17 Mar Jon Cartu Writes: COVID-19 (coronavirus) Updates
Please note: This document does not constitute legal advice. CDA recommends checking with legal counsel regarding specific employment scenarios. Feel free to contact CDA Practice Support or your liability carrier’s risk management department if you need an attorney referral.
Why is CDA recommending dental office closures?
CDA is strongly advising dental offices to limit patient treatment to only care for those patients with urgent oral health needs. Reducing patient visits to urgent care only will reduce risk of disease exposure for your patients, your staff and yourself.
How do we define urgent versus nonurgent procedures?
Dentists should proceed with treatment if the patient is in pain, if infection is present or if nontreatment will severely inhibit normal operation of a patient’s teeth and mouth or negatively impact their health in the next three to six months. Patients who have received recent treatment requiring the removal of sutures would also be considered appropriate for treatment. All other treatments can be delayed until the COVID-19 crisis has eased.
How long do we keep our practice closed? How will we know when it is safe to open our doors again?
Returning to practicing dentistry full time will require dentists to assess the risks of doing so. If public health officials see positive indications of slow disease spread and possible containment, the recommendations for social distancing may ease. As time goes on and more is understood about the virus, such as how long it remains infectious in the air and on different surfaces, scientists can make better recommendations on how individuals can protect themselves from the virus. In addition, the PPE supply chain may be improved so that sufficient PPE is available.
What protocols should be used when we treat patients requiring urgent care?
Patients should be screened for active disease prior to providing dental care in the office. Take note of:
To reduce the production of aerosols during dental treatment, which is also advised during this time of increased transmissibility:
- Avoid or minimize operations that can produce droplets or aerosols; use rubber dams as much as possible.
- Rinse the oral cavity slowly, avoiding unnecessary splatter.
- Use high-speed evacuation for all dental procedures producing an aerosol.
- Have patient use an antimicrobial rinse before starting a dental procedure; ADA suggests using 1% hydrogen peroxide.
- Avoid or minimize procedures that may induce coughing, such as taking routine intraoral X-rays.
If our staff has agreed to assist with treating patients needing urgent care, should we document that they are comfortable working in the current environment?
As long as there isn’t a direct or imminent threat of harm to the employee and the office is complying with all OSHA and CDC guidelines for infection control (including taking patient temperatures), it should not be necessary to have an employee sign any documentation for continued work. You should continue to encourage sick employees and patients to stay home and send anyone home who arrives at the office and is exhibiting symptoms of illness.
Can we require that employees use any sick leave/PTO prior to paying them for time they are not working?
Note: CDA continues to monitor pending federal legislation to address family and sick leave due to COVID-19 and will update members accordingly. The information below is based on current state and federal laws.
An employer cannot require the use of unused paid sick leave; that is the employee’s choice. If the employee decides to use paid sick leave, the employer can require they take a minimum of two hours of paid sick leave. The determination of how much paid sick leave will be used is up to the employee. Employers can visit the Department of Industrial Relations’ California Paid Sick Leave: Frequently Asked Questions.
If an employee does not qualify to use paid sick leave or has exhausted sick leave, other leave may be available (see question below regarding other payments available through the state). If there is a vacation or paid time-off policy, an employee may choose to take such leave and be compensated provided that the terms of the vacation or paid time-off policy allows for leave in this circumstance. Employers should review their current policies and discuss with employees.
Can we allow employees to take unpaid leave due to school closures and the need to take care of their children?
Keep in mind that pending federal and state legislation may change sick leave and unpaid leave laws dramatically but, currently, employees at practices with 25 or more employees may be provided up to 40 hours of leave per year for specific school-related emergencies such as the closure of a child’s school or day care by civil authorities (Labor Code section 230.8).
Whether that leave is paid or unpaid depends on the employer’s paid leave, vacation or other paid time-off policies.
Employers may require employees use their vacation or paid time-off benefits before they can take unpaid leave but cannot mandate that employees use paid sick leave. For example, CDA’s Sample Employee Manual template policy stipulates employees are required to exhaust vacation or PTO prior to taking any unpaid time.
A parent or guardian may choose to use any available paid sick leave to be with their child as preventive care.
The law does not require employers to provide unpaid personal leave. An employer may decide whether to provide unpaid personal leave, if there are any eligibility requirements for unpaid leave, the amount of time available, which benefits are continued during leave and the employee’s reinstatement rights. Employers should document the requirements or restrictions in their employee policies. Policies should be applied fairly and evenly to all employees who are covered by the benefit.
As a best practice, in order not to extend unexpected leave indefinitely, employers should outline the details of the personal leave agreement in writing, such as anticipated dates of leave, the reevaluation of extending leave depending on the current situation, any health coverage premium payment agreements, and communication expectations.
Employees experiencing missed work because of school closures may also be able to file an unemployment claim.
Can we lay off employees so they can get unemployment and then rehire them?
In the event of a schedule reduction or practice closure, employers are not required to lay off or terminate employees they intend to continue to employ. Partial unemployment claims are available for employees whose employers want to keep them when there is a lack of work. The employer certifies that the employee is expected to return to work and gives them a form to file (DE 2063) for an unemployment insurance claim. More information is available from the EDD here.
What resources are available for our employees if we can’t pay them?
Partial wage replacement may be available to those employees through the EDD. See above.
Reporting-time pay hourly employees: In the event of a mid-day closure and if an employee is furnished less than one half of their scheduled hours, the employee must be compensated for at least two hours, or no more than four hours, of reporting time pay. If employees are notified of a practice closure, then an employer is not obligated to pay an hourly employee.
Pay for salaried employees: An employee is exempt if they are paid at least the minimum required salary and meet the other qualifications for exemption. Federal regulations require that employers pay an exempt employee performing any work during a week their full weekly salary if they do not work the full week because the employer failed to make work available.
An exempt employee who performs no work at all during a week may have their weekly salary reduced. This is further explained in the CDA article, “Proceed with caution when making pay deductions for salaried employees.”
What are the compensation and leave requirements for hygienists?
Hygienists are considered employees of the practice and should be eligible for any of the above leaves of absence if they meet the eligibility requirements of the policy. For example, if a hygienist works 30 or more days in a 12-month period for the employer, the hygienist would be eligible to receive paid sick leave benefits in accordance with the employer’s paid sick leave policy. More is included in the CDA Practice Support Guide to California Paid Sick Leave Law.
What is our liability if an employee gets infected in the office?
If an employee should become ill or injured as a result of work or while at work, the employer should contact their workers’ compensation carrier and follow the claims process. Whether the employee would be covered by workers’ compensation insurance would be determined on a case-by-case basis.
Additional employment resources:
EDD Coronavirus 2019 (COVID-19) FAQs
Unemployment Insurance Claim checklist
Coronavirus Disease (COVID-19) – FAQs on laws enforced by the California Labor Commissioner’s Office
Simplified table of Benefits for Workers Impacted by COVID-19
What financial assistance will be available for small businesses to help pay costs when no income is being generated?
We recognize closure of the dental practice will have an economic impact. Please know that CDA will continue its advocacy on behalf of the profession to seek economic relief at the federal and state levels.
U.S. Small Business Administration is offing relief to businesses impacted by COVID-19.https://www.sba.gov/page/guidance-businesses-employers-plan-respond-coronavirus-disease-2019-covid-19
Small Business Administration disaster assistance loans will be available to small businesses that have been severely impacted by the situation. More information is available in this California OES news release.
In addition, local city assistance may be offered, and…