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February/March 2009
•
Vol. 23, No. 1
•
www.rcdso.org
Dentist Wellness Initiative
Close to Reality
Dentistry Preserves
Prescribing Rights
In Latest HPRAC Report
Royal College of Dental Surgeons of Ontario
6 Crescent Road, Toronto ON M4W 1T1
416-961-6555
1-800-565-4591
fax: 416-961-5814
[email protected]
www.rcdso.org
DISPATCH Vol. 23, No. 1
February/March 2009
Dispatch is the official publication of the Royal
College of Dental Surgeons of Ontario (RCDSO).
RCDSO is the regulatory body governing the practice
of dentistry in Ontario. Dispatch is published four
times a year. The subscription rate is included in the
annual membership fee. The editor welcomes
comments and suggestions from our readers.
Peggi Mace
EDITOR
EDITORIAL ASSISTANT Aurore Sutton
ART DIRECTION AND PRODUCTION
Roger Murray and
Associates Incorporated
COVER DESIGN
Public Good
COVER ILLUSTRATION Tracey Walker
REGISTRAR
CONTENTS
Features
5
New legislation for
patient apologies
6
Moving ahead with
dentist wellness
initiative
8
Progress in trade
agreement discussions
10 Fight for fluoridation continues
Irwin Fefergrad, CS, BA, BCL, LLB
(Certified as a Specialist by the Law
Society of Upper Canada in CIVIL
LITIGATION and in HEALTH LAW)
12 Election results
Reprint Permission
RCDSO COUNCIL MEMBERS
Material published in Dispatch should not be
reproduced in whole or in part in any form or by
any means without written permission of the
College. Please contact the editor for permission.
President
Dr. Frank Stechey
Environmental Stewardship
This magazine is printed on paper certified by the
international Forest Stewardship Council as
containing 25% post-consumer waste to minimize
our environmental footprint. In making the paper,
oxygen instead of chlorine was used to bleach the
paper. Up to 85% of the paper is made of hardwood
sawdust from wood-product manufacturers. The
inks used are 100% vegetable-based.
Vice-President
Dr. Peter Trainor
Elected Representatives
District 1
Dr. Elizabeth MacSween
District 2
Dr. David Clark
District 3
Dr. Peter DeGiacomo
District 4
Dr. John Kalbfleisch
District 5
Dr. Ted Schipper
District 6
Dr. Joe Stasko
District 7
Dr. Peter Trainor
District 8
Dr. Frank Stechey
District 9
Dr. Eric Luks
District 10
Dr. Natalie Archer
District 11
Dr. Marvin Klotz
District 12
Dr. Hartley Kestenberg
Appointment by Lieutenant-Governor In Council
Kelly Bolduc-O'Hare
Little Current
Mohammed Brihmi
Ajax
Dr. Harpal Buttar
Ottawa
Parminder Chahal
Brampton
Mofazzal Howladar
Toronto
Kurisummoottil Joseph
Thunder Bay
Catherine Kerr
Scarborough
Evelyn Laraya
Oakville
Dr. Edelgard Mahant
Toronto
Jose Saavedra
Woodbridge
Abdul Wahid
Scarborough
Academic Appointments
University of Toronto
University of Western Ontario
Dr. R. John McComb
Dr. Stanley Kogon
PUBLICATION MAIL AGREEMENT #40011288
ISSN #1496-2799
2
DISPATCH • February/March 2009
Ensuring Continued Trust
Upfront
Professional Practice
4
22
Dentist/patient communications
in informed consent process
23
Informed consent focus of
latest education package
24
Immunizations essential
to infection prevention and
control program
27
Correction: drug chart for medical
emergencies in dental office
28
Avoiding the problem account
30
Collection of delinquent accounts
32
Dentists/denturists working
together under one roof
Steady focus on results with integrity
The Back Page
48
Dentistry preserves prescribing rights
Departments
21
PEAK
34
Dental Ethics 101 – Case Study
35
Complaints Corner
40
Ounce of Prevention
42
On Appeal
44
Dental Ethics 101 – Discussion
News & Views
39
Illegal practice of dentistry
39
Calendar of events
Issue Enclosures:
PEAK: Unspoken fears
Summaries of Discipline Committee hearings
DISPATCH • February/March 2009
3
UpfrontThePresident’sMessageUpfrontThePresident’sMessage
Steady Focus
on Results
with Integrity
T
wo years ago when I wrote my first column, I said that assuming the presidency of
the College was the pinnacle of my nearly 40 years in dentistry. Now that my
colleagues around the Council table have entrusted me with a second term as
president, I want to reaffirm that statement.
I accept this responsibility with a pledge to fulfill this privilege to the best of my ability.
I can think of no greater honour.
As I said in my election speech to Council, my primary focus is to stay the course.
I believe that the College has passed a significant milestone in our history. Our challenge
now is ensure that this progress is preserved while still moving forward to new success.
DR. FRANK STECHEY The values of the organization have changed, and from the comments I have heard from
dentists around the province, you have noticed.
The College is firmly committed to the belief that professional regulation should be as
much about sustaining and improving professional standards as it is about identifying
and addressing poor practice.
We know that the number of
excellent dentists far outnumber
the few who let patients down.
We know the vast majority of
dentists routinely meet high
standards and sincerely want to
continue to do that.
Garder le cap sur les
résultats sans perdre
notre intégrité
Il y a deux ans, j’écrivais dans mon premier article
pour Dispatch : « Avoir été nommé au poste de
The College is doing its best to
président représente l’apogée de mes 40 années de
support this commitment to high
carrière en tant que dentiste. » Maintenant que mes
professional standards.
collègues du Conseil d’administration m’ont réélu à la
The best proof is that, over the
présidence du Collège, je veux réaffirmer cette
last two years, there have been
déclaration.
the fewest number of referrals
J’accepte d’assumer cette responsabilité en
from Complaints and Executive
promettant de vous servir du mieux que je peux. Je ne
to Discipline than ever before in
peux pas imaginer de plus grand honneur.
the College’s history. We try other
Dans le discours que j’ai prononcé lors de l’élection,
avenues first that stress the
j’ai dit que mon objectif principal est de continuer à
resolution of complaints, instead
aller de l’avant. Je crois que nous avons franchi un pas
of sending dentists immediately
important dans l’histoire du Collège. Aujourd’hui
to Discipline. This has benefits
notre défi consiste à poursuivre sur notre lancée en
for both the dentist and the
allant à la rencontre de nouveaux succès.
patient.
Les valeurs de l’organisation ont changé. Et d’après les
CONTINUED ON PAGE 45
4
DISPATCH • February/March 2009
SUITE À LA PAGE 45
Ensuring Continued Trust
New Legislation Opens Door to
Patient Apologies
Without Fear
T
COLLEGE CONTACT
Irwin Fefergrad
Registrar
416-934-5625
1-800-565-4591
[email protected]
The province of Ontario is moving forward with legislation that would allow
people and organizations to apologize without fear of the apology being used
against them. The legislation would not affect a victim’s right to sue, or their
right to compensation for harm done. The bill is currently awaiting third
reading and Royal Assent into law.
The Apology Act is designed to:
• allow individuals and organizations, such as hospitals and other public
institutions, to apologize for an accident or wrongdoing, without it being
used as evidence of liability in a civil legal proceeding under provincial law.
• help victims by acknowledging that harm has been done to them as an
apology is often key to the healing process.
• promote accountability, transparency and patient safety by allowing open
and frank discussions between patients and health care providers.
• enhance the affordability and speed of the justice system by fostering the
resolution of civil disputes and shortening or avoiding litigation.
“We fully support this legislation,” explained College Registrar Irwin
Fefergrad. “It allows dentists to deal openly and honestly with their patients
and their families and improve patient safety. It means dentists can
communicate with patients with genuine compassion and caring without
worrying about whether that will be used against them later in civil court.”
This kind of legislation already exists in Canada. British Columbia passed its
Apology Act in May 2006, Saskatchewan amended its Evidence Act in May
2007 to include apology legislation, and in November 2007 Manitoba adopted
a bill similar to British Columbia’s.
In 2007, the Uniform Law Conference of Canada passed a resolution
recommending all provinces adopt apology legislation, either as an
amendment to the evidence code or as a stand alone act.
As well, 35 US states have some form of apology legislation, as do most
Australian states.
DISPATCH • February/March 2009
5
Moving ahead with
DENTIST
WELLNESS
INITIATIVE
T
The creation of a pilot project wellness program for Ontario dentists in
crisis with addiction issues is close to a reality. This is the culmination
of the work of the ODA/RCDSO Wellness Working Group. The details of
how the program will work are now being ironed out.
The College and the Ontario Dental Association will be working with
three centres, all well-known for their work in drug and alcohol
treatment and recovery, to create a resource network for Ontario
dentists. These centres are Homewood Health Centre in Guelph,
Ontario, The Farley Center in Williamsburg,Virginia, and the Talbott
Recovery Campus in Atlanta, Georgia.
COLLEGE CONTACT
Irwin Fefergrad
Registrar
416-934-5625
1-800-565-4591
[email protected]
In November 2008, College Council unanimously passed a motion to
authorize staff to take all the necessary steps to move the
implementation of a wellness program forward.
A delegation made up of members from the ODA/RCDSO Wellness
Working Group has already made several fact-finding trips to
investigate the facilities and services offered in the three facilities.
Late last October a delegation from the Wellness Working Group
conducted site visits to the Talbott Recovery Campus and The Farley
Center. Then in early December a site visit to the Homewood Centre
was conducted. All these facilities are well-regarded for the assessment
and/or treatment services that they offer for health care professionals
in crisis.
6
DISPATCH • February/March 2009
Ensuring Continued Trust
Research shows that dentists are no more or no less likely to develop
substance use disorders (alcohol or drug abuse or dependence) than the
general population. In other words, 10 to 15 per cent of dentists will have a
drug and/or alcohol problem sometime in their lives.
Addiction is a human disease, and some of the people who have it are
dentists. The disease of addictions shows no favourites.
However, what is different for dentists and other health care professionals
from the general population is the public trust that goes with the privilege to
practise, and the responsibility to obey the provincial dental act and
controlled substance regulations.
It is the dentist’s paramount duty to ensure the safe treatment of his or her patients. An
untreated substance use disorder in a dentist can not only threaten the dentist’s life and
family stability, but place patients, and the practice itself, in jeopardy.
In an article in the May/June 2007 issue of Dispatch, Dr. Martyn Judson, Assistant Professor of
Family Medicine and Assistant Professor of Psychiatry at the University of Western Ontario,
stated that substance abusing dentists are not bad people. Instead, they are just unwell.
In the same article, Dr. Judson described that “… the rewards of successful treatment, which
approaches 85 per cent for addicted dentists, are immeasurable.”
In his column in the November/December 2007 issue of Dispatch, College Registrar Irwin
Fefergrad clearly outlined why the College believes that this is an important issue:
With the demand for help on the increase, it appears timely for the dental community
to ask itself if we are doing the best we can do to help our colleagues who are in
distress. Here at the College, we need to ask ourselves an additional question: Are we
doing the best we can to assist these dentists in a progressive and proactive way that
supports their recovery and meets our additional responsibility to protect the public
from the actions of a dentist who may be practising while impaired?
Working with our colleagues at the
Ontario Dental Association, I hope we can
move forward and be of even greater
assistance in supporting dentists in the
best possible way to address the unique
needs of the dental professionals
struggling with an addiction, no matter
where they live in the province.
ON THE WEB
www.rcdso.org
Working Under the Influence: Functioning Addicts
DISPATCH AUGUST/SEPTEMBER 2007 PAGES 18-23
Substance Abuse and the Dentist
DISPATCH MAY/JUNE 2007 PAGES 16–19
DISPATCH • February/March 2009
7
Latest developments
on national and
international trade
agreements dealing
with dentistry
On January 16, 2009, the provincial premiers met in Ottawa and
agreed, along with the Prime Minister, to an amended internal
trade agreement called the Agreement on Internal Trade (AIT)
that enables workers to move freely within the boundaries of
Canada. This agreement has been pending since 1996; however,
because of the lack of movement by professional and regulatory groups to achieve
voluntary compliance, governments took matters into their own hands.
COLLEGE CONTACTS
Irwin Fefergrad
Registrar
416-934-5625
1-800-565-4591
[email protected]
Robert Lees
Manager, Registration
416-934-5613
1-800-565-4591
[email protected]
8
In plain language the Labour Mobility Chapter (Chapter 7) of the AIT means that
any worker certified for an occupation in one province will be certified for that
occupation in any other province without a requirement for additional material
training, experience, examinations or assessments. This is called permit-to-permit
registration.
The updated dispute resolution mechanism of AIT provides for monetary penalties
of up to $5 million, depending on the size of the jurisdiction, for continued noncompliance with AIT obligations. The compliance date is August 2, 2009. Clearly
there is a strong incentive for provinces to have all their regulators comply.
On January 23 and 24, the Canadian Dental Regulatory Authorities Federation
(CDRAF) hosted a national summit in Toronto for dental regulators from across the
DISPATCH • February/March 2009
Ensuring Continued Trust
country to come together to find solutions
that work for dentistry. This meeting follows
up on extensive work done over the past few
years or so on mobility agreements.
CDRAF’s aim was to have the country agree on
national non-exemptible standards and put a
national agreement in place so there would be
not be a patchwork of standards across
Canada. Other organizations, like the National
Dental Examining Board, the Royal College of
Dentists of Canada, the Commission on
Dental Accreditation of Canada and the
Association of Canadian Faculties of Dentistry,
sent observers to this meeting.
College Registrar Irwin Fefergrad explains why
this issue is so important for public
protection: “Without a national agreement,
the provinces with the weakest or easiest or
most accessible entrance requirements for
licensure would become the ports of entry.
Their standards would become the norm,
racheting the whole country down to the
lowest common denominator because once
an applicant got licensure through that
province, every other one would be obligated
to register that applicant too.
“We made substantial progress on reaching a
national accord on process for assessment of
non-accredited, internationally trained
general dentists to ensure that we comply with
the AIT ,” said Fefergrad. Already national
agreements for specialists were signed in
August 2001 and for non-accredited
internationally trained specialists in October
2007.
