Effective Date of Rule: Thirty-one days after filing.

     Purpose: New WAC 246-817-450 and 246-817-460, sexual misconduct rules for dentists, the purpose of the sexual misconduct rules is to establish clear definitions for sexual misconduct by dentists. In its efforts to ensure public safety, the commission is helping dentists avoid sexual misconduct and educating consumers regarding what they should expect from health care providers.

     Statutory Authority for Adoption: RCW 18.32.0365 and 18.130.050 (1) and (12).

      Adopted under notice filed as WSR 06-21-105 on October 17, 2006, and 07-13-098 on July [June] 20, 2007.

     A final cost-benefit analysis is available by contacting Allen Spaulding, P.O. Box 47867, Olympia, WA 98504-7867, phone (360) 236-4863, fax (360) 664-9077, e-mail al.spaulding@doh.wa.gov.

     Number of Sections Adopted in Order to Comply with Federal Statute: New 0, Amended 0, Repealed 0; Federal Rules or Standards: New 0, Amended 0, Repealed 0; or Recently Enacted State Statutes: New 0, Amended 0, Repealed 0.

     Number of Sections Adopted at Request of a Nongovernmental Entity: New 0, Amended 0, Repealed 0.

     Number of Sections Adopted on the Agency's Own Initiative: New 2, Amended 0, Repealed 0.

     Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 0, Amended 0, Repealed 0.

     Number of Sections Adopted Using Negotiated Rule Making: New 0, Amended 0, Repealed 0;      Pilot Rule Making: New 0, Amended 0, Repealed 0; or Other Alternative Rule Making: New 2, Amended 0, Repealed 0.

     Date Adopted: December 19, 2007.

Pramod Sinha, DDS, BDS, Chair

Dental Quality Assurance Commission

OTS-9114.4

SEXUAL MISCONDUCT RULES FOR DENTISTS
NEW SECTION
WAC 246-817-450   Definitions.   (1) "Dentist" means an individual applying for a credential or credentialed specifically as defined in chapter 18.32 RCW.

     (2) "Health care information" means any information, whether oral or recorded in any form or medium that identifies or can readily be associated with the identity of, and relates to the health care of, a patient.

     (3) "Key party" means a person legally authorized to make health care decisions for the patient.

     (4) "Legitimate health care purpose" means activities for examination, diagnosis, treatment, and personal care of patients, including palliative care, as consistent with community standards of practice for the dental profession. The activity must be within the scope of practice of the dentist.

     (5) "Patient" means an individual who receives health care services from a dentist. The determination of when a person is a patient is made on a case-by-case basis with consideration given to a number of factors, including the nature, extent and context of the professional relationship between the dentist and the person. The fact that a person is not receiving treatment or professional services is not the sole determining factor.

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     (a) Sexual intercourse;

     (b) Touching the breasts, genitals, anus or any sexualized body part except as consistent with accepted community standards of practice for examination, diagnosis and treatment and within the dentist's scope of practice;

     (c) Rubbing against a patient or key party for sexual gratification;

     (d) Kissing;

     (e) Hugging, touching, fondling or caressing of a romantic or sexual nature;

     (f) Examination of or touching genitals without using gloves;

     (g) Not allowing a patient privacy to dress or undress except as may be necessary in emergencies or custodial situations;

     (h) Not providing the patient a gown or draping except as may be necessary in emergencies;

     (i) Dressing or undressing in the presence of the patient or key party;

     (j) Removing patient's clothing or gown or draping without consent, emergent medical necessity or being in a custodial setting;

     (k) Encouraging masturbation or other sex act in the presence of the dentist;

     (l) Masturbation or other sex act by the dentist in the presence of the patient or key party;

     (m) Soliciting a date with a patient or key party;

     (n) Discussing the sexual history, preferences or fantasies of the dentist;

     (o) Any behavior, gestures, or expressions that can reasonably be interpreted as seductive or sexual;

     (p) Sexually demeaning behavior including any verbal or physical contact which can reasonably be interpreted as demeaning, humiliating, embarrassing, threatening or harming a patient or key party;

     (q) Photographing or filming the body or any body part or pose of a patient or key party, other than for legitimate health care purposes; or for the educational or marketing purposes with the consent of the patient; and

     (r) Showing a patient or key party sexually explicit photographs, other than for legitimate health care purposes.

     (2) A dentist shall not:

     (a) Offer to provide health care services in exchange for sexual favors;

     (b) Use health care information to contact the patient or key party for the purpose of engaging in sexual misconduct;

     (c) Use health care information or access to health care information to meet or attempt to meet the dentist's sexual needs.

     (3) A dentist shall not engage in the activities listed in subsection (1) of this section with a former patient or key party if the dentist:

     (a) Uses or exploits the trust, knowledge, influence or emotions derived from the professional relationship; or

     (b) Uses or exploits privileged information or access to privileged information to meet the dentist's personal or sexual needs.

     (4) When evaluating whether a dentist has engaged or has attempted to engage in sexual misconduct, the commission will consider factors, including but not limited to:

     (a) Documentation of a formal termination;

     (b) Transfer of care to another health care provider;

     (c) Duration of the dentist-patient relationship;

     (d) Amount of time that has passed since the last dental health care services to the patient;

     (e) Communication between the dentist and the patient between the last dental health care services rendered and commencement of the personal relationship;

     (f) Extent to which the patient's personal or private information was shared with the dentist;

     (g) Nature of the patient's health condition during and since the professional relationship; and

     (h) The patient's emotional dependence and vulnerability.

     (5) Patient or key party initiation or consent does not excuse or negate the dentist's responsibility.

     (6) These rules do not prohibit:

     (a) Providing health care services in case of emergency where the services cannot or will not be provided by another health care provider;

     (b) Contact that is necessary for a legitimate health care purpose and that meets the standard of care appropriate to the dental profession; or

     (c) Providing dental services for a legitimate health care purpose to a person who is in a preexisting, established personal relationship with the dentist where there is no evidence of, or potential for, exploiting the patient.

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