A DOCS Education Member located in Washington state asks:
I have just had an initial visit with a male patient and would like your input on how to proceed. Patient is an alcoholic and is currently taking Librium and an anti-depressant. My first thought is not to sedate this patient.
Dr. Jerome Wellbrock, DOCS Education faculty, responds:
If the patient is currently abusing alcohol, I would not treat this patient with sedation, nor would I provide any manner of dental care if they arrive at the office under the influence. This is broader advice however; I'd like to hear more detailed information about this patient before a final recommendation.
The DOCS Education member replies:
Patient is a 33-year-old male who denies any current medical problems. He has told me that he is a "functional alcoholic" and purports to be attempting to quit drinking. He is not in any detox or rehabilitation program, but is receiving care from a primary physician. The patient’s is taking 25mg of Librium TID PRN to control drinking urges and anxiety and 20mg QD of Lexapro® for depression. He claims he’s only taken one Librium over the last several months.
I have spoken with the patient’s primary care physician and was informed that unless his condition improves, detox and a treatment program will be necessary.
As he is a self-described "functioning alcoholic", what are the signs I should look for when determining if he is under the influence? He has never exhibited any signs of being intoxicated, though I have smelled alcohol on his breath. I agree 100% that sedation with this patient would be a mistake, but am unsure on how I can refuse to treat him.
Dr. Wellbrock expands on his answer:
You have the right to refuse treatment and sedation on any patient that you do not feel, in your professional judgment, is a proper patient to be treated in your office. It sounds like this patient has a serious long standing abuse problem that needs to be addressed. You also need to know the status of his liver health and function because of possible damage from long term abuse. My recommendation is not to treat the patient at this time.
John Bitting, Esq., regulatory council for DOCS Education, clarifies:
The Washington rules have this to say about patient abandonment:
WAC 246-817-380
Patient abandonment.
The attending dentist, without reasonable cause, shall not neglect, ignore, abandon, or refuse to complete the current procedure for a patient. If the dentist chooses to withdraw responsibility for a patient of record, the dentist shall:
- Advise the patient that termination of treatment is contemplated and that another dentist should be sought to complete the current procedure and for future care; and
- Advise the patient that the dentist shall remain reasonably available under the circumstances for up to fifteen days from the date of such notice to render emergency care related to that current procedure.
DOCS Education members have access to regulatory support as a membership benefit. If you have any questions regarding patient abandonment in your state please call a customer service representative at 1-877-325-3316 for more information.
