You are obligated to make reasonable arrangements for the emergency care of your patients of record. A charge of patient abandonment may result from a failure to make reasonable arrangements. Also, dental benefit plans require contracted providers to make arrangements for after-hours emergency care of their patients. Examples of reasonable arrangements include:

• Before leaving on an extended vacation or absence from the practice, arrange for emergency coverage with one or more colleagues. Notify your patients in advance and provide your colleagues’ contact information or that of your answering service.
• For times when your office is closed, leave an outgoing message on your telephone answering system that provides instructions on how a patient can contact you or a colleague who is providing emergency coverage. If using an answering service, instruct the operator to collect information from the patient that includes full name, date seen by the dentist, complaint and a phone number. You should have a method of verifying patients of record or verifying patients of colleagues for whom you are providing emergency coverage.

After listening to the patient’s complaint, you may choose to:

• Prescribe pain relief medication, as appropriate, with direction to the patient to schedule an examination at the earliest possible time.
• Direct the patient to an emergency room or urgent care facility.
• Direct the patient to schedule at your dental office for an examination as soon as possible.

If you agree to see a patient at a time when your office is typically closed, take appropriate precautions for your safety.

It is not required to see an emergency patient in the middle of the night. If a patient in pain contacts you in the middle of the night, refer the patient to a hospital emergency room or urgent care facility for pain relief and direct the patient to present at your office at the earliest possible time.

Be sure to keep a record of these after-hours consultations.

Patients not of record: When consulted in an emergency by a patient not of record, you are obligated to make reasonable arrangements for emergency care of that patient. Consulting with a patient for the first time in an emergency does not make the individual a patient of record.

Do not leave an outgoing message directing emergency patients to contact the local dental society, unless the dental society has agreed to and implemented a plan for handling such calls. Check with your dental society for more information.

You cannot advise patients to call 911 only, with no other options available to them. This is a misuse of the 911 system (refer to Penal Code section 653y linked below). You can state if the patient thinks they are having a medical emergency to call 911, but you must provide other alternatives for the patient to receive emergency dental care. If you need assistance finding options for your patients, reach out to colleagues to see if they are available to assist your patient base, ask what their methods are for these situations, or consider hiring an answering service. A google search will provide you with several choices. If using an answering service, be certain the service signs a HIPAA business associate agreement.

Reference

CDA Code of Ethics

Section 8: Emergency Service

A dentist has the obligation to make reasonable arrangements for the emergency care of his or her patients of record.

A dentist has the obligation, when consulted in an emergency by a patient not of record, to make reasonable arrangements for emergency care of that patient.

Advisory Opinion:

8.A.1. Continuity of care: In the interest of preserving the patient’s continuity of care, a dentist who treats a patient not of record shall recommend to the patient to continue treatment with the original treating dentist unless the patient expressly reveals a different preference.

Penal Code 653y:

A person who knowingly allows the use or who uses the 911 emergency system for any reason other than because of an emergency is guilty of an infraction.