11.4 Continuity of Care: Dismissing Patients, Interruptions, New-Patient Records, and Relocation

Ending a dentist-patient relationship (K2121)

Patients may be dismissed for legitimate, nondiscriminatory reasons: repeated missed appointments, nonpayment, abusive or threatening conduct, harassment of staff (Section 3.3), or a breakdown of trust. The law defines what is not allowed:

• B&P § 1680(u): abandonment is unprofessional conduct when the licensee ends treatment without written notice that treatment is to be discontinued, and before the patient has ample opportunity to get another dentist or hygienist, where the patient's health is jeopardized.
• ADA 2.F / CDA 1.B.1: once a course of treatment has started, do not stop it without adequate notice and an opportunity to get another dentist, and do not let the patient's oral health be jeopardized.
• Dismissal may not be discriminatory (B&P § 125.6; Unruh Act) or retaliatory (§ 1680(q)).

A defensible dismissal protocol

1. Stabilize first. Do not leave an open endodontic access, an unseated temporary, or an unfinished surgery. Complete the current phase or make it stable.
2. Send written notice by a trackable method, such as certified plus first-class mail, stating the date the relationship ends. A detailed reason is optional; if one is given, keep it factual.
3. Offer emergency care for a reasonable transition period. Thirty days is a common practice benchmark, not a statutory number.
4. Offer records transfer and remind the patient of pending treatment needs.
5. Help the patient find care, for example by naming the local dental society's referral resources.
6. Document the reasons, the notice, and any contact afterward.
7. Honor the patient's right to records regardless of any balance (Health and Safety Code § 123110(i)).

When the dentist cannot provide care (K2122)

• Vacations and absences: arrange coverage with another dentist and route after-hours calls to them (Section 11.5).
• Illness or impairment: ADA Advisory Opinion 2.D.1 requires a dentist whose disease or impairment might endanger patients or staff to limit practice, with a qualified physician's advice, and keep monitoring.
• Death or incapacity: under B&P § 1625.3, a conservator, executor, or trustee may employ licensees and charge for their services for up to 12 months without being considered to practice dentistry, and may not interfere with professional judgment. Every renewal application must include a notice about this option (§ 1625.5). Plan ahead with a written practice-continuation agreement.
• Public health emergencies: ADA Advisory Opinion 3.A.1 says that during a public health crisis, dentists should weigh the risk to the patient and the public before elective care, but should still treat urgent or emergency conditions.
• Disasters: keep off-site, secure backups of records so care can continue elsewhere (Section 2.3).

Records when accepting a new patient (K2123)

• Ask about current care. The CDA Code (Section 9) requires a reasonable inquiry into whether a prospective patient is under another dentist's care.
• Request prior records with the patient's authorization, especially recent radiographs, to avoid repeating radiation and to understand treatment history. The previous dentist is ethically obliged to provide records beneficial to future treatment, whether or not the account is paid (ADA 1.B, Advisory Opinion 1.B.1), and legally obliged under Health and Safety Code § 123110 when the patient requests them.
• Review records objectively and avoid disparaging comments (ADA 4.C).
• Handle sensitive information carefully. ADA Advisory Opinion 1.B.2 advises written permission before forwarding records with sensitive content, such as HIV status or chemical dependency.

When a dentist relocates (K2124)

• Patients' right to know: CDA Advisory Opinion 1.B.2 says patients of a dentist who leaves a practice have the right to be informed of the dentist's new contact information. It is unethical to withhold it, if known, when a patient asks, or to give misleading information. If notifying patients is the departing dentist's job, the practice must not interfere by withholding patient lists.
• Names: a departed dentist's name may stay in the practice name for up to one year (ADA 5.G; CDA 6C). A longer use requires the departing dentist's permission and prominent notice of the retirement (ADA 5.G.1). A departure from a fictitious-name practice must be reported to the Board within 30 days (B&P § 1701.5(i)).
• Records custody stays with the practice that holds them, but patients may request copies or transfer at any time.

Worked scenario

Dr. Nguyen decides to dismiss a patient who has missed five appointments and been verbally abusive to staff. The patient has a temporary crown on tooth #3.

• Stabilize: first cement the final crown, or confirm the temporary is secure and document it.
• Notify: send written notice with a termination date and an offer of emergency care for 30 days, include instructions for requesting records, and document everything.
• Avoid abandonment: ending care with only a verbal "don't come back" while the temporary fails would risk an abandonment finding under § 1680(u).