Understanding the Common Pitfalls of Patient Abandonment

Often in practice, a dentist whether generalist or specialist is confronted with a complexity of legal, ethical and financial situations which can complicate everyday practice. Patient abandonment is one of these issues that will often cause practitioners to consult with their local dental societies, state dental boards or malpractice carriers and seek guidance on how to navigate this possible pitfall.

Patient abandonment is defined as “a form of malpractice that occurs when a dentist terminates the doctor-patient relationship without reasonable notice and fails to provide the patient with an opportunity to find a qualified replacement.”¹  Often declining to treat a patient can result in a “negligent termination” of the relationship if the provider has failed to provide the necessary continuity of care required to complete the course of treatment.²

The ADA Principles of Ethics and Code of Professional Conduct states the following with respect to patient abandonment:

2.F. Patient Abandonment. Once a dentist has undertaken a course of treatment, the dentist should not discontinue that treatment without giving the patient adequate notice and the opportunity to obtain the services of another dentist. Care should be taken that the patient’s oral health is not jeopardized in the process.³
Examples of patient abandonment include the following:

Scenario #1

Doctor A is having financial difficulty and can no longer afford to operate his/her practice. Doctor A closes his/her practice but does not inform patients via letter, announcement in the newspaper, formal email notification, etc. In addition, Doctor A does not advise patients on how they can obtain their records and/or records of their dependents. Hence, patients must now pay for services that their insurance company will only cover every 3-5 years, i.e. extraoral film.

Scenario #2

Doctor B has dismissed a patient from his/her practice due to failure to show for appointments based on a signed policy that is in the patient’s chart. Doctor B does not inform the patient in writing that they are no longer eligible for care at Doctor B’s practice. In addition, Doctor B does not advise the patient that he/she is eligible for emergency care 30 days following the date of the dismissal letter.  The patient contacts Doctor B’s practice because they have an abscess. Doctor B’s receptionist advises the patient that they are no longer eligible for care in the practice due to multiple failed appointments.  The staff does not assist the patient in finding another provider.

Scenario #3

Doctor C declines to provide active treatment to a patient after discovering the patient is HIV positive.

Scenario #4

Doctor D, a general dentist has practiced for 15 years without taking an extensive vacation. Doctor D decides to close his/her practice for two weeks to take a second honeymoon. The office closed for a two week period and staff was not available to take calls. A routine patient contacted the office because a root canal was started but not completed on tooth #30.  Over this two week period, the tooth became infected and caused facial swelling.  The patient, unable to contact Doctor D, sought the care of an oral surgeon in the area for the extraction of tooth #30.

In order to avoid the above scenarios of patient abandonment, dental practitioners can take the following corrective actions:

Scenario #1: Corrective Action

According to the ADA’s Guide to Closing a Dental Practice, a provider should notify patients via a letter or an announcement in a local newspaper, roughly 30-60 days in advance. If a patient is undergoing active treatment, the practitioner must complete a minimum of the following four steps:

1) Identifying a skilled practitioner who will accept the unfinished case; 
2) providing the accepting dentist with the necessary clinical information to continue or alter treatment, if necessary; 
3) the patient agreeing to the referral; and 
4) the patient actually submitting to the treatment in a cooperative fashion. Short of achieving all four, a dentist may unnecessarily be exposing himself to an allegation of patient abandonment, depending on applicable law.⁴

Scenario #2: Corrective Action

Dental practitioners must have clear office guidelines regarding failed appointments. These guidelines should be signed by the patient and kept on file prior to conducting the initial examination. If termination of the doctor/patient relationship is initiated due to multiple missed appointments, patients should be notified in writing of the termination and this notification should be sent via registered and certified mail. The patient should be provided a reasonable amount of time to seek the services of another provider. Typically the required notification is 30 days. The letter should include a brief explanation of why the relationship is being terminated although this is not required.⁵

References

1 Chowdri, Prathyusha. What is Patient Abandonment? Nolo: Law for All. http://www.nolo.com/legal-encyclopedia/whatpatient-abandonment.html.

2 Segan’s Medical Dictionary. Definition—Abandonment. http://www.medicaldictionary.thefreedictionary.com/Abandonment.2012.

3 American Dental Association. ADA Principles of Ethics and Code of Professional Conduct. Last modified, 2012. http://www.ada.org/~/media/ADA/About%20the%20ADA/Files/code_of_ethics_2012.ashx.

4 American Dental Association. Guide to Closing a Dental Practice. Page 4.
2004/2008. http://www.ada.org/~/media/ADA/Member%20Center/FIles/topics_disability_closingpractice.ashx.

5 Passineau, Theodore. The Less-Than-Perfect Dentist-Patient Relationship: Case Studies and Tips. The Virginia Dental Meeting. Hot Springs, Virginia. September 18, 2014.