Dispatch
Ja n u a r y/ Fe b r u a r y 20 03
Official publication of the RCDSO
Vol. 17, No. 1
Access to Dental Care for
6 Elections 2003
Special elections
report
Seniors
14 Access Dental
Care
College explores
access to dental
care for seniors
17 Dental Audits
Update on new
program protocol
18 Aboriginal
Health
College invites
aboriginal
communities to
work in partnership
Incorporation • PEAK • Ounce of Prevention • College Outreach
Contents
Dispatch
Vol. 17 , No. 1
January/February 2003
4 President’s Message
18 Aboriginal Health
Registrar invites aboriginal communities to work in partnership with
College.
6 Elections 2003
Read our special elections
report and meet your
new Council.
20 Incorporation
Avoid common errors in the
incorporation process.
Cover Story
14 Access Dental Care
Dispatch
Vol. 17 , No. 1
January/February 2003
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. It is published four times a year. The
editor welcomes comments and
suggestions from our readers.
Registrar
Irwin Fefergrad, BA, BCL, LLB
Symposium
College explores access to dental
care for seniors.
Editor
Peggi Mace
Editorial Assistant
Aurore Sutton
21 Amalgam Waste
Disposal
Circulation of proposed regulation
and standard is only the first step.
22 Advertising by Dentists
Frequently asked Q + A
16 Dental Clinic Closure
College supports battle to keep
unique clinic open.
Graphic Design
Artful Dodger Communications Inc.
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.
The subscription rate is included in the
annual membership fee.
A one-year subscription is available for
$40.00. This includes the annual report.
Royal College of Dental Surgeons
of Ontario
6 Crescent Road
Toronto, ON M4W 1T1
Phone: 416-961-6555
Toll-Free: 1-800-565-4591
Fax: 416-961-5814
E-mail: info@rcdso.org
Web site: www.rcdso.org
Publication Mail Agreement # 1563645
23 2003 Membership
Directory
17 Dental On-Site Audits
Update on new program protocol
2
Dispatch • Jan/Feb 2003
The new RCDSO membership
directory is in production - we
need your help!
Ensuring Continued Trust
Printed in Canada on chlorine free,
recyclable paper.
ISSN # 1496-2799
Contents
Dispatch
Vol. 17 , No. 1
January/February 2003
26 Practice Check
Handling the release or transfer of
patient records
32 On Appeal
Review of Complaints Committee
decisions are excellent educational
resource.
RCDSO COUNCIL MEMBERS
President - Dr. Cam Witmer
Vice-President - Dr. Douglas Smith
34 Ounce of Prevention
The perils of late
reporting a
potential
claim
Elected Representatives
District 1 (Ottawa) - Dr. Douglas Smith
District 2 (Durham/York) - Dr. Larry Parker
District 3 (Northern Ontario)
Dr. Albert Bouclin
District 4 (Halton-Peel) - Dr. Randy Lang
District 5 (Muskoka-Simcoe) - Dr. Eric Luks
District 6 (London) - Dr. George Grayson
District 7 (Haldimand/Norfolk)
Dr. Cam Witmer
28 Practice Check
Dental treatment for patients with
pacemakers and implantable cardioverter defibrillators
36 Complaints
Corner
A look at current
trends observed
by the
Complaints
Committee.
District 8 (Hamilton/Wentworth)
Dr. Frank Stechey
District 9 (Toronto North) - Dr. Virginia Luks
District 10 (Toronto West)
Dr. Bohdan Kryshtalskyj
District 11 (Toronto Central) - Dr. Marvin Klotz
District 12 (Toronto East)
Dr. Hartley Kestenberg
Appointed By Lieutenant-Governor
In Council
Lynne Arnill, Duntroon
38 Mailbag
Vic Braney, West Hill
Robert Marr, Mississauga
Doug McVeigh, Bobcaygeon
40 PEAK Article
Are you ready for an emergency?
30 Dental Ethics 101
Challenge yourself with a new ethical dilemma.
31 New Brochure
on Complaints
Process
Robert Metras, Mississauga
John Pappain, Brampton
Lloyd Pollack, Toronto
Krystyna Rudko, Ottawa
41 Proposed Letter
Elesh Ruparel, Richmond Hill
Standing
Joan Stewart, Cache Bay
We need to hear from you.
Ben Wiwcharyk, Thunder Bay
Academic Appointments
University of Toronto - Dr. Philip Watson
42 Dental Ethics 101
Discussion of this issue’s case study
47 Executive Committee
Orientation
University of Western Ontario
Dr. David Charles
Issue Enclosures
• Summaries of Recent Discipline
Committee Hearings
48 From The Registrar
New Council and Committees
swing immediately into action.
Ensuring Continued Trust
• PEAK: Emergency Drugs
Dispatch • Jan/Feb 2003
3
President’s Message
Communication and
Consultation Hallmark
Full and Open
Of Term As President
My Actions As President Will Be In the
Interest of the Public, This College and
All Dentists In Ontario
WITH THIS MY FIRST COLUMN AS YOUR
NEW PRESIDENT, I WANT TO PUBLICLY
THANK MY COLLEAGUES ON COUNCIL,
AND THE DENTISTS IN DISTRICT 7 FOR
THEIR CONTINUING SUPPORT.
This is not a responsibility that I take
lightly. I pledge to do my best over the
next two years to reply to your vote of
confidence in me.
I want to take this opportunity to
share with you a few of my thoughts
about what is important to me as I take
on the role as your president.
During my over 30 years in practice
as a general dentist, and particularly
during my four years on Council - two
years on Executive Committee and one
year as Vice President - my experience
has shown time and time again that
respectful communication and consultation always takes precedence. I am
determined that this will be one of the
hallmarks of my term as president of
this College.
The importance of this open dialogue has never been more crucial. We
are rapidly becoming the national
leader in the regulatory arena, and not
just in dentistry. This is directly due to
the outstanding calibre of our Council,
our incredibly talented and dedicated
staff, and of course, our phenomenal
Registrar. It is now part of the normal
course of events at the College to deal
with issues of vital importance on a
4
Dispatch • Jan/Feb 2003
Dr. Cam Witmer (right) joins Executive Committee members Dr. David Charles
(left) and public member Ben Wiwcharyk (centre) for a break during the special
orientation on January 24 for the new Executive Committee.
provincial, national and international
level.
I would like to specifically refer to
two very difficult issues that we must
address.
The first is the continuing difficulty
that this College, and others too, face
in getting approval for proposed regulations. We currently have eight regulations sitting at the Ministry of Health
and Long-Term Care. These regulations
appear to have hit an obstructive wall
in the Ministry. They are stalled there;
some of them for close to 10 years. This
is a very troublesome and frustrating
situation.
Look at the specific example of the
dental waste amalgam regulation that
Council approved in principle in
November 2002. This College led the
province, the country, and indeed the
world, by commissioning the only
study of its kind ever done to determine the fate of mercury amalgam in
the dental office. Based on this landmark study by Dr. Philip Watson and
his colleagues, the College proposed a
province-wide regulation that would
require the mandatory use of amalgam
separators in dental offices. This
Ensuring Continued Trust
approach would eliminate the growing
trend for the over 430 municipalities to
create individual by-laws: by-laws that,
as the Watson report has demonstrated,
cannot be adhered to by dentists. Our
draft regulation has garnered the support of the Ministry of Environment
and the Ministry of Municipal Affairs,
and has the personal support of the
Minister of Health. This regulation is of
vital importance to the public of
Ontario. Yet it is stalled within the
Ministry of Health.
I believe that the time has come to sit
down with the Minister of Health and
the Premier to resolve these issues. That
is why the first official letter I signed as
President is to the Minister of Health
urging swift passage of this regulation
to affirm the ability of government and
the regulator to work together for the
common good. I have also offered to
make myself available at any time for a
face-to-face meeting.
Of course, we are not a one issue
College. Recently I participated in the
one-day symposium on access to dental
care in long-term care facilities organized and hosted by the College. I expericontinued on page 47
Le mot du président
Processus ouvert et approfondi de
communication et de concertation
comme pierre angulaire du mandat du président
Mes actions en tant que président seront dictées par l’intérêt du public,
de ce Collège et de tous les dentistes en Ontario
DANS MON PREMIER MESSAGE EN TANT QUE PRÉSIDENT,
JE TIENS À REMERCIER PUBLIQUEMENT MES COLLÈGUES
DU CONSEIL D’ADMINISTRATION ET LES DENTISTES DU
DISTRICT 7 DE LEUR SOUTIEN CONSTANT. C’EST UNE
RESPONSABILITÉ QUE JE NE PRENDS PAS À LA LÉGÈRE.
JE M’ENGAGE À FAIRE DE MON MIEUX AU COURS DES
DEUX PROCHAINES ANNÉES POUR RÉPONDRE À VOTRE
VOTE DE CONFIANCE.
Je profite de cette occasion pour
partager avec vous certaines de mes
idées sur ce que je crois important alors
que je prends mes fonctions en tant
que votre président.
Mon expérience - plus de 30 ans en
tant que dentiste généraliste et en particulier mes quatre années au sein du
Conseil d’administration : deux ans au
Comité exécutif et un an au poste de
vice-président - a prouvé à maintes
reprises qu’une communication et une
concertation respectueuses sont primordiales. Je suis résolu à en faire l’une
des caractéristiques de ma présidence.
L’importance de ce franc dialogue n’a
jamais été plus cruciale. Nous sommes
rapidement en train de devenir le
leader national dans l’arène de la réglementation, et pas seulement en dentisterie. Ceci est directement dû à l’envergure exceptionnelle de notre Conseil, à
notre personnel incroyablement talentueux et dévoué, et bien sûr, à notre
Registraire hors pair. C’est maintenant
dans la nature des choses au Collège de
traiter de sujets d’importance majeure
au niveau provincial, national et international.
Je souhaite évoquer en particulier
deux problèmes très difficiles que nous
devons examiner.
Le premier est la difficulté constante
que ce Collège, et d’autres aussi, rencontre pour obtenir l’approbation des
règlements proposés. Nous avons
actuellement huit règlements en
attente au Ministère de la Santé et des
Soins de longue durée. Ces règlements
semblent se heurter à une forte opposition au sein du ministère. Ils sont au
point mort; certains d’entre eux depuis
près de 10 ans. C’est une situation très
pénible et frustrante.
Prenons l’exemple spécifique du
règlement sur les rejets de résidus d’amalgame dentaire que ce Conseil a
approuvé en principe en novembre
2002. Le Collège a montré l’exemple à
la province, au pays, et en fait au
monde entier, en commissionnant la
première étude du genre pour déterminer le sort du mercure lié aux amalgames dans le cabinet dentaire. Selon
cette étude historique menée par Dr.
Philip Watson et ses collègues, le
Collège a proposé un règlement à
l’échelle provinciale qui exigerait l’utilisation obligatoire des séparateurs d’amalgame dans les cabinets dentaires.
Cette approche éliminerait la tendance
croissante pour les plus de 430
Ensuring Continued Trust
municipalités de créer différents arrêtés
municipaux : arrêtés municipaux auxquels, comme le rapport Watson l’a
démontré, les dentistes ne peuvent pas
se conformer. Notre projet de règlement a reçu l’appui du Ministère de
l’Environnement et du Ministère des
Affaires municipales, ainsi que l’appui
personnel du ministre de la Santé. Ce
règlement est de la plus grande importance pour le public de l’Ontario.
Pourtant il reste dormant au sein du
Ministère de la Santé.
Je crois qu’il est temps de s’asseoir
avec le ministre de la Santé et le Premier
ministre de l’Ontario afin résoudre cette
situation. C’est pourquoi la première
lettre officielle que j’ai signée en tant que
président est adressée au ministre de la
Santé, recommandant l’adoption rapide
de ce règlement pour établir la volonté
du gouvernement et de ce Collège de
travailler de concert dans l’intérêt commun. J’ai également offert de me rendre
disponible à tout moment pour un
entretien en tête-à-tête.
Naturellement, notre tâche au
Collège ne se résume pas à résoudre un
seul problème. Récemment, j’ai participé au colloque d’une journée que le
Collège a organisé et animé et qui était
consacré à l’accès aux soins dentaires
dans les établissements de soins de
longue durée. J’ai éprouvé un regain
d’enthousiasme et de fierté d’appartenir à ce Conseil.
Nous avons invité tous les intervenants à travers la province : directeurs
d’établissement, dentistes de la santé
publique, médecins, dentistes généralistes, groupes de protection du consommateur, et représentants des
suite à la page 47
Dispatch • Jan/Feb 2003
5
Elections 2003
Returning Officers Report
IN ACCORDANCE WITH BY-LAW NO.6: ELECTION AND SELECTION OF COUNCILLORS, THE
RETURNING OFFICERS, GREG MOORS, DAYNA SIMON AND JULIE WILKIN, COUNTED THE
BALLOTS AT THE RCDSO OFFICE ON WEDNESDAY, DECEMBER 11, 2002. FOLLOWING IS
THEIR REPORT ON THE ELECTION OF THE COLLEGE’S GOVERNING COUNCIL FOR THE
2003-2004 TERM OF OFFICE.
Electoral District 1
Electoral District 7
Dr. Douglas Smith was declared elected by acclamation.
Dr. Cam Witmer was declared elected by acclamation.
Electoral District 8
Electoral District 2
Number of eligible voters - 954
Number of valid ballots received - 307
The 307 eligible ballots were marked as follows:
For Dr. David Clark - 96
For Dr. Larry Parker - 211
Number of eligible voters - 497
Number of valid ballots received - 292
The 292 eligible ballots were marked as follows:
For Dr. Peter Kalman - 102
For Dr. Frank Stechey - 190
Dr. Larry Parker was therefore declared elected.
Dr. Frank Stechey was therefore declared elected.
Electoral District 9
Electoral District 3
Number of eligible voters - 351
Number of valid ballots received - 244
The 244 eligible ballots were marked as follows:
For Dr. Albert Bouclin - 130
For Dr. William Hettenhausen - 101
For Dr. Terrance Witzu - 13
Dr. Albert Bouclin was therefore declared elected.
Electoral District 4
Dr. Randy Lang was declared elected by acclamation.
Dr. Virginia Luks was declared elected by acclamation.
Electoral District 10
Dr. Bohdan Kryshtalskyj was declared elected by acclamation.
Electoral District 11
Number of eligible voters - 565
Number of valid ballots received - 177
The 177 eligible ballots were marked as follows:
For Dr. Marvin Klotz - 103
For Dr. Richard Speers - 69
Electoral District 5
Dr. Marvin Klotz was therefore declared elected.
