As dental attorneys in Columbus, Ohio, Nardone Limited advises dentists and dental practices on a variety of matters, including labor and employment issues, human resource issues, as well as other legal issues that arise. As an example, we are occasionally asked to provide guidance to dentists regarding terminating the dentist-patient relationship. It is important for dental practices to be aware of its legal obligations when considering terminating a patient relationship.
Acceptable Reasons for Terminating a Patient
A dentist may consider terminating a patient for a variety of reasons, however, the reason must not be discriminatory. Terminations are discriminatory if the reason for the termination is based on race, gender, physical or mental disability, religion, age, or national origin. Generally, however, if a patient displays the following behaviors, the dental practice may be justified in terminating the dentist-patient relationship.
The Patient is Not Following the Dentist’s Treatment Plan.
If a patient is neglecting or refusing to follow the treatment plan provided by the dentist, the dental practice should consistently document the non-compliant behavior. This provides back-up to the dental practice in the event the patient claims that the dental practice terminated the patient for personal or discriminatory reasons. Before terminating a patient for non-compliance, the dentist should explore why the patient is not following the treatment plan and should work with the patient to overcome obstacles preventing the patient’s compliance. The steps taken by the dental practice to assist the patient in overcoming any obstacles should be documented in the patient’s chart. Finally, the dental practice should send the patient a warning letter, explaining the consequences of not following the dentist’s treatment plan before it terminates the patient. If the dental practice has sent the patient a warning letter and has also attempted to assist the patient in overcoming any obstacles that prohibit the patient from following the treatment plan, a termination letter may be an appropriate next step.
NL Comment: Before sending a termination letter to a patient, the dental practice should review the insurance contract related to that particular patient to ensure that the dental practice is not bound by any contractual obligations.
The Patient Verbally or Physically Threatens Staff Members.
If a patient verbally or physically threatens a dentist or the dental practice staff, it may be appropriate to bypass a warning letter and go straight to a termination letter. If a termination letter is sent to a patient for threatening behavior, the letter should include the specific reason for the termination, as well as the specific date and time of the incident(s).
The Patient Harasses Staff Members or Other Patients.
There are circumstances that arise within dental practices whereby patients harass staff members or other patients. In some instances, that harassment represents sexual harassment whereby they continuously make the staff members or other patients uncomfortable. There are other instances where the patient may make suggestive or inappropriate comments related to race, gender, religion, age, or national origin, as well. In those instances, the dental practice, as the employer has an obligation to take reasonable steps to protect its employees, and its patients, from this type of behavior.
The Patient Has Made No Effort to Pay Off Debts.
Before terminating a patient for failing to pay, the dental practice should work with the patient to set up a repayment plan. It is appropriate to send the patient a warning letter indicating that the patient’s bill is past due and that the failure to work with the dental practice to set up a repayment plan may result in a termination of the dentist-patient relationship. The payment plan offered by the dental practice should consider the patient’s financial situation when determining monthly payments. Finally, each patient should be given the opportunity to enter into a repayment plan if that option is also extended to another patients.
The Patient Is Drug Seeking.
Depending on the severity of the behavior displayed by the patient—such as criminal behavior—the dentist may terminate a patient for seeking out drugs without sending a warning letter. But, before immediately terminating a drug seeking patient, the dentist should investigate the patient’s behavior to see if the behavior is being caused by an underlying problem. If you are interested in learning more about how to identify drug seeking behavior, see our article on patients with substance abuse problems.
Regardless of the reason the dentist-patient relationship is ended, dental practices should establish office policies specific to each circumstance, to ensure that patient termination is done consistently and uniformly each and every time. Establishing an office policy for handling the situations listed above reduces the risk that a patient could claim they were discriminated against. In addition to establishing office policies, the dental practice should be diligent in documenting the patient’s behavior, as well as the steps taken by the dental practice to mitigate the patient’s behavior. Because the dental board takes patient abandonment very seriously, dental practices must be cautious that the dental practice is following the law. For more information on the legal obligations of a dentist terminating the dentist-patient relationship, see our prior blog article.
The dental attorneys at Nardone Limited can provide education and training to you and your staff regarding establishing policies and procedures regarding terminating the dentist-patient relationship. We specialize in representing dentists and dental practices in a variety of areas such as: (i) dental practice succession planning; (ii) dental practice purchase and sales; (iii) dental board matters; (iv) real estate matters, including lease agreements and commercial real estate purchases; and (v) employment-related matters. Contact Nardone Limited for more information related to our representation in matters affecting our dental clients.