Adding more urgency to the situation is the
labour mobility agreement or Accord between
the provinces of Ontario and Quebec that
mirrors the national agreement. The trigger
date for the implementation of this agreement
is April 2009.
Unlike the national AIT, the Ontario-Quebec
Accord includes an enhanced complaints
referral process for those denied registration.
It will also list in the agreement the
professions that are compliant.
The Quebec dental regulator is mandated by
its government to assess the equivalency of
internationally trained dentists. This
assessment process has two possible streams.
One is the two-year advanced standing
programs that dentists are already familiar
with. The other is for those for whom the twoyear programs might not be necessary. In this
stream, there is a process of credentialing
followed by an examination in fundamental
knowledge. If successful, candidates then
complete a series of suitably challenging
examinations of their clinical skills and
judgement. Once these hurdles are met, the
candidate challenges the same examination of
the National Dental Examining Board of
Canada that all graduates of accredited
programs must take.
An Ontario delegation, including members of
the Registration and Executive Committees,
have met several times with our Quebec
counterparts to review their approach. “We’re
pleased to report that we are comfortable with
the process and are not concerned about this
aspect of the AIT agreements,” explained
Fefergrad.
“While it is too early to predict the impact of
this Quebec/France agreement,”
said Fefergrad, “the College is
actively working on this issue to
ensure we are not caught short.”
DISPATCH • February/March 2009
9
Fight for
Fluoridation
Continues
I
In a flashback to the 50s and 60s, some municipalities
in Ontario are voting on whether or not to retain
fluoridation in the municipal drinking water. In those
days, some opponents argued that fluoridated water
was a communist plot to control the population. Now
the debate continues, just framed a bit differently.
Towards the end of 2008, the city of Hamilton and the
Halton Region held long and heated public
discussions about the merits of fluoridation. In the
end, both these municipalities voted to retain
fluoridation, but by very slim margins.
The situation in Hamilton is probably similar to that
of many Ontario municipalities. The city needs to
replace its water treatment plant equipment at a cost
of $2.1 million and rising chemical costs will mean an
expenditure of $1 million a year.
In 2008, Dryden and Niagara Region councils voted
against fluoride in their drinking water. Waterloo
voters will be asked in the 2010 election whether they
want to keep fluoride in their water.
The College is proud to have played an important role
in this public debate. Dr. Frank Stechey, the College
president, appeared as a delegation before the
municipal officials in both Halton and Hamilton.
As the regulator, the College brings a unique voice to
ON THE WEB
www.rcdso.org
Policy Statement – Water Fluoridation
PROFESIONAL PRACTICE/PRACTICE RESOURCES
10
DISPATCH • February/March 2009
these discussions. As Dr. Stechey said in his
presentations:
RCDSO is a provincial health care regulatory
college. We are mandated by provincial law to
protect the public’s right to quality oral health care
in Ontario. We do not represent the dental
profession but license and regulate the dental
profession in Ontario.
I want to emphasize the point: RCDSO does not
speak on behalf of the dental profession. We are the
body directed by the provincial government to
work in the interests of public protection and
safety.
In addition, other pro-fluoridation voices at these
meetings were Dr. Larry Levin, President of the
Ontario Dental Association; Dr. Dick Ito, President of
the Ontario Association of Public Health Dentistry
and Dr. Peter Cooney, Chief Dental Officer of Canada.
As the supporters of fluoridation state:
• Fluoridated communities have 20-40% fewer
caries.
• Every dollar spent on water fluoridation avoids $38
in dental care, while the increase in drinking water
costs to consumers is less than 1%.
• Fluoridation benefits come to all consumers across
the socio-economic spectrum.
• Fluoridation benefits all age groups, from children
to senior citizens.
The College has had a policy statement in support of
fluoridation since May 2003.
Ensuring Continued Trust
Serving at the College
Every two years at election time, it is time to welcome
new friends and say goodbye to old ones. For members
who put their name forward to serve as a non-Council
committee member, it is literally the luck of the draw
whether or not they return to serve again. For those
who decided to serve but did not have their name
pulled in the blind draw, it is time for farewells.
DR. IRA MARDER
DR. SANGEETA PATODIA
Toronto
Mississauga
As my two-year term at RCDSO as a non-Council
member draws to an end, I want to take this
opportunity to thank you [College Registrar Irwin
Fefergrad] and everyone at the Royal College. I
imagine that I was like most dentists, in that my
perception of RCDSO was negative to neutral at
best. These last two years have drastically
changed that view for the positive.
Just wanted to drop you [College Registrar Irwin
Fefergrad] a little note to say a BIG thank you for
all you have done – your support and guidance.
When I was appointed as a non-Council member
and a member of the Complaints Committee
panel, I had no idea what to expect. I have been
involved with many dental and non-dental
organizations and associations but I must say that
the experience I had at the College rivals them all.
RCDSO is composed of caring and concerned
people. I was very impressed with the people and
their roles at the College. While the task and
mandate of the College is legislated, the process
and delivery of that requirement is professional
and considerate. I found my time at the College to
be enlightening, entertaining and even enjoyable.
I am glad that I had the opportunity these past
two years to serve at RCDSO and get to know its
inner workings and all the College staff. I hope
that our paths cross again in the future (but in a
non-complaint manner though).
I am disappointed by the luck of the draw for
selection of non-Council members but alas that is
how it goes. I was very lucky to have been selected
two years ago. The experience was immensely
rewarding. I learned a great deal about selfregulation, the complaints process and how well
RCDSO runs. It is a wonderful place under your
leadership!
PLEASE NOTE
As of the next Council meeting, Council
Highlights will be available to all members
of the College on the homepage of our
website at www.rcdso.org within 36 hours
of the Council meeting, while delivery by
surface mail will be discontinued.
DISPATCH • February/March 2009
11
Elections 2009-2010
At the inaugural meeting of the new RCDSO Council on January 21 and 22, 2009,
Council members elected a president and a vice-president for the College and
members of the Executive Committee for 2009 and 2010.
Executive Committee
Dr. Frank Stechey, Chair and President
Dr. Peter Trainor, Vice-President
Kelly Bolduc-O’Hare
Mohammed Brihmi
Dr. David Clark
Elected Representatives
District 1
District 2
District 3
District 4
District 5
District 6
District 7
District 8
District 9
District 10
District 11
District 12
Dr. Elizabeth MacSween
Dr. David Clark
Dr. Peter DeGiacomo
Dr. John Kalbfleisch
Dr. Ted Schipper
Dr. Joe Stasko
Dr. Peter Trainor
Dr. Frank Stechey
Dr. Eric Luks
Dr. Natalie Archer
Dr. Marvin Klotz
Dr. Hartley Kestenberg
Appointed by Lieutenant-Governor in Council
Kelly Bolduc-O’Hare
Mohammed Brihmi
Dr. Harpal Buttar
Parminder Chahal
Mofazzal Howladar
Kurisummoottil Joseph
Catherine Kerr
Evelyn Laraya
Dr. Edelgard Mahant
Jose Saavedra
Abdul Wahid
Little Current
Ajax
Ottawa
Brampton
Toronto
Thunder Bay
Scarborough
Oakville
Toronto
Woodbridge
Scarborough
Academic Appointments
Dr. R. John McComb
Dr. Stanley Kogon
12
DISPATCH • February/March 2009
University of Toronto
University of Western Ontario
Ensuring Continued Trust
College Committees
Members of the various College committees were selected by the
Executive Committee on January 21 and 22, 2009 and were ratified by
Council on January 22, 2009.
Audit Committee
Dr. R. John McComb, Chair
Dr. John Kalbfleisch
Evelyn Laraya
Dr. Frank Stechey, President (ex officio)
Complaints Committee
Dr. Marvin Klotz, Chair
Dr. Natalie Archer
Dr. Peter DeGiacomo
Dr. Ian Grayson (non-Council)
Mofazzal Howladar
Dr. Kirandip Johal (non-Council)
Catherine Kerr
Dr. Victor Kutcher (non-Council)
Abdul Wahid
Discipline Committee
Dr. Stanley Kogon, Chair
Dr. R. John McComb, Vice-Chair
Dr. Albert Bouclin (non-Council)
Dr. Lance Burnham (non-Council)
Dr. Harpal Buttar
Parminder Chahal
Dr. Robert Clinton (non-Council)
Kurisummoottil Joseph
Dr. Hartley Kestenberg
Evelyn Laraya
Dr. Edelgard Mahant
Dr. Bruce Pynn (non-Council)
Jose Saavedra
Dr. Peter Trainor
Dr. Katherine Zettle (non-Council)
Elections Committee
Kurisummoottil Joseph, Chair
Parminder Chahal
Dr. Edelgard Mahant
Finance, Property and Administration Committee
Dr. Elizabeth MacSween, Chair
Dr. Marvin Klotz
Dr. Peter Trainor
Abdul Wahid
Dr. Frank Stechey, President (ex officio)
Fitness to Practice Committee
Dr. Eric Luks, Chair
Evelyn Laraya
Dr. Lyon Schwartzben (non-Council)
Legal and Legislation Committee
Dr. Ted Schipper, Chair
Dr. Peter DeGiacomo
Dr. Eric Luks
Jose Saavedra
Dr. Frank Stechey, President (ex officio)
Patient Relations Committee
Dr. John Kalbfleisch, Chair
Dr. Harpal Buttar
Dr. James Carter (non-Council)
Dr. Daniel Diamond (non-Council)
Catherine Kerr
Quality Assurance Committee
Dr. Elizabeth MacSween, Chair
Kelly Bolduc-O’Hare
Dr. Neil Gajjar (non-Council)
Dr. Ted Schipper
Dr. Susan Sutherland (non-Council)
Registration Committee
Dr. Hartley Kestenberg, Chair
Dr. Natalie Archer
Mohammed Brihmi
Dr. Joseph Stasko
Professional Liability Program Committee
Parminder Chahal, Chair
Dr. Vincent Carere (non-Council)
Dr. Michael Glogauer (non-Council)
Dr. Stanley Kogon
Dr. Gurneen Sidhu (non-Council)
Dr. Gordon Sylvester (non-Council)
Dr. Ronald Yarascavitch (non-Council)
DISPATCH • February/March 2009
13
Elections 2009-2010
Elected Representatives
District 1
District 2
District 3
District 4
Dr. Elizabeth MacSween
Dr. David Clark
Dr. Peter DeGiacomo
Dr. John Kalbfleisch
Dr. Elizabeth MacSween is a graduate
from University of Toronto Faculty of
Dentistry, Class of ‘80. She has
maintained a general practice in Orleans,
Ontario for 28 years.
As past president of the Ontario Dental
Association in 1996 to 1997 and a
governor of the Canadian Dental
Association, she brings her many years
of involvement in organized dentistry to
RCDSO. During her past two terms at
RCDSO she has sat as chair of the
Registration Committee and in the last
term as vice-president of the College.
Elizabeth has one son, Devon, 23 years
old, a Masters student in Engineering at
Queens. When spare time presents she
can be found biking, skiing, hiking or
reading at Starbucks.
Dr. David Clark is Director of Dental
Services at Whitby Mental Health Centre
in Whitby, Ontario and is an Associate in
Clinical Dentistry, Department of Oral
Medicine, Faculty of Dentistry, University
of Toronto. He obtained his MSc in Oral
Pathology at the University of Western
Ontario in 1986 and is both a Fellow of
the Pierre Fauchard Academy and the
Royal College of Dentists of Canada.
His hospital-based practice is devoted to
the general dental care of individuals
undergoing primary care for various
forms of psychiatric illness, often
coexisting with other medically
compromising conditions.
David also participates in the teaching of
the undergraduate dental curriculum
relating to the topics of oral medicine and
oral diagnosis at the Faculty of Dentistry
at the University of Toronto. He also
lectures in oral pathology in the secondyear dental hygiene program at both
George Brown College and Regency
Dental Hygiene Academy in Toronto and
is also part-time clinical instructor in the
second-year dental hygiene program at
Durham College in Oshawa.
He has lectured internationally since
2005 on the subject of psychiatric illness
and dental management considerations.
Personal interests include spending time
at the cottage, reading and enjoying his
two young grandchildren, Joshua and
Ashley.
Dr. Peter DeGiacomo earned his DDS
degree from the University of Western
Ontario in 1974 graduating with a Bronze
‘W’ for rowing. He maintains a general
practice in Thunder Bay.
Peter has been very involved in the
activities of the Thunder Bay Dental
Association at the committee, executive
and social level. He was founder,
publisher and editor of the quarterly
regional dental newspaper, The Northern
Bites, for 10 years. He continues his local
involvement through the TBDA Access to
Care Committee and the TBDHU/TBDA
Liaison Committee.
His community involvement includes
serving on the Northern Ontario School of
Medicine Bursary Fund Committee and
being vice-president of The Thunder BayMatanzas (Cuba) Friendship Association.
Provincially, Peter served on many
Ontario Dental Association committees,
ODA Council and the Board of Directors.
He co-authored the Ontario Dentist
article, Facial Reconstruction Enhanced
Through Teamwork, in June 2005. He
was recently presented with the ODA
Service Award.
He is a member of the Thunder Bay
Dental Study Club, a Fellow in The Pierre
Fauchard Academy and a Deputy Regent
of The International College of Dentists.
The focus of his life is his family. Peter
has two sons, a beautiful daughter and
three adorable grandchildren. His travel
buddy and the love of his life is his wife
Marja.
Dr. John Kalbfleisch completed his DDS
at the University of Western Ontario in
1980. A Hospital for Sick Children’s
internship was followed by Graduate
Orthodontic training (1983) and a MSc
degree on sleep apnea, both at the
University of Toronto (1988). RCDC
Fellowship examinations were completed
in 2005.
John is a past president of the HaltonPeel Dental Association, Toronto
Orthodontic Study Club and the Canadian
Association of Orthodontists. He is also a
past governor of the Ontario Dental
Association and has been a 20-year
orthodontic instructor and lecturer at U of
T, also serving on the Faculty Council for
the School of Dentistry.
