Mental and Emotional Disabilities in Dental Offices

The Americans with Disabilities Act and c. 151B of the Massachusetts General Laws protects not only employees with physical disabilities but those with mental and emotional disabilities.   It is important for dental offices to make the correct decisions when employing someone who is perceived to have a mental or emotional disability.

The definition of a disability which may fall under the categories of mental or emotional disabilities is fairly broad, and any condition that “substantially limits”  a “major life activity,” such as learning, thinking, sleeping, working, interacting with others, and concentrating, can be considered a disability.  Some of the conditions fitting this definition include bipolar disorder, depression, anxiety disorder, personality disorder, and schizophrenia disorder.

In a dental office, an employee must always be able to show that he or she can perform the “essential functions” of a position in order to claim protection under disabilities statutes.  Since interacting with the public is an essential part of any dental practice, the employee must be able to work without significant interference with the practice’s ability to serve the public.  For instance, if an employee is rude to patients to the extent that he or she alienates them from the practice, but still claims that anxiety or another personality disorder makes it difficult to deal with patients all the time in a pleasant and courteous way, the dental practice can claim that the employee can’t fulfill an essential function of the position and can be terminated.  Some of the new investigative practices of the Massachusetts Board of Registration in Dentistry provide a basis for using this as a valid reason to terminate an employee, since there have been complaints of “rudeness” that have prompted the Board to initiate investigations which may result in disciplinary actions against the practice.  The employee also has to disclose the disability prior to gaining its protections, and the employer may then request an independent medical examination to determine the validity of the claim of mental or emotional disability.

Dental practice work can be a high-stress occupation with significant time constraints in performing detailed treatments with large numbers of patients efficiently and within appointment schedules.    Inability to deal with the stress inherently present in a dental office is not a valid reason to claim a protected disability.  Nor are problems with particular supervisors.

An employee can be dismissed because of misconduct if their mental or emotional disability surfaces enough so that they are breaking the rules of the workplace.  Having a written handbook stating the requirements of courteous behavior with patients and among other employees is a good idea.  Threats to coworkers are something that may allow an employer to terminate an employee if another employee’s safety is at risk.  Getting to work on time may be considered an essential function of a position, and an employee is not entitled to a flexible work schedule because depression makes it difficult to avoid being late to work.   However, occasional or isolated incidents of bizarre or inappropriate behavior are not considered “egregious” enough of a violation of workplace rules to terminate an employee with a mental or emotional disability.

An employee with an emotional or mental disability can request a reasonable accommodation, and the employer must work on an interactive basis to make that accommodation.  Flexibility of work schedules or a little less time having direct patient interaction, as long it is still possible to perform essential functions of a job within the office are examples of reasonable accommodations.   Accommodation with different less stressful work schedules, as long as essential functions are still performed, is also an example, perhaps used with those with anxiety disorders.

The employee’s personal life should not be examined by the employer to allow determine of whether a disability exists, for such information is confidential, and such an investigation may trigger protections of disability and privacy statutes in and of itself.   The determination of whether a disability exists is the job of an independent medical examination, if the employer requests one.  Employees with mental or emotional disabilities caused in large part by a difficult personal or family life can many times still function very well in the workplace, and are a class of individuals for which the statutes and the cases protecting mental and emotional disabilities are designed to protect.