Dr. Eric Luks was declared elected by acclamation.
Electoral District 12
Electoral District 6
Number of eligible voters - 664
Number of valid ballots received - 472
The 472 eligible ballots were marked as follows:
For Dr. Peter Fendrich - 186
For Dr. George Grayson - 286
Number of eligible voters - 774
Number of valid ballots received - 347
The 347 eligible ballots were marked as follows:
For Dr. S. Hartley Kestenberg - 180
For Dr. Gary Pitkin -167
Dr. S. Hartley Kestenberg was therefore declared elected.
Dr. George Grayson was therefore declared elected.
6
Dispatch • Jan/Feb 2003
Ensuring Continued Trust
Elections 2003
Meet Your New Council
AT THE INAUGURAL MEETING OF THE NEW RCDSO COUNCIL ON JANUARY 15-16, 2003,
COUNCIL MEMBERS ELECTED A PRESIDENT, VICE-PRESIDENT AND MEMBERS OF THE
EXECUTIVE COMMITTEE FOR THE 2003-2005 TERM.
President - Dr. Cam Witmer
District 8 (Hamilton/Wentworth)
Dr. Frank Stechey
Doug McVeigh, Bobcaygeon
District 9 (Toronto North) - Dr. Virginia Luks
John Pappain, Brampton
Elected Representatives
District 1 (Ottawa) - Dr. Douglas Smith
District 10 (Toronto West)
Dr. Bohdan Kryshtalskyj
Lloyd Pollack, Toronto
District 2 (Durham/York) - Dr. Larry Parker
District 11 (Toronto Central) - Dr. Marvin Klotz
District 3 (Northern Ontario)
Dr. Albert Bouclin
District 12 (Toronto East)
Dr. Hartley Kestenberg
Vice-President - Dr. Douglas Smith
District 6 (London) - Dr. George Grayson
District 7 (Haldimand/Norfolk)
Dr. Cam Witmer
Krystyna Rudko, Ottawa
Elesh Ruparel, Richmond Hill
Joan Stewart, Cache Bay
Ben Wiwcharyk, Thunder Bay
District 4 (Halton-Peel) - Dr. Randy Lang
District 5 (Muskoka-Simcoe) - Dr. Eric Luks
Robert Metras, Mississauga
Appointed By Lieutenant-Governor
In Council
Lynne Arnill, Duntroon
Academic Appointments
University of Toronto - Dr. Philip Watson
Vic Braney, West Hill
University of Western Ontario
Dr. David Charles
Robert Marr, Mississauga
Elections 2003
Non-Council Members Selected
for College Committees
THE NEW RCDSO EXECUTIVE COMMITTEE RECOMMENDED
NAMES OF MEMBERS TO SERVE ON DESIGNATED COLLEGE COMMITTEES FOR THE 2003-2005 TERM. IN
ACCORDANCE WITH RCDSO BY-LAW NO.5, THESE COLLEGE MEMBERS HAVE BEEN RANDOMLY SELECTED TO
ENSURE A FAIR AND IMPARTIAL PROCESS.
This blind selection process was first
used in 2001. Here’s how it works.
Prior to the selection, a file card is created for each interested applicant. The
card is sealed in an envelope with the
district number written on the front as
the only identification. Then at a formal meeting the Registrar, district by
district, opens the sealed envelopes,
shuffles the cards, and selects a file card
at random. As each file card is drawn,
the Registrar shows it to the assembly,
and then reads the candidate’s name
aloud. The file cards are then given to
the recording secretary who enters the
candidate’s name into the minutes of
the meeting.
These non-council people are then
interviewed by the Executive Committee, and placed on a committee, subject
Ensuring Continued Trust
to the approval of Council.
This time round there were 81 eligible applicants.
District 1: Dr. George Trigylidas
District 2: Dr. Malcolm Yasny
District 3(a): Dr. Terrance Witzu
District 3(b): Dr. Leslie Armstrong
District 4: Dr. Lorne Akler
District 5: Dr. Stephen Brown
District 6: Dr. Marcel Paiement
District 7: Dr. Katherine Zettle
District 8: Dr. Victor Krueger
District 9: Dr. Sven Grail
District 10: Dr. John Anthony
District 11: Dr. Louis London
District 12: Dr. Jim Ho
Dispatch • Jan/Feb 2003
7
E L ECT E D M E M B E R S
Council Elections 2003
Council Profiles
Dr. Douglas Smith
District 1
Dr. Smith has a DDS from the University of
Toronto and has worked as a general practitioner
in Ottawa since graduation. He has served on a
number of committees with both the Ottawa
Dental Society, and the Ontario Dental
Association (ODA). Dr. Smith was a member of
the ODA's Board of Governors, and is a recipient
of the ODA Service Award. He is currently a
member of the Bytown Study Club, a member of
the Canadian Academy of Restorative Dentistry
and Prosthodontics, and a Fellow of the Pierre
Fouchard Society and of the Academy of
Dentistry International.
Dr. Larry Parker
District 2
Dr. Parker studied dentistry in Johannesburg,
South Africa, followed by two years of clinical
practice in London, England. Additional studies
included a DDS from Dalhousie University, a
Diploma in Orthodontics from the University of
Toronto, and a MSc from the School of Graduate
Studies and the Hospital for Sick Children. Dr.
Parker is a part-time lecturer and researcher at the
University of Toronto's Faculty of Dentistry. This
year he is president of the Toronto Orthodontic
Study Club, in addition to this fifth year on
Council. He has a full-time orthodontics practice
in Richmond Hill.
Dr. Albert Bouclin
District 3
Dr. Bouclin earned his DDS from the University
of Toronto in 1970 after completing a BSc at the
University of Manitoba, and teaching high school
for three years. For the past three years, he has
been a member of the Quality Assurance
Committee of the RCDSO. He is an active
member of the Sudbury Dental Society, and has
served on its executive. Dr. Bouclin served for four
years on the Board of Governors of the Ontario
Dental Association. He practises general dentistry
in Garson, Ontario.
Dr. Randy Lang
District 4
8
This is Dr. Lang's 16th and 17th year serving on
the Council of RCDSO. He is an orthodontic
lecturer at the University of Toronto, and a past
president of the Ontario Association of
Orthodontists. He is a faculty member of
Omicron Kappa Upsilon, a Fellow of the
International College of Dentists, the American
College of Dentists, and the World Federation of
Orthodontists. He is the co-chairman of the
Dispatch • Jan/Feb 2003
Ensuring Continued Trust
editorial board of Oral Health. He currently
practises orthodontics in Mississauga and
Etobicoke.
Dr. Eric Luks
District 5
Dr. Eric Luks is well-known in the province for his
continuing commitment to the dental community for
the past 30 years. He has served in many capacities in
dental education, association leadership, as well as
dental governance at the College. Dr. Luks has served as
president of the Ontario Society for Orthodontists, the
Toronto Orthodontic Club, and the Great Lakes
Association of Orthodontists. He has also been an
instructor with the graduate department of
orthodontics at the University of Toronto’s Faculty of
Dentistry. Dr. Luks received his DDS from
the Faculty of Dentistry at the University of
Toronto in 1965, and a Diploma in
Orthodontics and MSc from the same university. He
maintains an orthodontic practice in north Toronto, as
well as Port Carling. More recently he has served as
president of the College, and by examination became a
Fellow of the Royal College of Dentists of Canada. He
was honoured this past year as an Alumnus of
Distinction by the University of Toronto Alumni
Association.
Dr. George Grayson
District 6
Dr. Grayson attended the University of Windsor
where he received a Bachelor of Science, and
Queen's University in Kingston where he received
a Master of Science in Microbiology and
Immunology. He then entered the University of
Western Ontario (UWO) Faculty of Dentistry and
graduated in 1974. Dr. Grayson received his
North East Regional Board Certificate in 1983,
and has practised in Michigan. He previously was
a Council member in 1984/85 as the first UWO
graduate to this position, and in 2001/02 to
replace his friend and colleague Dr. Robert
Brandon. He has also sat as a provincial
representative on the board of the Windsor Essex
County Health Unit for four years. Currently he
practises in Windsor, and is consultant for a
number of dental companies.
Dr. Cam Witmer
District 7
Dr. Witmer has been in private practice since
graduating with his DDS from the University of
Western Ontario in 1972. He has been very active
with the Ontario Dental Association, serving on
its Executive Council for a number of years. He is
also involved in his community, working with the
Kitchener-Waterloo Handicapped Services, the
Heart and Stroke Foundation, and the Kinsmen
of Canada.
Dr. Frank Stechey
District 8
Dr. Stechey is a 1971 graduate of the University of
Toronto. He is past president of Hamilton's
Academy of Dentistry, and currently works parttime as general family dentist. A consultant
forensic dentist for police services and children's
aid societies, Dr. Stechey is an American Academy
of Forensic Sciences (AAFS) Fellow. He was a
dental identification team member at the New
York World Trade Center disaster. He is also an
International Academy for Sports Dentistry
(IASD) Fellow, and is the team dentist for the
Hamilton Bulldogs hockey team, a farm team of
the Montreal Canadiens and Edmonton Oilers,
and for the Toronto Rock lacrosse team.
Dr. Virginia Luks
District 9
Dr. Virginia Luks is the first female to hold an
elected office at the College, and is serving her
second term as a member of the RCDSO Council.
She received her dental and specialty training in
orthodontics at Case Western Reserve University
in Cleveland, Ohio. Additionally, she completed
her Master's of Science degree in the area of
obstructive sleep apnea. Dr. Luks recently received
her fellowship in Orthodontics from the Royal
College of Dentists of Canada, and currently she
is completing her certification with the American
Board of Orthodontics. Dr. Luks plays an active
role in many study groups of a general,
interdisciplinary and specialty nature. She is the
eldest daughter of Dr. Eric Luks, and they practise
orthodontics together in both North Toronto and
Muskoka.
Ensuring Continued Trust
Dispatch • Jan/Feb 2003
9
E L ECT E D M E M B E R S
Council Elections 2003
E L ECT E D M E M B E R S
Council Elections 2003
Dr. Bohdan Kryshtalskyj
District 10
District 11
Dr. Kryshtalskyj earned his BSc, DDS, and
Diploma in Oral and Maxillofacial Surgery and
Anaesthesia from the University of Toronto. He
has a full-time practice in west Toronto. He is
Chief, Division of Oral and Maxillofacial Surgery
and Dentistry at the Trillium Health Centre; staff
oral and maxillofacial surgeon at Toronto General
Hospital University Health Network and the
University of Toronto. He is a member of the
Royal College of Dentists; and a Fellow
of the American College of Oral and Maxillofacial
Surgeons, the American College of Dentists, the
Academy of Dentists Internationale, and of the
Pierre Fouchard Academy. He is contributing
editor of the oral and maxillofacial surgery
section of Oral Health.
Dr. Marvin Klotz
1982. In addition, he is editor of the AORTA
magazine. Dr. Klotz previously served on the
RCDSO Council from 1991-1996 and was a
member of several committees, including
executive and chair of quality assurance. He has
been actively involved on the local, provincial
and national levels of organized dentistry
including as a governor of the Ontario Dental
Association from 1968-1974, and editor of
Ontario Dentist from 1978-1981. He is the
recipient of many distinguished honourary
memberships, and is active in his community.
Dr. Klotz is a graduate of the University of
Toronto with a DDS in 1960, and from
Northwestern University with a MSc in 1964. He
is a certified specialist in pediatric dentistry, and
obtained a Fellowship in the Royal College of
Dentists in 1967. Dr. Klotz has been on the
teaching staff at the University of Toronto since
1980 in both the undergraduate and graduate
departments. He has been editor of the faculty's
Alumni Today magazine since its inception in
Dr. Hartley Kestenberg
ACADEMIC APPOINTMENTS
District 12
Dr. Kestenberg graduated with a DDS from the
University of Toronto in 1982, followed by a
Diploma in Dental Anaesthesiology in 1987, also
from the University of Toronto. He has since been
practising anaesthesia and general dentistry in
Scarborough. He is past president of the Ontario
Dental Society of Anaesthesiology, and has served
as an executive member with the Toronto East
Dental Society. He has taught in several
departments at the Faculty of Dentistry, University
of Toronto, and is currently a part-time clinical
instructor in the Department of Anaesthesia. This
is Dr. Kestenberg's first term serving on the
RCDSO Council.
Dr. Philip Watson
Dr. Philip Watson graduated from Dentistry at the
University of Toronto in 1967 and completed a
Masters Degree at Indiana University School of
Dentistry in 1971. Dr. Watson is Professor and
Head of Biomaterials at the Faculty of Dentistry,
University of Toronto. His clinical specialty is
Prosthodontics.
University of Toronto
Dr. David Charles
University of
Western Ontario
10
A Montreal native, Dr. Charles graduated from
the McGill Faculty of Dentistry in 1965. He
joined the RCDSO when posted to Canadian
Forces Base Trenton as a dental officer in the
Royal Canadian Dental Corps. Presently an
Associate Professor at the School of Dentistry at
the University of Western Ontario, he teaches in
the Division of Prosthodontics, and maintains a
one day a week extramural practice. As an avid
Dispatch • Jan/Feb 2003
Ensuring Continued Trust
cyclist, he rode 7,650 kilometres across Canada in
2000 to raise money for needy dental students.
LIEUTENANT-GOVERNOR IN COUNCIL APPOINTEES
Council Elections 2003
Lynne Arnill
Ms. Arnill has been a public member of the
Council for six years. During this time, she has
served on the Executive Committee, Discipline
Committee, Patient Relations Committee and the
Fitness to Practice Committee. Ms. Arnill is an
active community member.
Vic Braney
Mr. Braney is currently proprietor of a private
investigation firm based in Toronto. He has more
than 30 years experience as a general manager with
a large Ontario-based retailing and distribution
company.
Robert Marr
Mr. Marr is a retired small business owner from
Mississauga. He has an admirable record of
community involvement, and was named
Streetsville Rotarian of the Year in 1995-96.
Doug McVeigh
Doug joined Medbuy in 1996 as Chief Operating
Officer. Presently, he is President and CEO of
Medbuy Corporation, Canada's largest group
purchasing organization owned by leading hospitals
across Canada. Doug has expanded the company
from $145 million to $219 million over a six year
timeframe by developing and implementing various
strategic planning programs that include
membership growth, new membership
classifications, increased contractual activities within
an established range of contract portfolios, and
increased efficiencies in the corporation.
Additionally, Medbuy Corporation has developed a
100% wholly-owned subsidiary, Canadian Health
Marketplace (CHM), an e-commerce business-tobusiness health care platform. Doug is the chairman
of the Board for CHM, and was instrumental in the
development of the business case and presentation
to the Medbuy Board to gain approval to launch the
company in 2000.
Robert Metras
Mr. Metras is currently vice-president in the eHealth
Solutions Group, BCE Emergis Inc. In Canada and
the US, BCE Emergis offers the health insurance
industry – including insurance companies, third
party administrators, governments, workers’
compensation boards and large provider
organizations – e-commerce solutions for the ever
increasing complexities of the health-care market.
Mr. Metras is a 1975 graduate of the University of
Western Ontario, and is taking graduate courses in
Epidemiology at the University of Michigan. He has
chaired several community boards, as well as having
served as executive assistant to a federal cabinet
minister. He is past president of the Ontario
Municipal Water Association, and a member of the
Board of Governors and Senate at the University of
Western Ontario.
Ensuring Continued Trust
Dispatch • Jan/Feb 2003
11
LIEUTENANT-GOVERNOR IN COUNCIL APPOINTEES
Council Elections 2003
John Pappain
Mr. Pappain is currently president and chief
executive officer of KMS Power Income Fund.
He is chairman of the Land Division Committee
of the Regional Municipality of Peel, past
chairman of the Board of Governors of Peel
Memorial Hospital and chairman of the City of
Brampton Committee of Adjustment. He also
sat on the Board of Governors of Sheridan
College until December 2000, and is past chair
of its Finance Committee.
Lloyd Pollack
Mr. Pollack, was born and educated in Toronto.
After graduation from the University of Toronto
with a major in chemistry, he then studied and
graduated from Osgoode Hall Law School. Since
his call to the Bar, he has practised in Toronto. In
1986, he received his Queen's Counsel. Very
active in community work, Mr. Pollack served on
the City of York Planning Board for eight years,
the last six as vice-chairman. He was also on the
executive of the Cedarvale Ratepayers Association
for many years, and served as president of the
Association for about five years.
Krystyna Rudko
Ms. Rudko is a communications and marketing
strategist who has spend over 15 years working in
the field of demographic and trends analysis.
Professionally trained in media relations and in
cultural and diplomatic protocols, she is a respected
public speaker, and has led projects for the United
Nations Fund for Populations Activities, the United
Nations Department of Technical Cooperation for
Development, USAID, and the Shanghai Bureau of
Statistics. She has lectured at Queen's University, the
University of Chicago, and in Addis Ababa,
Ethiopia. Ms. Rudko acquired experience in public
consultations, crisis management, federal-provincial
relations, and policy development in her role as
Director, External Relations for Canada's
Demographic Review, and last in Statistics Canada's
Social Statistics Development Project.
Elesh Ruparel
Mr. Ruparel has a background in finance and has
served with on the Council of Registered Brokers
of Ontario as a member of both its Discipline
Committee and Complaints Committee. He has
served the College for the past four years on the
Discipline Committee, Property, Finance and
Administration Committee, and the Executive
Committee. He is very active in the East Indian
community.
Joan Stewart
Ms. Stewart has served the College during the past
five years on the Discipline Committee,
Registration Committee, Complaints Committee,
and as chair of the Patient Relations Committee.
With an extensive background in community
service, her volunteer work with the Canadian
Cancer Society includes 15 years as chair of the
annual daffodil fundraising campaign. She is also
a life member of the Ladies Auxiliary of the Royal
12
Dispatch • Jan/Feb 2003
Ensuring Continued Trust
Canadian Legion, and has worked for a number
of local candidates for office at all levels of
government. She is now serving on the West
Nipissing Environmental Corporation of
Sturgeon Falls.
Elections 2003
College
Committees 2003 - 2005
Complaints Committee
Dr. Marvin Klotz, chair
Dr. Hartley Kestenberg
Dr. George Grayson
Dr. Louis London (non-council)
Dr. Lorne Akler (non-council)
Dr. Marcel Paiement (non-council)
Doug McVeigh
Vic Braney
Joan Stewart
Discipline Committee
Dr. Eric Luks, chair
Dr. Philip Watson, vice-chair
Dr. Albert Bouclin
Dr. Virginia Luks
Lynne Arnill
Dr. John Anthony (non-council)
Dr. Jim Ho (non-council)
Dr. Stephen Brown (non-council)
Dr. Katherine Zettle (non-council)
Dr. Victor Krueger (non-council)
Robert Metras
John Pappain
Elesh Ruparel
Robert Marr
Ben Wiwcharyk
Elections Committee
John Pappain, chair
Krystyna Rudko
Robert Marr
Patient Relations Committee
John Pappain, chair
Dr. Malcom Yasny (non-council)
Dr. George Trigylidas (non-council)
Dr. Virginia Luks
Robert Metras
Executive Committee
Dr. Cam Witmer, chair
Dr. Doug Smith
Dr. David Charles
Krystyna Rudko
Ben Wiwcharyk
Quality Assurance Committee
Dr. Randy Lang, chair
Dr. Bohdan Kryshtalskyj
Dr. Leslie Armstrong (non-council)
Dr. Sven Grail (non-council)
Lloyd Pollack
Finance, Property and
Administration Committee
Dr. Bohdan Kryshtalskyj, chair
Dr. Doug Smith
Lloyd Pollack
Dr. Randy Lang
Dr. Cam Witmer (ex-officio)
Registration Committee
Dr. Larry Parker, chair
Joan Stewart
Dr. Virginia Luks
Dr. Frank Stechey
Fitness to Practice Committee
Dr. Randy Lang, chair
Dr. Terrance Witzu (non-council)
Lloyd Pollack
Legal and Legislation Committee
Doug McVeigh, chair
Dr. Frank Stechey
Dr. Albert Bouclin
Dr. Philip Watson
Dr. Cam Witmer (ex-officio)
Professional Liability
Program Committee
Krystyna Rudko, chair
Dr. David Charles
Dr. Steven Cohen (non-council)
- 3 year term
Dr. Dominic Belcastro (non-council) - 3 year term
Dr. Mary Krywulak (non-council)
- 3 year term
Dr. Ron Palinka (non-council)
- 2 year term
Dr. Ron Yarascavitch (non-council)
- 2 year term
Ben Wiwcharyk
Mr. Wiwcharyk has served the College on the
Discipline Committee for the past three years. He
has a background in real estate and securities. He
has 20 years experience as an owner/operator of a
business systems and equipment company. He is
currently president/owner of Sherlock Properties,
consisting of commercial real estate and
apartment blocks. He also serves the Thunday Bay
community as a director for Thunder Bay
Development, Canadian Lakehead Exhibition
and Thunder Bay Kennel and Training Club.
Ensuring Continued Trust
Dispatch • Jan/Feb 2003
13
LIEUTENANT-GOVERNOR
IN COUNCIL APPOINTEES
Audit Committee
Dr. Frank Stechey, chair
Dr. Larry Parker
Doug McVeigh
Dr. Cam Witmer (ex-officio)
Access Dental Care Symposium Rated As
Great
Success
By All Participants
Another First for RCDSO: College Hosts One Day Session To Help Identify
Barriers To Delivery of Oral Health In the Long-Term Care Sector
AN HISTORIC OCCASION - THAT’S THE FEEDBACK FROM REPRESENTATIVES FROM THE
LONG-TERM CARE SECTOR WHO PARTICIPATED IN THE ACCESS DENTAL CARE SYMPOSIUM ON JANUARY 10, 2003, HOSTED AND ORGANIZED BY THE COLLEGE.
Gathered together, for what many said
was the first time, were a broad spectrum of individuals and organizations all passionately interested in the question of how to improve the oral health
care of people in the long-term care
sector, whether institutionalized or at
home.
Nearly 20 invited participants joined
RCDSO Council members and staff in
an informal discussion led by the
College Registrar Irwin Fefergrad.
Participants included long-term
care providers; general practice
dentists who serve this population group both on a not-forprofit and for-profit basis; clinical dentists; medical director
from a home for the aged; public health dentists; consumer
advocacy groups; for-profit company representatives; academics
and researchers; long-term care
physicians; professional services
director from a long-term care
facility; government policy staff;
dental advocacy group reps and
the dental regulatory college.
The symposium is one of a
series of consultations by the
College to help identify issues
related to the delivery of oral
health care in the long-term sector. As then College President
Dr. Eric Luks explained in his
opening remarks: once the
(left to right) Dr. John Roberts and Dr. Andres Traverse
College has collected enough
14
Dispatch • Jan/Feb 2003
Ensuring Continued Trust
information, Council will examine the
issue and determine if RCDSO is in a
position to offer or participate in solutions. Dr. Luks emphasized that the
Barriers To Oral Health Care
Some of the major barriers to effective delivery of oral health care in
the long-term care sector included:
• no systemized plan for delivery
of services
• inadequate funding and no coordination of funding
• care delivery fragmented
• provincial standards not linked
to resources and outcomes
• inadequate equipment, transportation and staffing
• lack of societal value for this
population group
• lack of appreciation for multidisciplinary approach to care of seniors
• oral health care seen as discretionary
• lack of government leadership
• complicated population with
53% cognitively impaired
• fear and lack of knowledge about
this patient population by
dentists
(left to right) Margaret Ringland and Dr. Ira Marder
Symposium Participants
Concerned Friends of Ontario Citizens in Care Facilities - Chris Denn
Council of Ontario Medical Officers of Health - Dr. Dan Otchere (dentist)
Direct Dentistry Services - Liz Scott and Jan Zewlewski
College will make every attempt to
meet the challenges involved.
“There is no denying the importance
of this problem,” said College Registrar
Irwin Fefergrad. “With 80% of the people in the long-term care sector in need
of oral health care, it is important that
this College play a realistic role in
working towards a range of solutions.
“Arriving at solutions will not be
easy. This is a long-standing and very
complex problem. The population
group offers some unique challenges
with about 53% cognitively impaired,”
explained Fefergrad. “From the
informed and energetic dialogue at the
symposium, it is abundantly clear
there will be no one cookie-cutter solution.”
The dentists who participated came
excited to share their personal experiences about success stories using a
range of models. The symposium
heard from individual dentists who
have a passionate interest in this area
volunteering their time and expertise,
to committed dental directors in public
health units, to for-profit companies
serving long-term facilities.
At the end of the day participants
unanimously agreed that an important
momentum had begun. RCDSO has
agreed to act as an information broker
to share relevant research among the
group, and has agreed to reconvene
another meeting of the group to continue discussions.
Durham Regional Health Department - Dr. Pat Abbey (dentist)
Ministry of Health and Long-Term Care, Long-Term Care Branch
- Karin Fairchild
Ontario Association of Non-Profit Homes and Services for Seniors
- Margaret Ringland
Ontario Association of Public Health Dentistry - Dr. Peter Wiebe (dentist)
Ontario Dental Association - Dr. David Matear (dentist)
Ontario Dental Association - Rose Abate and Frank Bevilacqua
Ontario Long-Term Care Association - Dr. Ira Marder (dentist)
Ontario Long-Term Care Physicians Association - Dr. James Edney
Ottawa Hospital/Grace Manor - Dr. John Roberts (dentist)
Plainsview Dental Office, Burlington - Dr. Andres Traveres (dentist)
St. Peter’s Hospital Seniors Dental Clinic, Hamilton - Dr. Jame Morreale
(dentist)
Toronto Rehabilitation Institute - Dr. Karen Burgess (dentist) and
Dr. James Edney
(left to right) Dr. Dan Otchere, Dr. Peter Wiebe, Chris Denn
Ensuring Continued Trust
Dispatch • Jan/Feb 2003
15
Supports
Battle
To Keep Unique Clinic Open
College
Fred Lum/The Globe and Mail. Reprinted with permission from The Globe and Mail.
SPECIAL ORAL AND MAXILLOFACIAL SURGERY PROGRAM OFFERS SERVICES NOT
AVAILABLE ANYWHERE ELSE IN ONTARIO AND ACTS AS MAGNET TO TOP NORTH
AMERICAN STUDENTS
Oral and maxillofacial surgeons Dr. Cameron Clokie (left) and Dr. George Sandor (right)
In November and late December 2002,
the College actively supported the
heroic efforts of oral and maxillofacial
surgeons Dr. George Sandor and Dr.
Cameron Clokie to keep alive the special oral and maxillofacial surgery program at the Toronto General Hospital,
part of the University Health Network
group of teaching hospitals in downtown Toronto.
The hospital announced late in the
afternoon of December 20, 2002, the
cancellation of the oral and maxillofacial surgery program by denying it
access to the operating rooms from
January 1 to at least April 1, 2003, for
both elective and emergent care. In an
16
Dispatch • Jan/Feb 2003
unprecedented move the hospital said,
without exception, any patient requiring treatment in an operating room
must be transferred to another hospital.
The College has actively supported
Dr. Sandor and Dr. Clokie right from
the beginning. As College Registrar
Irwin Fefergrad explained, the College’s
mandate is to represent the public
interest: when the public’s health could
be compromised, RCDSO has an obligation to speak out. The College took
an active role in arranging media interviews and handling media calls, and
providing ongoing support and advice
to these RCDSO members.
As Dr. Clokie, discipline head of oral
Ensuring Continued Trust
and maxillofacial surgery, described at
a media conference on December 30,
2002, the persons served by this program are the most challenging cases,
very vulnerable people, and most cannot be treated in a routine dental clinic
setting, but require an operating room
environment, with the appropriate
back-up.
The clinic treats close to 2,000 patients a year and specializes in surgery in
the oral and maxillofacial complex for
people with serious infections of the
throat and jaws, accident victims, cancer and HIV patients. These patients
would now be redirected to other hospitals, or may have to travel out of
province or to the United States, or
even go without treatment at all.
The clinic is also home to nine residents in a four-year training program.
Dr. Sandor, director of the graduate
training program, said these residents
who had turned down offers from top
American universities to study at the
clinic have now been set adrift. The
accreditation of the program is now at
risk and this could affect the graduation of some of the residents. The program has been housed at TGH for over
50 years. It has an international reputation and has attracted applicants to its
fellowship position from Finland,
Switzerland, Australia, Argentina and
the United States.
At the time of printing, mediation
between the two groups resulted in an
extension of the clinic until the end of
June. Sandor and Clokie are now looking for a new home for the clinic.
