05/29/2015

What to expect when your employee is expecting


Not only must dentists stay up to date on advances in technology, they must also stay current on ever-changing employment laws. As owners or partners of practices, employee issues will always be of concern and importance to dentists. A pregnant employee usually prompts many questions and concerns in the office, for the dentist and the staff as well as the employee herself. It is best to know how to handle these situations before they arise, according to Michelle Corbo, CDA Practice Support analyst.

“When an employee learns of her pregnancy, she should inform her employer as soon as possible. As an employer, it’s an opportunity to say, ‘Congratulations!’ and provide a copy of the office policy manual for the employee to review leave policies,” Corbo said.

Corbo said it’s best to remain available should the employee have any questions she would like to discuss.

“Open communication during this time is vital. Have a discussion with your employee about how much time she expects to be away from the office. If she’s unsure, allow her the time to determine this as she progresses,” Corbo said. “Your office policy should indicate that all pregnant employees should provide a letter from a physician stating estimated delivery date, any special accommodations, work limitations and probable duration of the disability required — and keep a copy in her personnel file.”

CDA reminds dentists that this policy should be consistent with all the types of disability leave documents required by the dental practice. The information provided by the dentist need not contain more than stated above, and as with all medical information it is considered confidential.

Dentists should be aware of “pregnancy discrimination” because it is potentially a form of sex/gender discrimination. If a pregnant employee is temporarily unable to perform her duties, the dentist must treat her like any other employee who has a temporary disability. For offices with more than five employees, dentists must hold the pregnant employee’s job open for her for a maximum of four months, or 17 weeks and three days or 88 working days without reducing the skill level required or pay scale before, during or after her maternity leave. The amount of leave is determined by the employee’s health care provider and can be taken before or after the birth date, if needed.

“As a general rule, if an office of fewer than five employees provides leave for other types of illnesses or disabilities, it is advisable that the same leave be provided for pregnancy-related disability as well,” Corbo said.

Once an employer is notified of a pregnancy, the first obligation is to assess if there are any risks within the workplace for the pregnant employee.

CDA recommends the following:

  • Assess the risks to which a pregnant woman, woman who has recently given birth or woman who is breastfeeding is exposed and the length of the exposure.
  • Inform any employee concerned with identified risks with information on the control/protective measures that will be put in place.
  • Determine the practical measures to be implemented in the workplace to protect against the risks.

“There are concerns around exposures to mercury, radiation and certain chemicals, including nitrous oxide, by women or men who are trying to conceive as well as by pregnant women. To be cautious, it is best to have a pregnant staff member, or one who is trying to conceive, refrain from being in the same operatory where nitrous oxide is being administered, unless the employee’s physician states otherwise,” Corbo said.

Even the best scavenger system does not prevent exposure to nitrous oxide gas as patients can have their mouths open during procedures allowing the gas to escape, according to Corbo.

It is important for office staff to be aware of the workplace risks for pregnant employees and to discuss ways in which the entire office can accommodate such employees without drastically altering the office environment. A letter from the employee’s physician may also advise how long she should avoid or limit exposure to specific substances, or avoid or limit performance of specific tasks. The employee should provide this physician’s letter to the employer, who should place it in the employee’s personnel file.

The California Radiation Control Regulations state that each licensed dentist must instruct occupationally exposed individuals on the health risks associated with radiation. Licensed dentists are responsible for knowing the following regulatory provisions:

  1. The licensed dentist shall ensure that the dose to an embryo/fetus during the entire pregnancy, due to occupational exposure of a declared pregnant woman, does not exceed 0.5 rem (5 mSv).
  2. The licensed dentist shall make efforts to avoid substantial variation above a uniform monthly exposure rate to a declared pregnant woman so as to satisfy the limit in paragraph (a) of this section.
  3. The dose to an embryo/fetus shall be taken as the deep-dose equivalent to the declared pregnant woman.
  4. If the dose to an embryo/fetus is found to have exceeded 0.5 rem (5 mSv), or is within 0.05 rem (0.5 mSv) of this dose, by the time the woman declares the pregnancy to the licensed dentist, the dentist shall be deemed to be in compliance with paragraph (a) of this section if the additional dose to the embryo/fetus does not exceed 0.05 rem (0.5 mSv) during the remainder of the pregnancy.

Employers should provide a pregnant employee with a personnel-monitoring device (dosimeter) to wear at all times while in the office. Results from the dosimeter can be provided to the employee and kept in the employee’s medical record. Employers can inform an employee of the risks of radiation exposure by providing a copy of Section XIII of the Radiation Safety in Dental Practice – A Study Guide, available on cda.org/practicesupport.

For pregnancy leave requirements, dentists can view the California Department of Fair Employment and Housing brochure, “Pregnancy Leave,” DFEH-186 (11-14), which is available at dfeh.ca.gov.

After a pregnancy disability leave or transfer, an employee is guaranteed a return to the same position and can request the guarantee in writing. If her same position is no longer available, such as in a layoff due to plant closure, the employer must offer a position that is comparable in terms of pay, location, benefits, working conditions, job content and promotional opportunities, unless the employer can prove that no comparable position exists, according to Corbo.

“As an employer, a dentist should be aware of legal and practical considerations affecting pregnant employees and those trying to conceive. It is wise to prepare office systems and procedures in advance so that your office will run more smoothly when one of your staff members announces that she is expecting,” Corbo said.

State law requires every employer to provide a reasonable amount of time to accommodate an employee who desires to express breast milk for her infant child. If possible, the time used to express milk should be at the same time as the rest break already provided to the employee. If they do not occur concurrently, the time used for expressing milk that does not occur during the allowed rest break time shall be unpaid.

An employer must also make reasonable efforts to provide the employee with the use of a room or other location, other than a toilet stall, in close proximity to the employee’s work area, for the employee to express milk in private. 

“In the course of your role as an employer, you will likely encounter a pregnancy leave of absence. You must do your due diligence and follow all disability laws. The cost of not providing the leave for your employees could be very costly to your practice,” Corbo said.

For more information on fair employment, visit dfeh.ca.gov. For a list of vendors of personnel monitors for radiation, nitrous oxide and other chemicals, visit cda.org/practicesupport.

Related Items

Many dental practices, because of their small size, may not be required to provide benefits to employees under the Family and Medical Leave Act (FMLA) or the California Family Rights Act. However, there may be other laws that do apply to employee leave. We have listed the four types of leaves for baby bonding/pregnancy that dentists and their staff should be aware of as well as a description of who is eligible and the amount of leave available under each type.

CDA Regulatory Compliance Manual
This guide  includes excerpts from California Radiation Control Regulations Title 17. Dental practices with x-ray equipment are required to have a copy of this guide or a copy of Title 17. They also are required to have a written radiation safety program. A template for a radiation safety program is included in the guide, as well as information to provide pregnant employees. This guide is part of the CDA Regulatory Compliance Manual. Updated December 2014

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