Mobile Dental Vans Risk Management/Legal and Insurance Issues
a. What are risk management considerations?

The American Dental Association's Give Kids A Smile® Program Planning Guide provides an overview of legal, insurance and risk management considerations associated with access programs, which typically utilize portable and mobile equipment. The main risk to be considered is patient injury, but staff, family, and others may also sustain an injury in connection with the dental appointment such as slipping and falling.

Other considerations include patient abandonment and the need to adhere to the legal requirements associated with record keeping, privacy, abuse and fraud, and antidiscrimination. These are the same issues and risks that dental teams routinely manage in their daily practices.

Professional liability policies typically insure the dental team against malpractice risks. It is recommended that the dental provider check with his/her insurance company in regards to coverage, limitations, transporting and storing equipment. A rider on standard homeowners and automobile policies may be necessary to provide adequate coverage. Hygienists who only have malpractice insurance may have to take out a separate liability policy. There may be additional fees depending on the number of sites where services are provided. See an example provided by one RDHAP in California of insurance expenses for her portable practice.

Working in alternative practice settings can also provide challenges in the obtaining of appropriate informed consent. Determining if a person is legally competent to make treatment decisions is very important. You will need to obtain prior consent from the appropriate proxy (e.g., family member, guardian) if the person is not competent to make decisions. 

Some states require special permits to use portable equipment. Some facilities may require background checks and fingerprinting. Another legal consideration is the possible need for a written contract when working with nursing homes and other entities. It is important to work with an attorney to address such areas of emphasis as: facility responsibilities (e.g., space, equipment, and liability insurance); dental provider responsibilities (e.g., space, equipment, and liability insurance); types of dental services to be provided; hold harmless clause; contract term and amendment possibilities; fee schedule, management of emergency care and referral; patient scheduling; payment for services; arrangements for informed consent; legal responsibilities when the contract ends. 

Groups in California recently developed School-based Dental Services Guidelines for Mobile and Portable Programs Information Toolkit.