Health Canada Non-Insured Health Benefits
(NIHB) Program Update
New Protocol Developed To Achieve Objectives of Both Health Canada
and the Dental Regulatory Authorities
THE NON-INSURED HEALTH BENEFITS (NIHB) PROGRAM, DENTAL REGULATORY
AUTHORITIES (DRAS), CANADIAN DENTAL ASSOCIATION (CDA) AND THE PROVINCIAL
DENTAL ASSOCIATIONS HAVE REACHED AN AGREEMENT ON A PROTOCOL WITH
RESPECT TO THE NIHB, DENTAL PROVIDER AUDIT PROGRAM.
The protocol has been developed to
ensure that the following two objectives are met:
1. Health Canada’s requirement to
maintain accountability for the
appropriate expenditure of public
funds.
2. The DRAs obligation to protect the
public interest through the regulation of the profession of dentistry,
and in doing so, to abide by the fairness provisions of various pieces of
provincial and federal legislation.
The protocol has identified three
options. Each DRA will select one of
the three options for implementation
within their jurisdiction. The three
options are:
1. referral to the dental regulatory
authority;
2. dental regulatory authority/Health
Canada conjoint on-site investigation/audit;
3. Health Canada administrative onsite audit.
Full details of the options are contained in the document called NonInsured Health Benefits (NIHB)
Program and Dental Regulatory
Authorities, December 2002. It is available on-line at the RCDSO Web site
www.rcdso.org.
The DRAs and Health Canada will
conjointly implement this protocol
“
This agreement
only came about because
of the sincere effort by
all the players to work
”
collaboratively.
- RCDSO Registrar Irwin Fefergrad
effective on January 1, 2003, for the
period up to and including June 30,
2003. The option selected by each DRA
will remain in effect for the identified
Ensuring Continued Trust
period. An evaluation of the effectiveness of the implementation of the protocol will be conducted, after which it
may be extended for a further period of
time.
As RCDSO Registrar Irwin Fefergrad
explained: “This agreement only came
about because of the sincere effort by
all the players to work collaboratively.
A special thanks to the staff at Health
Canada involved in this project - Dr.
Peter Cooney, Valerie Malazdrewicz,
Tom Bird and Dr. Harry Ames. This
kind of co-operation has set a very
encouraging and positive tone for our
future relationships.”
Mr. Fefergrad, along with ODA’s
Director of Government Relations
Frank Bevilacqua, were part of a national working group struck to negotiate
with Health Canada officials. Other
members of this team were from the
Canadian Dental Association - Andrew
Jones, Dr. Daryl Smith and Marc
Favreau; Dr. Gordon Thompson,
Alberta; and Dr. Diane Legault, Quebec.
This article was prepared in co-operation with
Health Canada’s Non-Insured Health Benefits
Program.
Dispatch • Jan/Feb 2003
17
Registrar Invites Aboriginal Communities to
Work in Partnership
Ontario wants to create a better connection between
regulatory college and aboriginal communities.
COLLEGE REGISTRAR IRWIN FEFERGRAD ISSUED AN INVITATION TO ABORIGINAL LEADERS TO ACCESS THE REGULATORY SYSTEMS IN THEIR PROVINCES AS YET ANOTHER
WAY TO ENSURE BETTER QUALITY AND ACCESS TO ORAL HEALTH SERVICES. RCDSO
WAS CHOSEN TO PROVIDE THE REGULATOR’S PERSPECTIVE DURING A TWO-DAY CONFERENCE ON HEALTH CARE MANAGEMENT IN ABORIGINAL COMMUNITIES ORGANIZED
BY THE ABORIGINAL MANAGEMENT INSTITUTE ON NOVEMBER 4 AND 5, 2002 IN WINNIPEG, MANITOBA.
Participants were primarily band councillors and health centre directors from
Quebec, Ontario, Manitoba, and as far
away as the Yukon. Other session lead-
ers were from Manitoba, Alberta and
British Columbia.
“In Ontario we would like to create
more of a connection between the
College and aboriginal communities,”
said Fefergrad. “We want to work
together in partnership to improve oral
health care delivery in aboriginal communities in Ontario.
“Dentists need to be challenged to
provide care in all communities in
Ontario. The model for oral health care
delivery hasn’t changed significantly in
the last 125 years. We need to examine
better and different ways of how to
deliver oral health care outside the traditional dental office,” said Fefergrad.
“Invite us to your communities, and
College staff will work with you to
develop protocols to help address problems with access and quality of care.”
Course participants (left to right): Patricia Big Canoe, Band Councillor (Health Portfolio),
Chippewas of Georginia Island First Nations, Sutton, Ontario; Sandra Big Canoe, Chair, Southeast
Area Health Board of Ontario, Chippewas of Georginia Island First Nations, Sutton, Ontario; RCDSO
Registrar Irwin Fefergrad
18
Dispatch • Jan/Feb 2003
Ensuring Continued Trust
These comments certainly dovetail
with the long-term vision of the First
Nations and Inuit Health Branch
(FNIHB) of Health Canada as
explained at the conference by the
(left to right): Co-chair Dr. Gilles Pinette, Associate
Director, Special Premedical Studies Program,
University of Manitoba, Winnipeg, Manitoba; RCDSO
Registrar Irwin Fefergrad; course participant Roland
Peltier, Health Director, Wikwemikong Health Centre,
Manitoulin Island, Ontario.
Branch’s Chief Executive Advisor Keith
Conn. The FNIHB’s long-term vision is
a reconfigured health system that
focuses on primary care and prevention and promotion with opportunities for First Nations and Inuit to control health services.
tries such as Costa Rica (4.8), or the
Ukraine (4.4).
In the results of a 1997 regional health
survey by the Assembly of First Nations
that covered First Nations people living
on-reserve all across Canada and the
Inuit of Labrador, about 48% of adults
The oral health care needs of the First
said that they needed some dental care.
Nations people are unique according to
Almost 1/4 had had a dental problem or
the December 2001 presentation by the
pain within the last month. The most
Canadian Dental Association to the
common types of dental care that people
Commission on
needed, in order of
the Future of Heaimportance, were
In Ontario we would like
lth Care in Canrestoration such as
ada. The decayed,
fillings and crowns,
to create more of a
missing, filled
maintenance such
teeth (DMFT) rate
as checkups or
connection between the
for 12-year old
cleaning, prosthetic
College
and
aboriginal
First Nations chilwork and extracdren is 4.4. This is
tion.
communities. We want
two or three times
to work together in
higher than the
RCDSO’s RegisDMFT for nontrar detailed the
partnership
to
improve
Aboriginal chilongoing discusdren in Canada
sions with FNIHB
oral health care delivery
where statistics are
to address conin
aboriginal
communities
gathered, and is
cerns with the
comparable to the
audit process and
in Ontario.
DMFT rates in
confidentiality
developing counissues in the deliv-
Ensuring Continued Trust
ery of oral health care. Mr. Fefergrad stated unequivocally that the College “does
not cut deals on complaints related to
fraud, economic abuse or sexual abuse.”
He stressed that the College continually must demonstrate that the dental
profession deserves the right to self-regulation. “In our last government
review, we shone,” he explained. “We
need to maintain that level of accountability and transparency.”
Other topics covered during the twoday meeting included privacy, confidentiality and access to information;
development of strategies to recruit
and retain health-care professionals;
legal liability and medical negligence;
and dealing with patient complaints in
the workplace.
If you have any questions about this
story, please contact Irwin Fefergrad,
Registrar at 416-934-5625, toll free at
1-800-565-4591 or by e-mail at ifefergrad@rcdso.org; or Peggi Mace,
Communications Director at 416-9345610, toll free at 1-800-565-4591, or by
e-mail at pmace@rcdso.org.
Dispatch • Jan/Feb 2003
19
Suggestions to Help Avoid Some of the
Common Errors In The
Incorporation Process
THE COLLEGE IS PLEASED
to report that more than 125 applications for a Certificate of Authorization
have been received, and 115 Certificates
of Authorization have been issued as at
December 31, 2002.
To assist you in avoiding delays in
processing your application, please
note some of the most common errors
made in the application process, and
please share this information with your
lawyer.
Stale-dated Statutory Declaration
Ensure that your Statutory Declaration
is executed not more than 15 days
before the application is submitted to
the Registrar. Too often, the application
form is invalid because more than 15
days have passed from the time the
Statutory Declaration was signed and
dated to the time the College received
the application form. When this
occurs, it is necessary to complete the
entire application form again. This
type of error will cost you valuable time
and money as it directly impacts the
validity of your Certificate of Status,
which is also time sensitive.
Reference: Ontario Regulation 39/02
made under the RHPA, 1991, paragraph 6
of subsection 2(1)
Stale-dated Certificate of Status/No
Certificate of Status
T h e C o l l e g e h a s r e c e i ve d m a ny
inquiries from members, lawyers and
20
Dispatch • Jan/Feb 2003
accountants questioning why the
College requires a Certificate of Status
verifying the existence of the corporation for a newly formed corporation.
This is a Ministry of Health requirement and applies to all health professions regulated under the Regulated
Health Professions Act, 1991. Receipt of
an application form that does not
include the Certificate of Status is not
only incomplete but the application
form itself becomes invalid since the
Certificate of Status must be executed
not more than 30 days before the
application is submitted to the
Registrar. Omitting this document will
delay the application process since a
new application form must now be
completed and resubmitted to the
Registrar.
Reference: Ontario Regulation 39/02
made under the RHPA, 1991, paragraph 3
of subsection 2(1)
Undertaking(s) and Statutory
Declaration not dated
Quite often a third party completes the
application form, with the dentist simply providing his/her signature on the
requisite forms (the application form
itself, the undertaking(s) and the statutory declaration). It has been our experience that while these forms have been
signed and witnessed they have not been
dated, thus making them invalid. When
completing the application form ensure
that you sign and date all pertinent secEnsuring Continued Trust
tions to avoid any unnecessary delays.
Certificate of Incorporation of the
Corporation and/or Articles of
Incorporation not notarized
and/or certified
In accordance with government legislation, a certified copy of the Certificate
of Incorporation of the corporation is
required. Please note that the College
will accept a notarized copy of the original Certificate of Incorporation and/or
a notarized copy of the original Articles
of Incorporation. The College will not
accept Articles of Incorporation and/or
Certificates of Incorporation that have
not been notarized and/or certified by
a lawyer and/or notary public. Certified
and/or notarized copies of these documents executed by Shareholders of the
Corporation will not be accepted.
Submitting documentation that has
not been notarized will cause delays.
Reference: Ontario Regulation 39/02
made under the RHPA, 1991, paragraphs
4 & 5 of subsection 2(1)
Photocopied and/or Scanned
Application Forms
When applying for a Certificate of
Authorization, the legislation requires
that a completed application be submitted in a form approved by the
College. At its August 28, 2002 meeting, the RCDSO Council approved the
application form.
It is this College’s policy to accept
only the original application form as
approved by Council. As such, photocopied and/or scanned copies of this
application form will not be processed.
To avoid delays, please ensure that you
submit the original Application Form
for a Certificate of Authorization. It is
understood however, that if you have
more than one Director and/or
Shareholder that the Undertakings in
Form (C) and Form (D) will need to be
photocopied and will be acceptable.
Reference: Ontario Regulation 39/02
made under the RHPA, 1991, paragraph 1
of subsection 2(1)
How to Order a Free
Incorporation Kit
If you would like to receive a free copy
of the incorporation kit, please contact:
• Kim Vivash, Administrative
Assistant, Registration
416-961-6555, ext. 4346
toll free 1-800-565-4591
e-mail: kvivash@rcdso.org
Who to Call at the College
If you have other questions about the
College process, you may contact any
of the following College staff:
• Julie Wilkin, Co-ordinator,
Professional Incorporation
416-934-5612
toll free 1-800-565-4591
e-mail: jwilkin@rcdso.org
• Rob Lees, Manager, Registration
416-961-6555, ext. 4353
toll free 1-800-565-4591
e-mail: rlees@rcdso.org
• Dayna Simon, Assistant to the
Registrar, Legal
416-934-5618
toll free 1-800-565-4591
e-mail: dsimon@rcdso.org
• Irwin Fefergrad, Registrar
416-934-5625
toll free 1-800-565-4591
e-mail: ifefergrad@rcdso.org
PLP Coverage Extended to Dental Health Professional Corporations
In addition to providing malpractice coverage for dentists and partnerships of
dentists, the College’s Professional Liability Program also provides coverage for
dental health professional corporations that hold a current certificate of authorization from the Royal College of Dental Surgeons of Ontario.
This coverage relates to the performance of professional services and not to
ancillary services performed on behalf of the corporation that are not within
the scope of practice of dentistry.
There is no additional cost for this coverage and it is not necessary for the
dentistry professional corporation to notify the Professional Liability Program
when a Certificate of Authorization has been granted.
Circulation of Proposed Regulation
& Standard Only First Step
College Emphasizes No Regulation Or Practice Standard Enforceable
Until Lengthy Process Completed and Membership Notified
EARLY IN JANUARY THE
College circulated to all members and
key stakeholders two important documents for review and input. One was a
proposed regulation relating to amalgam waste disposal.
The other was a proposed standard of
practice relating to amalgam waste disposal. Both these documents are only
proposals. They were forwarded from
the Legal and Legislation Committee to
Council, and approved in principle
only by Council at its November 2002
meeting.
Following the normal RCDSO
process, this approval in principle of a
regulation is made by Council so that it
can circulate the proposed regulation
for input by College members and
external key stakeholders including the
Ontario Dental Association. Generally
at least 60 days is provided for written
submissions to be made to the College.
The next step in the process is that
this input is sent to the appropriate
College committee, usually the Legal
and Legislation Committee, for its consideration. The committee then makes
a recommendation to a future Council
meeting about what, if anything, needs
to be done.
At that time, Council could decide to
pass the proposed regulation, or take no
action, or pass a different form of the
regulation. If changes to the regulation
were significant, that new proposed regulation would be approved in principle,
and then recirculated to members and
key stakeholders for comment.
Even after Council passes a regulation,
it is not enforceable unless, and until
• the approval of the Minister of
Ensuring Continued Trust
Health and Long-Term Care is given;
• the Ontario Cabinet passes the regulation, has it signed by the Lieutenant-Governor In Council, and
published the regulation in the
Ontario Gazette.
Once that lengthy process is completed and the regulation, approved by
Council, passed into law by the government, the College would notify you,
and provide you with advice about
how to comply with the regulation.