A lifelong resident of Halton-Peel, John is
a partner in VILLAGE ORTHOdontics, a
private practice in Mississauga. Local
and national charitable endeavours, plus
a focus on treatment communication via
internet technology on iCANADEN, have
been important.
Personal interests include horology (the
science of time, timekeeping and
timekeepers), reading and running. His
greatest passion remains his wife,
Lianne, and four daughters, Jenny,
Marissa, Melanie and Olivia.
14
DISPATCH • February/March 2009
Ensuring Continued Trust
District 5
District 6
District 7
District 8
Dr. Ted Schipper
Dr. Joe Stasko
Dr. Peter Trainor
Dr. Frank Stechey
Dr. Ted Schipper attended the University
of Toronto, graduating from dentistry in
1971. He received his orthodontic
specialty certification in 1974 and he
maintains a full-time orthodontic practice
in Collingwood.
Ted teaches in the graduate orthodontic
department at the University of Toronto
and holds a cross appointment in the
dental department at Mt. Sinai Hospital in
Toronto. Ted served a six-year term on
the Faculty Council at the Faculty of
Dentistry at the University of Toronto.
Ted is a past president of the Ontario
Association of Orthodontists and the
Toronto Orthodontic Study Club. He is a
past Ontario director to the Canadian
Association of Orthodontists board of
directors. He also holds a certificate in
dispute resolution from the University of
Toronto.
During the past Council term Ted was the
chair of the Legal and Legislation
Committee and a member of the Quality
Assurance Committee. Ted begins his
third term with appreciation and thanks
to the District 5 membership who
returned him to Council.
After completing his BSc at the University
of Windsor and his DDS at the University
of Toronto, Dr. Joe Stasko has worked full
time in a group practice in Windsor,
Ontario for 38 years. He is a past
president of The Essex County Dental
Society.
He served as a representative on the
ODA Board of Governors for six years and
as chairman of the Dental Auxiliaries
Committee.
In the past, Joe served as a dental
examiner for the RCDS dental hygiene
examinations and as a consultant to the
Ontario Dental Nurses and Assistants
Association. Joe was instrumental in the
development and initiation of the Dental
Hygiene Clinic at St. Clair College in
Windsor where he instructed in the
dental assistant and dental hygiene
programs for 16 years.
When not in the office, Joe enjoys early
morning gym workouts, family cottage
life and live music (as he was a member
of a popular band in his college days).
Movie watching, vacationing abroad and
cutting the grass fill his free time.
He has been happily married to Nancy for
37 years and has five adult children,
many of whom are still in graduate
studies at university.
This year, Joe will join a medical mission
team for two weeks in Nicaragua treating
school-aged children.
Dr. Peter Trainor has a general practice in
Listowel, which he established after
graduating from the Faculty of Dentistry
at the University of Toronto.
He has been active in municipal, church
and dental governance. In the immediate
past, he has participated in all levels of
governance at the Ontario Dental
Association, and was ODA President for
the term of 2001to 2002.
He has represented Ontario at the
Canadian Dental Association and
participated in several task forces and
work groups.
Currently, Peter is vice chair of the
Committee for Adjustment and the
Planning Advisory Committee for the
Municipality of North Perth.
He has been awarded Honorary
Fellowship in The Pierre Fauchard
Academy, the International College of
Dentists, the Academy of Dentistry
International, and the American College
of Dentists. He has also received the
Ontario Dental Association’s Award of
Merit and Service Award. Most recently,
Peter has achieved Fellowship Status in
the International Congress of Oral
Implantologists
Dr. Trainor is in his second term on
RCDSO Council as the elected
representative of District 7. During his
first term, Peter served as chair of the
Patients Relations Committee, chair of
the RCDSO Strategic Planning Work
Group, was a member of the Discipline
Committee, as well as serving on the
ODA- RCDSO Idea Forum (ORIF) and the
Wellness Group.
He and his wife, Sara, have been married
for 38 years and have three children and
four beautiful grandchildren.
Peter and his wife live on an active farm
and share a fondness for horses, as well
as equestrian sports. In the past, they
have bred Hanoverian horses for sport
activities and standardbred horses for
racing. His wife, Sara, shows in dressage
and Peter competes in combined driving.
Since 2003, Dr. Frank Stechey has
served on the College’s governing
Council representing the Niagara
Peninsula and Greater Hamilton area. His
over 38 years in dentistry culminated
with his election as president of the Royal
College Dental Surgeons of Ontario in
January 2007. Following graduation in
1967 from the University of Western
Ontario in London, he attended the
University of Toronto’s Faculty of Dentistry
and graduated in 1971.
Frank now practises in Hamilton. He is an
active member of the Ontario Dental
Association, has served as president of
the local Hamilton Academy of Dentistry,
and is recognized as a Fellow in eight
dental and professional organizations.
With over 24 years of forensic dental
experience involving civil and criminal
cases, product liability, homicides, and
child, domestic and senior abuse
involving bite marks, he often appears as
a guest lecturer and works as a
consultant for the Children’s Hospital at
Hamilton’s McMaster University Medical
Centre, as well as with several police
services and Children’s Aid Societies
throughout North America.
Frank also volunteers as the team dentist
for several professional and junior sports
teams including the Toronto Rock
lacrosse and McMaster University’s
Marauders football team. Community
involvement is a hallmark of his career.
He has been an active Rotarian for over
38 years, chair of Crime Stoppers of
Hamilton and is a director with the
Salvation Army’s Advisory Board in
Hamilton.
Frank is married with three grown
children and two wonderful grandchildren.
DISPATCH • February/March 2009
15
Elections 2009-2010
Elected Representatives
District 9
District 10
District 11
District 12
Dr. Eric Luks
Dr. Natalie Archer
Dr. Marvin Klotz
Dr. Hartley Kestenberg
Dr. Eric Luks is known in Ontario for his
continuing commitment to the dental
community for the past 40 years. He
graduated with honours from the Faculty
of Dentistry, University of Toronto in 1965
and subsequently received a Diploma in
Orthodontics and a MScD. He became a
Fellow of the Royal College of Dentists of
Canada in 2002.
Eric practises orthodontics with his
daughter Dr. Virginia Luks, who was the
first female to be elected to RCDSO in
2001. Previously Eric has been elected to
the College Council eight times by
members from Districts 5 and 9 during
which time he served on every
committee of the College, including the
office of President.
Dr. Luks is most recently known at the
College for his work on ethics in
dentistry. Over the years, he has been the
recipient of many awards including
Alumnus of Distinction from the
University of Toronto. Eric is personally
very gratified that two of his eldest
children and daughter-in-law are
practising dentists in this province as are
dozens of his former patients including
five who have become orthodontic
specialists.
Dr. Natalie Archer obtained her Doctorate
of Dental Surgery from Dalhousie
University in Halifax, Nova Scotia, in
2001. She has both a BA in Sociology
and a BSc in Biology, and represented
her graduating class at Dalhousie as
valedictorian.
She has a general dental practice in the
Rosedale Medical Centre in Toronto, and
practises geriatric dentistry in the west
end of Toronto.
During her past two-year term as RCDSO
Council member for District 10, she
served as a panel chair on the
Complaints Committee and as a member
of the Registration Committee. Natalie is
proud to have been returned for a second
term as RCDSO Council member for
District 10 and looks forward to
representing all of the Toronto West
dentists for another term.
Natalie is a proponent of access to care
whether in nursing homes, long-term
care facilities or hospitals. She is
committed to activism and leadership
within her profession and her community.
She takes on every task with energy,
determination, a “get-it-done” attitude,
while knowing how to listen to others.
Personal interests include competitive
badminton, gardening, and spending time
with her husband and two children.
Dr. Marvin Klotz obtained his DDS from
the University of Toronto in 1960, his
MSc from Northwestern University in
Chicago in 1964 and in 1967 his
FRDC[c].
He was certified as a pediatric dentist in
1964 and has been on staff of the
Hospital for Sick Children and the
University of Toronto faculty since the
70s.
Marvin became a director of the Toronto
East Dental Society in 1968. He sat as a
governor of the Ontario Dental
Association from 1968 to 1974 and
chaired several ODA committees. He was
editor of Ontario Dentist from 1978 to
1981 and created and edited the U of T
Faculty of Dentistry’s Alumni Today
magazine from 1981 to 2003.
From 1991 to 1996, he was twice
elected to RCDSO Council and served on
a number of committees: Complaints,
Quality Assurance, as chair, and
Executive. From 2001 to 2009, he was
elected four times to Council and served
on the Property and Finance Committee,
Complaints Committee, as chair, and
Executive, as vice-president of the
College.
After a long and successful career as a
pediatric specialist, he was appointed
Director of the Unite Here Wellness and
Dental Centre, a non-profit facility that
provides practice opportunities for many
recent and older professionals, as well as
current U of T graduate students.
He has received many awards and
honours from a wide variety of dental
organizations and continues to teach
part-time. Marvin is considered to be an
expert on jazz, baseball, philosophy
writing and humour – except by his own
family.
Dr. Hartley Kestenberg is a 1982
graduate of the University of Toronto,
Faculty of Dentistry and completed his
Diploma in Dental Anaesthesia in 1987
from the same institution.
His practice is limited to the treatment of
dental patients who deal with severe
phobias, those who are medically
compromised, and those who are
physically and mentally challenged.
Having just recently passed the specialty
examinations in dental anaesthesiology,
Hartley is the first Certified Specialist in
Dental Anaesthesiology to hold a position
on the RCDSO Council.
Representing Toronto East, District 12,
this is Dr. Kestenberg’s fourth and final
term with the College. He has served
twice on the Complaints Committee and
during this past term was a member of
the Executive Committee.
Hartley is an avid year-round cyclist and
a downhill skier. His hobbies include
travelling, stained glass window making
and playing the piano. He practises
dentistry in partnership with his wife,
Dr. Shelley G. Kestenberg. They are the
proud parents of two children, Jillian and
Joshua.
16
DISPATCH • February/March 2009
Ensuring Continued Trust
Academic Appointments
University of Toronto
Dr. R. John McComb
University of Western Ontario
Dr. Stanley Kogon
Dr. John McComb graduated from the
Dental School, University of Edinburgh in
1968 and went to the University of
Manitoba to do a MSc in Dental Science.
He then completed his Oral Pathology
training at the University of Toronto and
took examinations to become a diplomate
of the American Board of Oral Pathology
and a Fellow of the Royal College of
Dentists of Canada. He became certified
as a specialist in Oral Pathology in 1974.
In 1975 he was appointed jointly as Chief
of Dentistry at Toronto Western Hospital
and to an academic staff position in the
University of Toronto. In 1987, after the
merger of the Toronto Western Hospital
and Toronto General Hospital, he became
Chief of the combined dental
departments until their closure in 2003.
He is a past president of the Royal
College of Dentists of Canada and a
former Examiner-in-Chief of the RCDC.
He is also a former president of the
Canadian Academy of Oral Pathology
(as it was then known).
During the past RCDSO Council term,
John was chair of the Audit Committee
and vice chair of the Discipline
Committee.
He is currently Discipline Head of Oral
Pathology and Oral Medicine at the
University of Toronto. Responsibilities
include directing the undergraduate and
graduate programs in oral pathology and
oral medicine, as well as administering
the oral pathology biopsy service with the
other members of the department. He
associates part-time in the private
practice of oral medicine.
Dr. Stanley Kogon has a long academic
history at the University of Western
Ontario. During more than 35 years, he
has served as Chair of the Divisions of
Oral Medicine, Oral Radiology and
Periodontics; Assistant Dean Clinical
Affairs; Director of Clinics; and Director of
the School of Dentistry (1998 to 2004).
After an administrative leave, Stanley has
returned to full-time teaching in the
clinics and lecture room, and pursuing
research of interest. The focus of his
energy, however, is trying to keep up with
his first grandson.
DISPATCH • February/March 2009
17
Elections 2009-2010
Appointed by Lieutenant-Governor in Council
Kelly Bolduc-O’Hare
Mohammed Brihmi
Harpal Buttar
Parminder Chahal
Kelly Bolduc-O’Hare and her husband
own and operate two small businesses:
the Anchor Inn Hotel and Lakeshore
Excursions, both of them are located in
Little Current on Manitoulin Island. Kelly
is very actively involved in the promotion
of tourism and hospitality industries in
Northern Ontario. In addition, she
continues to make a significant volunteer
commitment to projects involving
economic and community development
on Manitoulin Island.
Mohammed Brihmi is President of EMB
Consulting. Among others, his firm
provides services in the fields of strategic
planning, human resources development
and project management for the private
sector, governments and the non-profit
sectors. Mohammed has been a speaker
and part-time professor of human
relations, sociology, issues in diversity
and strategic planning.
Mr. Brihmi is the first Canadian of North
African, Arab and Muslim origin to get
elected to chair a school board. He was
elected to public office as a trustee, vicechair and chair of the Metro Toronto
French School Board and was elected as
a member of the Metropolitan Toronto
School Board, the largest school board in
Canada. He has chaired several
community organizations and served on
the Boards of Directors of many
institutions, such as the Toronto
Foundation for Students Success, the
Moroccan Association of Toronto, the
Scarborough Community Care Access
Centre, The Canadian Arab Network, the
Learning Partnership, the French
Committee of the City of Toronto, and the
Ontario Advisory Council on
Multiculturalism and Citizenship of the
Government of Ontario.
Mohammed has also served on the
Selection Committee for the Lincoln M.
Alexander Award for Leadership in
Eliminating Racism of the Ministry of
Immigration and Citizenship. He is also
the founding president of l’Association
interculturelle franco-ontarienne, an
umbrella organization for ethnic and
racial minority francophones of Ontario.
He is the recipient of several distinctions
following many years of volunteer
commitments.
Dr. Harpal Buttar is a senior scientist in
the Therapeutic Products Directorate,
Health Canada, Ottawa. He received his
degree in Veterinary Medicine from the
Punjab University (India), and MSc and
PhD degrees in Pharmacology from the
University of Alberta, Edmonton, Alberta.
Harpal holds Adjunct Professorship
in the Department of Pathology &
Laboratory Medicine, Faculty of
Medicine, University of Ottawa. He is
also a scientific consultant to the
Institute of Cardiovascular Sciences,
Faculty of Medicine, University of
Manitoba, Winnipeg.
