Once a dentist begins treating a patient, he or she may not cease providing needed treatment without potentially incurring liability. The dentist and the patient, however, may mutually agree to discontinue treatment if appropriate efforts are made to facilitate referral to another dentist. In addition, the dentist may unilaterally withdraw from treatment if the patient is given appropriate notice of the dentist's intent to terminate the dentist-patient relationship and an opportunity to secure a new dentist. See also, “Patient Rights and Responsibilities,” later in this section. [[link to p.58]]
The following material includes general guidelines. The laws of each state may vary, and the reader may want to seek legal advice from an attorney licensed in the state where the health professional practices for specific guidance.
State and federal laws protect patients against being discharged from a practice for a number of reasons, including the following:
A dentist can terminate the dentist-patient relationship for the following reasons, as long as certain legal standards are met:
If a patient is discharged from a practice for a valid reason, the dentist must still ensure that the patient does not suffer harm as a result of the termination. First, the patient’s current condition must be considered; immediate treatment needs should be met to make sure that the patient’s condition is stable. If the patient is in a non-emergency condition, the dentist should provide the patient with a notice of intent to withdraw. The notice must inform the patient of the need for follow-up care and give the patient sufficient time to obtain the care. In the interim, the dentist should remain available to treat the patient, should the condition become acute. Finally, the notice should always be documented. One method for documenting notice is to mail a certified letter and maintain the receipt in the patient’s chart.
Four elements should be met in the letter informing the patient of the intent to withdraw from treatment:
Additionally, the dentist should inform the patient that a copy of the patient’s dental records will be sent to the new dentist after an appropriate release has been signed. Be aware that laws in some states dictate what the practice is allowed to charge for copies of the dental record. The letter should be sent by certified mail, return receipt requested. If the patient refuses the certified letter, the dentist should place the letter in the patient’s dental record, and another letter should be mailed by regular mail. These steps should be documented in the patient’s record. Your malpractice insurance carrier may have samples of letters that can be used when withdrawing from the treatment of a patient.
A certified letter is not necessary if the practice closes. However, you should still provide the patient reasonable advance written notice, at least 30 days, that the relationship will be ending. You should also inform the patient about how to seek the care of another dentist in the area, provide information about emergency care, and include advice for future treatment, if necessary.
If the patient ends the relationship for any reason, you should: