When Ending Treatment Can Lead to Trouble: Understanding Patient Abandonment Risks for Orthodontists
Most orthodontists enter the profession because they love transforming smiles — not because they want to navigate legal and ethical landmines. But one area where clinical and legal duties often overlap is patient abandonment. It is an issue that can arise more easily than many practitioners realize — especially when treatment ends abruptly due to nonpayment, or when a provider becomes ill or incapacitated without a plan in place for their patients.
What Counts as Patient Abandonment?
In simple terms, patient abandonment happens when an orthodontist terminates a professional relationship without giving the patient a reasonable opportunity to obtain continued care.
According to the Codes of Ethics of both the American Association of Orthodontists (AAO) and the American Dental Association (ADA), orthodontists have a duty to “do no harm” and make every reasonable effort to enable continuing care. Even when financial issues arise, the provider’s ethical responsibility to avoid harming the patient — for instance, by leaving appliances in place or ending treatment mid-course — remains paramount.
Regulatory bodies and courts have consistently held that refusing to complete or remove orthodontic appliances solely because of nonpayment can constitute professional misconduct or negligence. In several disciplinary cases, orthodontists faced penalties for delaying or withholding essential treatment after accounts became delinquent.
Why Mutual Assistance Agreements Matter
The AAO Principles of Ethics, Code of Professional Conduct and Advisory Opinions go a step further, recommending that orthodontists enter into Mutual Assistance Agreements or similar arrangements with trusted colleagues. These agreements ensure that if an orthodontist becomes unexpectedly ill, injured, or incapacitated, another professional can step in to provide care.
Without such an agreement, even a temporary absence can unintentionally leave patients stranded — a situation that may be interpreted as abandonment by state boards or professional regulators.
The ADA Principles of Ethics and Code of Professional Conduct similarly emphasize the obligation to avoid “patient abandonment” and to take reasonable steps to protect patients when circumstances prevent the practitioner from continuing care.
State Boards Take This Seriously
State dental boards — including those in New York, New Jersey, and North Carolina — have all underscored that abandoning a patient mid-treatment violates professional standards. The New York State Board of Dentistry, for example, warns that discontinuing care without adequate notice or arrangements for follow-up may be deemed professional misconduct.
Even where patients have unpaid balances, the ethical and legal expectation is clear: orthodontists must separate business disputes from their clinical duties. Patients should not be left in a position where the lack of treatment or appliance removal could harm their oral health.
Practical Steps to Reduce Your Risk
Here are a few ways orthodontists can stay compliant and protect their practices:
- Have clear financial and termination policies. Put them in writing and communicate them upfront.
- Document all efforts to contact and transfer patients when ending treatment.
- Provide reasonable notice and referrals to other providers when withdrawing from care.
- Establish a Mutual Assistance Agreement with another orthodontist to ensure continuity of care in emergencies.
- Stay current on your state’s board rules and ethical codes — they can vary in wording but share the same underlying duty: do not leave patients without options.
Final Thoughts
Patient abandonment issues often arise from situations that seem practical or unavoidable — a patient stops paying, or a practitioner faces a health emergency. But without careful handling, those moments can have serious professional consequences.
If you are unsure whether your policies or agreements adequately protect your patients and your license, we can help.
Contact Evan Sampson, Counsel within the firm’s Health Care Practice Group, at esampson@postschell.com or 856.301.2561 to discuss Mutual Assistance Agreements or to review your practice policies for compliance with state and professional standards on patient abandonment.
Disclaimer: This post does not offer specific legal advice, nor does it create an attorney-client relationship. You should not reach any legal conclusions based on the information contained in this post without first seeking the advice of counsel.
