ACCEPTING A DISMISSED PATIENT
BACK INTO THE PRACTICE
By TDIC Risk Management
Whether an old flame or a disloyal
friend, choosing to accept someone back
into one’s life can be a difficult decision.
But what about accepting dismissed
patients back into the practice? Do they
deserve a second chance?
The answer is: It depends. According to
The Dentists Insurance Company, in
some cases, such as noncompliance,
accepting a dismissed patient back to
the practice can lay the groundwork for
a liability claim. But in other cases, the
answer isn’t so clear.
TDIC Senior Risk Management Analyst
Carla Christensen reports cases in which
patients claim they never received
dismissal letters, so the dentists are unsure
as to whether to take them back. In these
situations, the practice is generally not
required to provide care as long as they
have documentation that they followed
the proper dismissal protocol.
When notifying patients of the intent to
dismiss, dentists should send two letters:
one by regular first-class mail and the
other by a tracked delivery service that
requires a signature upon receipt, such
as FedEx. This method of delivery
provides evidence of notification should
a patient claim he or she was not
informed of the dismissal. Confirming
each patient’s mailing address and
contact information at every
appointment can also protect dentists
should a letter be returned.
“That way, a dentist has evidence a good
faith effort was made to inform the
dismissed patient via the last known
address on file,” Christensen said. “It
serves as documentation of the dentist’s
efforts to provide formal notification of
discharge from care.”
Another consideration concerns patients
who were dismissed for noncompliance.
It is common practice to send a failed
appointment letter, advising the patient
of the need to return and the importance
of maintaining dental health. But if these
letters go unanswered, dentists often
have no choice but to dismiss the patient
from care.
Los Angeles Dental Society Explorer
“A dentist should document attempts to
educate patients regarding related risks
and to provide a specific date for the
patient to appoint or take the
recommended treatment actions,”
Christensen said. “Failed appointment
letters reduce the likelihood a patient
would hold the dentist responsible for
failure to treat or refer, because the
provider warned them of the urgency and
risks related to the treatment concern.”
In one case reported to TDIC, a dentist
provided a temporary restoration and
scheduled the patient to return in a
week for cementation of the final
crown. The patient failed to appear for
the cementation appointment and the
office sent a failed appointment letter.
The patient did not respond or
reschedule the final cementation
appointment, so the office sent the
patient a noncompliance dismissal letter.
Six months passed before the patient
finally contacted the office to request
completion of treatment.
“Because the dentist had fully
documented the patient’s
noncompliance with treatment
recommendations and termination of
the treatment relationship, TDIC
advised her that she was not required to
reappoint the patient,” Christensen said.
Failing to document treatment options
and communication with patients can
lead to serious problems. In one case, a
patient was only coming in for
emergency care. She was diagnosed with
a deep cavity and the dentist
recommended a filling. But she failed
multiple follow-up appointments and
the dentist eventually dismissed her
from the practice. Three months later,
she called and begged the dentist to take
her back. The dentist agreed, placing an
amalgam filling in the tooth. He advised
her that the filling was very large and
depending on how the tooth responded,
a root canal could be necessary. A few
weeks later, the patient showed up to
the practice unannounced, upset
because the tooth had fractured at the
gumline. She demanded that the dentist
pay for her implant and a crown.
Unfortunately, the dentist did not have
thorough documentation in the patient’s
chart. Although the patient was only
coming in for emergency care, the dentist
allowed her to do so and failed to discuss
the importance of regular care, including
exams, radiographs and cleanings. He did
not inform her that failing these routine
maintenance appointments could result
in her dismissal.
There are many reasons why a dentist
chooses to take a patient back.
Sometimes, it’s purely financial —
driven by a desire to maintain his or her
patient base. Other times, it’s out of
sympathy — a desire to help a patient in
need. In some cases, the patient
manipulates the situation by appealing
emotionally or complimenting the
dentist and the dentist’s judgment
becomes clouded. But none of these
reasons offset the risk to the practice of
bringing back a dismissed patient.
Generally speaking, TDIC recommends
dentists do not accept patients who have
been dismissed for noncompliance or
nonpayment. But there are specific
situations when accepting a patient back
could be considered. For example, some
patients do not fully understand the
gravity of failing routine hygiene
appointments until they receive the
dismissal letter in the mail, and they call
right away to be seen. Still others are
dismissed simply because they moved
away or changed insurance; in these
cases, it is acceptable to allow them to
return as patients.
Choosing to give a patient a second
chance is a personal decision that
demands thorough consideration on a
case-by-case basis. There is risk
associated with accepting a patient back
into the practice, but dentists can lessen
the risk and protect themselves from
liability by following a few guidelines.
TDIC’s Risk Management Advice Line
at 800.733.0634 is staffed with trained
analysts who can answer patient
dismissals and other questions related to
a dental practice. 䡲