Message Boards
Today's Active Topics Today's Active Cases Browse Forum Categories My Recent Activity My Messages Private Groups My Marked Threads My Subscriptions
Today's Active Images Today's Active Polls Most Active Topics Global Townie Map Advanced Message Board Search Message Board Terms of Use

Practice Management: What Do I Do With All This Plaster? Wm. Randol Womack, DDS, Editorial Director, Orthotown Magazine

More by this author (71)

Actually, my headline is incomplete. What I really want to ask is
a two-part question, "What can I do with these old patient records and how long should I keep them?" This is the question I asked Winn L. Sammons, a malpractice defense specialist at Sanders
& Parks P.C., a law firm in Phoenix, Arizona. I was familiar with some of our discussion points, but there were a couple of "items" we talked about that really set me back a couple of steps.

The answer to the "second" part of the question (how long to keep them?) has always been, in my understanding, that you must keep records forever. That is why so many orthodontists have a storage room separate from their offices for all the folders and plaster from their years of practice. However, Winn explained to me that today's answer is more related to the statute of limitations as it is written in each state. For Arizona, when a child reaches the age of majority (18 years old) the statute of limitations for filing a complaint or lawsuit is two years following majority.

I asked Winn to comment on an example that was presented in a seminar I attended several years ago. Hypothetically, a 30-year-old sits in a dentist's chair and is told by the dentist that his teeth need orthodontic treatment. The patient states that he had orthodontic treatment as a child. When the conversation ends the patient is given the impression that the previous orthodontic treatment was not successful (inferring that it may have not been done properly) and it needs to be repeated. The obvious thought that immediately runs through the patient's mind is the cost of doing orthodontics again. This thought continues to aggravate the patient until he decides to contact the state board or an attorney. My questions to Winn were, "Does a new statute of limitations begin at this ‘time of discovery' some 15 years after treatment and run for two years going forward? What if the patient is 40 years old and it is 25 years after treatment? Is the orthodontist going to be asked to produce records that have been in a storage room for all that time – records that might have been discarded or have degenerated in quality?"

Winn's answer was that it would be in the orthodontist's best interest to have access to the records for this patient. Several questions that would be addressed in a situation like this would be answered in the patient's record. Was the treatment concluded with a result that met the standard of care for orthodontic treatment at the time? Did the orthodontist record the final result? Did that patient have cooperation or hygiene issues during treatment that affected the outcome? Was the patient given instructions about the retention program and how long it should continue? Were there any comments recorded indicating that the patient was happy or unhappy with the result or about any other issues? Did the patient have any follow-up appointments after the retention program started? Was the treatment completed or did circumstances outside the area of professional judgment influence or affect the treatment and the result? Did the patient leave the practice on a satisfactory or unsatisfactory basis and was that documented?

For most of us, these answers might be in the records, but do we have access to them 15 or 25 years later? Is it mandatory that we keep them that long (or even forever)? Exactly what do we really have to do? Winn stated that it isn't really an "all or nothing" requirement when it comes to past patient records. It would be very helpful in the case of a lawsuit or complaint to have them, but there might be some factors that are related to the excessive time that lapses between the "discovery" and the earlier finish date of the treatment that could help in defense of an accusation. For example, did the patient contribute to the problem that is now being discussed years later?

In answering an accusation, even without the patient's records, producing examples of how cases are customarily finished in your office or testimony of employees about the procedures and instructions when a patient has completed treatment would be an asset to a defense. But there is no denying that every piece of a patient's record is a distinct advantage to defending your position, but all is not lost in case they just aren't available.

The next item we discussed was the possibility of anything like this happening 15 or 25 years after someone is treated. What's the chance? If it is less likely with passing years, then when can you draw the line about the need for keeping records (of course there is the danger of Murphy's Law kicking in. You keep the records for 25 years and the day after you get rid of them you get a certified letter). Winn stated that, in his experience, the more the records age, the statistics point to a decrease in the likelihood that you will have to produce them on demand.

Another item that was brought to my attention was the scenario where the orthodontist and the patient just never connect personally, professionally or emotionally during the treatment. It is the case where everything started off on the wrong foot, the treatment did not progress satisfactorily, there were missed appointments, broken braces, oral hygiene problems and just a general bad time of it all. The degree of frustration can lead to a very bad decision to just wash your hands of the whole thing and tell the patient, "Your treatment is finished (when it is not) and we are taking your braces off." What you don't do is document the termination and disclose that the treatment is not finished and the reasons that the braces are coming off. You just want to get this "pain in the clinic" out of your practice forever. The real problem is that "forever" might not be forever. If this patient is confronted with a crooked tooth problem in five or 10 or 15 years and, because of some "discussions," decides to file a complaint, even if your records are accessible and can be reviewed, you are in a serious jam. The circumstances around the patient's dismissal from the practice could be construed as "fraudulent concealment." This was a term that I was totally unfamiliar with. Winn simply explained this means that you are in very serious trouble. Talk about a field day for the prosecution.

So, we ended our conversation talking about what you should have in your records, even if they are not as preserved perfectly. Winn stated that "forever" storage might not be realistic. However, there are key elements of patient records that can be preserved while all the excess paper could be eliminated. Photographs, X-rays and treatment cards are certainly core elements of what would be beneficial to any defense. But he also emphasized that a log of telephone calls, clinic discussions, comments positive or negative made by patients and/or parents, your comments to patients and/or parents during an appointment or in a consultation, etc., can be just as valuable as photos and X-rays when a dispute arises. So a "communication record" (CR) or a log of any discussions and comments, kept separately from the clinical treatment card is a very valuable asset. The CR needs to be part of every patient's orthodontic records and, in and of itself, could provide valuable defense evidence.

I began using a paper form for a communication record in the early 1980s and today our practice management software has a CR page available in every patient treatment record. The rule is, when I comment or the patient/parent comments about treatment or any other issue, a clinical assistant is typing. If I take a phone call related to a patient, then I am typing.
Orthotown Magazine
November 2025
Orthotown Magazine November 2025 Read Current Issue Read Archived Issues
Sponsors
Townie® Poll
What format of CE do you prefer?
  
Site Menu
Message Boards Magazine Continuing Education Podcasts Blogs Classifieds News Events Townie® Poll Ebooks Townie Choice Awards
Company Info
Contact Us Advertise With Us Howard Farran DDS, MBA Policies and Agreements
Site Help
The Orthotown Team, Farran Media Support
Phone: +1-480-445-9710
Email: support@orthotown.com
©2025 Orthotown, a division of Farran Media • All Rights Reserved
9633 S. 48th Street Suite 200 • Phoenix, AZ 85044 • Phone:+1-480-598-0001 • Fax:+1-480-598-3450