Harpal is the author and co-author of 70
research and review papers, including
three book chapters. He is a member of
several professional societies and
editorial boards of scientific journals.
His biographical sketches have been
published in: Directory of International
Biography; Men of Achievement; and
Men & Women of Science. He is the
recipient of the Fifteen Years Volunteer
Services Award from the Ontario Ministry
of Citizenship and Culture, as well as the
Commemorative Medal for the 125th
Anniversary of the Confederation of
Canada. Dr. Buttar has served for three
years as a public appointee on the
Council of the College of Dietitians of
Ontario.
Parm Chahal began his career as a
young entrepreneur. At age 22, he built
his first real estate complex for third
party clients while also managing inhouse projects. Then, as a construction
project manager for mmmuffins Canada,
Parm negotiated substantial savings for
the company by clearly defining new
systems and construction procedures,
while building strong relationships with
suppliers and vendors. Prior to his tenure
at mmmuffins, Parm was a senior
operations manager for Famous Players
where he managed new theatre openings
and was responsible for a staff of 400.
He earned a Business Management
degree at Ryerson University, majoring in
accounting and finance with a minor in
business communications.
Mr. Chahal has now come full circle and
is refocusing on his construction and
development interests. At 31, he was
billed as “Brampton’s youngest
developer.” He takes a keen interest in
developing and constructing buildings
that reflect the communities in which
they are located.
Parm is also very involved in many
community and volunteer organizations.
He is a current sitting member of
Brampton’s Committee of Adjustments.
At the College, he has been a member of
the Discipline Committee and Chair of the
Professional Liability Program
Committee.
18
DISPATCH • February/March 2009
Ensuring Continued Trust
Mofazzal Howladar
Kurisummoottil S. Joseph
Catherine Kerr
Evelyn Laraya
Mofazzal Howladar graduated in 1977
with a Diploma in Chemical Engineering
from Dhaka Polytechnic Institute in
Bangladesh. He then worked until 1986
as a quality control technician at the
Pharmadesh Laboratory in Dhaka. From
1989 until 1998, he worked in Toronto in
several positions as a security officer and
building custodian.
Mofazzal has made a significant
contribution to community activities since
coming to Toronto. For almost the past
10 years, he has been General Secretary
of the Regent Park Khadeem Committee.
He currently volunteers as a tenant
counsellor through the Toronto
Community Housing Corporation in
Toronto’s Regent Park. Mofazzal has also
been actively involved in the Regent Park
redevelopment and revitalization project
since 2004, both as a community
participant and as a community animator
and leader.
Kurisummoottil S. Joseph (K.S.) came to
Canada in March 1967 and joined the
then Provincial Court in Thunder Bay in
April 1967. He was appointed as the
Administrator of the Court in March 1976
and later that year as a Justice of the
Peace. K.S. continued in that position
until his retirement in September 2004,
except for a five-year secondment to the
Family Support Plan as a regional
manager. He was appointed by the
Minister as a public member to the Royal
College of Dental Surgeons of Ontario in
September 2004 for a three-year term
and reappointed for another three-year
term in 2007. He was elected to the
Executive Committee of the College in
2006 and re-elected in 2007.
K.S. has volunteered on several
community organization boards. He was
the president of India-Canada Association
of Thunder Bay for two terms, president
of the Family Development Centre of
Thunder Bay for two terms, member on
the Board of Directors of the St. Joseph’s
General Hospital for 15 years, member
on the Board of Thunder Bay MultiCultural Association, and member on the
Board of the Rotary Club of Thunder Bay.
K.S. is married to Annie and they have
two sons, Sebastian and Thomas, and
four grandchildren, Haydyn, Jaiya, Kiryn
and Imogene.
Catherine Kerr is a retired civil servant
who worked at the Ministry of Health &
Long-Term Care for 20 years. During that
time, she held a number of positions
including Legislative Policy Consultant,
Executive Assistant to the Deputy
Minister, Corporate Author and Manager,
Operational Support. Prior to this, she
worked in administration at Sunnybrook
Health Sciences Centre for both the
President and the Chief of Staff, Regional
Trauma Unit.
Catherine is a graduate of York University,
holding a BA (Hon) in English and
continues to enjoy literature.
Retirement has given her an opportunity
to more fully pursue other interests
including birding, travelling, gardening
and spending time with her dog, Nika, a
Bouvier des Flandres.
Evelyn Laraya is an active community
leader serving her fourth year on Council.
A social worker by education, she retired
after 27 years in banking, as a financial
analyst. During her banking career,
however, she was always involved in the
community taking on various
responsibilities, which included being
president of her alumni association and
of the Silayan Community Centre, raising
funds for various community projects, as
well as serving as director of many
charitable organizations including the
Filipino Centre, Toronto. Her
accomplishments include sponsoring a
scholarship at U of T, the successful
hosting of first ever ICANAS conference
in Toronto, housing assistance and job
search to newcomer immigrants, and
activities and programs for live-in
caregivers.
Now retired from “number crunching”
Evelyn is realizing her dream of full-time
service to the community. She devoted
10 years with the Halton Children’s Aid
Society, volunteered at the Rape Crisis
Centre of Peel Region, volunteered with
ANCOP (Answer to the Cry of the Poor)
Canada and assisted Counterpoint in
developing a mentoring-training program
for Filipino women in abusive
relationships.
She is currently serving as Volunteer
Executive Assistant to the President of
the Kalayaan Cultural Community Centre
based in Mississauga, organizing
fundraising events, such as the annual
golf tournament, bowlathon, dinner
dances, as well as hosting seminars for
live-in caregivers, new immigrants, teens
and seniors. Evelyn and her team at the
Kalayaan Centre are responsible for the
preparation and completion of grant
applications for numerous projects.
Having served Council as a member of
the Complaints Committee, Evelyn is
currently a member of the Discipline,
Audit, and Fitness to Practise
Committees where she finds herself most
rewarded and fulfilled.
DISPATCH • February/March 2009
19
Elections 2009-2010
Appointed by Lieutenant-Governor in Council
Dr. Edelgard Mahant
Jose Saavedra
Abdul Wahid
Dr. Edelgard Mahant traces her
background to the central European
maelstrom of World War II. She considers
British Columbia her home, though she
also has a few soft spots for northern
Ontario.
She is a professor of Political Science at
York University’s bilingual Glendon
College, where she bemoans her parttime status (because the Ontario
government did not abolish mandatory
retirement soon enough). Her academic
specialization consists of European
politics and foreign policy, and she has
published widely in these fields.
Her other interests include human rights
– she is a long-standing member of
Amnesty International – and politics. She
also enjoys keeping in touch with former
students, reading (especially Canadian
fiction), travel and cooking (in
moderation).
Edelgard’s biggest fault is also her major
virtue: she is seldom afraid to speak up
and speak out. She lives in Toronto’s
Greektown and can communicate in
English, French and German. Her
immediate family consists of her
husband, an adult son and daughter, and
two grandchildren, who all live in the
Toronto area.
Jose Saavedra is currently the president
of Triple A Personnel, Inc., a company
involved in the placement of permanent
and temporary industrial and warehouse
personnel to clients, including
multinational companies, primarily in the
airport area.
Before moving to Canada in 1989, Jose
worked as a tax lawyer with Del Monte
Philippines and as an auditor/consultant
with SGV & Co., a member practice of
Arthur Young International.
Jose is a member of the Illinois Chartered
Public Accountants Society, the
Integrated Bar of the Philippines, and the
Philippine Institute of Philippine
Chartered Public Accountants. He
graduated with a BA in economics in
1976, a BSc in accounting in 1977, and
a Bachelor of Laws degree in 1983 from
the University of the East in Manila.
From 1998 to 1999, he was president of
the Association of Filipino Canadian
Accountants. From 2002 to 2005, he
was president of the Philippine
Independence Day Council, a Torontobased non-profit umbrella organization of
Filipino Canadian associations. In 2004
and 2005, Jose was president of the
Canadian Multicultural Council of Asians
in Ontario, an umbrella organization of
over 20 Asian Canadian organizations
representing over 16 countries and
regions in Asia.
Jose is very actively involved in
fundraising activities for various Filipino
Canadian associations and groups in
Ontario.
Born in Bangladesh in 1951, Abdul
Wahid obtained a Bachelor of Commerce
degree in 1972 from the University of
Rajshahi. He completed his CA degree at
the Institute of Chartered Accountants of
Bangladesh in 1986, a CPA degree from
USA in 2001, and become a member of
Illinois CPA Society USA. In 2002, he
completed a CGA degree from CGA
Ontario. He is currently working as
Assistant Controller of Accounts with
Nor-Don Collection Network Inc. He has
worked with the British American
Tobacco Company in Bangladesh as
Accounting Executive, with Northern
Brewery Ltd. and Zambia Pork Ltd. in
Zambia as Chief Financial Officer.
Abdul is involved in a number of
volunteer activities in different
organizations. He is currently the
president of Bangladeshi-Canadian
Community Services, secretary of
Bangladeshi-Canadian Political Action
Committee, chairman of the Institute of
Chartered Accountants of Bangladesh
North America Chapter, and board
member of the Canadian Multi-Cultural
Council of Asia.
Abdul is married with two sons and one
daughter.
Disclaimer: The biographical profiles
were submitted by the individual
Council members and have not been
vetted or edited by the College.
20
DISPATCH • February/March 2009
Ensuring Continued Trust
PEAK
UNSPOKEN FEARS
The Things That Give
Brave People Nightmares
W
We live in a fearful society. Whether it is the current financial crisis,
ongoing wars abroad or pandemic flu predictions, we have a lot to
worry about. In addition to external fears, most of us have our own
private, internal demons. We fear the unknown, not being good
enough and disapproval from the ones we love.
Fear breeds anxiety and stress. Dentists are trained to recognize these
signs in others and manage them in the delivery of oral health care.
We learn to calm and reassure our patients, all the while projecting an
air of quiet confidence. By accepting this
mantle of utter fearlessness, however, do we
become incapable of facing our own doubts?
key points to consider:
PEAK (Practice Enhancement
and Knowledge) is a College
service for members, whose
goal is to regularly provide
Ontario dentists with copies
of key articles on a wide
range of clinical and nonclinical topics from the
dental literature around the
world.
It is important to note that
PEAK articles may contain
opinions, views or statements
that are not necessarily
endorsed by the College.
However, PEAK is committed
to providing quality material
to enhance the knowledge
and skills of member dentists.
COLLEGE CONTACT
Dr. Michael Gardner
Assistant to the Registrar,
Dental
416-934-5616
1-800-565-4591
[email protected]
Dentistry is a profession of perfectionists,
whose expectations are never fully met. We
learn to fear failure and the loss of control,
and in the process may become hypercritical
of ourselves and others. Over time, our fears
may ultimately limit our growth and
development as individuals.
With this issue of Dispatch, PEAK is pleased to
offer members the following introspective
article: “Unspoken Fears: The Things That
Give Brave People Nightmares,” from the
September/October 2008 issue of Northwest
Dentistry.
The article identifies the most common fears
of dentists and their relationship to chronic
stress. The article emphasizes that the hardest
step for most dentists is to acknowledge their
own doubts and fears, and then offers several
strategies to deal with them.
Live in the present moment – By focusing
on the past or future, we may actually miss
the living of our lives.
Stop “awfullizing” – There is significant
healing power in positive thinking.
Learn to go with the flow – Even the most
difficult things in life often bring a gift.
Live your authentic, genuine self – Living
true to yourself, instead of trying to be
what others want you to be, is liberating.
Challenge your irrational fears – Worry is a
waste of time. If something happens, deal
with it then.
Faith is the antidote to fear – Having faith
in a power greater than yourself, however
you understand this, can be a source of
comfort, guidance and healing.
In Ontario, any dentist can access the
Member Assistance Program (MAP) offered
through the Canadian Dental Service Plans
Inc. by calling toll-free: 1-800-268-5211. MAP
provides short-term counseling, consulting and referrals at no cost to
dentists, their families and dental office staff. The service is absolutely
free and confidential. Help is just a phone-call away, 24-hours a day,
7 days a week.
DISPATCH • February/March 2009
21
PROFESSIONAL PRACTICE
Importance of Good
Dentist/Patient
Communications
in the Informed
Consent Process
Good communication is
essential to maintaining your
relationship with your patients
and is vitally important to
obtaining your patients’
consent to treatment.
COLLEGE CONTACT
Dr. Don McFarlane
416-934-5609
1-877-817-3757
[email protected]
Patients frequently contact the College about treatment plan options or the
cost of dental treatment. Some examples of these inquiries include:
• Patients call to request information about whether alternative types of
treatment are possible. These patients often state that their dentists
offered them only one option.
• Patients ask such questions as “What is root canal treatment?” When
asked why they are not speaking directly with their dentists, they often
reply that it is difficult to talk to them.
• Some patients call with questions when treatment has failed. When
asked why they haven’t discussed their questions with their dentists,
many of these patients say that their dentists are too busy to talk with
them.
• Many patients call with questions about the cost of a specific dental
treatment. Those who are angry about the cost of treatment that they
have received invariably say that their dentists or staff did not discuss
the cost of treatment before the beginning of treatment.
22
DISPATCH • February/March 2009
Ensuring Continued Trust
Exciting News! Informed
Consent Focus of Latest
Education Package
The latest production in the College’s LifeLong
Learning program will deal specifically with the
topic of informed consent. Production of the CD
is a collaborative project with the Ontario
Dental Association. Distribution is slated for
October.
Highlights include:
• Dramatization of dentist/patient scenarios,
dentist/patient discussions with their
lawyers, and an in-court sequence with a
decision delivered by a real judge
• Case studies based on real life problems in
different specialties
• Informed consent checklists for dentist’s
use
• Roundtable review of case studies by
leading lawyers
COLLEGE CONTACT
Peggi Mace, Communications Director
416-934-5610 • 1-800-565-4591
[email protected]
Remember that dentists are required both
legally and ethically to obtain their patients’
informed consent to treatment. Your treatment
planning consultations should include a
discussion of the diagnosis and rationale for
treatment, and the risks, benefits, expected
outcomes, and costs of the different
reasonable treatment options.
