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Clear patient communication during COVID-19 pandemic will help dentists avoid charges of patient abandonment

April 16, 2020 22273

Although dental practices in California have suspended routine care to help prevent the spread of the novel coronavirus in accordance with the state directive and CDC recommendation, dentists must either remain available to patients of record who require emergency dental treatment or have arranged coverage for emergencies with another dentist.

Although dental practices in California have suspended the provision of routine care to help prevent the spread of the novel coronavirus in accordance with the state directive and CDC recommendation, dentists must either remain available to patients of record who require emergency dental treatment or have arranged coverage for emergencies with another dentist.

Failure to communicate with patients and failure to treat patients or refer them for treatment can create legal liabilities for dentists, including charges of negligence or patient abandonment ― a form of dental malpractice. Dentists are responsible professionally and ethically to communicate treatment expectations with their patients of record.

During the temporary restriction of patient treatment to emergent care only, dentists must have in place clear protocols for patient communication and emergency treatment, including patient screening and the appropriate use of personal protective equipment for the dentist and dental staff.

Dentists who don’t yet have these protocols in place can take the following steps now to help protect their patients and the practice. All dentists may want to review these steps to ensure they are following the best guidance.

Patient communication

In addition to the state’s directive to postpone all routine dental care, all Californians are still under the “stay-at-home” order issued March 19 by Gov. Gavin Newsom, and some Californians are also following more stringent county or local orders to practice social distancing and limit travel to essential purposes only, such as for groceries, medicine or emergency health care.

The dental office’s patients of record should understand how the office is handling appointments and emergencies while those orders are in effect. CDA created announcements that dentists can use on their professional websites and social media pages in addition to posting on the practice’s front door. A short message could, for example, communicate:

During the COVID-19 pandemic, our dental office is postponing routine care. Contact us if you think you have a dental emergency to ensure that you receive care that shouldn’t be postponed. In the meantime, brush two minutes, twice a day with a fluoride toothpaste and floss regularly.

If the dental office is not handling patient emergencies, the office must provide the contact name and phone number for the dentist who is handling the office’s emergencies.

Similarly, the message should be available to patients who call the office, whether they connect with a dentist or staff member working remotely or reach voicemail. Regardless, the patient must be able to reach a dentist to communicate their need for dental care and to receive any needed emergency dental treatment.

Uncontrolled bleeding, severe pain, trauma and cellulitis are considered dental emergencies, but dentists should use their clinical judgment to determine on a case-by-case basis whether a patient has a dental emergency.

Dentists who need to refer patients to another dentist for emergency treatment and who have not identified that referral, may wish to check with their local dental societies for a list of dentists who may be available and have the proper PPE to treat emergency patients.

Patient screening and recommended PPE

To reduce the risk of disease exposure to dentists and dental staff, dentists should continue to screen emergency patients for COVID-19 by telephone or telehealth platform before the patient enters the office or is otherwise seen. Patients who pass the screening questions should receive emergency treatment at the dental office and not be referred to a hospital emergency room.

When providing emergency treatment for patients, dental health care personnel will wear the recommended PPE, which varies according to whether the patient has known or suspected COVID-19 and whether the procedure is aerosol generating. (COVID-19-positive patients should not be seen in the typical dental office if the treatment will produce an aerosol, as more stringent protection measures are needed.)

Dental personnel may have heard reference to “doing the best with what they have” with regard to PPE, and offices that are experiencing a shortage of proper PPE may have legitimate concerns about the potential risk to themselves and their staff. Some staff may even be hesitant to work if they feel they aren’t adequately protected.

Adequate PPE is essential for treating the emergency dental patient, including at minimum a face shield and level-3 surgical mask for non-aerosol-producing care for the COVID-19-negative patient. Dentists who do not have the minimum required PPE to treat the emergency dental patient should request it from their colleague or local Medical and Health Operational Area Coordinator.

Providing emergency treatment for patients with known or suspected COVID-19 requires more extensive PPE, not “best available” PPE, and dentists should contact the patient’s medical provider to locate an appropriate treatment facility if the dental office is not properly equipped.

Staff availability, risks

Some dental offices may also be short-staffed to provide emergency dental treatment due to employee furloughs.

If a dental team member is able but not willing to report to the office to provide emergency care, employers should discuss the employee’s concerns, be cautious about how they respond and consider whether the employee’s reasoning falls under any legal obligations to follow paid sick leave laws, other leave laws or ADA reasonable accommodation. The employee may state that the risk of providing care in the current environment is too high and exposure due to an underlying medical condition or proximity to an at-risk family member could lead to serious consequences. Flexibility and clear protocol for staff that outlines when and how emergency patients will receive care and what essential PPE dental personnel will use will establish clear guidelines for employees and help ensure a safer work environment.

But ultimately, just as offices without proper PPE should not treat the emergency dental patient, offices without sufficient staff to perform treatment should also refer emergency patients to another dentist with adequate PPE and personnel.

Defining patient of record

When determining if an individual is a “patient of record,” dentists should err on the side of caution to prevent potential liability.

Although a patient of record is typically understood to mean an individual who has received dental treatment from the dentist, including the diagnosis or treatment of teeth, gums, jaws or associated structures, The Dentists Insurance Company says dentists should assume the dentist-patient relationship begins once the patient sits in the chair requiring that some kind of patient record be established. Therefore, completing a health history or receiving an examination or teeth cleaning could also establish the individual as a patient of record.

Avoiding liability should be the dentist’s goal. Dentists must ensure their patients of record can discuss their dental needs with a dentist to determine whether emergency treatment is warranted, and dentists might also inform all patients how to maintain good oral health during the practice’s limited office hours.

Should a patient of record claim their dentist was negligent, caused pain and suffering or abandoned the patient and if the patient reports it to the Dental Board of California, the board is obligated to investigate the claim.

TDIC’s Professional & Dental Business Liability policy may cover legal obligations associated with a patient abandonment claim. However, TDIC cannot make blanket coverage determinations, and a claim would have to be submitted to fully evaluate coverage for every particular situation.

More information to assist dentists who are providing emergency treatment only is available in the dental practice interruptions FAQ and more at CDA’s COVID-19 information center.