By Dr. Sarah Parsons, D.D.S. Private Practice Dentist and Associate Executive Director of The Dentist Professional Liability Trust of Colorado

An unexpected treatment outcome can be stressful for both a patient and the dentist. Patients want answers, and dentists want to address concerns with honesty and compassion. Yet the fear that a conversation could later be used in a lawsuit can make those discussions feel difficult.

Colorado’s Candor Act offers a structured path forward: an opportunity for open, protected communication after a qualifying adverse incident. Enacted in 2019, the law can help dentists and patients work toward understanding and resolution.

An opportunity to rebuild understanding

A patient who feels heard may be better able to understand an unexpected outcome.

Candor creates room to explain findings, answer questions, discuss prevention, and an appropriate path forward. Under Colorado law, the Dentist must initiate the Candor process by sending a written notice to the patient within 180 days of adverse incident. The TRUST assigns legal counsel to help our Colorado Dentist navigate and prepare for a Candor meeting. This preparation and representation allow the TRUST Dentists to have more successful Candor outcomes and hopefully deter a formal lawsuit from being filed.

Contact the Trust early

If an outcome raises concerns, contact the Trust promptly before attempting to arrange a Candor meeting. We can work with legal counsel to evaluate the circumstances, reporting implications, and required steps.

You do not have to navigate a difficult patient situation alone. The Trust is here to help you respond thoughtfully, protect your interests, and keep patient care at the center of the conversation.

For dentists. By dentists. It’s personal.

by Dr. Kami Marr, President, The Dentists Professional Liability TRUST of Colorado

As I step into the role of The Trust Board President, I am reminded of just how meaningful this organization has become to me personally and professionally. Since joining the Board in 2017, serving alongside such thoughtful and dedicated colleagues has been one of the most rewarding parts of my dental career.

In dentistry, we spend our days building relationships, earning trust, and navigating the unexpected, and we always have our plan B in the back of our minds. We know that even with the best intentions, excellent clinical skills, and careful planning, challenges can arise. And when they do, having someone in your corner who understands what it’s like to sit in the dentist’s chair—not as a patient, but as the provider—can make all the difference.

That’s what makes the Dentists Professional Liability Trust of Colorado so special.  Our motto, “It’s Personal,” isn’t just a catchy phrase. It’s the foundation of who we are and how we serve our members.  The difference is a conversation. 

One of the greatest benefits of the Trust is the ability to pick up the phone and speak directly with a local, licensed Colorado dentist. Someone who understands the realities of practicing dentistry and the concerns that can keep us awake at night.

Sometimes, that conversation is all it takes to provide reassurance, perspective, or guidance. Other times, early support can help manage a difficult situation before it escalates into a formal complaint or malpractice claim.

The Trust is also different because of how it is structured. We are a member-owned, not-for-profit organization.  Our priorities are aligned with the dentists we protect. Rather than focusing on shareholders, we focus on providing meaningful coverage, stabilizing premiums, and returning value to our members.

Equally important, the Trust is led by our peers—Colorado dentists who understand firsthand the challenges and rewards of practicing in our state. Our Board is comprised of diverse clinical backgrounds and perspectives to help ensure that the Trust remains relevant and prepared for the evolving needs of our profession.

At our recent Board Retreat in Colorado Springs, I discussed with our group about the important aspects of this very special organization and the pearls of wisdom that come with this responsibility and experience.  We don’t solve every issue at a single board meeting, but we do keep asking the right questions, listening to our members, and making thoughtful decisions that will strengthen the Trust for years to come.   

When the unexpected happens, and it will, insurance is important. But knowing who’s on the other end of the phone when your Plan B didn’t work as you had planned?  That’s personal and makes all the difference.

