State and federal laws protect patients against being discharged from care for a number of reasons, including the following: (1) HIV or AIDS status, as long as the condition is within the dentist’s current practice realm; (2) age; (3) sex; (4) religion; or (5) ethnicity.

A dentist can terminate the dentist-patient relationship for the following reasons, as long as certain legal standards are met: (1) non-payment for services, (2) failure of the patient to attend follow-up appointments or to follow the dentist’s instructions, (3) threat of a lawsuit by the patient, or (4) the patient’s refusal of standard treatment.

If a patient is discharged from care for a valid reason, the dentist must still ensure that the patient does not suffer harm as a result of the termination. First, the patient’s current condition must be considered; immediate treatment needs should be met to make sure that the patient’s condition is stable. If the patient is in a non-emergency condition, the dentist should provide the patient with a notice of intent to withdraw. The notice must inform the patient of the need for follow-up care and give the patient sufficient time to obtain the care. In the interim, the dentist should remain available to treat the patient, should the condition become acute. Finally, the notice should always be documented. One way to document the notice is to mail a certified letter and keep the receipt in the patient’s record.

A letter informing the patient of the intent to withdraw from treatment should include four elements: (1) a statement of intent to withdraw from treatment, (2) a designated date for withdrawal (preferably in no less than 30 days), (3) an agreement that the dentist will see the patient in case of emergency, and (4) a referral to an appropriate source where the patient can find a new dentist.

Additionally, the dentist should inform the patient that a copy of the patient’s dental records will be sent to the new dentist after an appropriate release has been signed. The letter should be sent by certified mail, with return receipt requested. If the patient refuses the certified letter, the letter should be kept in the patient’s record, and another letter should be mailed via regular mail. These steps should be documented in the patient’s record. Malpractice insurance carriers may have samples of letters that can be used when withdrawing from treatment. Ohio law (Section 3701.741 of the Ohio Revised Code) dictates the costs that health professionals, including dentists, may charge for copies of the medical record. 

If a clinic closes, it does not need to send patients certified letters. However, patients should still be notified at least 30 days in advance that the relationship will be ending. Patients should also receive information about how to seek the care of another dentist in the area, where to get emergency care, and what future treatment they may need, if any.

If the patient ends the relationship for any reason, the clinic should (1) document the patient’s decision, (2) advise the patient in writing of incomplete treatment, (3) recommend continuation of incomplete treatment, (4) offer to forward records to the patient’s next dentist, and (5) document these steps in the patient’s record.