Renovating the Dental Office
Laws affecting a decision to renovate a dental office can complicate the process of getting the work done without unnecessary delays or expense caused by not foreseeing legal hurdles which must be surmounted before completing the improvements. Sometimes the improvements are done with an eye towards accommodating more patients such as the handicapped, in which case the Americans With Disabilities Act rules must be followed carefully. Zoning regulations can be a significant obstacle which must be looked at before towns or cities hold up improvements with permit delays. HIPAA concerns enter into the design of an office which will allow security and privacy of health information. Dental offices must be particularly attuned toward satisfying OSHA on waste management and sterilization to name just a few rules. Contractors can be difficult to deal with, and can hold up the process or cause cost overruns or delays which aren’t dealt with properly in contracts before they begin work.
Accessibility is always a primary concern, both for accommodating new patients with handicaps as well as meeting minimum disability act standards. As a facility open to the public, the Americans with Disabilities Act has specific requirements regarding size of doorways, counter heights, restrooms, elevators and parking lots, to name just some of the specific rules in the Act. Existing facilities are required to be accessible as long as the changes to the office are “easily accomplishable and able to be carried out without much difficulty or expense.” New construction is dealt with more specifically and has much stricter guidelines that have to be followed. With renovations, the costs of adding accessibility is not required if it exceeds 20% of the entire cost of the alteration. Both landlords and dental practice tenants have responsibility for meeting requirements, and most often the responsibility for these costs is written into the commercial lease.
HIPAA requires that security of protected health information, particularly the new technology dealing with electronic information (ePHI), be met with any new computer systems or other technology for transfer of that information. Additionally, large open areas within the practice sometimes make it difficult to meet HIPAA privacy concerns, so the design plans must take this into account from the outset.
OSHA compliance is always important, and numerous types of dental equipment must meet certain standards both in the physical equipment itself, where it is positioned and how it is used in the office. Plumbing issues must be dealt with, with necessary access to areas where cleaning out systems or correcting problems are ensured. The practice must also deal with the regulations governing x-ray equipment, handling mercury or amalgam in wastewater, and separating medical waste from other waste. Facilities must be designed to handle correctly other hazardous wastes also, and both OSHA and local laws deal with this issue.
State and local laws must be researched thoroughly before making changes to the office design. Building permits will not be granted until inspections by the local building inspectors are done and all codes are met to their satisfaction. The practice owner must make sure that contractors obtain these permits and build the costs of meeting codes into their estimates. Contractors have to be licensed properly to get these permits as well.
Contractors also must sign contracts for their work before hand to eliminate liability as well as duplicating costs if there are multiple contractors. Practice owners or those hiring these companies or individual contractors should obtain waivers before all payments are made indemnifying the practice from having to pay subcontractors in case the general contractors have financial difficulties or don’t’ pay their subcontractors properly. Otherwise a subcontractor who hasn’t been paid by the general contractor can ask for mechanic’s liens on the property until they are paid.
These are just a sampling of the legal considerations that must be made before taking an idea for renovating and obtaining the financing or estimating the costs for the project. An attorney can help guide you through the process and supplement the knowledge of the dental office design manager to ensure that costly and unforeseen legal difficulties interrupt the renovation.