The Extra Tooth, the Extra Fee, and the Records Request
Dr. Lindqvist treatment-planned extraction of tooth #30 with socket preservation for a 58-year-old patient, quoting $2,850 and obtaining a signed consent form listing "#30 extraction, bone graft, membrane." During surgery the crown fractured, the root required sectioning, and Dr. Lindqvist also extracted the adjacent #31, which had been asymptomatic and had tested within normal limits, telling the patient afterward that it "would have gone bad soon." He placed an additional membrane and added $900 to the bill. At the 10-day visit the patient asked for copies of his complete record, including the pre-operative radiograph and the signed consent form. The office manager said records are released only after the $640 balance is paid, at $1.25 per page plus $25 per radiograph. The patient filed a Board complaint alleging he never agreed to lose two teeth. Records are three years old; the practice destroys charts at five years.
1. Evaluate the consent. Which parts of what was done were covered, which were not, and what should have happened when the surgical plan changed mid-procedure?
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A signed form is evidence of consent, not a substitute for it; the test is whether the patient authorized the procedures actually performed, with material risks and alternatives disclosed.
Covered. Extraction of #30 with graft and membrane was expressly authorized, and managing an unexpected crown fracture or root sectioning is within the ordinary contingencies of an authorized extraction.
Not covered. Extracting asymptomatic #31 was a separate procedure with permanent consequences, undertaken for the dentist's convenience prognosis rather than to address an emergency. "It would have gone bad soon" is a clinical opinion, not consent, and there was no immediate threat justifying unilateral action. The additional membrane and the extra $900 is a material change in cost that the patient was entitled to weigh.
What should have happened. The consent conversation should have identified who to contact if the plan changed. Once #31 became a question, the options were to stop, close, and re-consent at a later visit, or to reach the patient in the chair (he was awake and able to consent to the additional extraction, which is the obvious miss here) and document that discussion. Post-operative explanation does not retroactively authorize treatment. The chart should carry the rationale, the contingency discussion, and the fee disclosure; if those notes are missing, add a dated addendum describing what actually happened - never rewrite the original.
2. Can the office condition release of records on payment, and charge these fees? What are Dr. Lindqvist's obligations now that a complaint is on file?
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Records access. The dental record is the practice's property, but the patient has a right of access to its contents, including radiographs and the signed consent. A billing dispute over treatment is not a lawful basis for withholding copies; conditioning access on payment of the $640 balance is itself the kind of conduct that generates a second, independent complaint. A reasonable, cost-based copying charge is generally permissible, but the amount should be checked against the current fee limit rather than invented, and a per-radiograph charge of $25 should be verifiable as cost recovery.
Now that a complaint exists. Respond through the Board's stated channel within the deadline. Preserve everything - original chart, consent form, radiographs, billing ledger, any images - and place a litigation hold on the file. Do not alter, supplement retroactively, or destroy anything; an addendum is dated and clearly labeled as later-added. Consult counsel before any written statement. Destroying charts at the five-year mark would be premature with a complaint pending; verify the retention rule and apply the longer interval where minors or pending matters are involved. Spoliating records converts a consent problem into an independent disciplinary and evidentiary one.