Dr. David Geck

By Dr. David Geck

Colorado’s New Damage Caps: Why a $1M Professional Liability Policy May No Longer Be “Enough

You have built a thriving practice.  Your patients trust you, your team respects you, and your reputation is “solid”.  Then the unthinkable happens.  A surgical complication, an adverse outcome.  You’ve always believed your $1 million professional liability policy would protect you. But under Colorado’s new legislation increasing tort damage caps, that assumption may leave you at personal financial risk.

As of January 1, 2025, Colorado enacted sweeping changes to its damage cap laws through House Bill 24-1472, dramatically increasing the maximum recoverable damages in civil and dental/medical malpractice lawsuits. For dental professionals, this isn’t just a subtle “tweak” to the law, it is a significant shift that could leave dentists underinsured with inadequate professional liability insurance coverage.

Many dentists in Colorado carry a $1 million per occurrence liability policy, long considered sufficient. However, under the new law, that coverage may no longer protect you against the full financial risk of a claim, whether it be a nuisance or a serious claim. It is time to address the key changes, their implications for dental practices, and the steps dentists should take to safeguard their professional and personal assets.

Colorado’s updated damage caps significantly increase the financial exposure for healthcare providers, including dentists. The most relevant changes include:

Noneconomic Damages in Civil Actions (General negligence)

• Old Cap: $250,000 – Adjusted to $729,790 as of 2024
• New Cap: $1,500,000
• Adjustment: Indexed for inflation every two years starting in 2028

Wrongful Death (General negligence)

• Old Cap: $250,00  — Adjusted to $729,790 as of 2024
• New Cap: $2,125,000
• Adjustment: Indexed for inflation every two years starting in 2028

Medical Malpractice – Wrongful Death

• Old Cap: $300,000
• New Cap: $810,000 (cases filed in 2026)
• New Cap: Phased increase to $1,575,000 over three years
• Adjusted for inflation effective 2030

Medical Malpractice – Noneconomic Damages

• Old Cap: $300,000
• New Cap: $530,000 (cases filed in 2026)
• New Cap: Phased increase to $875,000 over three years
• Adjusted for inflation effective 2030

Medical Malpractice Overall Damages Cap – Economic and Noneconomic Damages

• New Cap: $1,012,500:  The greater of $1,000,000 or 125% of the Medical malpractice and Wrongful Death noneconomic damages cap in effect at the time the acts or omissions occurred.
• Increases to $1,968,750 over next three years
• Adjusted for inflation effective 2030

These increases reflect a broader national trend toward expanding patient rights and compensation. Colorado’s biennial inflation adjustments mean these caps will continue to rise, further increasing liability exposure over time.

 For example, consider the following hypothetical claims:

A patient suffers severe infection and permanent facial nerve damage from a dental procedure, resulting in extensive follow-up care, chronic pain and loss of function. Economic damages alone, such as medical or surgical expenses, lost wages and future care, could quickly eclipse $1 million. This is especially true if the patient has a difficult medical course, is a substantial wage earner, or the future treatment is likely to be extensive. Then, the noneconomic damages for pain and lost enjoyment of life could easily add up from there, leaving a six- or even seven-figure gap in coverage. 

A patient experiences post-treatment complications alleged to have been caused by dental/medical care, and sadly the patient dies. Numerous factors can drive exposure in wrongful death claims filed under a dental/medical malpractice theory. Before the recent changes to the damage caps, most such claims were subject to a $300,000 exposure. The new wrongful death caps, especially as they grow in the future, can make settlement or verdict amounts exceed the historically common $1 million policy limit.

If your coverage stops at $1 million, you’re personally responsible for the rest.

In each case, if a judgment exceeds your insurance coverage, plaintiffs may pursue your personal assets, including savings, property, and future earnings.  This could bring considerations about additional legal challenges, liquidating assets, facing wage garnishment, or enduring long-term financial hardship.  As damage caps rise, insurers may adjust premiums, policy structures, and underwriting criteria. Dentists should expect potentially higher costs for enhanced coverage.

So, what’s your plan moving forward?

Start with a review of your current coverage.  Contact your professionally liability provider and confirm your per-occurrence and aggregate limits. Understand the scope of your coverage and any exclusions.

