By Daniel J. Schulte
MDA Legal Counsel
Published in the August 2005 issue of the Journal
Question: I have some patients who continuously do not show up for scheduled appointments and ignore my cancellation policy. How do I end our relationship?
Answer: Once a dentist-patient relationship is established, a dentist is under both an ethical and legal obligation to provide services until the relationship has been properly terminated. This relationship may be terminated by: (1) the mutual consent of the patient and dentist; (2) unilaterally by the patient, due to the patient changing dentists or patients dismissing the dentist in the event the dentist’s services are no longer needed; or (3) by the dentist unilaterally.
A dentist does have the unilateral right to terminate the relationship for the patient’s refusal to follow an established appointment cancellation policy and for other reasons. However, a dentist’s termination should be handled carefully. You will want the termination done in a way that will avoid any claim of abandonment by the patient and such that you can objectively prove later on (in a malpractice case or otherwise) exactly when the relationship was terminated.
A dentist’s unilateral termination could lead to a claim of "abandonment." The termination must be done in such a manner that the patient is given reasonable notice so as to enable the patient to 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 dentist. The patient must show more than 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, as a result, the patient was injured.
In 2003 the Michigan Court of Appeals held that a claim of patient abandonment is viable under Michigan law for damages suffered by the patient caused by the way in which the dentist terminated the relationship. In this Michigan Court of Appeals decision, an obstetrician withdrew from treating a high-risk patient very late in her pregnancy. The obstetrician withdrew following his discovery that this patient had filed a lawsuit against another physician. As a result, the patient’s surgery was delayed for four days and the patient suffered a miscarriage.
This is an extreme case. However, it illustrates the point that a patient may sue for and receive damages from a dentist if injuries result from the dentist’s termination of the patient at the wrong time and/or without proper notice. To avoid such a claim against you, follow these steps when terminating a patient:
- provide written notice to the patient, preferably by certified mail;
- provide the patient with some explanation for terminating the relationship;
- offer to continue treatment and access to services for a reasonable period of time (for example, 30 days) to allow the patient to secure another dentist;
- state that you will provide emergency services for a period of time;
- help the patient locate another dentist; and
- offer to transfer the patient’s records to a new dentist and/or advise the patient of his/her right to obtain a copy of these records for a fee.
Below are links to some sample letters that you may consider using in your practice when terminating a patient relationship. These letters assume you have an established policy regarding patients who miss appointments without properly canceling. Your own policy may be different than that described in these sample letters and therefore they may need to be revised.
Finally, it is wise to share your policy with your own legal counsel to ensure it does not conflict with any payor contract that you have entered into. Also, disclose your policy to your malpractice insurance carrier to determine if your policy in any way affects your coverage.