. They're not hard. They're not expensive.
They're not. So in the end, the office was shut down for two weeks and the doctor faced potential
license suspension, which is really serious. But we didn't talk about the fines. Tell us about the
actual cost of this in dollars that was imposed upon the practice. And I know when we talk about
fines, you often say that that's the least of it. So I want you to comment on your thoughts on
that. You know, I always say it and I always will say it. People are so worried,
so nervous. Practice owners about what will the OSHA fine be? What's a typical OSHA fine? They'll
ask me. I'll say, you know what? I find the typical OSHA fine is, you know,
five to $30,000 is what I tend to run into often. Now,
you know what? Let's split that in the middle. $15,000. $15,000 is not going to put.
any of us out of business. It never feels good, right? It's not a business deduction, by the way.
That's in after-tax dollars. So that means what? You need to earn probably,
what, to pay $15,000? You need to earn $30,000. But anyway, what will really cause harm is,
first of all, your reputation. Take an orthodontic practice. You know how much people love their
kids. How would you like to read in the local paper that the doctor...
the specialist, the orthodontist you're taking your child to, is being closed down for a couple of
weeks by the public health department. This is all public domain information. Simply the fact that
it's closed down, we all know what we have to produce per hour just to pay the bills. And staff,
we all know how hard it is to get and maintain quality staff.
and then to keep them happy when they're there. So to me, this is where it becomes really
expensive. This is why we need to be in compliance. The fines are the least of our problems.
It's the terrible damage it'll do to our business and those other three areas. Yeah, I think
there's no question that a person's integrity, their reputation is everything in life. And I think
that applies obviously to a dental practice. I'm just wondering whether a patient typically digs
that deep to investigate whether or not that practice has been inspected by OSHA and what the
findings have been. What's your feeling on that? Surprisingly, we have seen many patients who are
sophisticated enough to not only check out online reputation, health grades, but to also see if
there are any violations. Pretty easy to check out the state board of dentistry,
the state public health department, particularly if it's their family, their children, they're
concerned about this. This is a trend that we see. So the take-home message,
Dr. Carpenter, is pretty simple. Whether you're an orthodontist, general dentist, or whatever, when
you own a dental practice, you are expected to follow the same guidelines that everybody else does.
There's no exceptions. And just because you feel you're not doing procedures that warrant the
stringent care and meticulous preparation that other dentists need to do because their services are
more aggressive induce more risk to bloodborne pathogens and everything else.
It doesn't matter. In the minds of the OSHA inspector, everybody's on the same playing field. No,
you're right. And I will be the first to admit, having practiced general dentistry for many years,
having spent a lot of time in every specialty office you can imagine, that an orthodontic office...
probably does have a few less chemicals. Certainly doesn't do the invasive procedures.
For example, you said not doing surgery. But still, it's like the OSHA regulations.
Someone says to me, well, do I have to follow OSHA regulations? I only have one employee.
Yes. If you have one employee, you have to follow the same OSHA regulations. You and I would fail
if we had a business that had a thousand employees. So it doesn't matter if you only have some
bloodborne hazards, some chemical hazards. We have to follow all the same regs or we can get in
trouble. I do want to share with the audience before we wrap up this podcast that you have an app
that essentially allows the office to do an audit, both for OSHA, infection control,
et cetera. And this audit could really help the office determine where they're deficient with their
compliance. exactly that's the first place to start is either download our app or you can write on
the website, actually go through and do an OSHA audit, an infection control audit, and for that
matter, a HIPAA audit. And really, as we're getting near the end, one thing I want to say to
everybody who's listening, I don't like to scare people. It really bothers me when people do
compliance podcasts or webinars or seminars and try to scare people. In fact,
what I'd like to mention is that don't be scared i've seen too many young practitioners who said
you know i don't think i want to own a practice this is scary this is too hard i don't know about
this compared to any class you took in dental school this is easy all you have to do is go through
an audit checklist assign a well-organized person in your office to oversee this program even if
they don't have experience using the checklist using resources like ours it's not going to cost you
that much money it's not going to take that much time it's not that hard don't let that ever be a
reason that you wouldn't want to own your own dental practice this is not difficult stuff And like
I mentioned earlier, if you're buying someone else's practice, you can't tell the inspector, well,
I just got here. I've been working on building out an operatory because you know what? They don't
care. They don't care. You are responsible day one for that office being compliant.
That's why due diligence is so important. You're right, Phil. And you know, a great thing is,
is you don't think of as dentists that we own intellectual property. But one of our clients said to
me recently, they recently retired and sold their practice. They said, you know, being in
compliance, I really had great intellectual property. I was able to sell my practice. at a bit
higher multiple because they were very impressed that on day one, this practice was in compliance
with OSHA, HIPAA, and infection control regulations. And you think about that. If you're looking at
two different practices to buy, which one would you want to buy? Which one would you pay more for?
Yeah, well, if I was buying the one that wasn't compliant, I would work that into the price. And
I'd say, listen, doc, I love your practice. I want to live here. The school system is great.
My kids want to move here. My wife wants to move here. But we have to take off $30,000 off the
price or more because if I got inspected the day after I take ownership of this place,
they're going to close me down. So there's a downside risk to that. And I need to get on top of it
immediately because I need to do it so quickly. It may cost me more money than if I had more time.
And I'm going to deduct it off the price. That's such a good point, Phil. That's absolutely a valid
statement. Yeah. All right. Well, listen, Dr. Carpenter, another good... Thank you so much for your
participation. We look forward to you doing some webinars this year. 2026 is going to be,
I know you have, I think four or five webinars planned. So I encourage all of our listeners to go
to VivaLearning.com. Check out Carpenter, C-A-R-P-E-N-T-E-R.
You can do that in the search bar. And you'll find all of his podcast episodes that he did with me
and also his upcoming webinars and his on-demand webinars. All good stuff. Thank you very much,
Dr. Carpenter. You're welcome, Phil, and see you next time.