Some regulations, such as the proposed amalgam waste regulation, need
to have a published standard of practice in place at the time the regulation
becomes enforceable. That accompanying standard, even if finally
approved by Council, would only
become effective once the appropriate
regulation became law.
Dispatch • Jan/Feb 2003
21
Advertising By Dentists:
Frequently
Asked
Q+A
Advertising is definitely one topic that generates a lot of questions year after year here at the
College. In fact, with new media like the World Wide Web gaining in popularity, the number of
questions just continues to expand. Because of the increasing interest in this area, a quick
review of some of the most common questions that we receive may be useful.
The College’s Practice Advisory on Professional Advertising clearly outlines the existing regulations. It is available on our Web site at www.rcdso.org. Just click on the Practice Advisory
heading on the home page.
Can fee reductions be advertised?
Dentists may advertise reduced fees,
but when they do, the advertisements
must be specific. So for example, either
the fee itself is advertised, or the percentage off a specified fee, or the percentage off a fee as per a specified year
of the suggested ODA Fee Guide.
The fee must apply to ALL patients,
whether they have insurance or not,
and whether they are aware of the
advertisement or not.
ices they provide in their practices.
However, in describing one’s practice,
comparisons and suggestions of
uniqueness or superiority are not permitted.
The use of “I” and “we” in articles
written about the practice may be considered as comparison or suggestion of
uniqueness, and may therefore be
inappropriate. Comparative adjectives,
especially those ending in “er” or “est”
should also be avoided for similar reasons.
Coupons cannot be used.
Can we offer prizes?
The regulations prohibit a dentist from
offering a rebate, credit or other benefits to patients. This includes any gifts
or special offers such as a free electric
toothbrush in conjunction with services being provided. As well it also prohibits any other gifts or prizes directly
or through contests.
In describing my practice, what are
the limitations?
Dentists may include the types of serv-
22
Dispatch • Jan/Feb 2003
Is it appropriate to include references to the practice’s sterilization
techniques?
No. All dentists must comply with the
College’s Guidelines on infection control.
References to the cleanliness of the
office, or to the sterilization techniques
used should not be included in advertisements.
Phrases such as state of the art, leading edge, and advanced in reference to
Ensuring Continued Trust
equipment, materials and/or techniques should not be included in
advertisements.
You may wish to include in your
advertisement an invitation for
patients to call the office with questions/concerns, and suggest that they
can visit the office before they make
appointments.
How can I ensure that my proposed
advertisement complies with the
regulations?
You may mail, e-mail or fax your advertisement - print, video, audio or Web to the College. Dr. Fred Eckhaus,
Assistant to the Registrar, Dental,
would be pleased to review your proposed advertisement, and advise you
on its appropriateness within the existing regulations.
You can contact Dr. Eckhaus by
calling 416-934-5624, toll free at
1-800-565-4591, or by e-mail at
feckhaus@rcdso.org.
A New Year...and A
Facelift for Dispatch
THE FIRST ISSUE OF DISPATCH FOR 2003 UNVEILS A
NEW LOOK. TO BE HONEST, IT IS WITH SOME TREPIDATION THAT WE LAUNCH THIS FACEFLIFT. YOU’VE TOLD
US THAT WE HAVE A WINNING PRODUCT, BUT AT THE
SAME TIME WE NEED TO CONTINUOUSLY STRIVE TO
MAKE IMPROVEMENTS.
We think that these small changes only
enhance all the things that readers have
told us over and over again that they
like about Dispatch. In fact, we hope
that the new look will make the magazine even more vibrant, and easier to
read.
Here’s a quick checklist of some of
the improvements:
• We’ve emphasized a linear layout so
that the pages are more open and
easier to read.
• To help you navigate through the
magazine, we’ve developed clearly
identifiable icons or graphics for all
our regular columns.
• Gone are the coloured borders on
the top of pages. That means there’s
more room on the pages, and that
means more white space so the copy
is easier to read.
• Photographs are used more creatively.
• The President’s column is now in
both official languages.
• Other subtle changes have been
made in how the stories are laid out
on the page to try and eliminate odd
word breaks and white spaces - again
to help make the magazine easier to
read.
We hope you like it. As always, your
feedback is welcomed. Just send me an
e-mail at pmace@rcdso.org, or give me
a call at 416-934-5610, toll free at 1800-565-4591, or drop me a note by
surface mail.
Peggi Mace
Communications Director
Membership Directory In Production
- We Need Your Help!
The new RCDSO membership directory is in production. We
want to be sure that we have the most accurate information
about each member listed.
Any changes that you wish to have reflected
in this latest version of the directory must be
received by the College on or before March 31,
2003. In order to ensure accuracy, all
changes must be received in writing.
As you know, the College is required by law to have available to the public, the current business address for all
RCDSO members. Any change in this information must be
reported to the College within 30 days of the change occurring. You may choose to designate another address as your
preferred mailing address for College communications. This
second address is not available to the public.
Please use the form on page 45 to send us your up-to-date
address information. You can send it to the College by mail
or by fax at 416-961-5814.
Ensuring Continued Trust
Dispatch • Jan/Feb 2003
23
Clear Distinction Between Supervision of
In-Office Laboratory and a
Commercial Operation
IN ONTARIO, ONLY A REGISTERED DENTAL TECHNOLOGIST (RDT) OR A DENTIST MAY SUPERVISE A COMMERCIAL DENTAL LABORATORY. IT IS THE COLLEGE’S POSITION THAT ANY DENTIST WHO PROPOSES TO SUPERVISE
A COMMERCIAL LABORATORY MUST BE ABLE TO FULFILL
THE SAME ROLE AS THE RDT.
In today’s market, many dental offices
are seeking to offer patients full-service
by providing many aspects of dental
care at a single location. That includes
offering an on-site dental laboratory
for the convenient construction and
repair of some dental prostheses and
appliances. In this scenario, laboratory
services are provided exclusively for the
patients of that office. The treating dentist is able to oversee its operation, and
assume responsibility for the quality of
the finished products.
The College is frequently contacted
by members and others to find out if a
dentist may supervise an in-office laboratory like the one described above.
Other inquiries relate to the operation
of a commercial dental laboratory that
offers services to the professional community-at-large.
The College draws a clear distinction
between an in-office laboratory, and a
commercial operation.
In Ontario, only a registered dental
technologist (RDT) or a dentist may
supervise a commercial dental laboratory. It is the College’s position that any
dentist who proposed to supervise a
commercial laboratory must be able to
fulfill the same role as the RDT.
The College of Dental Technologists
(CDTO) has published guidelines
about laboratory supervision for its
members that stipulate the supervising
RDT must:
24
Dispatch • Jan/Feb 2003
• Assume full responsibility and
accountability at all times for the
technical aspects of dental technology practice, as well as for the administration of the laboratory.
• Be responsible for overseeing the
design, construction, repair and
alteration of each dental prosthetic,
restorative or orthodontic device that
is processed in the laboratory.
• Ensure that no case can be released,
other than on an interim basis, without his/her authorization. Such
authorization means that
the supervisor has:
1. Examined all records supplied by
the prescribing dentist, and any other
records (e.g. impressions, intra-oral records, models, diagrams, written and verbal instructions) necessary
to the design, fabrication, repair
or alteration in question.
2. Certified that the records reviewed
are adequate to design, construct,
repair or alter the case.
3. Examined the case for conformity
to the prescription.
4. Certified that the case was
designed, constructed, repaired or
altered in accordance with appropriate standards.
5. Confirmed that the invoice accurately reflects the processes, materials and charges for the case.
• Only supervise a single laboratory
on a single day.
RCDSO will use this same document
to determine whether a member of this
College has performed according to
acceptable standards, and is maintaining his or her responsibilities as a
health-care professional. You can
access the complete CDTO document at www.cdto.ca/english/lab.pdf.
In addition, all invoices,
design consultations, and
any document authorizing the release of the case
must clearly identify the
supervising RDT or dentist.
Members are reminded to
look for the official verification
stamp of the supervising RDT that
signifies that the case conforms to
continued on page 43
Section 32(1)(a) of the Regulated Health Professions Act stipulates that
no person shall design, construct, repair or alter a dental prosthetic,
restorative or orthodontic device unless the technical aspects of the
design, construction, repair or alteration are supervised by a member of
the College of Dental Technologists of Ontario or the Royal College of
Dental Surgeons of Ontario.
Ensuring Continued Trust
Is Your Practice In Need
of a
Preventative
Check-Up?
The voluntary practice review program is underway
for 2003, and the call goes out for volunteers.
THE QUALITY ASSURANCE
(QA) Committee has approved continuation of the voluntary practice review
program for this year. Originally
launched in mid-1998, the program
has seen over 200 dental office
reviewed - all on a voluntary basis.
A practising colleague carries out the
half-day preventative checkup. The
goal is to provide assistance, and helpful and practical advice about a number of key areas of your practice.
Because of the educational nature of
the program, dentists who volunteer
for a practice review will receive six
MCDE credit points for their participation.
Feedback from dentists who have
already participated is extremely positive. Dentists have remarked on the
understanding, consideration and support offered by the reviewers. Those
practices reviewed on a voluntary basis
will not be subject to another review
for at least five years.
Although the province has not yet
passed the government regulation that
would make the participation in the
quality assurance program mandatory,
the QA Committee believes it is important to proceed on a voluntary basis
while awaiting government action.
If you would like to volunteer your
practice, or have any questions about
the volunteer dental practice review
program, contact Dr. Bob Carroll,
Manager, Professional Practice at 416934-5611, toll free at 1-800-565-4591,
or by e-mail at rcarroll@rcdso.org.
Feedback from Dentists Who Volunteered For The Practice Review
We found the whole process very
affirmative for staff. They were left
with the feeling that they were doing
a good job, but at the same time eager
to improve in the areas pointed out
by the reviewer. The reviewer’s style
was very constructive. He was able to
point out areas that needed improvements without creating resentment
or discouragement. Our staff’s personal esteem was strengthened, and
we are working better as a team as a
result of our review.
Dr. Thomas Williams
Mississauga
An excellent experience. It is good to
know when our practice out in the
trenches is doing things as best as
possible. The RCDSO is commended
for its proactive stance on this issue.
Dr. John Sujak
Waterloo
The whole staff appreciated and
enjoyed the practice check and it was
definitely a positive experience. I
would like to thank RCDSO for this
review.
Dr. Arasaratnam Selvarajah
Don Mills
CDHO Notice of Illegal Practice of Dental Hygiene
THE COLLEGE OF DENTAL HYGIENISTS
of Ontario (CDHO) has informed RCDSO that Ms. Elena
Stancu has held herself out to be a dental hygienist and performed controlled acts without being registered with CDHO.
She had told her employer she was a registered paradental
practitioner. In June 2002, a judge of the Ontario Court ruled
that Ms. Stancu has breached provisions of the Dental
Hygiene Act, 1991, and the Regulated Health Professions Act,
1991. The judge ordered her to refrain from any further
breaches of the law, and awarded CDHO costs of $10,000.
The CDHO suggests that employers check with CDHO to
ensure that the individual that they propose to hire is registered as a dental hygienist in Ontario.
Ensuring Continued Trust
Dispatch • Jan/Feb 2003
25
Practice Check
How To Handle the
Release or
Transfer of Patient Records
The release of a patient’s dental charts or recent radiographs
cannot be contingent on the settlement of the patient’s account.
DENTISTS WHO ARE REQUESTED TO PROVIDE PATIENTS OR OTHERS WITH RECORDS
AND/OR RADIOGRAPHS ARE REQUIRED BY LAW TO COMPLY WITH THIS REQUEST IN
ORDER THAT ALL PATIENTS MAY HAVE THE BENEFIT OF CONTINUITY OF CARE.
The records may be necessary for the
transfer of a patient to the care of
another dentist, for the referral to a specialist, or for legal reasons.
Dental records belong to the dentist,
and, in the case of an adult, must be
kept for at least 10 years after the last
entry. However, patients do have the
right to examine and copy information
from their own records, or to have
copies of pertinent portions of their
records provided to them directly, or
sent to another practitioner.
Information usually required by a
patient’s new dentist would include:
26
Dispatch • Jan/Feb 2003
• A summary of all information relevant to the patient’s ongoing treatment plan i.e. clinical notes plus information obtained from other practitioners.
• Copies of the most recent full mouth
series or panoramic film, and any
other radiographs taken within the
last 24 months.
If a patient, or their authorized representative, requests all the information
in the patient’s record, they are entitled
to copies of everything, even if the
request does not appear to be relevant
to the patient’s ongoing care.
Ensuring Continued Trust
A dentist’s responsibilities with respect
to an associate or partnership relationship are the same as outlined above. The
dentist must ensure that patient care is
not compromised due to a breakdown
in a principal/associate relationship.
Patient Consent Required
Dentists have the responsibility to keep
in confidence any information those
patients or their colleagues may have
divulged, unless the patient or their
authorized representative, such as their
lawyer, has given permission to the
dentist to impart this information.
Practice Check
This consent can either be in writing
in the form of a patient release, or other
correspondence. This consent may also
be provided verbally directly from the
patient. When it is verbal, the consent
should be recorded in the patient’s
record.
Compensation
Dentists are permitted to ask for outof-pocket expenses for copying patient
records and radiographs. But the dentist cannot charge an hourly rate or fee
to put together the information requested. Depending on the reason for
the patient transfer, as a goodwill gesture it might be advisable to absorb the
costs incurred.
In the case where there is a delinquent account, the dentist is still required to prepare and transfer records on
request. Other avenues of settling overdue accounts must be pursued.
Release of Dental Records for
Missing/Deceased Persons
Release of patient records without the
consent of the personal representative
of the deceased would constitute professional misconduct, unless the dentist is required to do so by law.
Dentists should request that the
police provide either a search warrant
issued by a justice of the peace, or a
coroner’s warrant in order to obtain
dental records for an investigation.
Dental-Legal Reports
A dentist should expect that a lawyer
would pay the professional fee for the
preparation of a dental-legal report.
The fee is usually based on the amount
the dentist would earn per hour, on
average, in his or her usual practice. The
dentist should be prepared to disclose,
upon request, the hourly rate or fee
that he or she will charge for the document preparation.
If you have any questions about this
article, please contact Dr. Bob Carroll,
Manager of Professional Practice at
416-934-5611, toll free at 1-800-5654591, or by e-mail at rcarroll@rcdso.org.
