Ethics
A message about the ethical and legal issues concerning patient records from Dr. Edward Rosenfeld, CDA Ethics Committee Chair
There seems to be a lot of confusion about patient records. It is important to understand these issues since they involve not only ethical concerns but also the Dental Practice Law of the State of Colorado. This article will cover situations such as how and when a patient is entitled to their records, what other entities are entitled to those records, confidentiality concerns, and how long to keep inactive records.
The American Dental Association Principles of Ethics and Code of Professional Conduct states that dentists, “are obligated to safeguard the confidentiality of patient records. Dentists shall maintain patient records in a manner consistent with the protection of the welfare of the patient. Upon request of a patient or another practitioner, dentists shall provide any information in accordance with applicable law that will be beneficial for the future treatment of that patient.” This means that a dentist need not gain the permission of a patient to discuss the records with another treating dentist unless the information includes health information of a sensitive nature such as HIV status, treatment for chemical dependency or mental illness.
The Dental Practice Law, 25-1-802 states that records, “shall be available to the patient upon submission of a written authorization-request for inspection of records, dated and signed by the patient, at reasonable times and upon reasonable notice”. The “patient record” does not include doctor’s office notes unrelated to treatment plan, radiographic interpretation, diagnosis or treatment. All of the aforementioned items are considered part of the patient record. A reasonable cost of obtaining a copy shall not exceed $12 for the first ten or fewer pages and $0.25 per page for every additional page. Postage may be charged if the copy is to be mailed. A reasonable cost for duplicating radiographs is $25.
Practitioners are strongly encouraged to keep the originals of any records and release only copies to patients. The State Board of Dental Examiners may request originals during the course of an ongoing investigation. The patient or his representative may not be charged merely to inspect the records but a signed release should still be obtained. Also, a request for patient records may not be refused if a patient has an outstanding balance for treatment but records may be withheld for lack of a reasonable payment for their duplication.
Occasionally a standing committee of the Metropolitan Denver Dental Society or the Colorado Dental Association, such as Peer Review or Ethics, may request copies of patient records as part of an ongoing investigation. It is unethical to refuse such a request.
How long should records be kept after a patient becomes inactive? State Board Rule XXIII states that records for adult patients should be kept for a minimum of seven (7) years after the last date of dental treatment or examination. Records for minors should be kept for a minimum of seven (7) years after the patient reaches the age of majority (age 18). Keep in mind that the statute of limitations runs from the date of discovery of a problem not previously disclosed so certain records should be kept indefinitely. That is why, from a liability standpoint, it is important to discuss all “misadventures” such as separated endodontic instruments with the patient and fully document such events and the discussion in the patient’s chart.
Once the decision is made to destroy records, the Board Rules specify that written notice to the patient’s last known address, or by publication (legal notice), must be made sixty (60) days prior to destruction. Actual destruction cannot take place until a 30-day period has elapsed wherein the patient may claim the records at no charge. Notice by publication may be accomplished by publishing in a major newspaper one day per week for four (4) consecutive weeks. Be sure to keep the receipt from the newspaper and a copy of the notice.
This is one of a series of articles and communications to educate MDDS members on the importance of following not only the State Dental Board rules but also the ADA Principles of Ethics and Code of Professional Conduct. The CDA mailed a letter to all its members on the subject of advertising unearned degrees and the proper way to list such degrees and courses. If a member of the Metropolitan Denver Dental Society is found to be in violation of the ADA Principles of Ethics and Code of Professional Conduct and refuses to rectify the problem, then that member, after a proper hearing may be found to no longer be “in good standing” with MDDS and CDA. This situation could have the unintended consequence of the inability to participate in dental society programs such as the Dentists Professional Liability Insurance Trust.
If uncertain about whether any treatment or action is in conflict with the Dental Practice Law or the ADA Code of Ethics, contact the Colorado State Board of Dental Examiners at (303) 894-7800 or any branch of organized dentistry.
