Closing a Practice: Records, Unpaid Balances, and a Minor's Chart
Dr. Ramirez has practiced general dentistry in Springfield, Missouri, for 22 years and plans to close her office in 60 days to relocate. She has about 1,400 active patients. One patient, Mr. Nguyen, owes $340 for a crown and has asked for a complete copy of his chart so he can transfer to a dentist closer to his new home. The front-office manager proposes withholding the copies until the balance is paid. A parent of a 9-year-old patient also requests the child's records; the child last visited 14 months ago. Dr. Ramirez has not yet notified patients of the closure, has no signed agreement for a records custodian, and is unsure whether she must keep the original charts after she closes. She asks you, as a colleague, what she may and must do.
1. May Dr. Ramirez withhold Mr. Nguyen's records until he pays the $340 balance? Explain the legal and professional reasoning.
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No. Although a dentist may charge a reasonable copying fee permitted by law, refusing to provide records needed for continuity of care solely to collect an unpaid balance is risky and generally treated as unprofessional conduct. Missouri protects patients' access to their dental records and does not allow a dentist to abandon a patient or obstruct transfer of care. The unpaid $340 is a civil debt; the office can bill it, send statements, or use lawful collection methods, but it should not hold the chart hostage. The better course is to provide legible copies promptly, document the request and the date copies were sent, and keep the original record. If the office charges a copying fee, it should be reasonable, disclosed in advance, and not used as a precondition when the patient needs the record to obtain treatment. The same principle applies even if the patient is transferring because of the closure rather than a dispute.
2. What steps should she take before closing to satisfy her obligations to patients and to the Board regarding records and notification?
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She should treat the closure as a planned patient transition, not an abrupt shutdown. Before the doors close, she should: (1) give patients written notice of the closing date and explain how to obtain copies or have records forwarded; (2) publish or post notice in a manner consistent with Board expectations so patients who have not been seen recently can learn of the closure; (3) arrange a records custodian and sign a written agreement identifying who will hold the records, where they will be kept, and how patients can request them; (4) keep original records for the retention period required by Board rule and make copies available on request; and (5) maintain a log of notices sent, records transferred, and requests refused or pending. She should not simply leave charts in a storage unit with no identified custodian. If she sells the practice, the agreement must address records ownership, patient access, and confidentiality. She should also check whether any patients are mid-treatment and arrange completion or referral so no one is left without care.
3. How should she handle retention of the 9-year-old's records?
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The minor's records require a longer view than an adult's. Missouri Board rules set a minimum retention period for dental records, and for a minor the practical approach is to retain the record until the patient reaches the age of majority plus the required retention period. A 9-year-old's chart should not be destroyed merely because the child has not been seen for 14 months. Dr. Ramirez should keep the original chart, provide a copy to the parent on request, and ensure the records custodian agreement specifically covers minor patients. If the parent asks that the record be sent to a new dentist, she should forward it with a signed authorization and document the transfer. She should also avoid discussing the child's care with anyone other than the parent or legal guardian unless the law requires or permits otherwise. The key is to preserve access for future treatment and to avoid a gap in the record if the child returns years later.