Some dentists make use of visual aids like
diagrams or models to help them explain
different dental procedures to their patients.
Some dentists provide their patients with
brochures or pamphlets to read, or let them
view videos after the treatment planning
consultation.
To ensure that the consent process is
complete:
• Make sure to use language and
terminology that your patients will
understand.
• Make sure that you give your patients the
opportunity to ask questions.
• Give your patients adequate time to
consider the treatment plan options so
they don’t feel pressured into consenting
to treatment. Patients often come back
with additional questions. Sometimes
these questions will show that your
patients didn’t truly understand what you
said at their initial consultations.
• Be sure to document the discussion
between you and your patient including
your patient’s consent to treatment.
DISPATCH • February/March 2009
23
PROFESSIONAL PRACTICE
Immunizations Essential Part
of Infection Prevention
and Control Program
I
COLLEGE CONTACT
Dr. Don McFarlane
416-934-5609
1-877-817-3757
[email protected]
mmunization substantially reduces the
number of health care workers susceptible
to infectious diseases, as well as the
potential for disease transmission to other
staff and patients. That is why immunizations
are an essential part of infection prevention
and control programs.
All health care workers should be adequately
immunized against the following diseases:
Hepatitis B
Influenza
Measles
Diphtheria
Mumps
Pertussis
Rubella
Tetanus
It is important that all health care workers
know their personal immunization status and
ensure that it is up-to-date. In this regard, you
can consult with your family physician. In
addition, the Canadian Immunization Guide
sets out recommendations and schedules for
adults, including those engaged in the
provision of health care.
Hepatitis B is the most important vaccinepreventable infectious disease for all workers
engaged in health care. The risk of being
infected is a consequence of the prevalence of
virus carriers in the population receiving care,
the frequency of exposure to blood and other
Varicella
Continued on page 26
Protocol for Prevention, Management
and Follow-up of Sharps Injuries
The College advises dentists to institute a protocol for the prevention, immediate
management and appropriate medical follow-up of sharps injuries, and then to train staff in
the protocol. Ontario’s Provincial Infectious Diseases Advisory Committee requires that these
protocols be in writing.
The Ontario Occupational Health and Safety Act, 1990 has the following general
requirements:
• Provide information, instruction and supervision to a worker to protect the health and
safety of a worker.
• Take every precaution reasonable in the circumstances for the protection of the worker.
• Prepare and review a written occupational health and safety policy, and develop and
maintain a program to implement that written policy.
24
DISPATCH • February/March 2009
Ensuring Continued Trust
First Person Story of an Ontario Dentist
Who Tested Positive for Hepatitis C
I went to get a vaccination for hepatitis A and B, and found out that I had
hepatitis C. It was a nasty surprise. I probably got it as a child in my home
country where infection control procedures are not as strict as in Canada,
or I could have even got it from a manicure. There is no way of knowing. I
was so ignorant. Before this I thought you could only get hepatitis through
dirty needles or unprotected sex so I thought how could I get this disease.
I immediately reported my condition to the College’s Registrar. I was very
pleased with how the College handled the matter. They were very sensitive
to my situation and to my patients. The College set up an anonymous
panel of experts to give advice, which I agreed to follow. I had to curtail my
practice and do absolutely no surgery. I wore two pairs of gloves. It really
bothered me that I had to refuse some of my patients and refer them out
to an emergency clinic. It delayed their care.
If you really care about your patients you have to report. I did not want to
expose them, no matter how low the risk might be. I was very encouraged
by the support and encouragement that I got from the College throughout
this ordeal.
The treatment took almost three years. Many times I was so exhausted,
but I had to drag myself to work because I needed the money to pay for
the interferon therapy that I had to go to the US to get and I needed to
help support my family. Luckily neither my husband nor my children were
infected.
This whole situation reaffirmed for me the importance of proper
sterilization and infection control practices in the dental office. Based on
my personal experience, I would say it is a good idea for all dentists to get
a vaccination for hepatitis A and B. When you get the vaccination, you get
the antibody test for hep A, B and C.
DISPATCH • February/March 2009
25
PRACTICE CHECK
Immunizations Essential Part of Infection
Prevention and Control Program
body fluids, and the contagiousness of
hepatitis B virus (HBV). That is why
immunization against HBV is strongly
recommended for all health care workers who
may be exposed to blood, blood products or
injury involving sharps.
Dentists who might perform
exposure-prone procedures have an
ethical obligation to know their
personal serologic status.
Serological testing for anti-HBs should be
conducted one to two months after
completion of the three-dose vaccination
series to establish antibody response. Health
care workers who fail to develop an adequate
antibody response should complete a second
vaccination series, followed by retesting for
anti-HBs. Health care workers who fail to
respond to the second vaccination series
should be tested for HBsAg.
If infected, dentists should seek
guidance from the College about
the potential for transmission of
their infection to their patients.
Non-responders to vaccination who are
HBsAg-negative should be consulted
regarding precautions to prevent
HBV infection and the need to obtain
immunoglobulin prophylaxis for any
known or probable parenteral
exposure to HBsAg-positive blood.
ON THE WEB
www.rcdso.org
Best Practices for Cleaning, Disinfection
and Sterilization
IMPORTANT HEALTH NOTICES
Health care workers who are HBsAgpositive should seek guidance
regarding necessary and reasonable steps to
prevent HBV transmission to others and the
need for medical evaluation. In particular,
health care workers who might perform
exposure-prone procedures should be
assessed on a case-by-case basis regarding the
need for possible work restrictions.
The College is currently reviewing its infection
control guidelines and the revised guidelines
will be considered for approval by Council at
its May meeting.
26
DISPATCH • February/March 2009
Ensuring Continued Trust
PROFESSIONAL PRACTICE
CORRECTION
Information About
Preparing for a Medical
Emergency in
the Dental Office
DRUG
INDICATION
INITIAL ADULT DOSE
RECOMMENDED CHILD DOSE
Oxygen
Epinephrine
Most medical emergencies
100% inhalation
100% inhalation
Anaphylaxis
0.1 mg i.v or
0.3-0.5 mg i.m*
0.01 mg/kg
Asthmatic bronchospasm
which is unresponsive
to salbutamol
0.1 mg i.v or
0.3-0.5 mg i.m*
0.01mg/kg
Cardiac arrest
1 mg i.v
0.01mg/kg
Nitroglycerin
Angina pectoris
0.3 or 0.4 mg sublingual
No paediatric dose
Diphenhydramine
or chlorpheniramine
Allergic reactions
50 mg i.v or i.m*
10 mg i.v or i.m*
1 mg/kg
Salbutamol
inhalation aerosol
Asthmatic bronchospasm
2 puffs (100 micrograms/puff) 1 puff
ASA
Acute Myocardial infarction
160 or 325 mg
Not indicated
* The dose suggested for the i.m. route is also appropriate for sublingual
injections. Total paediatric dose should not exceed the adult dose.
COLLEGE CONTACT
Dr. Don McFarlane
416-934-5609
1-877-817-3757
[email protected]
In the November/December 2008 issue of
Dispatch, the Practice Check article “Preparing
for a Medical Emergency in the Dental Office”
provided a chart showing the necessary drugs
and dosages.
The College is reprinting the chart with the
misprint corrected and the new modification
added because a minor error occurred on the
chart and a modification to one of the
recommendations has recently occurred.
DISPATCH • February/March 2009
27
PROFESSIONAL PRACTICE
Avoiding the
PROBLEM ACCOUNT
Like any business, dental practices frequently
incur problems with an unpaid or disputed
account. However, unlike many other
commercial transactions, a dental service is
often more difficult for the patient or purchaser
to understand and compare due to the
complexity of treatment, the specific
circumstances related to each case, as well as
varying office policies regarding payment.
COLLEGE CONTACT
Dr. Don McFarlane
416-934-5609
1-877-817-3757
[email protected]
So, it is no surprise that confusion occurs and
patients dispute an account. In fact, many of
the complaints that the College receives and
the claims that the Professional Liability
Program (PLP) receives have their origins in a
misunderstanding about fees and payment
terms.
There are many factors that can result in an
unpaid or disputed account. The most
common that come to the attention of the
College are:
Sometimes the patient has that opinion
because the dental office has failed to instruct
him or her on the office policy related to
insurance. Or maybe the dentist has
proceeded with treatment with both parties
assuming total insurance coverage was in force
and without an understanding of who is
responsible if that is not the case.
To avoid misunderstandings and confusion,
dentists should establish clearly with the
patient:
$$$$$$
• confusion related to insurance coverage;
• absence of a consistent office policy on
payment of accounts;
• failure to establish financial arrangements
and/or contracts for long-term or more
expensive treatment plans.
Confusion related to insurance coverage
Perhaps the most common dispute occurs
when a patient receives a payment from an
insurance company that is less than the
dentist’s charges. Many patients feel that it is
the dentist’s responsibility to write off the extra
amounts and absorb the costs.
28
DISPATCH • February/March 2009
• what the office policy is related to
insurance including deductibles, copayments, different fee schedules, and
non-covered expenses;
• who is responsible for predetermining
benefits;
• who is responsible to the dentist if a claim
is not paid despite inaccurate information
from the insurance company that led the
parties to initiate the treatment.
Ensuring Continued Trust
$$$$$$
Absence of a consistent policy on
payment of accounts
The dental office should have a clear and
consistent policy for paying of accounts. This
policy should be communicated to the patient,
perhaps in a welcoming letter to new patients,
and reinforced by all staff, including the
dentist. This policy should include payment
terms, insurance claims policy, charges for
missed appointments and charges related to
overdue accounts.
Very often a patient forms the opinion that he
or she has a special arrangement for payment
based on comments made by a staff person or
the dentist. Dentists should make it clear what
flexibility a staff member has in altering the
office policy.
If the dentist changes the policy with a specific
patient, the dentist should inform the staff
person in charge of the account, as well as
enter the specific agreement into the patient’s
chart.
Very often the patient’s confusions result from
poor communication between staff and
dentist, or the dentist’s off-the-cuff remarks to
the patient about a fee and payment that is not
recorded in the chart. It is then forgotten until
at some future point when payment is
requested.
Failure to establish financial arrangements
and/or contracts for long-term or expensive
treatment plans
When complicated treatment plans are made,
dentists should consider creating a detailed
financial agreement. In this agreement the
total fee, the lab fee, and the payment
schedule could be made clear to the patient.
Also, the agreement could address such issues
as unforeseen complications, failed
appointments, discontinuation of treatment
by the patient and any refunds that would
result, and fees for additional consultation
time the patient requests that was not part of
the dentist’s estimate. The dentist should try to
anticipate potential areas of difficulty and
establish a policy to deal with them.
In conclusion
Of course, no one article can be a complete
guide to practice management issues related
to financial arrangements with patients.
However, it does give an overview of questions
and concerns related to financial issues that
the College hears from patients, and suggests
some practical preventive measures for
dentists and their staff.
ON THE WEB
www.rcdso.org
Risk Management Guide
PROFESSIONAL PRACTICE/PRACTICE RESOURCES
DISPATCH • February/March 2009
29
PROFESSIONAL PRACTICE
Collection of
DELINQUENT ACCOUNTS
From time to time, dentists are faced with the uncomfortable task of
dealing with patients who have delinquent accounts. Despite best efforts,
the account often remains outstanding and consideration must be given
to using a collection process to resolve the matter.
Instructions to the collection firm
In making the decision to use a collection
process, it is important that no action be taken
that could make the dentist vulnerable to a
complaint or lawsuit.
COLLEGE CONTACT
Dr. Don McFarlane
416-934-5609
1-877-817-3757
[email protected]
Debts cannot be sold to a third party collection
agency. Anyone who is hired by the dentist to
interact with patients becomes an agent of the
dentist and the dentist is responsible for the
agent’s actions. That is why it is important
careful instructions must be given to the
collection firm to ensure that privacy laws and
College guidelines are respected when a
dentist uses an agent to collect delinquent
accounts.
setting, and from making rude or hostile
phone calls at unusual hours.
• Emphasize that no action should be taken
by the agent to place the patient’s name in
any kind of negative credit-reporting
agency or roster. If a small claims court
action is necessary, the court’s ruling will
be public. Credit agencies can use this
public information, but it is unwise for a
dentist or his agent to initiate a negative
credit report. This is especially important
in some communities where the
collection agency is also the credit bureau.
$$$$$$
With these instructions to the collection
agency, you should:
• Enter into a formal agency agreement
with the collection agent acting on your
behalf with your instructions and
obligations set out in writing.
• Advise the agent that the information that
the company receives is confidential and
can not be relayed to other parties,
including employers, relatives, and other
agencies acting on behalf of the patient.
Other ways to minimize problems
In addition to the above suggestions there are
other ways to minimize problems:
• Provide the agent only with the
information that is necessary to collect
the account. Information that is
unnecessary to establish the debt, such as
the patient’s medical history, oral care and
previous treatment, should not be given to
the agent. This will reduce the risk of the
agent abusing the information and
breaching the confidentiality of the
patient.
• Ensure that the methods used to collect
the account reflect well on the
professionalism of you as a dentist. The
agent should refrain from contacting the
patient at the patient’s workplace or social
30
DISPATCH • February/March 2009
Ensuring Continued Trust
$$$$$$
• Contact a patient when an account is
approaching delinquency to try to
establish if the patient is withholding
payment due to any dissatisfaction with
the treatment or with those who rendered
it. If the patient indicates a problem with
the care received, it may be possible for
the dentist to resolve the problem. When
contacted, if the patient indicates that he
or she is not experiencing problems with
his or her care but has other reasons not
associated with the dental treatment, it is
important this information be recorded. If
a collection action becomes necessary at a
later date, the patient would then have
reduced credibility in withholding
payment due to a complaint about the
care.
In summary
Dentists are entitled to collect their fees by
reasonable means and should not be
intimidated by the threat of an unreasonable
complaint or lawsuit. However, you should be
aware that the College receives a significant
number of complaints from patients about
their treatment that are motivated by an
aggressive approach to collecting the patient’s
account. Often, a small problem that a patient
was willing to ignore becomes a major one
when the patient is pressed for payment.
