Forty-Five Days on an Expired License
Dr. Nguyen believed he had renewed his Maine dental license online in December. In fact, his credit card payment failed, and the renewal was never completed. He continued treating patients for 45 days, seeing 20 patients, including a crown preparation, two restorations, and an extraction. He prescribed antibiotics for one patient and wrote a prescription for acetaminophen with codeine for another. His office manager discovered the lapse when a patient's insurance carrier questioned the license number. Dr. Nguyen immediately stopped seeing patients and asks what he should do. He has current CPR, has completed his continuing education, and has no prior disciplinary history. His malpractice carrier has not yet been notified.
1. What is the legal character of Dr. Nguyen's practice during the 45-day lapse, and what are the likely consequences?
Read the worked answer
Practicing on an expired license is unlicensed practice, even if the failure was administrative and unintentional. The Board generally treats the license status as objective: either a valid license exists or it does not. Intent and payment failure may mitigate penalty, but they do not make the treatment lawful.
Likely consequences include a Board complaint or self-report, disciplinary action ranging from a reprimand to suspension or probation, civil penalties, and possible insurance recoupment or denial for the 20 encounters. Prescribing during the lapse adds risk because prescribing authority flows from the license. His clean history and prompt cessation are mitigating factors, but they do not erase the violation. He should not treat the lapse as a paperwork problem.
2. What steps should Dr. Nguyen take now, in order and with documentation?
Read the worked answer
He should first stop all practice-which he has done-and confirm that status in writing with staff. Second, he should contact the Board, explain the lapse, and ask about reinstatement and self-reporting procedures rather than wait for a complaint. Third, he should complete the renewal or reinstatement application, pay all fees and any late penalties, and confirm the license is active before resuming.
Fourth, he should notify his malpractice carrier and ask about coverage for the lapse period; do not assume coverage. Fifth, he should review the 20 charts, identify any patient harm or incomplete treatment, and arrange follow-up. Sixth, he should document everything: the failed payment, the discovery, the stop-work date, and communications with the Board and carrier. Prompt, honest remediation is more credible than a defensive explanation.
3. A patient from the lapse period calls with post-extraction pain and asks for a refill. What should Dr. Nguyen do?
Read the worked answer
He should not prescribe while unlicensed. Prescribing authority depends on licensure, so writing a refill now would compound the violation. He should arrange for a currently licensed dentist or the patient's physician to evaluate the patient and manage the pain, and he should document the referral and the reason.
The patient's clinical needs still matter: post-extraction pain can signal dry socket, infection, or a retained root, so telephone reassurance alone is inadequate. Dr. Nguyen should facilitate an in-person evaluation by a licensed provider, send the relevant records with the patient's authorization, and follow up to confirm the patient was seen. He should also disclose the situation to his carrier and, if the Board requires it, include this contact in his self-report.