Supreme Court Of Canada Decision on Patient Records
In June 1992, the Supreme Court of
Canada delivered a unanimous judgment in McInerney v. MacDonald, a
case involving confidentiality of
health-care records.
Although the case involved a physician’s records, there is no reason to
believe that the court would make a
different finding in the case of a dentist’s records.
The court considered two questions:
1. Are the treatment records prepared
by a practitioner the property of
that practitioner, or are they the
property of the patient?
The court found that “the physician, institution or clinic compiling
the medical records owns the physical records.”
2. Does the patient have a right to
examine and obtain copies of all
documents in the record?
The court found that, because of
the patient’s vital interest in the infor-
mation contained in the records, the
patient has right to inspect the
records, and to obtain copies of the
records.
Practitioners may be able to refuse
access to records if “there is a significant likelihood of a substantial
adverse effect on the physical, mental
or emotional health of the patient, or
harm to a third party.” Although the
court did not give examples, this
argument has been used in the past
where the records concerned psychiatric treatment of the patient.
The court also held that the patient
is entitled to examine and copy the
records, provided the patient pays a
legitimate fee for the preparation and
reproduction of the information.
The court also held specifically that
the practitioner must disclose not
only records made by the practitioner, but also information obtained
from other practitioners.
Patient Records Cannot Be Held As Ransom for Account Collection
A
s the College’s Guidelines on the release and transfer of patient
records outline: “Since patients have the right of access to or a copy of
their complete patient dental record, dentists are required to follow the
direction of a patient and provide copies of what the patient has requested.”
As the Complaints Committee has reminded members in the past, a
patient’s records are not to be held as ransom for the collection of
accounts. The regulations under the Regulated Health Professions Act, and
the College Guidelines require that members transfer records upon the
receipt of a written direction signed by the patient so that continued
patient care is not compromised or delayed.
The College Guidelines on the release and transfer of patient records is
available on the College Web site at www.rcdo.org, or you can order a free
copy by calling Aurore Sutton, Communications Assistant at 416961-6555, ext. 4303, toll free at 1-800-565-4591, or by e-mail at
asutton@rcdso.org.
Ensuring Continued Trust
Dispatch • Jan/Feb 2003
27
Practice Check
Dental Treatment for Patients with
Pacemakers &
Implantable
Cardioverter
Defibrillators
OVER THE YEARS, SOME CONCERNS HAVE BEEN RAISED ABOUT DENTAL TREATMENT
FOR PATIENTS WHO HAVE PACEMAKERS OR IMPLANTABLE CARDIOVERTER DEFIBRILLATORS (ICD). MUCH OF THESE CONCERNS ARE UNFOUNDED AND BASED ON ERRONEOUS INFORMATION. THE TWO MAIN AREAS OF CONCERN ARE: 1) REQUIREMENTS FOR
PROPHYLACTIC ANTIBIOTIC COVERAGE FOR DENTAL TREATMENT, AND 2) INTERFERENCE THAT EQUIPMENT IN A DENTAL OFFICE CAN HAVE ON THE FUNCTION OF A PACEMAKER OR AN ICD.
Prophylactic Antibiotic Coverage
The American Heart Association does
not feel that antibiotics are necessary
for patients with pacemakers or ICDs.
A cardiologist may wish to recommend
antibiotics if the device has been
implanted within the last few months
before the dental treatment date, or if
there are any other heart conditions
that may recommend the use of pretreatment antibiotics. It would be prudent for dentists to check with the
patient’s cardiologist if the device has
been implanted within the last six
28
Dispatch • Jan/Feb 2003
months, or if other heart problems
exist.
Interference with Function
A pacing system consists of a generator
that will produce an electric impulse
that is transmitted by a lead. This lead
is in contact with heart tissue and its
signal assists in producing regular
heartbeats. This electrical message can
be interfered with by electric or magnetic fields called electromagnetic
interference (EMI). Electric motors and
equipment can generate EMI. Since
Ensuring Continued Trust
some types of dental equipment can
produce EMI, dentists are naturally
concerned when treating patients with
pacemakers and ICDs.
For the last 15 years, this problem
has almost been eliminated by the fact
that the implantable devices have been
made with filtering systems designed
to block EMI from reaching the sensor
of the device. Therefore, almost all
patients today do not need to worry
about dental equipment causing this
effect. However, in some cases with
some patients who may be quite frag-
Practice Check
ile, it is prudent to be cautious.
A patient’s device identification card
can provide the model number and the
manufacturer of their device. With this
information, the patient’s dentist can
investigate if their device has an adequate filtering system. As stated above,
it is unlikely that any device less than
15 years old will not have an adequate
filtering system.
The following is a list of the dental
equipment often identified as a potential problem and the actual effects on a
pacemaker or ICD.
Dental x-rays
Dental x-rays taken on the patient will
not affect an implanted pacemaker or
ICD. The energy density of an x-ray is
not sufficient to interfere with the
device or cause damage.
Ultrasonic equipment for cleaning
instruments
The equipment generally operates in
the 50-500 watt output range. Tests
have indicated safety up to 1000 watts
as it relates to the effect on implanted
devices. Also, research indicates a
patient’s device would have to be 30
cm from the machine in order to have
an effect. This set of circumstances
would not be likely to happen in a dental office unless the machine was very
much larger than normal, and the
patient was positioned with their
device 30 cm from the operating
machine.
Ultrasonic dental scalers
These machines have typical power
outputs of 30 watts and operate at 25
kHz. This energy level will not affect
the pacemakers and ICDs made in the
last 15 years in any significant amount
due to the filtering mentioned earlier
in this article. The ultrasonic machines
must be properly grounded in order to
prevent conducted current leakage
from the handle of the cleaner. Dentists
would be aware of this problem, as all
patients would report small shocks
when the machine was used. Therefore,
it should not be a concern.
One study* did report a small impact
if the scaler was closer than 37cm from
the implanted device. For those
patients with very fragile conditions, a
dentist may wish to consult the
patient’s cardiologist regarding this
minor effect.
Pulp testers
The current flow and direction of a
pulp tester is not of sufficient strength
to cause any problems.
Electronic apex locators
For most patients the current flow will
not be a problem. However, it would
be wise to check with the patient’s cardiologist prior to using this instrument
as it could have negative consequences
to very sensitive patients.
Dental drills, chairs, mixers
Use of dental drills, chairs, mixers, etc.
will not affect pulse generators. The
motors are small and do not radiate sufficient EMI to affect the pulse generator.
Similar to the ultrasonic scaler, a faulty
electrical grounding could conduct current into the body if in direct contact.
Amounts that were less than those sufficient to produce a mild shock would
not cause any effect. If a shock was experienced the effect could be to switch the
device from the demand mode to the
fixed rate mode. The danger of this effect
is minimized for two reasons. First, the
shock the patient experienced would
signal the dentist or dental hygienist to
discontinue the use of the machine.
Once the use was stopped, the device
would likely return to the correct mode.
Second, most modern devices allow the
patient to take corrective action to vary
their device.
Electrosurgery equipment
This equipment represents the most
likely cause of a problem, and caution
Ensuring Continued Trust
should be exercised. A dentist might
consider alternatives to electrosurgery
and electrocautery. However, with
appropriate precautions this equipment can be used. A dentist should
have sufficient training in the use of
this equipment with pacemaker and
ICD patients to make him or her quite
comfortable with its use in these circumstances. Dentists should be familiar with the appropriate placement of
electrodes in these circumstances, and
whether or not it is required or safe to
suspend the detection function of an
ICD during the procedure.
If you have any questions about this
article, please contact Dr. Bob Carroll,
Manager of Professional Practice at 416934-5611, toll free at 1-800-565-4591,
or by e-mail at rcarroll@rcdso.org.
SUMMARY
1. antibiotic coverage
- not necessary
2. ultrasonic scaler and apex
locators
- OK for most patients but a
minor concern in very
fragile patient
3. electrosurgical instrument
- significant concern
- discuss all issues with
cardiologist including
risk/benefit ratio.
4. all other dental equipment
- OK
5. Dentists and patients should
not be apprehensive in
seeking or receiving dental
treatment.
* Journal of Oral Surgery, Oral Medicine and
Oral Pathology, January 1998
Dispatch • Jan/Feb 2003
29
Dental Ethics 101 - Case Study
Crank
it
up!
Patient Seeks a High From Nitrous
“
”
Oxide-Oxygen Conscious Sedation
Alan Norris is a 35-year-old advertising salesman for a local
company who came to your general practice because a coworker said that you were painless and used laughing gas.
You first saw Alan three months ago as an emergency
patient with a pericoronitis associated with a partially erupted mandibular third molar. His medical history and vital
signs were unremarkable. His dental history included several
painful experiences as a child, which made him afraid of the
dentist. He also admits to using recreational drugs, especially
marijuana, in college, although he didn’t inhale. All of his
dentists used the “gas,” and he added, “this is the only way I
can tolerate dental drilling.”
1. Continue to treat Mr. Norris using nitrous oxide-oxygen
conscious sedation.
2. Continue to treat Mr. Norris using nitrous oxide-oxygen
conscious sedation, but lower the dosage during the
appointment.
3. Discuss your concerns with Mr. Norris and attempt to
determine if he is a substance abuser. If he denies being an
abuser, proceed with #1 or #2.
4. Discuss your concerns with Mr. Norris, and if he admits to
being an abuser, insist that he seek out professional counselling before you resume treatment using nitrous oxideoxygen conscious sedation.
You used nitrous oxide-oxygen conscious sedation during
the surgical extraction and his restorative appointments. This
is his third appointment, and you are concerned that his
need for gas was more for pleasure than the avoidance of
pain. He inhales deeply during the appointments and asks
you to crank it up. He even told your assistant in confidence,
“this gas is great, it really gives me a high.”
(Printed with the permission of Dr. Thomas K. Hasegawa, Baylor College of
Dentistry, Dallas, Texas.)
You are now faced with an ethical dilemma. Circle the
course(s) of action that you would follow.
Now turn to page 42 to find the case study discussion of
this ethical dilemma.
30
Dispatch • Jan/Feb 2003
5. Discontinue treating Mr. Norris.
6. Consider another alternative.
Ensuring Continued Trust
New Brochure for Public
Explains Complaint Process
Ensuring public trust is one of the
profession’s highest priorities.
THE COLLEGE’S PHILOSOPHY OF WORKING THROUGH A
RESPONSIVE AND RESPECTED PROCESS PERCEIVED
AS FAIR BY BOTH THE DENTAL PROFESSION AND THE
PUBLIC IS THE KEY MESSAGE OF A NEW BROCHURE
FROM THE COLLEGE THAT EXPLAINS THE COMPLAINT
PROCESS TO THE PUBLIC.
The copy on the front cover of the brochure encourages patients to discuss any
problems with their dentist. As the brochure copy explains, patients must be
able to put their trust in dentists, and dentists themselves rank this as one of the
profession’s highest priorities. In fact, the College is totally funded by the dues
paid by each dentist in the province.
Commonly asked questions such as how to make a complaint, time limit for
filing a complaint, and the appeal process are covered. The College’s successful
alternate dispute resolution program is also explained in detail.
Copies of this brochure are available free-of-charge from the College by calling Aurore Sutton, Communications Assistant at 416-961-6555, ext. 4303, toll
free at 1-800-565-4591, or by e-mail at asutton@rcdso.org. The brochure is also
on-line on our Web site at www.rcdso.org.
College Publication Turns Into
Best Seller
OUR GUIDE FOR ONTARIO DENTISTS AND PATIENTS ON
MEDICAL HISTORY RECORDKEEPING HAS TURNED INTO A
BEST SELLER.
A number of community colleges in
the province have asked for copies to use
the guide as a teaching tool in programs
for both dental assistants and dental
hygiene students. To date requests have
come in from Niagara College,
Confederation College, Cambrian
College and Conestoga College.
Other regulatory authorities across
Canada, such as Prince Edward Island,
have asked for copies to share with
their registrants. Alberta is considering
circulation of a copy to every dentist in
the province (at their cost). Another
province is hoping to use our Guide as
a model for development of one of
their own.
And, as you can see if you turn to our
Mailbag section, the value of the Guide
has not escaped the notice of an
Ontario cabinet minister.
The guide is the culmination of an
enormous amount of work by the
Quality Assurance Committee, College
Ensuring Continued Trust
staff
and experts
in the field who
kindly volunteered their
time to work on the project.
Dispatch • Jan/Feb 2003
31
On Appeal
When the Complaints Committee issues a decision, 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 self-governing regulatory agencies of the 23 regulated health professions.
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.
If you would like a full version of any of these decisions, you can either contact the Board
directly at 416-327-8515, or call the College’s Petula Widyaratne, Co-ordinator, Complaints at
416-961-6555, ext. 5311, toll free at 1-800-565-4591, or by e-mail at pwidyaratne@rcdso.org.
CASE 1
The Complaint
The patient complained to the College
about his care and treatment when he
attended as an emergency patient. The
patient had an existing cervical spine
disease that he advised prohibited him
from sitting for longer than one hour.
The treatment, however, extended
beyond the one hour. The complainant
alleged that the member, a new graduate, lacked experience and caused undue
suffering. The complainant also refused
to pay the balance of fees owing.
Complaints Committee
The Complaints Committee decided to
caution the member in writing because
it appeared from the investigation that
the member did not take into account
the cervical spine disease in determining the length of treatment, and misrepresented himself as someone who
was experienced.
Health Professions Appeal and
Review Board
The patient was dissatisfied and
appealed to the Board.
The Board found that the investigation
was adequate, but ordered the Committee to remove the caution. The Board
reviewed the medical record and noted
that it was very thorough and nowhere
on the record was there any reference to
32
Dispatch • Jan/Feb 2003
any cervical spine condition.
There was also no reference to medication, and therefore the Board was of
the view that the member could only
go by the information that was made
available to him by the patient. The
Board also accepted the member’s
observation and judgement that the
work that was required was endodontic
work could not be done in an one hour
sitting.
CASE 2
The Complaint
The patient complained to the College
about the care of his late aunt, alleging
that the member had avoided communicating with him about the cost of her
replacement denture, and that the
denture prepared did not fit.
The College’s investigation revealed
that there were several pieces of correspondence from the member to the
complainant. The member offered to
treat the patient until the denture felt
comfortable. While no dentist fee was
being charged, the member advised
that there would be a reimbursement
cost to the denturist.
