Subpoenas for Forensic Radiographs

At some point in his or her career, it’s possible that a dentist may be contacted and asked to assist in a forensic investigation. While these cases might require some extensive research, their potential to bring closure to a family that has lost a loved one makes the effort important and worthwhile.In the event that properly authorized investigators contact you with a subpoena or even a request for radiographs, it’s recommended that you:

•  Provide the original radiographs since even a very old radiograph that’s in good condition might assist them in identifying the victim.
  •  Providing duplicate or printed radiographs may delay victim identification since the copies may not offer any diagnostic value.
•  Include all types of radiographs — bitewings, occlusals, periapicals, panoramics, and cephalometrics that you have on file.
•  Indicate the date of exposure.
•  Indicate “right” and “left” on mounted radiographs or how you read the indicator bubble.
•  Label any envelope containing radiographs with the patient’s name, unique patient identification, and the number of individual radiographs in the envelope.
  •  Prevent accidental loss of the contents of any envelope containing loose radiographs by sealing them before releasing them to authorities.
  •  Create a precise list of what records you’ve released and keep copies of those records for your files.
•  Securely attach your business card to each mounted radiograph and/or envelope containing the records.
  •  Knowing whom to contact and how to reach the dentist providing the radiographs can make it easier for authorized investigators to clarify or confirm information that could be vital to an identification.
  •  Make certain that staples do not puncture any radiographs.
•  In cases where you know that other radiographs of the patient’s head and neck are on file with a hospital or specialist, provide investigators with the contact information for that practice or
• institution so they can request information from those sources.
•  Digital radiography and imaging are increasingly replacing traditional photographic X-rays.
  •  The benefits of digital radiography are that the images can be viewed instantly on any computer screen and manipulated to enhance detail and contrast.
  •  The images can be transferred or printed and digital sensors require 50-80% less radiation at the time of exposure.

Any available diagnostic casts for a suspected victim should be provided to investigators as well since that information could aid in an identification. There have been previous cases where incidental information, such as rugae patterns on submitted casts, has confirmed a victim's identity. Make certain that the patient's name and the date of the impression appears on the casts. Do not use pencil since those markings can come off or smudge during handling and delay the identification process. Securely wrap diagnostic casts in bubble wrap or loose packing material inside a case box to prevent damage during transit. Make sure your complete contact information is on the outside of any packaging.

The American Dental Association maintains this policy regarding victim identification:

Dental Radiographs for Victim Identification (Trans.2003:364; 2012:442)
Resolved, that the ADA promote to practicing dentists the importance of providing, as permitted by law, radiographs, images and records on patients of record that are requested by a legally authorized entity for victim identification and which will be returned to the dentist when no longer needed, and be it further resolved, that copies of these records should be retained by dentists as required by law.

Resources

Subpoenas for Dental Records 

The Guidance on HIPAA & Cloud Computing article on the U.S. Department of Health and Human Services’ (HHS) website