How to dismiss a dental patient: ADA steps and letter notes

Patient dismissal is the formal end of the dentist and patient relationship, started by the dentist. It is a legal and ethical matter as much as a front-office one. This post summarizes what the American Dental Association (ADA) and its Code of Ethics say, lays out common steps, and points to where an attorney should step in. It is general education, not legal advice.

When can a dentist dismiss a patient?

The ADA says that a dentist “has the right to dismiss a patient in situations where it is impossible to resolve differences or if the dentist cannot abide the patient’s behavior within the practice, as long as the dismissal is not for a legally impermissible discriminatory reason.” The ADA also describes the cause as friction that cannot be resolved or a difference in philosophies of care.

The words “legally impermissible” matter. Which reasons are barred depends on federal and state law. A practice owner should ask an attorney before relying on a reason, and before treating one patient differently from another in a similar case. The glossary entry on patient dismissal gives the short definition.

What does the ADA Code of Ethics say about ending care?

The Code of Ethics addresses “patient abandonment” in section 2.F: “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.”

In plain words, the ethical concern is a patient left in the middle of care with no time to find another dentist. State law may use the term abandonment with its own legal meaning, so read your state dental practice act. The Code is an ethical standard. It is not the same as the law.

What steps do practices commonly follow?

The ADA page does not give a numbered procedure, but it lists the main elements. The table puts them in order with the reason for each.

What goes in a dismissal letter?

The ADA says to “develop a template for a dismissal letter,” fill in the cause objectively, advise the patient to find another provider, and state how many days you remain available for an emergency. Beyond that, the ADA links to sample letters on its practice management pages. Open them, compare them to your state rules, and let an attorney check your version.

Points that offices commonly ask about include:

• Tone. Keep the letter factual and short, without blame.
• Records. Say how the patient can request a copy of their records. HIPAA and state law may set rules for access and timing. The HIPAA for dental offices post gives the starting point.
• Open treatment. If care is in progress, ask an attorney how to handle it, in line with the abandonment standard above.
• Delivery. Ask an attorney whether your state expects a particular delivery method and whether you should keep proof of delivery.

How do informed consent and documentation connect?

Good records protect both sides. The ADA also offers sample forms for informed consent and informed refusal on its patients page. If a patient declines recommended care, a signed refusal on file is part of the record that a later review may look at. Dismissal should follow a pattern of documented attempts to resolve the problem, such as missed visits, unpaid balances or conduct that put staff at risk. It should not come as a surprise.

If missed visits are the issue, a written cancellation policy gives a clear record of what the patient agreed to. The dental cancellation policy post covers it.

What should an owner ask an attorney?

Bring a short list to your attorney:

1. Which reasons for dismissal does state law restrict or bar?
2. How many days of emergency availability does the state expect?
3. What must the letter say, and how should it be delivered?
4. How should the practice handle open treatment, unpaid balances and records requests?
5. Does any payer contract or employment agreement affect the process?
6. Should the practice call its professional liability carrier first?

The last question is practical. The ADA’s guide to selling a practice, for example, suggests contacting your professional liability company for recommendations, and the same habit helps here.

Next step

Patient relations and written policies sit within the wider topic of running a practice, covered in the dental practice management guide. To discuss practice policies with Dr. Jon Copeland, DDS, a general dentist in Wildwood, Missouri, contact Dr. Copeland about consulting.