When patients are not wearing a mask

Posted March 8, 2021

During the ongoing COVID-19 pandemic in Ontario, the College requires dentists to ensure that patients and visitors wear a mask at all times while in the office, except during the provision of care and other limited circumstances set out below.

Dentists are responsible for enforcing the mask mandate on anyone entering the practice according to the policy in their municipality. As employers, dentists must also take all reasonable precautions to protect the health and safety of their staff. While doing so may seem straightforward, there are intersecting obligations and issues that dentists should be aware of before turning patients away for not wearing a mask.

The pandemic has created a new legal landscape that has not yet fully formed, and this information represents the College’s best efforts to help dentists understand their obligations at this time. Dentists should consult with a lawyer for more information on this evolving area of the law.

Some patients may request an exception from the mask requirement 

The Ministry of Health, some public health units, and some municipalities, including Toronto, have set out guidance on the circumstances where an individual might not be able to wear a mask. Broadly speaking, it includes:

  • Children under the age of two;
  • Individuals with a medical condition that makes it difficult to breathe;
  • Individuals who are unconscious or incapacitated;
  • Individuals who have a hearing impairment or work with those with a hearing impairment where the ability to see the mouth is essential for communication;
  • Individuals who are unable to put on or remove a mask without assistance; and
  • Individuals with a medical, mental, or cognitive condition or disability that otherwise prevents them from wearing a mask.

Dentists should consult their municipality for the most applicable guidance. 

Plan ahead to help accommodate the needs of such patients and find ways to help them access care safely.

Dentists have a duty to provide health care services free from discrimination and a duty to accommodate under the Ontario Human Rights Code

It is likely that most conditions preventing someone from wearing a mask would be considered disabilities by the law and thus require dentists to provide accommodation.

There is no defined list of reasonable accommodations. Dentists will need to work with the patient to determine what alternatives exist that can address their needs.

Some examples of potential reasonable accommodations related to masks could include:

  • having the patient wear a different type of face covering such as a face shield or other covering;
  • having the patient wear a mask or face covering for short portions of the visit (e.g., as they move through the waiting areas);
  • scheduling the patient at the end of the day to limit exposure to other patients; and/or
  • waiving the requirement for the patient to wear a mask.

Cases where a dentist may refuse service are likely to be rare

The paramount responsibility of a dentist is to the health and well-being of patients. Dentists must provide care with respect for human rights and dignity and without discrimination.

Dentists also have a legal, professional, and ethical obligation to provide or arrange for dental emergency treatment for their patients. Although a dentist is not obligated to provide treatment for every new patient who contacts the dental office, a patient with a dental emergency should be assessed and either provided treatment or referred to another practitioner or facility capable of treating the patient.

If you encounter a situation where a patient declines to wear a mask, and none of the exceptions noted above apply to the situation, sensitively explain the expectation that the patient wear a mask and the importance of protecting public health. Depending on your patient’s needs, your ability to safely isolate them from other patients, and your ability to safely provide care, you may need to defer or reschedule their appointment or redirect them to a setting that can safely provide care.

Record relevant information about mask use in the patient’s medical record

If the patient has indicated that they have a reason for not wearing a mask, this information should be recorded. If the dentist has provided an accommodation for the patient, this should also be recorded.

The Ministry of Health has stated that documentation is not needed to support requests for health-related accommodations to the mask mandate. The Ontario Human Rights Commission, by contrast, has indicated that it may be reasonable to ask people with disabilities to verify their needs, but that they need not share any information beyond what is necessary to accommodate them. Keep in mind that individuals requiring accommodation may not have had access to their doctor during the pandemic, and consider working to arrange a suitable accommodation even without documentation. 

Dentists should

Plan ahead
You will encounter patients with valid reasons for not wearing a mask. Be prepared to offer reasonable accommodations and to take precautions to minimize the risk of spreading COVID-19 while providing treatment.

Train staff on exceptions to the mask policy
Ensure that front desk staff who greet patients are aware of the most common categories of exceptions they may encounter.

Ask questions
Verify whether the patient falls under one of the exceptions, and inquire about what accommodations they may require. You may ask patients for suggestions, but you are ultimately responsible for determining how a patient can best be accommodated.

Dentists should not

Refuse services automatically
You have a duty to provide health care services free from discrimination and you have a duty to accommodate.  Most conditions preventing someone from wearing a mask are likely to be considered disabilities by the law, and thus fall within the scope of these legal protections.

Make assumptions
A person may have valid needs that require accommodation that are not immediately apparent, such as asthma or hearing loss.

Refuse reasonable requests for accommodation because an individual does not have medical documentation to support their request
The Ministry of Health has specified that individuals do not need to prove their need for accommodation on the basis of disability or health condition.