Complaints Committee
The Committee engaged the services of
an expert who advised that the achievement of a satisfactory balance between
the comfort and the retention of the
Ensuring Continued Trust
denture could be most challenging. In
this case, it appeared that the patient
was less than co-operative because the
patient did not attend the appointments booked. The Committee therefore ordered no further action.
Health Professions Appeal and
Review Board
The patient was dissatisfied and
appealed to the Board.
The Board reviewed the investigation
of the College including the expert’s
report and confirmed the Committee’s
decision. The complainant tried to seek
an order from the Board requiring the
College to provide money. The Board
stated that it had no jurisdiction over
money awards, nor did the Complaints
Committee. Any matter of financial
recovery is for the civil courts.
CASE 3
The Complaint
The patient was insured and dental
insurance was afforded the patient. The
carrier complained to the College that
the member was either charging for
services not rendered, or was providing
inappropriate treatment because, for a
period of three years, the member had
billed six procedures for flap surgery
and six procedures for surgical curettage when on several occasions the
patient had received root planing by a
On Appeal
periodontist. The insurer’s letter of
complaint stated that in its view it was
“...unusual to see a pattern of root planing from a periodontist and a periodontal surgery from a general practitioner.” The member in question was a
general practitioner.
The College’s investigation revealed
that, in fact, work charged by the periodontist was done by the periodontist,
and the work charged for by the member was done by the member. The
patient was very satisfied with the
member’s work.
Complaints Committee
The Committee was not pleased with
poor records of periodontal examination and charting by the member. The
Committee wished to determine
whether or not there was sufficient evidence to refer to Discipline, and asked
the Registrar for an opinion. The
Registrar reviewed the file and advised
the Committee that it was doubtful
whether there was sufficient evidence
to prove the case. He also added, and
commented to the Committee, that
they might wish to take into account
that there was a satisfied patient.
The Committee saw fit to take the
Registrar’s advice, and did not refer
specified allegations to Discipline but
asked the member to attend for an oral
caution.
Health Professions Appeal and
Review Board
The insurance company was dissatisfied and appealed to the Board. In particular, the insurance company felt that
the Registrar’s involvement in advising
the Committee as to the evidentiary
basis for proof of discipline should not
have been given consideration. Also,
the insurance company was of the view
that a more thorough investigation
might have, in fact, produced that
proof.
The Board reviewed in detail the
investigation of the College and found
that it was adequate. It stated that: “The
Board is satisfied that all reasonably
available and relevant information had
been acquired by the Committee. The
Committee has no powers to compel
individuals, such as the patient, to cooperate with the Committee or to provide information to it”... when the
patient is not the complainant. The
Committee went on to say that an
investigation did not need to be
exhaustive in order to satisfy the Board
that it is adequate.
The Board commented on the
Registrar’s involvement. The Board
noted that the Registrar was involved
only at the request of the Committee,
and only to assist the Committee
because it had doubts as to the adequacy of the evidence available to prove
the case. “In view of these doubts, it
was appropriate for the Committee to
seek advice and guidance on this point,
and it did so by obtaining the opinion
of the College Registrar.... The
Registrar’s opinion confirmed the concerns of the Committee.”
The Board therefore confirmed the
decision of the Complaints Committee.
[Editor’s Note: The proposed amendments to the Regulated Health Professions Act (RHPA) made by this
College requires the Complaints Committee to satisfy itself that any case
which the Committee wishes to refer to
Discipline must be provable. This was
part of the College’s own submission
during the RHPA review.]
CASE 4
The Complaint
The patient complained to the College
because the member, a general dentist,
did some orthodontic work. The
patient reported tenderness. After an xray was taken, which the member
noted presented severed internal
resorption, several teeth were extracted.
The patient was aware that the member
was not an orthodontist. The patient
subsequently attended before a periodontist for a periodontal evaluation,
and it was noted that there were serious
Ensuring Continued Trust
periodontal problems
affecting numerous
teeth.
Complaints Committee
The Committee noted that the crown
and bridge work on teeth 47 and 26
was attempted with insufficient biological width to hope to have successful
crown margins established. The panel
believed that the member failed to
diagnose ongoing periodontal potential problems for this patient, and further, there was a lack of full mouth xrays prior to the orthodontic treatment.
The member agreed to enter into a
written undertaking with the College
in which he agreed to successfully complete courses approved by the Registrar
in periodontics related to diagnosis
and treatment planning, including
cases which involve orthodontic and
crown and bridge services; and also a
hands-on course approved by the
Registrar in these areas. In addition the
undertaking restricted the member
from initiating any orthodontic treatment without having first completed
the courses, and then having his practice monitored at his own expense by
an orthodontist approved by the
Registrar.
The Committee was of the view that
the issues of concern which had been
detected in its review of the case would
all be addressed by the courses required
by the undertaking.
Health Professions Appeal and
Review Board
The patient was dissatisfied and
appealed to the Board.
The Board was of the view that the
remedial action was required and this
led to the undertaking, and the remedial action was reasonable, and that the
public interest was suitably protected
via that vehicle. In the event the member breached the undertaking, it could
result in a referral to the College’s
Discipline Committee. The Board
therefore supported and upheld the
Complaints Committee’s decision.
Dispatch • Jan/Feb 2003
33
Ounce of Prevention
Risk Management Advice from PLP
This feature in Dispatch has been prepared by the College’s Professional Liability
Program (PLP) to offer guidance to members regarding the prevention of malpractice claims,
or the minimization of the magnitude of an existing claim.
The Perils of
Late Reporting
PLP staff appreciates the anxiety created when a patient gives an indication,
either orally or in writing, that there is
some dissatisfaction with the treatment outcomes, and that a demand for
compensation and/or refund may be
made. If this situation arises, let PLP
help you. We are as close as your telephone.
had performed negligent extractions,
improper root canal treatment and had
placed an ill-fitting bridge. The patient
demanded compensation. Dr. Laite
responded to the patient, indicating
that he would consider paying an
amount of $2,000. Dr. Laite did not
report the matter to PLP, nor did he
obtain a release from the patient.
Timely reporting not only preserves a
dentist’s right to coverage, but it also
can result in matters being resolved on
a mutually satisfactory basis for you
and your patient. Conversely, failure to
report a potential claim can result in a
denial of coverage. Most times PLP is
able to convince the insurers that their
position has not been prejudiced by a
dentist’s failure to give notice of a
potential claim; however, rarely, coverage has been denied.
Over the next 2 1/2 years, the patient
wrote four more letters. During that
time, all members of the College
received notice that there was to be a
change of malpractice insurers.
Members were informed that it was
imperative that they give notice to PLP
of any instances that could reasonably
be expected to give rise to an insurance
claim, no matter how insignificant
they might be. Members were further
advised that failure to do so before a
specified date might result in the claim
being uninsured. Dr. Laite still did not
report this matter.
Case 1
Dr. Laite, a general dentist, treated a
patient over a period of five years.
During that time he performed extractions, root canal treatment and restorative treatment and placed a bridge. The
patient subsequently moved and, soon
after, developed dental problems. She
wrote a letter to Dr. Laite alleging he
34
Dispatch • Jan/Feb 2003
After receipt of the fifth letter from
the patient, Dr. Laite increased his offer
of payment to the patient to $4,000
and, shortly thereafter, contacted PLP.
Ensuring Continued Trust
Discussion
PLP informed Dr. Laite that it was possible the malpractice insurer would
deny coverage due to the late reporting.
Following deliberation, the insurer
denied coverage because a) Dr. Laite
delayed in reporting the claim to PLP,
b) the claim arose before the policy
was in force, and c) his actions were
considered to have prejudiced the
underwriter’s ability to defend the matter. PLP advised Dr. Laite that, if he had
not already done so, he should retain
defence counsel immediately.
We wish we could tell you that everything turned out well for the member,
but we simply do not know. This sort
of situation is most distressing to PLP
staff, as it surely must have been to the
member. Unfortunately, in this case,
there was no argument to be made. The
failure to report was simply insurmountable.
Case 2
Dr. Slowe, a general dentist, treated a
patient for 14 years. The patient moved
and presented to a new dentist who
informed her that a crown, recently
inserted by Dr. Slowe, was faulty and
Ounce of Prevention
required replacement. The patient then
demanded a refund of fees paid to Dr.
Slowe for the crown. Without prior
advice from PLP, Dr. Slowe provided
the refund.
Six months later, the patient advised
Dr. Slowe she had seen a specialist who
had prepared a treatment plan for follow-up dental reparative work,
totalling $25,000. Dr. Slowe refused
the patient’s demand for more money.
Six months later, Dr. Slowe received a
letter from the patient’s lawyer, notifying her that the patient intended to file
a claim for damages. Dr. Slowe then
contacted PLP. A Statement of Claim
was subsequently served, alleging
supervised neglect and demanding
$250,000 compensation for pain and
suffering.
Discussion
The malpractice insurer agreed to
investigate and defend this claim subject to a reservation of its rights under
the Notice of Occurrence or Claim and
Co-operative Provisions in the policy.
Notice of Occurrence or Claim refers
to a general condition of the policy,
which states that: “Upon the (member) becoming aware of any occurrence which might reasonably be
expected to be the basis of a claim covered herein, WRITTEN NOTICE
SHALL BE GIVEN by or on behalf of
the (member) to the Adjuster.”
Co-operative Provisions refers to a
general condition of the policy,
which states that: “The (member)
shall not, except at his own cost,
voluntarily make any payment,
assume any obligation or incur
any expense.”
PLP POINTERS
You should call PLP when:
• You receive a call or letter from a patient or patient’s representative seeking
compensation.
• You are served with a legal action.
• You rendered treatment to a patient where the result is adverse and not
consistent with the anticipated outcome.
• Your patient is unhappy with and complaining about the treatment rendered.
• You are unsure whether or not to call - if in doubt, call PLP. There is no
downside to doing so.
In Order to Protect Your
Right to Coverage
Notify PLP immediately if your patient wants or might want money. Do not take
any steps that may jeopardize your right to coverage.
Phone: 416-934-5600
Toll free: 1-877-817-3757
E-mail: PLP@rcdso.org
Dr. Slowe breached each of these
provisions of the policy. First, she did
not notify PLP at the outset of the claimant’s dissatisfaction with treatment and
demand for a refund. Second, Dr.
Slowe failed to obtain PLP’s input,
including both assistance in drafting
a letter to the claimant, and a release
for the claimant to sign, before making
the refund.
PLP eventually convinced the malpractice insurer that, although Dr.
Slowe should have reported the matter
when she was first aware of the potential claim, neither her failure to do so,
nor her refund with respect to the
crown had prejudiced its position.
Ensuring Continued Trust
Coverage was afforded and PLP was
able to settle the claim. The refund
made without the prior knowledge of
PLP did not serve to reduce the
deductible applicable under the policy.
If you have questions about how to
handle a particular situation with a
patient, call PLP and one of our Claims
Examiners will be happy to assist you.
If you have questions or comments
about this article, contact Dr. Judi
Purvs, Dental Claims Advisor at 416934-5600, ext. 3103, toll free at 1-877817-3757.
Dispatch • Jan/Feb 2003
35
Complaints Corner
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 edited versions 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. If you
have any questions about any of these scenarios, please contact the College’s Registrar Irwin Fefergrad
at 416-934-5625, toll free at 1-800-565-4591, or by e-mail at ifefergrad@rcdso.org.
THEME: INFORMED CONSENT
TO TREATMENT
Case 1
The patient complained that there had
been no mention of potential risks
prior to the extraction of two wisdom
teeth by an oral & maxillofacial surgeon. He subsequently suffered what
he described as vicious hiccupping for
three days.
The Complaints Committee was satisfied that the patient records supported the member’s position that at two
prior consultation appointments, he
had discussed potential complications.
As well, the patient signed an informed
consent document.
The Committee understood that
dentists must inform patients of material risks or potential complications of
treatment.
“
To the panel, this is indicated where
there is at least the possibility of a
known risk occurring and where the
known risk carries significant health
consequences - that is, it can pose a
threat to the patient’s life, health or
comfort - and such relevant factors as
the patient’s age, medical history and
medications are taken into account. In
the panel’s opinion, while hiccuping
may be a known side-effect of Valium,
and may be a significant consequence,
the probability of such an event is
remote and it is impossible for a practitioner to anticipate every eventuality.
36
”
Dispatch • Jan/Feb 2003
No action was taken against the
member.
See the table at the end of this article
for details on the probability of material risks.
Case 2
The patient alleged that an oral & maxillofacial surgeon did not caution her
about the nerve damage that could
occur from removal of a painful
swollen lesion in the lower left cheek.
The member’s records included a
signed consent form.
The Complaints Committee
obtained an opinion from an expert in
oral & maxillofacial surgery who examined the patient. In the expert’s opinion, the probability of permanent neurological damage from such a procedure in the location concerned was
remote. The expert believed that the
residual paraesthesia did not follow
the pattern normally seen for an injury
to the left mental nerve, and it was the
result of unforeseen peculiarities specific to the case. In the expert’s opinion,
the standard of care was followed.
The Committee took no action
against the member.
Case 3
The patient alleged that she was not
told of possible risks or complications
of removal of her partially impacted
wisdom teeth. The procedure was difficult and she was referred to an oral &
maxillofacial surgeon for its completion. She suffered permanent nerve
damage in the area.
The member said he explained that
Ensuring Continued Trust
there was a low risk of complications,
including paraesthesia. While he had
to take great care because the roots of
tooth 48 were in intimate association
with the inferior alveolar nerve, he had
never had a case of permanent paraesthesia in his many years of experience
with extractions.
The Complaints Committee
obtained an opinion from an expert in
oral & maxillofacial surgery. The expert
stated that there was no doubt that this
patient was at risk for nerve injury, but
the member “shows a woeful disregard
for the literature and as a result has seriously underestimated the risks, whatever his own anecdotal experience.”
The expert concluded that “the explanations prior to obtaining consent
were inadequate.”
The Committee required the member to attend for an oral caution.
Case 4
The patient complained that she did
not sign a consent form prior to a gingival graft procedure and was not properly informed of the risks. She said the
graft was unsuccessful and resulted in a
life-threatening infection.
The member maintained that he
thoroughly discussed the proposed
treatment, including options and risks,
three times with the patient, once with
her physician husband present. She
declined to sign the consent form at
the first appointment and staff forgot
to give it to her again.
In the Complaints Committee’s view,
“proper informed consent is not conditional solely on a written consent ... For
Complaints Corner
Material Risks
All health procedures bear some risk of
adverse effects. However, as the panel
said in Case 1, a practitioner cannot
risks that may be encountered.
