Treating Non-Resident Patients
Ontario dentists occasionally
treat patients from other
provinces or countries.
American residents in
particular sometimes seek
dental services in Ontario
because of geographical
proximity and favourable
currency exchange rates.
While RCDSO members have
malpractice protection for
treatment provided to foreign
patients in Ontario, treating
non-resident patients raises
a number of clinical and
The Dangers of Telehealth
Health practitioners have no difficulty recognizing
in-person consults as treatment, but many may
not be aware that electronic communications may
Telephone or email advice provided to a patient in
another jurisdiction raises tricky questions about
where the treatment is provided. Many provinces
in Canada and countries around the world deem
telehealth to be rendered where the patient resides.
If the practitioner is not registered in the other
jurisdiction, he or she could be guilty of practising
without a licence.
If PLP’s insurer were to adopt that position,
liability protection for such interactions would be
denied, since the contract only covers services
provided in Ontario.
The Problem of Follow-up and Aftercare
One of the problems in treating a non-resident
patient is that it may be difficult for the patient to
attend follow-up appointments or to return to the
treating dentist in the event of a complication.
A dentist who is unable to properly monitor a
patient’s progress may not meet the standard of
care required in the circumstances. Leaving the
patient to his or her own devices in dealing with an
untoward clinical event also exposes a health
practitioner to liability, since he or she will have no
influence over the ultimate outcome.
The Challenges of Defending a Foreign Legal Action
A non-Ontario resident may choose to commence
proceedings for alleged dental malpractice in his or her
province or country as a matter of convenience or to
take advantage of a more favourable legal climate in the
foreign jurisdiction, including the potential for a higher
If an action against an RCDSO member were to be
brought outside Ontario, PLP would assign local counsel
to attempt to have it dismissed on technical grounds. If
that was unsuccessful, PLP would provide a defence.
However, the defendant would likely be required to
attend pre-trial proceedings in the foreign jurisdiction
and would be obliged to be present for trial should it get
that far, resulting in considerable expense and
inconvenience. The member would also be exposed to
personal liability for damages beyond the protection
provided by PLP or the excess coverage purchased by
him or her.
Minimizing the Risks
Because PLP is not financially or structurally set up to
defend foreign legal actions, it is our recommendation
that RCDSO members not treat non-Ontario residents
electively. Of course, emergency treatment should be
provided to foreign patients as required, but only insofar
as is necessary to stabilize the situation.
Except in emergencies, PLP members who do treat
non-Ontario residents should have each foreign patient
sign a Governing Law and Jurisdiction Agreement in
favour of all members of the practice who may
participate in the patient’s care as part of the consent.