A dentist suspects a dental assistant of substance abuse and, on being confronted, the assistant confirms it. Each of the following is an appropriate next step EXCEPT one. Which is the EXCEPTION?

Correct answer: D. Dismiss the assistant immediately

• A. This IS appropriate and is regarded as supportive and constructive, though it is not obligatory.
• B. This IS appropriate. Referral to a treatment programme or a state professionals' health programme is the central action.
• C. This IS appropriate. While treatment is arranged the individual must be monitored, and any duties involving patient safety or access to controlled drugs restricted.
• D. CORRECT — this is the EXCEPTION. IMMEDIATE DISMISSAL is not the appropriate first response. Substance use disorder is a treatable illness, and the professional obligation — as with an impaired colleague — is to protect patients while directing the person toward help. Summary dismissal abandons the individual, removes any leverage to secure treatment, and in many jurisdictions raises disability-discrimination exposure.

Note: The governing principle is that patient safety comes first and is non-negotiable — remove the person from unsafe duties at once — but the response to the PERSON is treatment-oriented rather than punitive. Dismissal is a last resort after treatment has been refused or has failed.