 If you are a member of the Dentists Professional Liability Trust, you are already have a $2M/$6M policy.  If you have a $1M/$3M policy, you should consider raising your limits.  The cost difference is minimal compared to the risk of underinsurance.  And as always, do your due diligence and consider which policy is the best fit for you.

Be proactive to reduce your risk.  Invest in continuing education, review and update patient hand-off and inter-office protocols.  And remember that detailed, accurate documentation and thorough informed consents (not just a signed form, but a true communication about risks, benefits, and alternatives) are pivotal in defending a claim against you. 

Prioritize communication and trust.  Establish rapport and trust with each patient and with your team.  Most lawsuits start with a breakdown in communication or a loss of trust.  When complications arise, speak directly with your patient.  They feel more reassured and valued when the dentist personally reaches out, offering clarity and a compassionate touch.  Often, a kind and empathetic face-to-face conversation (not just a text message) can go a long way toward de-escalating a matter.

 Colorado’s new damage caps mark a turning point in malpractice liability. For dentists, the message is clear; the old standard of a $1 million policy is no longer enough. By taking proactive steps, reviewing coverage, increasing limits, and enhancing risk management, you can protect yourself, your practice and your future.

Don’t wait for a claim to test your limits. Prepare today for tomorrow’s risks.

Contact the Dentists Professional Liability Trust of Colorado Today at ask about our 2million/6 million claims made policy to make sure you are protected. It’s Personal to us and your protection matters.

Dismissing a Patient,

By Dr. Candace DeLapp, D.D.S.

It’s Monday morning- morning huddle time. There’s a patient’s name on the schedule that makes everyone in the office cringe! You know who I am referring to: the person who won’t let you take radiographs, won’t let you do an exam but once every three years, and refuses routine dental care. Basically, it’s that patient who makes threats if you are not willing to treat them or not treated them based on their demands or is out-right abusive.

The Dentist-patient relationship is based on mutual trust and respect. This is commonly termed, rapport- defined by Webster’s Dictionary as “a close and harmonious relationship in which the people or groups concerned understand each other’s feelings or ideas and communicate well. ” Occasionally, there comes a time when this relationship becomes strained or no longer exists and you now have concerns about continuing dental treatment on this patient.

Some other behaviors or actions that breach this relationship are: frequent no shows or last minute cancellations, non-compliance on referrals, ignoring treatment recommendations, refusal to obtain full and timely records for treatment planning, not following directions on medications prescribed, breaching financial arrangements (written and signed), as well as being rude, threatening or abusive to your team and yourself. There are many other examples.

Have you found yourself asking “should I dismiss this patient from my practice?” and/or “when should I dismiss this patient?” Not all patients are the perfect fit for your practice. You are allowed and might need to dismiss patients from your practice- and once you find yourself asking these questions seriously, it’s time to take appropriate action.

Ending the relationship must be done properly. The Dental Practice Law of Colorado addresses grounds for disciplinary actions as “Failing to provide reasonably necessary referral of a patient to another licensed dentist or licensed health care professionals for consultation or treatment when the failure to provided referral does not meet generally accepted standards of dental care;” (C.R.S. 12-220-130 (1) (W)). Failing to dismiss a patient from your practice properly could put you in violation of this provision.

Here are some recommendations to include in a dismissal letter to a patient

• Advise the patient to immediately seek the services of another dentist (you may refer them to an appropriate dentist or dentists for treatment).
• Advise the patient of the reasons for dismissal (i.e. Failure to follow through with recommended treatment).
• Advise the patient of conditions that require follow up or evaluation.
• Advise the patient that you will be available for any dental emergency for the next 30 days.
• Advise the patient that you will provide a copy of their records upon recieved a Release of Information request and attach a copy of a release to the letter (this can be obtained from the ADA or tdplt.com).

