Saturday, November 01, 2003
by Richard D. Weber, J.D.
MDA Legal Counsel
Published in the November 2003 issue of the Journal
Question: How do I end my relationship with patients? I am leaving a practice with another dentist and I am unable to obtain addresses of my patients to notify them.
Answer: Once a dentist-patient relationship is established, a dentist is under both an ethical and legal obligation to provide services until the relationship is properly ended. The relationship may be ended by consent of the patient and dentist; by the patient changing or dismissing the dentist in the event the dentist's services are no longer needed; or when a dentist unilaterally withdraws from the case.
It is this latter instance - unilateral withdrawal by the dentist - that can lead to the claim of "abandonment." Although a dentist has a definite right to withdraw from treating a patient, it must be done in such a manner that the patient is given reasonable notice so he or she can secure other dental treatment.
Abandonment is generally defined as the termination of a professional relationship between a dentist and patient at an unreasonable time and without giving the patient the chance to find an equally qualified replacement. But for abandonment to exist, the patient must show more than just a simple termination of the relationship. The patient must prove that the dentist ended the relationship at a critical stage of the patient's treatment without good reason or sufficient notice to allow the patient to find another dentist and that the patient was injured as a result.
A recent Michigan Court of Appeals decision held that patients may sue for damages on a claim of patient abandonment without sufficient notice. In the decision, an obstetrician withdrew from treating a high-risk pregnancy patient because the patient had filed a lawsuit against another physician. As a result, surgery was delayed for four days and the patient suffered a miscarriage. The court's findings apply to dentists as well.
Steps to terminate the dentist-patient relationship typically include:
- providing written notice to the patient, preferably via the use of certified mail;
- providing the patient with some explanation for why the relationship was terminated;
- offering to continue treatment and access to services for a reasonable period of time, such as 30 days, in order to allow the patient to secure another dentist;
- offering to treat the patient for any emergency services for an additional period of time;
- providing assistance to help the patient locate another dentist; and
- offering to transfer records to a new dentist upon receipt of a signed authorization from the patient.
In your situation, it will be difficult to properly terminate the dentist-patient relationship, because you are unable to obtain your patients' addresses. Although you haven't indicated the specifics of your departure, some general observations can be made.
First, you should consult with your attorney to make sure that the patients are properly transitioned. You may need to send a model patient transition letter to your previous practice or to whomever is withholding the patient addresses. Request that the letter be sent to those patients for distribution. While this isn't a perfect solution, it could nonetheless satisfy your ethical obligation and protect you from liability for abandonment.
Ideally, dentists should avoid contractual arrangements that preclude contact with patients. Any contract should authorize access to patient records during and subsequent to the departing dentist's relationship with the practice entity. In fact, proper notification is not just the legal and ethical obligation of the treating dentist. Failure to provide such notification could also be deemed to be a violation of ethics on the part of the dentist whose practice you are leaving, if he or she withholds this information to the detriment of patients you've treated. Again, consultation with your attorney is highly recommended.