Experience shows that open communication
between dentists and patients can resolve
many disputes before an official complaint is
filed with the College.
In certain cases, an objective analysis of the
situation may lead to the decision to opt for
alternative action that would require less time
and reduce stress for the dentist and staff and,
in the long run, be less expensive.
• Ensure that all patients are aware of the
office policy regarding payment of
accounts for routine procedures, and that
the dental staff adheres to that policy or at
If that decision involves reducing or
least makes very accurate records if the
eliminating the outstanding debt or offering a
policy has been modified for a particular
refund or other consideration, it would be wise
patient. For more expensive and involved
to consult the College’s Professional Liability
treatment for which the payment policy
Program (PLP) to ensure that such action does
may deviate from the policy for routine
not compromise PLP coverage or otherwise
procedures, it would be advisable to
worsen the situation.
utilize a pretreatment financial
agreement. This agreement should always
be part of the patient’s record to
avoid any disputes about costs
ON THE WEB
and when payments are due.
www.rcdso.org
This is also an important part in
Counterclaims – Don’t Invite Them
establishing informed consent.
DISPATCH APRIL/MAY 2002 PAGE 32
DISPATCH • February/March 2009
31
PROFESSIONAL PRACTICE
Dentists/Denturists
Working Together
Under One Roof
COLLEGE CONTACT
Dr. Don McFarlane
416-934-5609
1-877-817-3757
[email protected]
Dentists sometimes want to enter into
business relationships with denturists where
they will be providing their respective services
to patients under one roof. This scenario raises
several important questions:
1. What are the different levels of
professional responsibility for patients
treated in common?
2. What types of business relationships are
permissible between dentists and
denturists?
3. What is the best way to handle patient
records and patient accounts?
4. How do you submit insurance claims in
these different business relationships?
1. Different levels of professional
responsibility
Dentists and denturists have different scopes
of practice and different controlled acts
described in the Dentistry Act, 1991 and
Denturism Act, 1991. Therefore, the College’s
view is that dentists and denturists hold
different levels of professional responsibility
for shared patients.
If a dentist refers a patient to a denturist to
perform specified services as part of an overall
treatment plan coordinated by the dentist, the
dentist has a professional responsibility to be
aware of the qualifications of the denturist, as
with any other health care provider to whom
he or she refers patients.
If a denturist refers a patient to the dentist for
rest preparations and other tooth preparation
for partial dentures or for the placement of
implants, which the denturist will later be
restoring with a removable denture, such as an
overdenture, the dentist’s responsibility does
not begin and does not end with this stage of
the patient’s treatment.
In fact, the decision as to whether a patient is a
candidate for a specific prosthetic treatment
plan rests with the dentist. Dentists are trained
to make these types of decisions and are the
only regulated dental health professionals in
Ontario who are authorized to communicate a
diagnosis identifying a disease or disorder of
the oral-facial complex as the cause of a
person’s symptoms.
The formulation and communication of
diagnosis and the subsequent treatment plan
is an integral component of obtaining a
patient’s informed consent to treatment for
prosthetic dentistry. So too is the suggestion of
reasonable treatment alternatives, some of
which are outside the scope of practice of
denturists.
The patient’s record must document the
dentist’s discussion with the patient and must
show evidence of adequate consultation with
all the professionals involved in the treatment
process. The patient’s record should document
the alternative treatment options discussed
and the patient’s choice of treatment.
With partial dentures, in addition to these
general requirements, the dentist must agree
with the specific denture design.
32
DISPATCH • February/March 2009
Ensuring Continued Trust
PROFESSIONAL PRACTICE
For implant supported removable
overdentures, the dentist should mount the
fixed hardware to the implants prior to
referring the patient back to the denturist.
The dentist is also responsible for the
placement of any implant-supported crown if
this will be serving as a precision attachment
for a removable partial denture.
Once prosthetic treatment is completed, the
dentist will be responsible for ongoing
evaluation by means of a clinical and/or
radiographic examination and for providing or
arranging for periodontal and preventive
maintenance of the abutments for implant
supported or conventional fixed prostheses.
Because there is no procedure code in the
Ontario Dental Association’s Suggested Fee
Guide for tooth preparation for a partial
denture, if the denture is being provided by the
denturist, fees for the dentist’s time in
preparation of the teeth may not be
reimbursed by dental insurance. Patients
should be advised accordingly before
proceeding.
To submit an insurance claim for these
services provided by the dentist, these would
require a word description in the dentist’s note
section of the insurance claim form.
2. Business relationships
The preferred business relationship is for the
denturist and dentist to operate independent
and separate practices, with each maintaining
their own patient records. The dentist and
denturist will bill patients for treatment
independently. They will submit insurance
claims separately using their own provider
numbers and the procedure codes of their own
associations – the Ontario Dental Association
and the Denturist Association of Ontario.
A denturist can pay rent to a dentist in order to
be able to work in the dentist’s office. If a
dentist wishes to rent space from a denturist,
the only permissible financial arrangement is
for the dentist to pay rent on a flat fee basis,
not a percentage of the fees charged to
patients.
A dentist is only permitted to fee split with
another dentist or with a dental hygienist
working in the dentist’s practice. Dentists
cannot fee split or profit share with denturists.
3. Employer-employee relationship
Dentists cannot be employed by denturists.
The College permits dentists to employ
denturists and the regulations made under the
Denturism Act, 1991 do not prohibit it. In such
cases, there would be a single set of patient
records, as is the requirement with dental
hygienists, and the dentist would bill or charge
patients for the dentures provided by the
denturist.
Dentists are advised to provide the denturist
with access to the records, if the denturist
should later require access to those portions of
the dental records pertaining to denturism
services provided by him or her to a patient for
a response to a complaint filed against the
denturist by a patient to the College of
Denturists of Ontario, or to comply with that
College’s quality assurance program, or to
respond to a lawsuit in which the denturist is
named.
In the case where the dentist employs a
denturist, the College considers that it would
be permissible for an insurance claim to be
submitted under the dentist’s name, as long as
there is an explanation in the dentist’s note
section of the dental claim form explaining
that the denture services were provided by a
denturist and the denturist’s name is noted.
DISPATCH • February/March 2009
33
Ethical Dilemma Case Study
DENTAL ETHICS 101
“Let’s skip the gum
work and get on
with the bridges!”
A
Arthur Green, PhD, a 48-year-old professor in mathematics at the nearby university,
joined your practice four months ago and has been a source of constant irritation due
to his obnoxious attitude.
Although his general health is good, his oral health, in the words of the dental hygienist
in your practice, “is horrible . . . the worst!” He has halitosis and obviously doesn’t brush
because you cannot see the gingival one third of his crowns because they are covered
with food debris.
His chief complaint is that he wants to have the gaps filled in with bridges since he
recently acquired dental insurance. Dr. Green feels that his teeth are a nuisance and
that he lets the dentist take care of them. He has generalized chronic periodontitis with
4-6 mm pockets with bleeding in all four quadrants.
As part of his preventive program, he has scheduled three appointments with the dental
hygienist. After the second appointment, he gets up from the chair and says: “Look, I
don’t have to brush and floss . . . that’s why I pay you! Let’s skip the gum work and get on
with the bridges!”
You are now faced with an ethical dilemma. What would you do?
◆ Have Dr. Green sign a letter acknowledging that he has gum disease
but wants the bridges anyway even though he knows they may fail in
a few years. Then proceed with the bridgework.
◆ Discuss with Dr. Green that you will only treat his periodontal disease
and active caries now and that you will not proceed with
prosthodontics until his disease is under control.
◆ Tell Dr. Green that his attitude makes it impossible for your office
to effectively treat his oral health problems. Offer to refer him to
another office.
◆ Dismiss Dr. Green from your practice.
Reprinted in part from the
Texas Dental Journal of the
Baylor College of Dentistry
with permission.
34
Now turn to page 44 to find the discussion
about this ethical dilemma.
DISPATCH • February/March 2009
Ensuring Continued Trust
COMPLAINTS CORNER
Complaints Corner
Case No. 1
COMPLAINT SUMMARY
A patient filed a complaint against her dentist
saying that he:
Complaints Corner is
designed as an educational
tool to help Ontario dentists
and the public gain a better
understanding of the
current trends observed by
the College’s Complaints
Committee.
These scenarios are an
edited version of some of the
cases dealt with by the
Committee. The law does
not allow for either the
dentist or the complainant
to be identified.
COLLEGE CONTACT
Irwin Fefergrad
Registrar
416-934-5625
1-800-565-4591
[email protected]
• did not take radiographs to confirm the
absence of decay;
• failed to record a restoration on her lower
right side;
• failed to diagnose three areas of decay that
required restoration and one area
of decay that should be monitored.
DENTIST’S PERSPECTIVE
In his response to the College, the dentist said
the complainant had been his patient since
she was four years old. The member provided
a chronology of her recent appointments at his
office:
June 6/01
Recall appointment and a buccal
amalgam restoration placed on
tooth 47 (lower right 2nd molar)
May 15/04 Recall appointment and
2 bitewing radiographs taken
Sept. 7/06
Recall appointment
He said that she was told in error that there
were no restorations in her permanent teeth,
despite the clinical chart indicating tooth 47
had been restored in 2001. He further
explained that the chart entry had been
missed by staff and they had not consulted
with him prior to providing the complainant
with this information.
The dentist acknowledged the difference in
professional opinions between dentists as to
what are carious lesions, what is a stain and
when lesions should be treated or watched.
A copy of the member’s response was sent to
the complainant for her information. She
submitted further comments and asked for her
complaint to be withdrawn.
obtained records from the complainant’s
subsequent treating general dentist. The
records showed that she first attended the
general dentist’s office on March 15, 2007. A
predetermination form was submitted for the
following restorative treatment:
• Tooth 37 (lower left 2nd molar) –
vestibular restoration
• Tooth 46 (lower right 1st molar) –
distal-occlusal restoration
• Tooth 47 – mesial-occlusal –
vestibular restoration
The College investigator also spoke with the
staff member that provided the claimant with
the information related to the restorations in
her teeth. The staff member confirmed the
dentist’s version of events.
DECISION OF THE COMPLAINTS
COMMITTEE
While the patient had decided to withdraw
her complaint, based on the panel’s understanding of the law that, notwithstanding the
withdrawal, the jurisdiction of the College
continues, it continued with its review and
decision-making.
The panel was aware of the complainant’s
concern that radiographs were not taken to
assess decay; however, it noted that
radiographs were taken on May 15, 2004.
Given the patient’s good dentition, the
frequency that radiographs were taken
appeared reasonable.
On reviewing the radiographs dated May
15/04, the panel:
• agreed that it would have been reasonable
to watch the distal-occlusal lesion on
tooth 46;
• felt that the mesial-occlusal-buccal lesion
on tooth 47 was not clearly visible on the
radiograph and, as such, it perhaps was
incipient in nature;
As part of its investigation, the College
DISPATCH • February/March 2009
35
COMPLAINTS CORNER
Complaints Corner
• was unable to view the buccal lesion on
tooth 37, as this view was not visible.
While the treatment plan of the subsequent
treating general dentist differed from the
patient’s former dentist, it was the panel’s view
that a disagreement among health
professionals in the reasonable exercise of
their professional judgment about a particular
form of treatment does not, by itself, give rise
to an inference of professional misconduct.
The panel also felt that the failure by the
dentist’s staff member to provide accurate
information to the patient was inadvertent.
Based on its review, the panel decided to take
no further action with respect to this
complaint. However, the panel was of the
opinion that the member’s clinical chart
entries were scant and encouraged him to
review the College’s Guidelines on Dental
Recordkeeping and to possibly take the
opportunity to attend the College-provided
course on recordkeeping.
Case No.2
COMPLAINT SUMMARY
A patient filed a complaint about the implant
treatment provided by a dentist, concerned
that:
• The surgical procedure resulted in a
fractured jaw, subsequent infections and
one implant that spontaneously exfoliated.
• She now has permanent numbness in her
lower lip.
• The member failed to appropriately
manage her post-implant complications.
However, after the College received her letter
of complaint, but prior to notification of the
member, the patient telephoned the College to
withdraw her complaint. She said the dentist
had paid her the compensation she requested.
DENTIST’S PERSPECTIVE
On notification of the formal complaint, the
dentist provided the College with a response
36
DISPATCH • February/March 2009
and his patient records. He stated that the
patient first presented to his office on August
3, 2007 for a consultation about the placement
of implants to support her complete lower
denture. The member noted that the
complainant had been edentulous since 1958.
An examination revealed healthy intraoral
tissues and severe atrophy of the lower
alveolar ridge. A panorex showed good bone
height. The dentist stated that the patient was
provided with options for her implant
supported denture.
The information on the consent form was
reviewed stressing her increased risk for
complications. The patient then booked an
appointment for the surgical placement of two
implants. She was provided with a folder that
included fee estimates, consent information,
office and implant information.
On September 7, 2006, the patient attended for
the implant placement. Before treatment
commenced, the consent information was
again reviewed. Two implants were then
placed in sites 33 (lower left cuspid) and 43
(lower right cuspid). The member reviewed in
detail his implant procedure and confirmed
that a posttreatment radiograph was taken.
The dentist noted that the treatment had
proceeded uneventfully.
At the complainant’s one week postoperative
appointment, she only reported mild
discomfort. The member suspected a possible
mild superficial infection and prescribed a
chlorhexidine antibiotic rinse and oral
antibiotics. When the patient returned a week
later, the dentist noted that she was healing
well. The patient told him that she had
stopped taking the oral antibiotics after three
days.
On October 4, 2006, the patient returned with
mild lower anterior swelling. The member
diagnosed a lower left anterior infection. The
complainant noted that, two days previously,
she had attended her medical doctor who had
prescribed the same oral antibiotic previously
Ensuring Continued Trust
prescribed by the dentist. The member
performed an incision and drainage procedure
and assessed and noted no fracture was
present. One week later, the dentist’s records
noted “excellent healing.”
