2.4 Telehealth and Teledentistry: Consent, Standards of Care, and Geographic Limits

2.4 Telehealth and Teledentistry: Consent, Standards of Care, and Geographic Limits

The Law and Ethics content outline places telehealth inside the privacy and protected health information domain, and asks candidates to demonstrate knowledge of the requirements governing geographic limitations in providing telehealth and the standards of care and delivery of telehealth. California treats telehealth as a mode of delivery, not as a separate license or a relaxed set of rules — and that framing answers most exam questions on the topic.

What Telehealth Is (BPC § 2290.5(a)(6))

BPC § 2290.5(a)(6) defines telehealth as "the mode of delivering health care services and public health via information and communication technologies to facilitate the diagnosis, consultation, treatment, education, care management, and self-management of a patient's health care." The definition covers both synchronous interaction (live two-way audio-video) and asynchronous store-and-forward transmission of images, radiographs, and records for later review. "Teledentistry" is simply telehealth applied to dentistry; California law does not define it as a separate service category.

Telephone calls, secure email, and patient portal messaging can all fall inside the definition when they are used to deliver care rather than to schedule an appointment or confirm a balance.

The Consent Rule (BPC § 2290.5(b))

Before care is delivered by telehealth, the health care provider initiating the use of telehealth must inform the patient about the use of telehealth and obtain verbal or written consent from the patient. Two details matter for the examination:

1. The duty falls on the provider who initiates the telehealth encounter, not on a downstream consultant.
2. Verbal consent is sufficient — the statute says "verbal or written." What the statute does not excuse is documentation: the consent should be recorded in the chart, because the burden of proving it falls on the licensee.

BPC § 2290.5(d) states plainly that "the failure of a health care provider to comply with this section shall constitute unprofessional conduct." For a dental hygienist that means a telehealth consent lapse is a DHBC disciplinary matter under BPC §§ 1949 and 1950.5(l), not merely a documentation criticism.

Telehealth Does Not Expand Scope (BPC § 2290.5(e))

BPC § 2290.5(e): telehealth "does not alter the scope of practice of a health care provider or authorize the delivery of health care services in a setting, or in a manner, not otherwise authorized by law."

Apply that to supervision. BPC § 1902(c) defines direct supervision as supervision by a dentist physically present in the treatment facility. A live video link is not physical presence. Therefore an RDH may not administer local anesthesia, administer nitrous oxide-oxygen, or perform soft tissue curettage under BPC § 1909 while the dentist supervises by video from another site. Telehealth changes how information moves; it does not change where the dentist must stand.

By the same logic, telehealth does not let a hygienist diagnose. BPC § 1908(b)(1) excludes diagnosis and comprehensive treatment planning from the practice of dental hygiene whether the hygienist is chairside or on a screen, and BPC § 1927(a) separately bars an RDHAP from inferring, purporting, advertising, or implying that they can provide dental services or make any dental diagnosis beyond evaluating dental hygiene status.

Standards of Care and Geographic Limits (BPC § 2290.5(g))

BPC § 2290.5(g): "All laws and regulations governing professional responsibility, unprofessional conduct, and standards of practice that apply to a health care provider under the health care provider's license shall apply to that health care provider while providing telehealth services."

The practical rule the outline is testing is this: the law follows the patient's location. Care delivered to a patient who is physically in California is the practice of dental hygiene in California, and it requires a California license — BPC § 1915 permits only a licensed RDH, RDHAP, RDHEF, or dentist to perform dental hygiene procedures on patients in this state. A California licensee likewise cannot use a video link to deliver care into a state where they are not licensed, and cannot use telehealth to sidestep the California standard of care by claiming the encounter "happened" elsewhere. There is no telehealth exception to licensure in the Dental Hygiene Practice Act.

Teledentistry in the Dental Practice Act (BPC §§ 1684.5, 1910.5)

Two provisions integrate telehealth into supervised auxiliary practice:

• BPC § 1910.5(a) authorizes an RDH to (1) determine which radiographs to perform on a patient who has not yet been examined by the supervising dentist, following the dentist's protocols, and (2) place interim therapeutic restorations after the dentist's diagnosis, treatment plan, and instruction. Both duties are available in a dental office setting or in a public health setting using telehealth, as defined by Section 2290.5, for communication with the supervising dentist — expressly including schools, Head Start and preschool programs, and community clinics. BPC § 1926.05 extends the § 1910.5 duties to an RDHAP in specified settings.
• BPC § 1684.5 governs the supervising dentist's side. It permits an RDAEF, RDH, or RDHAP to determine and perform radiographs to aid a dentist in completing a comprehensive diagnosis and treatment plan using telehealth; confirms that a dentist "is not required to review patient records or make a diagnosis using telehealth"; requires that where treatment occurs outside the dentist's office, the patient receive written notice including the authorizing dentist's name, practice location address, and telephone number; and caps concurrent supervision at five such auxiliaries at a time.

Privacy Obligations Travel With the Data

A telehealth encounter is still a disclosure of protected health information. The HIPAA Security Rule (45 CFR Part 164, Subpart C) requires administrative, physical, and technical safeguards for the platform used; the California Confidentiality of Medical Information Act (Civil Code § 56 et seq.) applies to the resulting record; and a breach triggers the notification duties covered in section 2.3. Two practical safeguards the Board expects: use a platform that supports encryption in transit and will sign a business associate agreement, and conduct the encounter where the audio cannot be overheard by people who are not part of the care team.