Firing a patient- Yes, it’s possible part two is the fourth topic in this blog series dedicated to confusing legal issues encountered in the practice of dentistry. Part one described why dismissing a patient might be necessary. Part two will discuss how to properly and legally end the doctor-patient relationship because if done improperly, a case of malpractice or abandonment can be made. Following are steps to end the relationship smoothly thus preventing legal issues.
- Send a certified letter with a return receipt- A simple phone call will not suffice in this instance. A certified letter with a return receipt must be sent to the patient. Because laws vary by state, you should consult with your attorney, but basically, the letter should contain:
- Date of termination
- objective and non-threatening language stating the reason for dismissal
- a reasonable amount of time you’ll be available for emergencies
- the patient’s current condition, any treatment plans, and consequences of not seeking care
- willingness to forward any x-rays or records. Records and x-rays can’t be withheld due to non-payment in most states
- information about finding a new dentist such as the local dental society. Don’t give specific dentist’s names
- financial balance intentions
- Never dismiss a patient due to age, race, sex, religion, or disability. Also, never terminate a patient who is in a life-threatening situation, extreme pain, bleeding profusely, or has extreme swelling.
- If the patient’s insurance coverage is an HMO, DMHO, or capitation plan, you can’t refuse care until the third-party payer is notified and the patient is reassigned.
- If a patient is seeing a doctor in a group practice, termination must include every doctor in the practice.
- HIPPA rules and regulations must be followed to the letter. When records are sent to another dentist, the patient must sign a Release of Records Authorization. If records are sent by traditional mail, send certified with a return receipt. If emailing, the patient must give written consent to transfer records via email and notified that the information is sent through an unencrypted format on an open and unsecured e-mail unless you use a HIPAA-compliant secured service. You may charge up to 75cents per page, but it may be wise to refrain from charging any fees for processing in this case.
- If refunding any money to the patient, a Release of Liability or All Claims must be signed by the patient. These documents should contain a clause protecting you, your practice, and team members from defamation and slander. Furthermore, the clause should prohibit the patient from speaking and writing anything negative regarding your practice or your employees.
- Inform all team members of the separation. All team members must be made aware of the dissolution. No doctor or employee of the practice should refer to the patient improperly amongst themselves or to any other practice or patient. When speaking of the patient, state that there were administrative differences which couldn’t be resolved.
A quick word on abandonment. Abandonment occurs when a dentist terminates a patient without providing the patient sufficient time to select another practitioner or refuses to complete or follow up treatment for no valid reason. Don’t operate in this manner because doing so can easily result in a case of malpractice.
Before deciding to fire a patient, reconsider and decide if it’s worthwhile to sit down one on one and see if it can be avoided. Make sure all reasonable efforts to resolve issues have been exhausted. If termination the only solution, consult with your attorney and follow all instructions to avoid any legal consequences.