On October 25, 2006, the patient again
returned with mild swelling. The previous day
she had attended her physician who had
prescribed an oral antibiotic. The complainant
was reminded to finish taking all of the
antibiotics prescribed and the dentist noted
that his differential diagnosis was perforation
or sequestrum. The patient was informed that
the implant might require removal and
replacement, but that the infection must be
controlled first. A re-evaluation appointment
was booked for November 15, 2006.
On November 1, 2006, the patient returned to
the office with the implant in site 33 having
exfoliated. An examination revealed no
significant findings. A panorex was taken but
not reviewed, as the patient had another
appointment scheduled in two weeks to
review the options. The member diagnosed an
ongoing infection as a result of the failing
implant.
On November 8, 2006, the patient attended for
an emergency appointment with swelling and
an extra oral fistula. The member stated that
he had assessed the panorex taken the
previous week and noted a fracture and
immediately referred the patient to an oral and
maxillofacial surgeon. Subsequently, the
member contacted the patient to follow up
and was told she was healing well. She advised
him that she did not wish to proceed with
implant replacement as she had decided to
have a new lower denture made without
replacing the implant.
As part of its investigation, the College
obtained records from the complainant’s
treating oral and maxillofacial surgeon. The
records from the oral and maxillofacial
surgeon indicated that the patient attended at
his office on November 9, 2006. He observed a
large draining fistula with submental and
submandibular swelling and erythema,
bilateral paraesthesia, draining pus of the
mucosa over the left implant and gross
mobility of the segments in the region of the
left parasymphysis of the mandible at the 33
implant site. He prescribed antibiotics and
booked a date for surgery in hospital to
address these issues.
On November 22, 2006, an incision and
drainage procedure was performed, as well as
an excision of the fistulous tract and an open
reduction to repair the fractured mandible.
DECISION OF THE COMPLAINTS
COMMITTEE
While the patient had decided to withdraw her
complaint, based on the panel’s
understanding of the law that,
notwithstanding the withdrawal, the
jurisdiction of the College continues, it
continued with its review.
The panel could see from the records that
there was an infective process that continued
over a couple of months, with signs of
swelling, discomfort, and an extra oral fistula.
The member did not refer the patient to a
specialist during this period of time.
The panel was of the opinion that the member
should have offered an earlier referral to a
specialist, either an oral and maxillofacial
surgeon or a prosthodontist, to assess the
status of the implant. Two months with pain
and other symptoms was too long to wait to
take definitive action.
In addition, the panel suggested that the
member should have taken a radiograph as
soon as there was pain and swelling present.
The panel was concerned that, when a
radiograph was finally taken, it was not viewed
but simply put aside pending an appointment
two weeks later. In the panel’s view, this was
unacceptable. In their view, because there was
never an absence of pain, more definitive
action should have been taken.
DISPATCH • February/March 2009
37
COMPLAINTS CORNER
Complaints Corner
Accordingly, the panel was concerned that
the dentist failed to diagnose the relevance of
the patient’s postoperative discomfort, failed
to make a diagnosis, plan treatment and offer
a timely referral to a specialist. As a result,
there was a negative outcome.
Therefore, in order to address the Committee’s
concerns, in part, about the member’s failure
to adequately manage the post-implant
complications, the dentist voluntarily signed
an undertaking/agreement to restrict his
practice from initiating any new implant
dentistry cases. The notice of this restriction
on his Certificate of Registration was placed on
the public portion of the College’s register. It
would be removed at such time as the College
was satisfied that he had taken and
successfully completed a course(s) in the
management of post-implant complications,
including the diagnosis and treatment of
complications and options to refer to a
specialist.
Following the member’s successful completion
of the course, the College would monitor his
practice for a period of two years to ensure
that the knowledge gained in the course has
learning points
• Once a complaint has been filed with the College, the
Complaints Committee panel is responsible for conducting a
thorough review of the matter and for providing the patient
complainant and the dentist with a written decision and the
reasons behind that decision.
• Once seized with this responsibility, it is the College’s view
that, despite the wishes of a patient to withdraw his or her
complaint, the investigation must continue.
• In the cases described here, areas requiring practice
improvement were identified and corrective action
recommended. Had the complaint been allowed to be
withdrawn, the College would not have had the opportunity to
deal with the issues in the interests of public protection.
38
DISPATCH • February/March 2009
been applied to his practice. The panel felt that
the member’s agreement to upgrade his skills
in this way would benefit him and protect the
public interest.
The panel agreed that a definitive
determination could not be made as to when
exactly the fracture occurred. The panel felt
that it had happened inadvertently, as the
placement of the implants themselves was
adequate.
The panel suggested that perhaps the fracture
occurred as a result of bone degradation due
to the ongoing infection, which could have
resulted from a bacterial introduction or load
on the implant.
The panel has also decided to require the
dentist to attend before it or another panel of
the Complaints Committee to be cautioned
with respect to the care he provided in this
case.
Specifically, the panel’s caution would advise
the member that he should have:
• conducted a timely interpretation of
radiographs ordered by him in order to
ensure patients are informed of his findings
and any necessary action can be initiated
quickly;
• sought a second opinion and/or referral to
a specialist, given the onset of pain
immediately postoperatively, and more
closely monitored the complainant’s
condition;
• considered removal of the implant if he
became aware of the fracture, in order to
avoid the significant bone loss that
occurred;
• recognized that the position of the implant
was reasonable and, therefore, the
immediacy of the pain symptomology
should have alerted him to a problem;
• in future, ensure that patients have access
to him, given his multiple practice
locations, to provide continuity of care for
post-operative complications.
Ensuring Continued Trust
NEWS & VIEWS
Recent Court Result:
Illegal Practice of Dentistry
COLLEGE CONTACT
Lori Long
Manager – Complaints,
Investigations and Hearings
416-934-5623
1-800-565-4591
[email protected]
When the College receives information about
individuals who may be engaging in the
practice of dentistry in Ontario without a
Certificate of Registration, it makes inquiries
and attempts to gather evidence. It is often
difficult to establish that someone is practising
dentistry as defined by the Regulated Health
Professions Act (RHPA). The College must have
evidence that an
unregistered individual has
performed controlled acts.
Calendar
of
Events
RCDSO Council meetings are open to the
public, with the exception of any in
camera portion dealing with personnel
matters or other sensitive or confidential
material. Meetings begin at 9:00 a.m.
The agenda is available either at the
meeting or in advance on request.
Mark Your Calendar…
2009 OPEN COUNCIL MEETINGS
May 14, 2009
November 12, 2009
Westin Prince Hotel
900 York Mills Road, Toronto
Seating is limited so if you wish to
attend please let us know in advance
by contacting the College.
COLLEGE CONTACT
Angie Sherban
Senior Executive Assistant
416-934-5627
1-800-565-4591
[email protected]
The College views the illegal
practice of dentistry as a
serious matter and it
commits the necessary
resources to obtain proper
evidence. When the evidence
is gathered and the College’s
investigation is complete, an
application is made to the
Superior Court for an order
compelling the individual to
comply with the RHPA.
The matter can be heard by
the Court usually within
days of establishing the
facts. If the order is breached
by the illegal practitioner, it
may constitute contempt of
court and incarceration may
result.
The College recently
obtained the following result
in the Ontario Superior
Court of Justice:
Abram Peters
As a result of an investigation by the College,
proceedings were held in Superior Court to
hear allegations that Abram Peters was
practising dentistry out of a Tillsonburg
residence, without a Certificate of Registration.
Results
The Court ordered that Abram Peters refrain
from:
• performing any of the controlled acts set
out in paragraphs 4.1 to 4.8 of the Dentistry
Act, 1991, which constitute practising
dentistry;
• holding himself out as a person who is
qualified to practise in Ontario as a dentist
or dental surgeon or in a speciality of
dentistry; and
• treating or advising a person with respect to
his or her health in circumstances in which
it is reasonably foreseeable that serious
physical harm may result from the
treatment or advice or from an omission
from them.
The Court also ordered Mr. Peters to pay costs
of $7,500.
ON THE WEB
www.rcdso.org
Illegal practitioners
PUBLIC PROTECTION
DISPATCH • February/March 2009
39
OUNCE OF PREVENTION
Risk
Management
Resolutions
P
This feature is prepared
to offer guidance to
members about the
prevention of malpractice
claims or complaints
and the lessening of the
magnitude of an existing
claim or a complaint.
COLLEGE CONTACT
Dr. Judi Heggie
Dental Advisor, PLP
416-934-5605
1-877-817-3757
[email protected]
Patient threats, the actual commencement of legal action against a dentist, or
demands for compensation for unsatisfactory results, failed treatment or a
mishap or accident are stressful events in a dental practice. Once the Professional
Liability Program (PLP) has assisted a member in resolving any such situation,
there are a number of positive lessons to be learned to avoid similar problems in
the future.
With another new year underway, here are some risk management resolutions to
consider:
• Be more proactive in my personal communications with my patients and not
rely as much on my office staff to shield me from dealing with patient
concerns.
• Keep detailed and accurate treatment records according to the College’s
Dental Recordkeeping Guidelines, including a record of all discussions and
interactions with my patients.
• Personally review, follow up and update my patients’ medical history
questionnaires.
• Review the informed consent process that I use in my practice to ensure that
the discussion is done in a systematic way, is accurately recorded and
includes:
– diagnosis;
– nature of treatment proposed;
– expected benefits of treatment;
– material risks and side effects of treatment, taking into account the
individual circumstances of the patient;
– alternatives to the recommended treatment, including other types of
treatment plus the option of no treatment, and the likely consequences
of declining the proposed treatment;
– costs.
• Treat only within the scope of my expertise.
40
DISPATCH • February/March 2009
Ensuring Continued Trust
• Provide treatment that I believe to be in the best interests of my patients. If a
patient demands treatment that I do not feel comfortable providing and/or that is
not in his or her best interests, I shall not allow the patient to dictate treatment.
I will explain why I cannot provide that treatment and I will document well.
• Retain my patients’ original records in my office at all times according to the record
retention standards of the College. I shall provide copies only when requested to do
so by the patient or his or her authorized representative. I shall make sure that any
new staff member is aware of this requirement.
• When my patients ask for a copy of their records, I shall provide them in a timely
fashion as outlined in the College’s Practice Advisory on Release and Transfer of
Patient Records. I will do this even if the patient has an outstanding account.
• Make sure that strategies are in place in my practice to prevent or minimize
mishaps. These will include checking that the rubber dam is on the correct tooth,
making sure that I have the patient’s current chart and most recent radiographs
before beginning treatment, isolating teeth properly when potentially caustic
materials are used.
• Improve communication regarding the referral of my patients to other dentists or
specialists by personally reviewing all written referral letters or notes for accuracy
and completeness before the referral appointment is made.
• Develop a personal continuing education plan that is tailored to my practice needs
and involves some hands-on components.
• Call PLP for advice when drafting a letter to a problem patient. My letter will set out
treatment options, the pros and cons of each option, and, if necessary, explain why
the particular treatment demanded would not suit his or her situation or needs.
• Call PLP even if I am not sure that a particular situation may eventually evolve into
a problem.
QUESTIONS ABOUT A PARTICULAR SITUATION?
If you have questions about how to handle a particular situation with a
patient, call the College.
PLP Claims Examiners
Practice Advisory Service
416-934-5600 • 1-877-817-3757
416-934-5614 • 1-800-565-4591
DISPATCH • February/March 2009
41
ON APPEAL
On Appeal
Case No. 1
When the Complaints
Committee issues a decision,
either the member or the
complainant has a right of
a review by the Health
Professions Appeal and
Review Board (HPARB) – as
long as it is not a referral of
specified allegations to the
Discipline Committee.
Under the Regulated Health
Professions Act, HPARB
hears appeals and reviews
decisions made by the selfgoverning regulatory
agencies of all the regulated
health professions.
These summaries of some
HPARB reviews are
published in Dispatch as an
educational resource for
both members and the
public. Institutional parties
may be named, but
individual parties will not.
COLLEGE CONTACT
Irwin Fefergrad
Registrar
416-934-5625
1-800-565-4591
[email protected]
THE COMPLAINT
The complainant was a patient of the dentist
for about 10 years. In addition, the dentist and
the complainant had a business relationship
and a social relationship. Issues arose in the
business aspect of their relationship that
resulted in deterioration and civil lawsuits.
The complainant filed a formal complaint
alleging that the dentist billed inappropriately
for dental services covered by the business
partnership’s employee benefits program
package.
DECISION OF THE COMPLAINTS
COMMITTEE
It appeared that the crux of the complaint
focused on the business relationship and
not on the dentist-patient relationship.
The Committee reviewed billing records,
correspondence, charts and records of the
complainant. The panel concluded that the
root of the dispute was the business
relationship and not the dentist-patient
relationship and, therefore, no further action
was ordered.
HEALTH PROFESSIONS APPEAL AND
REVIEW BOARD
The complainant was dissatisfied with the
decision and sought a review with the Board.
The Board found the investigation to be
adequate. The Board agreed with the
Complaints Committee that the majority of
the issues complained were rooted in an
unhappy business relationship and not in a
dentist-patient relationship.
The Board found that the central issue focused
on whether the dentist violated the boundary
of the dentist-patient relationship. The Board
examined the charts and records, as well as the
College’s Code of Ethics found in the College’s
bylaws. The Board agreed with the Committee
that the deterioration of the relationship did
not find its origins in the dentist-patient
relationship but in the nature of the business
relationship.
While the Board confirmed the decision of the
Complaints Committee it commented that it
would have been more appropriate for the
respondent (dentist) to relinquish his dentistpatient relationship with the applicant
(complainant) upon entering into a business
relationship with the applicant.
Case No. 2
THE COMPLAINT
The complainant wrote a letter of complaint to
the College claiming that he was a new patient
of the dentist and had an initial examination
and subsequent follow-ups. He felt that the
dentist had overcharged and recommended
unnecessary treatment, such as changing
amalgam fillings to composite resin fillings. In
addition, the complainant stated that new
crowns recommended were unnecessary, that
the dental hygienist was too slow and had
performed unnecessary cleaning, and that the
dentist did not examine the complainant at
any time.
DECISION OF THE COMPLAINTS
COMMITTEE
The Committee obtained the patient charts
and records and reviewed the correspondence.
