12.3 Dentist Impairment and the Dental Board's Diversion Program

The ethical duties (K2091, K2092)

ADA Section 2.D (Personal Impairment):

• It is unethical to practice while abusing controlled substances, alcohol, or other chemical agents that impair the ability to practice.
• All dentists must urge impaired colleagues to seek treatment, and those with first-hand knowledge must report to a dental society's professional assistance committee (Section 11.1).

Advisory Opinion 2.D.1 (Ability to Practice) reaches beyond substances. A dentist who "contracts any disease or becomes impaired in any way that might endanger patients or dental staff" must:

1. Get consultation and advice from a qualified physician or other authority (K2091).
2. Limit practice to areas that do not endanger patients or staff (K2092).
3. Keep monitoring the condition and add limits as needed.

Examples of limiting practice include stopping surgical procedures during a hand tremor while continuing consultations, not administering sedation while taking sedating medication, taking leave during an episode of severe depression, or following a physician's work restrictions after an infectious illness.

The CDA Code's competence value makes the same point: competence requires "continual self-assessment."

California law on impairment

The diversion program (K2093)

Purpose (§ 1695): to identify and rehabilitate licensees whose competency may be impaired by abuse of dangerous drugs or alcohol, so they can return to practice safely, as a voluntary alternative to traditional discipline. The program addresses substance abuse. Mental or physical illness without substance abuse is handled under §§ 820–822.

Who must enroll: participation is voluntary unless the Board orders it as a condition of disciplinary probation (§ 1695.5(a)). A licensee not under investigation may self-refer confidentially. A licensee under investigation may ask to enter, but may have to sign a statement acknowledging that violations can still be investigated and disciplined (§ 1695.5(b)–(c)).

Eligibility (16 CCR § 1020.1):

• Is a California-licensed dentist or dental auxiliary and lives in California.
• Abuses narcotics, dangerous drugs, or alcohol in a way that may affect safe or competent practice.
• Voluntarily asks to be admitted.
• Agrees to medical or psychiatric evaluations, provides releases, and agrees in writing to follow the treatment program and pay its costs.
• Has not been convicted of a crime involving the sale of narcotics or dangerous drugs.

Committees: each diversion evaluation committee has six members: three licensed dentists, two public members, and one physician or psychologist, all experienced with impairment (16 CCR § 1020.4). Committees evaluate applicants, designate treatment facilities, review progress, and decide whether the licensee can safely keep practicing (§ 1695.6). They may deny admission to someone who won't benefit or poses too great a risk, and may terminate participants who don't comply (16 CCR §§ 1020.2–1020.3).

Benefits and limits:

• If an investigation is based mainly on self-use of drugs or alcohol, or illegal possession or procurement for self-use, with no direct harm to the public, the Board closes it when the licensee successfully completes the program (§ 1695.5(d)).
• Records are confidential and not subject to discovery or subpoena, and they are purged after successful completion (§ 1698).
• Participation does not shield other unprofessional conduct before, during, or after the program (§ 1695.5(e)).
• If the licensee withdraws or is terminated for noncompliance, or tests positive for a banned substance, the records go to the enforcement unit and may be used in discipline (§ 1695.5(f)).

Returning to practice

Recovery is expected and supported. A diversion participant may keep practicing if the committee finds it safe, sometimes with restrictions such as a practice monitor or no access to controlled substances. After revocation or suspension for illness, reinstatement under § 822 requires competent evidence that the condition is absent or controlled.

Worked scenario

Dr. Lopez realizes she has been taking leftover hydrocodone from her own patients' prescriptions to manage stress, and she once treated a patient after drinking. No complaint has been filed.

• Ethically, she should stop clinical practice, get a physician's evaluation, and seek treatment (ADA 2.D, 2.D.1).
• Legally, she may self-refer confidentially to the Board's diversion program, since she is not under investigation. Taking drugs for self-use violates § 1681 and Health and Safety Code § 11170.
• Completing diversion gets her structured treatment and monitoring, and records purged at the end. The program cannot excuse any patient harm she caused.