Records Withheld and an Abrupt Dismissal
Dr. Amara Okafor practices in Evansville. A 44-year-old patient, Ms. Lewis, received a crown two weeks ago and owes $1,150. Ms. Lewis requests a complete copy of her dental record to obtain a second opinion. The front desk tells her the practice "does not release records until the balance is paid." Dr. Okafor then sends a letter stating: "You are terminated effective today. Do not return to this office." The letter contains no referral list and no emergency instructions. That evening Ms. Lewis calls complaining that the temporary crown has come off and she has pain. The office manager says the practice has no duty to her because she was terminated and owes money. Dr. Okafor asks what she must do about the records request, the dismissal, and the after-hours call.
1. Must Dr. Okafor release the dental records despite the unpaid balance? What may she charge and how should she respond?
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Yes. The patient has a right to a copy of her dental record, and the practice should not withhold records solely because of an unpaid balance. Withholding records needed for a second opinion or continuing care can obstruct treatment and support a Board complaint. The practice may require a written request and identity verification, and it may charge a reasonable, permitted copying fee-not a punitive amount-but it must provide the records within the applicable timeframe. HIPAA generally requires access within 30 days, with limited extensions. Dr. Okafor should provide the complete record, including radiographs, chart notes, the crown consent, and billing statements if requested, while keeping the original. She should not alter the record or insert late opinions about the patient's character. The unpaid bill remains a separate business matter that can be pursued through ordinary collection methods; it is not a lien on the chart.
2. Was the termination letter adequate? What steps are required to end the dentist-patient relationship without abandonment?
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No. A one-line termination effective immediately, with no referral or emergency instructions, is inadequate and creates abandonment risk, especially with a recently placed crown that may need follow-up. Proper termination should be in writing, give reasonable notice-often about 30 days depending on the circumstances-state that emergency care will be available during the transition, provide a referral list or explain how to find another dentist, offer to transfer records, and document delivery. The dentist should not terminate mid-treatment without arranging continuity. The letter should avoid abandoning the patient for nonpayment alone without transition. If the patient's conduct is threatening, the practice may shorten the timeline but still must arrange emergency care. Dr. Okafor should send a corrected notice, keep a copy, and ensure staff know the patient is still entitled to emergency coverage during the notice period.
3. What must Dr. Okafor do when Ms. Lewis calls that evening with the temporary crown off and pain?
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She must respond to the dental emergency or arrange coverage. A dislodged temporary crown with pain can usually be managed promptly; ignoring the call because the patient was "terminated" and owes money is exactly the kind of conduct that supports an abandonment finding. The practice should see the patient, re-cement the temporary if appropriate, assess the tooth, and provide pain management, or direct her to an on-call dentist or emergency facility with a clear explanation. The call and the response should be documented. If the practice truly cannot see her, it must arrange another licensed dentist and communicate that arrangement. The termination letter does not instantly erase the duty to provide emergency care during a reasonable transition. Billing disputes should not be handled at the chair during an emergency.