Risky Business: Referrals-The Risk

Malpractice cases involving general dentists and referrals can be avoided by documenting, systematically following up, and communicating with specialists. These guidelines help manage risks:

1. Always refer to a specialist in written form. Send the original with the patient to the specialist; keep a copy in the general dentist’s chart.
2. The written referral form should include the date of referral and latest date the referral may take place. Timeliness can be a key component in a claim.
3. If the referral is accompanied by a phone conversation to the specialist, document the phone call’s date, time, and topic in the general dentist’s chart. If there is a dispute about the recommendations of the general dentist and specialist, document the dispute. Typically, a specialist’s recommendation trumps a general dentist’s.
4. If a referral form is faxed to a specialist, keep a copy of the fax and confirmation receipt in the general dentist’s chart.
5. If a general dentist recommends an immediate referral appointment, advise the patient and document it in the referral form and chart. Adhere to the patient follow-up process and document follow-up details.
6. The general dentist should receive communication from the specialist in writing or by phone to confirm that the problem is being handled by the specialist. If that communication is via phone, document details of the call in the chart. Never release original records or radiographs to a patient, but make copies available.
7. The referral form should indicate that records or films are available to the specialist if needed. Important records or films should be sent as copies.
8. If the general dentist knows a patient has not followed up with the referral, the dentist should communicate with the patient by either a documented discussion concerning lack of compliance or a written letter detailing the need to follow up with the referral. Patient fault or lack of compliance can be a strong defense.
9. Communications concerning the referral and follow-up process should be committed to a regular protocol.
10. Never assume that a patient has followed up on a referral, especially if the patient’s need for a referral was urgent. Many referring dentists assume that once a referral has been made, it is no longer their responsibility. Dental negligence law does not necessarily absolve a referring dentist from liability because he or she told a patient to see a specialist. If the patient ends up with serious problems related to that referral, the lack of detailed documentation makes it difficult to prove that the patient was fully aware of the reason, need, and timeliness for the referral, or seriousness of the potential condition. Clear communications between the general dentist and specialist regarding evidence of the patient’s condition help to delineate responsibilities.

Often, referrals are not well-documented and communication is informal. If a patient develops a problem that the specialist did not realize was urgent or the general dentist assumed was handled, then the general dentist has exposed herself to a potential claim that the standard of care required follow up by the general dentist to assure timely diagnosis and treatment. Without the clarity of these communications and details, referrals can be fraught with risk.

Linda J. Hay, JD

Hay is a partner at Alholm Monahan Klauke Hay Oldenburg, LLC in Chicago. She graduated from The John Marshall Law School in 1986 and has defended dental professionals for more than 15 years. She may be reached at [email protected].