Dentist threatens to call CPS, if you don't make an appointment

[Perd Hapley]

A dental practice in Pennsylvania has a novel method for guaranteeing return business: Threaten to turn parents in for neglect if they stop bringing in their kids.

Smiles 4 Keeps, which has three offices in the state, insists that its threats are being misinterpreted. But the letter it sent out is pretty clear: Get your kids back in here.

"To keep your child as healthy as possible and to avoid a report to state authorities, please call Smiles 4 Keeps immediately to schedule an appointment."

https://reason.com/blog/2018/03/27/dentist-threatens-to-report-parents-for

They try that with the wrong people, and the staff may need some dental work of their own.

[cordex]

That letter would not have the intended impact on me.

[Hawkmoon]

I think I'd be tempted to schedule an appointment for a tune-up ... of the dentist.

[MechAg94]

I think I would be choosing another dentist.  I am not even in a big city and there are several to choose from. 

[K Frame]

Two of those offices are in Scranton and Wilkes-Barre.

Plenty of other dentists to choose from.

Regarding not allowing the parent to see X-rays, etc., I'm suspecting that some of that may be HIPPA driven. I've heard of other medical providers adamantly refusing to provide any information about treatment of a minor child because they're terrified that they'll run into issues with the incredibly flawed HIPPA laws.

[RoadKingLarry]

Right up there with some insurance agents here.
A number of years ago the state required insurance agents to inform them if a customer let their auto insurance lapse.
In theory, not a bad idea for combating uninsured drivers.
Didn't quite work that way.
Find a better deal on car insurance, cancel your policy with the old company and old company notified the state that you no longer had car insurance. The State, in their infinite wisdom, automatically suspended your drivers license for not having insurance, of course they didn't bother to notify you. Get pulled over for a minor infraction, go to jail for driving on a suspended license, car gets towed and impounded.
Of course you got your "due process and the chance to sort it all out in court. So, even after having done nothing wrong, you got to deal with the courts and associated legal fees, deal with paying for towing and impound/storage fees.

Didn't last too long and the legislature actually managed to fix it.

[cordex]

Regarding not allowing the parent to see X-rays, etc., I'm suspecting that some of that may be HIPPA driven. I've heard of other medical providers adamantly refusing to provide any information about treatment of a minor child because they're terrified that they'll run into issues with the incredibly flawed HIPPA laws.

No defense of the HIPAA flaws, but that doesn't make sense.  With the exception of emancipated minors and certain specific mental health treatments or HIV testing, nothing in HIPAA precludes a parent or guardian from acting as a personal representative for a minor in their charge which means full access to all PHI and medical information as well as being responsible for approval of medical treatments.

There may be state-specific laws that are different, but HIPAA is pretty clear that something like dental x-rays should be equally available to the parent as to the patient.

[K Frame]

They're already reporting you to children & youth services for possible neglect based on an imperfect understanding of state law, why should they bother to understand HIPPA, too.

[cordex]

They're already reporting you to children & youth services for possible neglect based on an imperfect understanding of state law, why
should they bother to understand HIPPA, too.

I don't think they are misunderstanding anything.  You see an example of ignorant bumbling implying that ignorant bumbling lead to both issues.  I see an example of maliciously weaponizing a law implying that malice lead to both issues.

[Brad Johnson]

Best I can tell they've disabled and/or deleted all comments on their Book of Face page. A cursory name search revealed a solid "eff you" opinion set. It'd be interesting to hear their voice mails. Also be interesting to hear conversations being had at the state regulatory level.

Given any reported parent will likely end up a permanent fixture on some state regulatory agency's black list, I'm waiting for the first time an overly-zealous practice reports someone who simply took their child to another provider for whatever reason, and who has no problem suing said practice for defamation of character or some such. It won't go anywhere criminally but there is definite civil liability involved.

Brad

[lupinus]

My response to them would....be very unkind. And include suggestions to do things that are anatomically impossible for a large percentage of humans.

Sent from my Pixel XL using Tapatalk

[zxcvbob]

That letter would not have the intended impact on me.

First thing I would do is check into an ethics complaint with the state licensing board.  Next would be to contact the consumer advocate at the news dept of the local TV station (assuming there is one)  It ought to make a good story.

Edit:  Someone has contacted the TV station :)  http://wnep.com/2018/03/23/16-investigates-smiles-4-keeps-letter/

[K Frame]

"I see an example of maliciously weaponizing a law implying that malice lead to both issues."

Never assume and attribute to malice that which can be more easily explained as mere dumbfuckery...

 

[cordex]

"I see an example of maliciously weaponizing a law implying that malice lead to both issues."

Never assume and attribute to malice that which can be more easily explained as mere dumbfuckery...

I know the quote, but I also read the letter.