It found that, in fact, the treatment
recommended was necessary, that the fees
were appropriate, and that the dentist himself
42
DISPATCH • February/March 2009
Ensuring Continued Trust
had completed the examinations referred to in
the records. In addition, the records
demonstrated that there was heavy calculus
requiring rigorous cleaning and that the crown
with the post and core was required.
With respect to the amalgams, the Committee
noted that the old existing amalgams needed
replacing. Consequently, the Committee
ordered no further action.
HEALTH PROFESSIONS APPEAL AND
REVIEW BOARD
The complainant was dissatisfied with the
decision and sought a review at the Board.
The Board reviewed the investigation of the
College and found it adequate.
The Board determined that the decision of the
Complaints Committee was reasonable. It also
determined that the dentist was appropriately
involved in the patient’s care and that the fees
charged were reasonable. Consequently, the
Board confirmed the decision of the
Complaints Committee.
Case No. 3
THE COMPLAINT
The complainant filed a letter of complaint in
2007 asserting that endodontic therapy in
October of 1998 caused him many years of
suffering. The complainant asserted that he
saw the dentist numerous times postoperatively, was referred to a pain
management specialist, as well as back to his
general dentist, but finally in 2005 his tooth
was extracted and his pain was resolved.
DECISION OF THE COMPLAINTS
COMMITTEE
The complainant first complained to the
College in 2003, but the second complaint
stated that there were aspects of his care which
the Complaints Committee did not consider
in 2003.
In a decision in 2004, the Complaints
Committee took no further action against the
dentist. With respect to this new complaint,
the Committee noted that the issues were the
same as those in the initial complaint.
Therefore, the Committee stated in its reasons
the determination that this second complaint
met the criteria of being a frivolous or
vexatious matter and an improper use of the
process. Therefore, there was no further
action.
HEALTH PROFESSIONS APPEAL AND
REVIEW BOARD
The complainant was dissatisfied with the
decision and sought a review at the Board.
The Board reviewed its own mandate and set
up various criteria for determining what would
constitute vexatious proceedings. These
include:
• bringing a second complaint to determine
an issue which had already been
determined;
• where it is obvious when a complaint
cannot succeed;
• where it appears that the complaint is one
of harassment;
• the grounds and issues raised in a new
complaint tended to follow similar patterns
of a former complaint.
The Board looked at the history of this matter
and confirmed that it would not proceed with
a review of the decision, claiming that a
second complaint was frivolous and vexatious.
DISPATCH • February/March 2009
43
Ethical Dilemma Discussion
DENTAL ETHICS 101
The Dental Ethics 101 Ethical Dilemma Case Study appears on page 34.
“Let’s skip the gum
work and get on
with the bridges!”
I
In this case, one is immediately drawn to the
obnoxious behaviour of the patient. Because
of this, the following questions arise:
Is the dentist obligated to treat this patient?
Is the dentist’s sole obligation to do what the
patient requests?
Is Dr. Green making a reasonable request?
Dr. Green is a new patient who has been both
non-compliant regarding his own oral health
and obnoxious in his relationships with office
staff. Most dentists have known patients like
him. The patient who elicits an audible groan
by the staff when his or her name appears on
the list of the day’s appointments. This could
be the patient who is rude or discourteous,
overly demanding or critical, impatient or curt,
or simply refuses to take responsibility for his
or her own oral health.
ON THE WEB
www.rcdso.org
Although a dentist’s primary professional
obligation is to serve the public, a dentist may
also exercise reasonable discretion in selecting
patients for his or her practice, providing this
discretion does not offend the
Ontario Human Rights Code.
Although dentists have a general
Handling the Difficult Problem obligation to treat patients, this
obligation is not absolute.
of Dismissing a Patient
Dentists may, for example, have
DISPATCH FALL 2005 PAGES 22-23
patients that are obnoxious but
follow professional advice. More
likely, the difficult patients are personable but
ineffective in maintaining their oral health. In
a case like Dr. Green’s, although the dentist
and his staff may be obligated to care for him,
it is unrealistic to expect the dental office staff
to change his personality.
44
DISPATCH • February/March 2009
How far should a dentist go when dealing with
these patients? It would seem reasonable for
the dentist to counsel Dr. Green and, if he
continues to be obnoxious and non-compliant
to the extent of becoming disruptive, the
dentist is justified in dismissing the patient,
following the RCDSO protocol that has
appeared in past issues of Dispatch.
Dr. Green’s case has brought together the
distinctive elements of the obnoxious/noncompliant patient who also may make
unreasonable demands on the dentist. Dealing
with the obnoxious/non-compliant patient is
stressful for the dentist and his or her staff, but
is not an unusual burden for health
professionals.
However, the dentist’s professional judgement
is not overridden by patients who request
treatment that is clearly inconsistent with
establish standards or central values of the
profession. The dentist cannot be forced to set
aside his or her standards of competent
treatment simply because the patient requests
to skip the gum work and start the bridges.
The dentist is ethically justified in this case to
inform Dr. Green of his disruptive behaviour
and to attempt to educate him about his oral
health and plan for periodontal therapy prior
to fixed prosthodontics. Then, if the patient
continues to be obnoxious and noncompliant, the dentist is justified in dismissing
Dr. Green after taking steps to assure that he is
not abandoned.
Reprinted in part from the Texas Dental Journal of
the Baylor College of Dentistry with permission.
Ensuring Continued Trust
UpfrontThePresident’sMessageUpfrontThePresident’sMessage
Steady Focus on Results with Integrity
CONTINUED FROM PAGE 4
We look for creative ways to help dentists sooner
with their problems. For example, through our
mentorship program, One-To-One, dentists who are
involved in the College process because of standard
practice issues can receive a guiding hand from a
seasoned dentist who can support them and teach
them how to improve their dentistry.
Council is constantly watching what is happening and
learning from the results. Good experimentation is a
process of constant tinkering, making little
adjustments as the results come in.
I am convinced that our achievements are due in large
part to the atmosphere of collaboration, collegiality
and consensus around the Council table. Council has
tapped into the strength and wisdom that comes from
working in harmony together: public members with
dentists, dentists with public members, Council with
staff.
As we embark on this next two-year term, I want
to reaffirm that we are staying the course. We will
continue to be proactive. We will continue to listen
to what you need. We will continue to deliver results
with integrity.
UpfrontChroniqueDuPrésidentUpfrontChroniqueDuPrésident
Garder le cap sur les résultats sans perdre notre intégrité
SUITE DE LA PAGE 4
propos que j’ai entendus de la part des dentistes
dans toute la province, vous l’avez remarqué.
Le Collège est convaincu que les lois qui reposent sur
les professionnels représentent la meilleure façon
d’assurer et d’encourager des normes élevées en
dentisterie ainsi que de s’attaquer aux problèmes que
pose le manque de compétence de certains dentistes.
Nous savons que les dentistes compétents sont plus
nombreux que ceux qui ne font pas correctement leur
travail. Nous savons aussi que la grande majorité des
dentistes se dévouent à respecter des normes de
conduite professionnelle élevées et à demeurer
compétents tout au long de leur carrière.
Le Collège fait tout son possible pour aider les
dentistes à maintenir de hautes normes
professionnelles dans le but de garantir des soins et
des services de haute qualité.
La meilleure preuve est apportée par le fait qu’au
cours des deux dernières années le nombre de
dossiers qui ont été référé par le comité de direction
ou le comité des plaintes au comité de discipline pour
une audience disciplinaire est le plus bas de toute
l’histoire du Collège. Nous essayons premièrement
d’autres moyens pour résoudre les dossiers de plainte
d’une manière satisfaisante, au lieu de citer
immédiatement les dentistes devant le Comité de
discipline. En principe, ces méthodes permettent de
trouver une solution qui est mutuellement bénéfique
pour le dentiste et le patient.
Nous cherchons de manière créative des solutions
nouvelles pour venir plus rapidement en aide aux
dentistes. Par exemple, dans le cadre de notre
programme de mentorat One-To-One, les dentistes
qui font l’objet d’une procédure disciplinaire pour
insuffisance professionnelle peuvent recevoir l’aide et
le soutien d’un dentiste plus expérimenté qui peut les
conseiller sur la manière d’améliorer leur pratique.
Nous n’allons pas nous arrêter en si bon chemin. Le
Conseil d’administration poursuit l’ouverture à
regarder, comprendre et apprendre à partir de ce qui
se passe dans le but d’améliorer constamment les
services que nous offrons.
Je suis convaincu que notre succès est en grande
partie dû à l’esprit collégial et de collaboration qui
règne parmi les membres du Conseil. Nous avons des
dentistes et des membres du public qui mettent
sincèrement les besoins de l’organisation au premier
plan et qui ont la vision et la force qui leur permettent
de prendre ensemble des mesures décisives.
Alors que j’entame mon deuxième mandat de
président, je tiens à vous assurer que nous allons
continuer d’aller de l’avant, de nous montrer
proactifs, de vous écouter et de vous servir avec
intégrité.
DISPATCH • February/March 2009
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TheBackPageFromThe RegistrarTheBackPageFromThe Registrar
Dentistry Preserves Prescribing Rights
CONTINUED FROM PAGE 48
This is a great compliment for the profession and
ensures we can continue to deliver quality care to our
patients.
In the College’s submission to HPRAC in midNovember, we advocated strongly for the retention of
the current prescribing privileges of dentists. As a
regulator, we stated that the current authorized acts
and regulations reflect best practices; and who is in a
better situation to make that judgement than the
College as the regulator.
We supported our position with an anonymous review
of activity in complaints, Registrar’s investigations and
discipline. We provided anecdotal evidence from our
professional liability program. We included a
summary of the pharmacological curriculum from
each of the dental programs. We stated unequivocally
that “pharmacotherapy is
essential to the modern
practice of dentistry” in the
interests of public safety and
access to care.
Dr. Mock and Dr. Dan Haas who led the review of our
anaesthesia and sedation guidelines, definitely paid
off.
HPRAC accepted our submission without reservation.
In addition, the College received praise for a number
of our initiatives, including:
• the Quality Assurance Regulation that has now
gone to government for review and approval;
• the newly updated guidelines on sedation and
general anaesthesia;
• the Adverse Drug Interactions Program available at
no charge to all dentists in the province from the
College’s website;
• our collaboration with the College of Physicians
and Surgeons of Ontario to jointly publish joint
advice to our respective members on the use of
prophylactic antibiotics
for the prevention of
infective endocarditis.
…profession’s continued
access to open prescribing is
a good day for dentistry and
for the public…
The College demonstrated
how we devote a substantial
portion of members’
continuing education to
pharmacotherapy. Our
submission included many
Dispatch articles, the new anaesthesia and sedation
guidelines revised in November 2008, and PEAK
articles. College staff then spent hours with HPRAC
staff reviewing all the material and explaining its
relevance.
Our position was supported by Dr. David Mock, Dean
of the Faculty of Dentistry of U of T who met with
HPRAC representatives. He spoke eloquently about
the possibility of a reduction in access to care if the
prescribing rights of dentists were curtailed. He also
addressed the use of chemotherapeutic drugs,
normally thought outside the scope of practice by
primary care dentists, by some specialists in their
practice.
The Ontario Dental Association also lent its support
and counsel throughout the process and was a
powerful advocate and ally.
The decision by HPRAC
to support the
profession’s continued
access to open
prescribing is a good day
for dentistry and for the
public of Ontario.
The report also deals
with a number of proposed reforms, as HPRAC
describes "to drive continuous improvement in health
professions regulation so that Ontarians derive the
maximum benefit from those who are charged with
protecting their interests."
Without question there are more challenges ahead.
They mean new layers of complicated responsibility
and ever increasing accountability added to our core
business of complaints and investigations.
This new Council, as those who have gone before, are
definitely up to the task ahead.
We can do no better than to reflect on the great insight
offered by Charles Darwin that “it is not the strongest
of the species that survives, nor the most intelligent
that survives. It is the one that is most adaptable to
change.” At this, our College has always excelled.
All that work by College staff and by others, such as
DISPATCH • February/March 2009
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TheBackPageFromThe RegistrarTheBackPageFromThe Registrar
Dentistry Preserves
Prescribing Rights in Latest
HPRAC Report
I
t is barely two months since the new Council took office, elected a new President,
Vice-President and Executive Committee. The statutory committees are in place and
the formal orientations are underway. We are also very busily dealing with critical
issues like the Agreement on Internal Trade (see page 8) and the Competition Bureau’s
national study of the dental profession, and implementation of the amendments to the
Regulated Health Professions Act.
There is really not a moment to lose. Since the end of last year, a number of major issues
that have a significant impact on the College continue to evolve very quickly.
IRWIN FEFERGRAD
On February 2, 2009 at 10:00 am the latest and largest report from the Health Professions
Regulatory Advisory Council was released online. This 458 page document is the
pinnacle of HPRAC’s intense activity over the last two years or so since it released the
report “New Directions” in June 2007.
Of course, there is no way that I can adequately summarize a report of that length in this
short column. I encourage you to visit the HPRAC website at www.hprac.org and look for
report called “Critical Links: Transforming and Supporting Patient Care.”
Definitely many of the recommendations from HPRAC will be referred to our Quality
Assurance Committee for consideration. You will also read more about them in depth in
future Dispatch issues throughout the year.
However there is one area addressed in the report that has immediate and direct impact
on nearly every dentist in the province. That is the prescribing of drugs by non-physician
health professions.
The Minister of Health had asked HPRAC to provide advice on whether specific
professions should prescribe by regulation from a list, category or class of drugs. This
meant that the prescription privilege authority of dentists was under scrutiny.
Would dentists have their prescribing privileges curtailed or restricted? Would dentists
lose the controlled act of prescribing and dispensing drugs?
The answer to both those questions from HPRAC is a resounding NO!
It is worth quoting directly from the HPRAC report:
HPRAC has concluded that dentists have a long history
of safely and effectively prescribing medications to
their patients working under broad prescribing
authority. This history, combined with the addition
of comprehensive standards of practice developed in
a collaborative framework with other health professions
supports the continuation of current prescribing
authority for dentists.
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Ensuring Continued Trust