As healthcare attorneys, we handle a myriad of compliance issues for our doctors and dentists. Patient abandonment is one of those compliance issues that sometimes arises for our dentists, as part of their overall treatment planning. It is important for dentists to (i) understand patient abandonment and (ii) know how to avoid it, as it can lead to dissatisfied patients, discipline by the dental board, and even legal claims involving professional liability. Basically, patient abandonment may occur if a dentist does not follow proper procedures for terminating an established dentist-patient relationship.
What Is Patient Abandonment?
Patient abandonment occurs when a dental provider terminates the dentist-patient relationship without reasonable notice or a reasonable excuse and fails to provide the patient with an opportunity to find a qualified replacement provider. Termination of a patient while treatment is in progress can be indicative of whether the patient would be considered abandoned. If the patient has not been given the opportunity to find a qualified replacement provider because of an inadequate time frame between notice and termination, the patient’s dental health could be at risk. Patient abandonment can also indicate that a dentist has violated the standard of care, which can give rise to a dental malpractice claim or may be grounds for discipline under Ohio Revised Code § 4715.30.
Practice Note: For purposes of this article, we are referencing Ohio law. Depending upon your state, you should review the relevant state and local codes.
Patient Termination: Reasonable Excuses and Reasonable Notice
Reasonable excuses for patient termination include situations in which a patient’s behavior in the practice is unacceptable or cases in which differences between the dentist, the practice, and the patient have been impossible to resolve. Examples of issues that provide a reasonable excuse include: (i) a patient not following their treatment plan; (ii) verbal or physical threats made by the patient; (iii) harassment by the patient of the practice’s staff or other patients; and (iv) no efforts made by the patient to pay off debts owed. A dentist has a right to terminate a patient if the dismissal is not for a discriminatory, and therefore legally impermissible, reason.
In Ohio, as an example, the following steps should be taken to terminate the dentist-patient relationship:
(1) The dentist should make all efforts to give the patient sufficient notice of termination of the patient’s dental services, which includes written notification to the patient as well as documentation in the patient’s chart of verbal communication with the patient.
(2) The dentist should make all efforts to stabilize the patient’s dental condition prior to the termination and not place the patient’s dental health in immediate jeopardy.
(3) If the patient or a subsequent treating practitioner submits a written request for records, copies of all records should be made available in a timely manner.
Following these three steps ensures the dentist is compliant with appropriate termination procedures and thereby demonstrates that the patient has not been abandoned.
(1) Develop a template for a patient termination letter.
When an issue of patient termination arises, if a template has already been created, a dentist can then fill in the details about the cause for the termination objectively and advise the patient of the necessity of finding another provider. Make sure the template includes the number of days that the dentist or dental practice will continue to treat the patient in the event of an emergency.
(2) Provide sufficient notice of termination and terminate using the correct delivery method.
Thirty days is usually considered a sufficient length of time between notice of termination and the termination. The notice should be sent to the patient by certified mail with return receipt requested to verify delivery. When using certified mail with return receipt requested, it is best to maintain a copy of the postmark and the date it was mailed, a copy of the front and back of the envelope to show it was properly addressed, and a copy of the contents included.
(3) Document the basis of termination as well as the steps followed.
A dentist or dental practice should document all patient interactions if there are signs that a patient may need to be terminated. This includes but is not limited to delinquent bills, interactions indicating noncompliance with treatment plans, disagreements with the patient, or other patient issues. Keep all documentation in the patient chart, whether the records are physical or electronic.
(4) Review the treatment plan with the patient prior to termination.
Patients should not be left with their dental health in jeopardy following termination. Therefore, the dentist should ensure that the patient is in stable dental health prior to termination, that the patient is aware of what procedures have already been completed, and that the patient understands any outstanding treatment that should be completed with another practitioner following the termination.
(5) Maintain copies of all records.
The practice should ensure that it has copies of all the patient’s records in case the patient or a subsequent provider requests the records.
(6) Perform patient audits.
Regular audits of patient records should be conducted to determine whether patients who are noncompliant with costs or treatment plans are seen on a regular basis, which can predict possible patient termination issues.
(7) Remain professional.
Patient terminations should be effectuated in a professional and cordial manner, and the issues should never be allowed to become personal.
In sum, complaints regarding patient abandonment are minimized simply by communicating well with our team members (i.e., employees) and our patients. As we advise our dental practices in other circumstances, it is all about documentation, documentation, and then more documentation. Or, put another way: If it is not in writing, it did not happen. We have found over the years that some doctors and dentists find their actions being questioned. This is not because they did something below the standard of care during the actual procedure but rather because documentation is lacking as to why they did or did not do something. So, to avoid a patient abandonment complaint: document, document, and document.
Vince Nardone is a partner with Benesch, with a focus in Benesch’s healthcare practice, and specifically a leader in the dental industry. He is a thought leader and regular speaker in the dental industry. He may be reached at (614) 223-9326 or firstname.lastname@example.org.