Remember, the patient is entitiled to a copy of their records. Although you may charge for a copy of the rcords, in this case it is probalby best to provide a copy at no charge.

Your letter should be sent both registered/certified mail and first-class mail. Retain a copy for the patient chart. Do not send a TEXT dismissing the patient. This places you at risk for a HIPAA violation.

What if the patient has a balance on their account? While sometimes hard to do, consider giving yourself the “gift” of writing off the balance and leaving a clean slate. Trying to collect at this point will most likely only prove to be a source of frustration and additional cost. Allow yourself to move on, let go, and be happy.

What if the roles are reversed and you find yourself being dismissed by the patient? If this occurs, put your pride aside and follow the previously mentioned steps to ensure that the patient is aware of their continued need for dental treatment so there is no risk of abandonment on your part. Send a letter reinforcing that the patient has informed you of the change in practitioners and remember to make the patient records available upon request.

Finally, breaking up doesn’t have to be hard to do. Communicate well and you can have harmonious outcome.

Contact Dr. Geck at the Dentists Professional Liability Trust of Colorado for more guidance on a dismissal letter [email protected]

Dr. Candace DeLapp, the former executive director of the Trust use to say:

“Your clinical notes are like a fire- they can either keep you warm on a cold night or burn your house down.”

It’s a simple statement, but it captures one of the most important principles of professional liability: your clinical records can become either your greatest asset or your worst enemy.

Your memory isn’t a defense, your records are.

Imagine receiving a board complaint or request for records on a pending lawsuit about a patient you treated several years ago. You may think you remember the patient, the procedure, the conversation had, the details… but truth is if isn’t written in your records… it didn’t happen.

You won’t remember every detail. That is why throughout documentation in your clinical notes are imperative. You can review it line by line, detailing the encounter.

When a complaint arises, your clinical notes can help tell that story of what really happened. What you diagnosed, what you recommended (alternative treatment and risk of no treatment), what you discussed with the patient, ultimately what the patient chose, what treatment was completed, complications or adverse outcomes, follow up, referrals, and patient’s demeanor.

If it isn’t documented… it didn’t happen. It’s that simple

If you don’t document details then it didn’t happen. It becomes a simple she said vs he said.

Good notes tell a story of the patient’s care.

“Crown placed. Patient tolerated procedure well.” Is not a good story and will often be that fire that burns your house down should a complaint arise.

A good clinical note should provide enough meaningful information that another dentist, attorney, investigator, or licensing board, can understand the whole scope of care.

A good documentation could include the following:

• Patient’s presenting cheif complaint
• Clinical and radiographic findings
• Your diagnosis and differential diagnosis
• Treatment recommendations, alternatives, and risk of no treatment
• Risks, benefits, and potential complications
• Patients questions and concerns
• Patients decision to accept, delay, or decline treatment
• Informed consent for procedure both verbal and written
• Relevant medical history and medical history changes
• Blood Pressure
• Detailed Anesthetic amounts administered including amounts of epi
• Details of procedures performed
• Post op instructions given
• Risks post operatively
• Referrals or consultations
• Follow up recommendations
• Significant communications with the patient

Avoid a “CYA” note. Good documentation includes “just the facts”. Avoid judgmental, inflammatory, or emotional language.

NEVER ALTER THE STORY AFTER THE FACT.

If you realize you forgot something or want to add to your clinical notes at a later date, follow your electronic health records proper procedure for adding an addendum to the note. DO NOT go back and rewrite the original note as though it had been entered contemporaneously.

The integrity of your notes matter. A transparent late entry can help clarify the record. An altered record can create an entirely different and worse problem.

Keep your fire burning for you.

Dr. DeLapp’s famous words are worth remembering every time you sit down to finish your notes:

Your clinical records can keep you warm at night or burn your house down.

Take a few extra minutes. Document the findings, recommendations, conversations, patient decisions, care, and any communication that is relevant.

Because years from now, when you may or may not remember exactly what happened, your notes will be there to protect you.