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Terminating Dental Provider - Patient Relationship Policy and Procedure

Subject: III. Clinical – H. Patient Administration

Department: Clinical Affairs

Origination Date: 1/1/2009

Effective Date: 1/1/09

Reviewed and/or Revised: 07/01/2016, 05/08/2017, 09/01/2017, 04/17/2019

Purpose: Follow proper procedure to terminate the dental provider-patient relationship ensuring that abandonment of patients does not occur. Faculty and Clinic Administration will ensure that the decision to terminate a dental provider – patient relationship is appropriate and/or necessary and that patients are properly advised of the decision.

Definitions: Abandonment – termination of a professional relationship between dentist and patient at an unreasonable time and without giving the patient sufficient opportunity to find an equally qualified replacement

Policy and/or Procedure:

Once a dental provider-patient relationship is established, a dentist is under both an ethical and legal obligation to provide services as long as the patient needs them. There may be times, however, when you may no longer be able to reliably provide care. It may be that:

The patient is:

  • Not compliant with policies or procedures
  • Unreasonably demanding with treatment or clinic policies
  • Threatening and/or abusive to the dental provider and/or staff
  • Not paying bill(s) for dental services rendered
  • Taking legal action against the dental provider, contributing to the breakdown of the dental provider-patient relationship
  • Unwilling to accept treatment recommendations

Or the dental provider is:

  • Relocating
  • Retiring
  • Limiting practice
  • Or there is unanticipated termination by a managed care plan and/or employer

    Regardless of the situation, to avoid a claim of “patient abandonment”, a dental provider must follow appropriate steps to terminate the patient-dentist relationship.

Terminating the relationship should be the last resort and except in extreme cases should occur only after advising and warning the patient that continued behavior will result in termination. These advisories and warnings must be documented in the patient’s chart. The dental provider-patient relationship will only be terminated if the supervising faculty agrees with and approves of this action. Faculty approval must also be documented in the patient record.

Hallmarks of proper procedure are reasonable notice of intent to terminate and adequate time for patient to find alternate care before termination takes effect. The following is the procedure when terminating dental provider-patient relationship:

  1. Provide written notice of termination of relationship (see letter template below).
  2. Mail letter certified mail return receipt requested.
  3. Specify effective date of termination (Note: patient may be treated in Urgent Care Clinic for emergency or urgent treatment until termination date).
  4. Advise patient in letter of any unfinished treatment, the need for continued care, and the risk of not continuing current and future dental treatment.
  5. Provide adequate time for patient to find another provider (30 days). Patient can obtain emergency or urgent care treatment if needed for 30 days
  6. Assist patient to transfer care to another provider.
  7. Provide the Maryland State Dental Association 410-964-2880 as a resource for patient to identify another provider.
  8. Provide dental record to new provider upon request (with patient signed authorization.
  9. Document in patient’s chart record and scan copy of notification letter.
  10. Place office code DNR on patient’s account.
  11. Advise the clinic Director, Program Director, and the Associate Dean of Clinical Affairs.
  • Other References: UMB Risk Management
  • Recourse for non-compliance: Academic Counseling; Suspension of Clinical Privileges

Sample Termination of Care Letter:

Date

name

address

address

Dear name:

The purpose of this letter is to inform you that the University of Maryland, School of Dentistry has decided that we must terminate our dental provider-patient relationship with you due to (EXPLAIN REASON). Effective immediately, the School of Dentistry will not begin any new dental treatment.

As of the date of this letter, there are (DESCRIBE TREATMENTS THAT HAVE BEGUN AND EXPLAIN THAT THEY NEED TO BE COMPLETED). We will complete those treatments if you are willing to do so. You will be financially responsible for all treatment that is completed and will be charged accordingly.

For the next thirty days, the School of Dentistry will remain available to you to provide emergency treatment only through the Urgent Care Clinic. Please phone (410) 706-2716 to arrange an emergency appointment.

It is recommended that you identify a new dentist as soon as possible to continue your dental care. Failure to continue with care could result in a worsening of your oral condition, including possible pain, infection, swelling and/or tooth loss. If you need assistance in selecting another dental provider, you may wish to contact the Maryland State Dental Association at (410) 964-2880.

At your request, we will forward a copy of your dental record to your next provider. Attached please find a Records Request Form for your convenience and for you to complete if you would like a copy of your dental record forwarded.

Thank you for your past confidence and for allowing the University of Maryland, School of Dentistry to treat your dental needs.

Sincerely,

(Patient Care Coordinator, Director, Program Director, Associate Dean of Clinical Affairs)