[MillCreek]

I call CPS several times a year for cases of child abuse and neglect evidenced by untreated dental trauma or disease. Most commonly, these are kids with extensive decay and caries causing pain to the child. And if we start a treatment plan, and the parents don't follow through and come back for the appointments, I chat with the caseworker some more.

[Northwoods]

I call CPS several times a year for cases of child abuse and neglect evidenced by untreated dental trauma or disease. Most commonly, these are kids with extensive decay and caries causing pain to the child. And if we start a treatment plan, and the parents don't follow through and come back for the appointments, I chat with the caseworker some more.

Slight difference between that and sicing CPS on a family for just not coming in every 6 months for routine cleaning/exams.

SWMBO probably averages a dental appointment with the kids about once a year, maybe 18 months.  Their teeth are fine.  It's only a matter of being a huge PITA to deal with 4 kids at the dentist, especially if I can't also be there.

[MillCreek]

Slight difference between that and sicing CPS on a family for just not coming in every 6 months for routine cleaning/exams.

I agree with you if indeed all we are talking about is routine care.

[cordex]

There may be state-specific laws that are different, but HIPAA is pretty clear that something like dental x-rays should be equally available to the parent as to the patient.

Oh really, Mr. Know it all?
https://www.kcci.com/article/parents-denied-access-to-their-childrens-medical-records-by-law/26032172

[MillCreek]

Oh really, Mr. Know it all?
https://www.kcci.com/article/parents-denied-access-to-their-childrens-medical-records-by-law/26032172

Oh, I can tell you about that, since I do this myself: in most states, persons under the age of 18 have the right to consent themselves for certain areas of medical care.  Those areas usually relate to sex, drugs and mental health.  Along with the right to consent for care comes the right to privacy in those areas. If we see a kid for treatment in these areas, and they want to keep it confidential, we are legally bound to respect that. The typical electronic medical record is not able to flag all relevant patient encounters as containing confidential information.  So in order to maintain the privacy of the minor patient, we have to turn off electronic access of the parents to the minor patient's chart.  The age at which the EMR turns off access varies by system. The typical ages are 10, 12 or 13.

The parents can still get paper copies of the minor patient's medical records.  But if those paper records contain any confidential treatment that the minor wishes to be kept private from the parents, we will redact that from the paper copy that is provided to the parents.

So this was a great story for the media, but it is routine across the healthcare systems and has been since EMRs have been in widespread use.

[230RN]

I guess it's not unprecedented.  In the 1940s and 50s in New York City, it was required that the kids go to the dentist every semester / 6 months / whatever.

I don't know if that was a State thing or a NYC Board of Education requirement, or what the penalties were for non compliance, but I remember having to bring to school a thing signed by our dentist that little old me had been to the dentist.  I don't know what the present status of this is, and don't remember if this was a requirement in Colorado for my kids (now adults), since ex-Wife1 dealt with that, mostly.

I have no real position on this matter; the dental office is probably correct about the law, but the letter was apparently written and approved by one of those authoritarian types of people.  Type A or Z or M or whatever.  It does smack of greed a bit, too.

I see it as part of the need to establish a delicate balance between "Statism" and "Protection" of those whose parental care is borderline, perhaps because of financial problems.

Millcreek, thanks for your input as a health professional.

Terry

[MechAg94]

And I think that "protection" is where a lot of people end up supporting "statism".  It's for the children.  You can justify a lot with arguments like that. 

[Fly320s]

The typical ages are 10, 12 or 13.

I'm curious as to how a minor, especially one that young, can
1. Understand the medical treatment and/or procedures
2. Be smart enough to form valid questions and concerns to the Dr.
3. Enter into a agreement/contract to perform medical services when that minor can not enter into other contracts legally.

[MillCreek]

I'm curious as to how a minor, especially one that young, can
1. Understand the medical treatment and/or procedures
2. Be smart enough to form valid questions and concerns to the Dr.
3. Enter into a agreement/contract to perform medical services when that minor can not enter into other contracts legally.

Generally they cannot, except perhaps for the 13 year old. The age of consent is different than the age of the EMR turning off parental access to the minor's chart that I stated above.  Most states have explicit statutory or case law providing the ages at which a minor can consent to treatment.

[Fly320s]

Generally they cannot, except perhaps for the 13 year old. The age of consent is different than the age of the EMR turning off parental access to the minor's chart that I stated above.  Most states have explicit statutory or case law providing the ages at which a minor can consent to treatment.

I'm confused.  Most minors can not consent to treatment, but some (or maybe most) minors can prevent their parents from seeing their medical chart?  Is that right?  If it is, how can a parent consent to treatment for the child without discussing it with the doctor?

[K Frame]

"I guess it's not unprecedented.  In the 1940s and 50s in New York City, it was required that the kids go to the dentist every semester / 6 months / whatever."

I think programs like that were pretty common after World War II, perhaps even before, especially in the days when dental decay was a lot more endemic than it is today.