Informed consent, patient privacy, and patient abandonment are ethical concerns outlined in a recent white paper on charity dental clinics. Some recommendations from the paper include the following:
That patients don’t allow volunteers to handle their medical records.
That patients are informed how and where to obtain follow-up care.
That patients are educated about the importance of finding a dental home.
Informed consent and lack of access to necessary follow-up care are two ethical concerns with charity clinics offering free dental care, according to a white paper from the American Dental Association (ADA).1
Thomas Raimann, DDS, the paper’s lead author, first grew concerned about ethical issues of charity clinics while working as a volunteer and chairing local events. After being appointed to the ADA’s Council on Ethics, Bylaws and Judicial Affairs, he found that other members shared his concerns. The following are some of the ethical issues identified in the group’s white paper:
The ability of patients to make informed decisions about treatments they receive at the events. According to the white paper, “Many factors play into treatment choices, but the provider must take responsibility to ensure that the patient understands the options available and the risks and benefits of each option.”
Access to patient records. “By their nature, these events have many volunteer providers. These providers do not keep the records of the treatment they provide,” says Raimann. It is important for the sponsors of the event to maintain the patient records to be available for any needed follow-up care. “Most events do this, and give the patients a number to call in case of problems with the treatment provided,” says Raimann.
Observance of health and safety protocols. The events have many different practitioners from many areas of the state and country. “There should be protocols and an orientation for providers, so that universal precautions are followed,” says Raimann.
The potential for patient abandonment. If follow-up procedures are required, the patient should be informed about when and where these can be obtained. “What we implemented was having people sign that they understand this is a short-term event and may not solve all their problems,” Raimann says.
It is easy for providers to become overwhelmed by the events when caring for a long line of people all needing care. “We need to take a time out and inform people that there may be other solutions to their problems,” says Raimann. The paper recommends giving patients education about the importance of finding a “dental home.” One way to do this is right after registration. “Some events may do that at the end, so it is fresh in patient’s minds,” says Raimann.
Confidentiality. Local volunteers might be friends, neighbors, or relatives of those seeking care. Usually, volunteers have no training in why and how to keep medical records confidential.
“One of the things we came up with was having patients hang on to their records as they move through the event, instead of handing the chart with confidential information to the volunteer,” says Raimann.
Raimann says that a broader ethical issue is the overwhelming number of people who need free care due to lack of coverage and poor access to a dental home. Some states eliminated non-emergent adult dental care as part of cost-containing efforts in their Medicaid programs. “So patients end up either in the emergency department, or at these events,” says Raimann.
Even if a state’s Medicaid program does provide dental coverage, many dentists don’t accept Medicaid patients due to low reimbursement rates. “All we can do is try to do the best we can in continuing to put these events on in the most ethical manner that we can,” says Raimann.
Raimann TE, Reynolds E, Ishkanian E, et al. The ethics of temporary charitable events. 2015. Retrieved at http://bit.ly/1RGQ4Ye.