And how are conflicting studies or ranges of probabilities to be interpreted? The following table attempts to be a more realistic
guide, albeit very generalized. The
main criteria are the probability of the
risk occurring and the seriousness of
the consequences of the risk. Dentists
should also take account of such factors as the patient’s age, medical history, and medications.
Medium/Significant
High/Serious/Grave
Probability of Serious Consequences Occurring
Low/Mild/Common/Obvious
Helpful Suggestions
The theme of consent to treatment was
explored in the Complaints Corner in
the Oct/Nov 2002 issue of Dispatch.
However, consent alone is not enough.
The patient must be given all the information necessary to enable a reasonable person in his/her circumstances to
make an informed decision about the
proposed treatment.
The cases above are samples of those
involving informed consent that come
before the Complaints Committee.
The subject can be challenging. This
topic was thoroughly and clearly discussed by Eleanore Cronk in an authoritative and comprehensive article commissioned by RCDSO on the subject
called Informed Consent in 2001:
Don’t Leave the Office Without It. It
was included as an insert with the June
2001 issue of Dispatch. It is available on
the College Web site at www.rcdso.org
by clicking on expert articles. Or you
can call us to request a free copy of the
article.
However, it is helpful in this Complaints Corner to highlight just one
aspect of this theme — material risks.
anticipate every eventuality. Material
risks are those that must be disclosed to
a patient. Some writers have defined
material risk as any significant risk with
a 1% chance of occurring. So, for example, studies indicate a 0.2-1.4% chance
of permanent paraesthesia from third
molar extraction, and an approximately 30% chance of temporary paraesthesia. While this is a useful yardstick, the
courts have not been so quantitative.
Neither will research conveniently provide statistical probabilities for all the
Seriousness of Consequences
example, a standard pro forma consent
form signed by a patient is merely evidence of some discussion. Confirmation that the discussion was full and
complete, that there was disclosure of
all necessary information, and that the
patient understood the nature of the
information must be established by
other means, such as individualized letters, notes, patient chart notations and
statements by others.”
The Committee believed that the
member’s position was amply supported by his patient records and by two
members of his staff. The Committee
noted that the family dentist had also
explained the procedure in detail. The
Committee was satisfied that the member obtained the patient’s informed
consent to the graft surgery and took
no action against the member.
Known risk of
High Probability:
Common or Likely
Known risk of
Medium-Low
Probability:
Possible but Remote
No known risk:
Probability Nil,
Negligible or
Speculative
DISCLOSE RISK
e.g. disfigurement from
orthognathic surgery;
permanent disability
from TMD surgery
DISCLOSE RISK
e.g. permanent
paraesthesia from
routine 3rd molar
extraction or lower
posterior implant or
mandibular block; death
from GA
DISCLOSURE
NOT REQUIRED
e.g. death from LA;
stroke from scaling;
hearing loss from root
planing
DISCLOSE RISK
e.g. infection from
surgery; RCT from deep
filling; temp
paraesthesia from 3rd
molar extn; failure of
endo treatment
DISCLOSE RISK
for cosmetic/elective
treatment e.g.
debonding of veneers;
sensitivity after
composites
DISCLOSURE
NOT REQUIRED
e.g. temp paraesthesia
from scaling; lockjaw
from RCT
DISCLOSURE
NOT REQUIRED
for necessary treatment
e.g. RCT after shallow
fillings
DISCLOSE RISK
for cosmetic/elective trt
DISCLOSURE
NOT REQUIRED
for necessary treatment,
e.g. bleeding, soreness
from cut tissue
DISCLOSURE
NOT REQUIRED
e.g. sore gums from
radiographs; tissue
damage from drilling
Ensuring Continued Trust
DISCLOSURE
NOT REQUIRED
e.g. eye strain from
overhead lamp; back
strain from dental chair
Dispatch • Jan/Feb 2003
37
Mailbag
We want to hear from you.We welcome your feedback on anything you read in Dispatch, or about any of the
College’s policies, programs and activities.
Some letters or excerpts printed may not contain the name of the author due to the confidential nature of the
original correspondence. In all the letters printed in Mailbag, the author has given his/her permission for its use.The College
reserves the right to edit letters for length and clarity. Due to space limitations, all letters may not be printed.
Please send your letters by:
Surface mail:
Mailbag
RCDSO
6 Crescent Road
Toronto, ON M4W 1T1
Positive Feedback for ADR Process
I thought you might appreciate some feedback on the recently concluded College-sponsored ADR mediation.
I believe that it is a productive use of College resources to
sponsor the mediation of disputes between members for reasons which lawyers well know, and need not be recited here.
I must tell you how impressed I was with the College staff
person assigned to the case. He had a complete grasp of the
issues, he had thoroughly reviewed and knew the material,
he understood the dental aspects and, most surprising to me,
he had a tremendous grasp of the accounting issues that had
to be resolved. I firmly believe that his input was critical to
having the matter resolved.
It is highly commendable that the College is offering ADR
to its members, and I believe that the College is, once again,
a leader in the profession for doing so.
(name withheld on request)
Praise for PLP
I found the Dentistry 101 for Lawyers presentation by Dr.
Judi Purvs very helpful. I came back to the office and drafted
a defence with a much clearer picture of the issues (and the
plaintiff’s teeth) in my mind. Thank you!
Elizabeth Kerr
Barrister and Solicitor
Brunner and Lundy
Fax:
416-961-5814
E-mail:
pmace@rcdso.org
Thank you for the support of the Toronto General Hospital
dental clinic through the press last month. Every bit helps.
Dr. Daniel Omura
Ontario Society of Oral Maxillofacial Surgeons
Reaffirming My Belief in the Fairness of the College
I just received the latest issue of Dispatch and came across
the Letters of Apology section and saw the write-up about a
dentist in my community. When that dentist’s newspaper
advertisements on TMJ and learning disabilities first
appeared, many patients, friends and colleagues questioned
me about the validity of the information. Many people were
left perplexed, or even outright enraged. I kept mentioning
that the RCDSO should be made aware of these publications. However, many of my dental colleagues would say,
“Ah, but they wouldn’t do anything about it.” So when I saw
the letter of apology I was very relieved. RCDSO did do
something about it, just as they should.
Thank you for reaffirming my belief that RCDSO has a fair
and just system, and is always on the lookout for the welfare
of the general public.
Dr. Montserrrat Bouvier
Ottawa
Thanks to the Complaints Committee
(Editor’s Note: From time to time PLP Dental Claims Advisor Dr. Judi
Purvs gives a Dentistry 101 seminar to lawyers who do work for the
Professional Liability Program so that they can better understand
dental issues and terminology.)
I received your letter dated October 23, 2002. I want to thank
you and all involved for your thorough investigation of my
complaint. I am satisfied with the effort put into the inquiry,
and therefore, I am happy with the panel’s decision.
Bahadeddin Ghotb
Toronto
Congrats to the Registrar and College Team
Feedback on Registrar’s Speaking Engagement
I want to congratulate you and your team on the recent issue
of Dispatch. The content is good as usual, but the look of it
as a publication is great. It just makes a person want to go
through it. It helps convey the fresh approach of openness
and approachability that you’ve brought to the RCDSO.
I am a dentist practising in London, Ontario. Let me say
thank you for your inspiring talk at our local dental society
last month. It is always a pleasure to hear you speak.
Dr. Barbara Barnard
London
38
Dispatch • Jan/Feb 2003
Ensuring Continued Trust
Mailbag
Handling Sexual Harassment In the Dental Office
I have practised in Ontario for 22 years, and eagerly digest all
information from the College, and dental associations. I
must congratulate you on what is without doubt the best
journal to cross my desk during that time. The information
was extremely well-organized, to the point, and timely.
In particular, the article on sexual harassment of dental
staff by a patient was of interest. We had a situation in our
office a few months ago that was handled a little differently,
but I feel was very professional, and protected the patient’s
confidential information. The staff member involved
informed me of the harassment, and she offered to write the
patient a very professional note stating that regulations prohibit relationships with patients, and that she was willing to
continue to take care of him in the office, but would not be
able to see him in any other manner. This was documented
in his chart, and the patient was very well behaved over subsequent visits. The patient was not aware that I was informed,
so he is comfortable returning to the office, not feeling that
the whole office is watching or gossiping about him.
Keep up the good work on Dispatch!
Dr. David Cornell
Brampton
shape the future of our College and our profession.
Dr. James Fawcett
Lindsay
Cabinet Minister Responds
I acknowledge and thank you for your recent letter and for
providing me with copies of your bi-monthly publication
Dispatch and your medical recordkeeping guide.
I am certain publications such as these will advance the
goals of the Royal College of Dental Surgeons of Ontario by
continuing to foster the trust of the public and dentists across
the province.
The Royal College of Dental Surgeons of Ontario continues to build on its reputation as a leader among regulatory
colleges in Canada, and initiatives such as your leadership
conference this past August demonstrate your commitment
to both the dentists of Ontario and the patients they care for.
Again, thank you for your letter and copies of your recent
publications.
Frank Klees, MPP
Minister of Tourism and Recreation
Gratitude for Scholarship
Leadership Role of the College
Congratulations once again on a marvellous presentation of
the Dispatch. You are to be congratulated for the upbeat,
informative and critical information that is being brought
forward on the many important issues challenging our profession.
You should indeed be proud of the two significant leadership conferences hosted by the College in the past few
months. Reading about them gives me much satisfaction
and pride to acknowledge that leadership role that our
College has been taking on these very vital issues. Your staff
and the members of Council have indeed been productive
and successful in carrying out the objectives of the legislation, and ensuring that the interests of the public are protected and enhanced. Well done.
I was also pleased to see the response of the College and
Dr. Eric Luks’ reply to the National Post article in regards to
the dentists and the issue of fraud and billing abuses. It was
offensive and troubling to me, especially the position reportedly taken by some of our members. I had written to the
Alumni Today some eighteen months ago on the subject
and, although the issue is always a concern, the vigilance of
the RCDSO, of necessity, must be forcefully brought forward
to the attention of the public and other professionals in support of the principles of self-regulation.
I most sincerely endorse the comments of Dr. Luks and his
reflections on the leadership provided by the Registrar of the
College. My congratulations and best wishes to you
[Registrar Irwin Fefergrad] and that you should continue to
It is with great gratitude and honour that I accept your generous donations, the Royal College of Dental Surgeons scholarship in basic sciences, and the James Branston Willmott
scholarship.
I intend to work hard to maintain my current academics
and continue to strive to become a contributing member of
society.
Again, thank you for your kind contribution.
David Cheng
Second Year Dentistry
University of Toronto
Impressed With Our Work
In my search to find a design firm to handle some of our
publications, I happened upon your impressive Web site and
annual report. Would you mind telling me the name of the
design firms that you used for these projects?
Tim Humphreys
Corporate Communications Advisor
Real Estate Council of Ontario
continued on page 44
Ensuring Continued Trust
Dispatch • Jan/Feb 2003
39
Are You Prepared for A
Medical Emergency?
THE ABILITY TO MANAGE MEDICAL EMERGENCIES IN THE
DENTAL OFFICE IS OF CRITICAL IMPORTANCE. WHILE
SYNCOPE IS THE MOST FREQUENTLY REPORTED EVENT,
IT HAS BEEN ESTIMATED THAT AN AVERAGE OF ONE
OTHER MEDICAL EMERGENCY WILL ARISE EVERY FOUR
YEARS IN THE TYPICAL GENERAL PRACTITIONER’S
OFFICE. WILL YOU BE PREPARED?
Preparing for a medical emergency
begins with prevention. Before initiating treatment, all necessary and relevant medical information should be
obtained in order to determine the
clearest indication of the patient’s
health status. Depending on the nature
and extent of the services contemplated, appropriate alterations to dental
treatments may be advisable to safely
manage the care of a medically compromised patient. In addition, key dental office staff - especially persons
directly involved with the delivery of
care to the patient - should have current certification in basic life support
(BLS), or cardiopulmonary resuscitation (CPR).
In the Winter 2000 issue of Dispatch,
the College provided recommendations to prepare for a medical emergency, including a list of six essential
drugs that should be readily available
in the emergency kit of every dental
office. However, it is not enough to
merely have these drugs available;
members must be prepared to use
them if necessary.
With this in mind, the advisory
board to PEAK is pleased to offer the
following article: Emergency Drugs,
from Dental Clinics of North America
(Volume 46, October 2002). The article
40
Dispatch • Jan/Feb 2003
plainly sets out the six essential drugs
that should be included in the office
emergency kit, and goes on to suggest
several supplementary drugs that
should be considered. It then reviews
the management of common emergencies that may be encountered in a
typical general practice, incorporating
the drugs discussed in the article.
Key points to consider:
• The most important aspect of nearly
all medical emergencies in the dental
office is to prevent or correct insufficient oxygenation of the brain and
heart.
• The management of a medical emergency starts with the assessment and,
if necessary, the treatment of the airway, breathing and circulation (the
ABCs of CPR). Only after the ABCs
are addressed should the use of
emergency drugs be considered.
• Six drugs should be readily available
in a dental office emergency kit. The
essential emergency drugs include
oxygen, epinephrine, nitroglycerin,
injectable diphenhydramine or
chlorpheniramine, salbutamol*
inhalation aerosol, and ASA
(aspirin).
• Dentists should know the indications and relevant doses for each of
the essential emergency drugs.
• Depending on the type of practice
Ensuring Continued Trust
conducted by the dentist, supplementary drugs should also be considered for the office emergency kit.
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 non-clinical 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, the PEAK advisory
board is committed in its desire to provide quality material to enhance the
knowledge and skills of member dentists.
If you have any suggestions for subjects to be addressed by PEAK, or questions about this membership service,
please contact Dr. Michael Gardner,
Assistant to the Registrar, Dental at 416934-5616, toll free at 1-800-565-4591,
or by e-mail at mgardner@rcdso.org.
* In the article, the list of essential
emergency drugs includes the drug
albuterol (Ventolin). Please note
that, in Canada, the generic name
for this drug is salbutamol.
We Need To Hear From You About
Proposed
Letter of Standing
BECAUSE THE COLLEGE HAS EXPERIENCED SOME DIFFICULTY IN OBTAINING ACCURATE INFORMATION - EVEN
FROM WITHIN CANADA - COUNCIL IS LOOKING AT A UNIVERSAL FORM FOR ALL APPLICANTS.
As the members are probably aware,
dentists applying for a certificate of registration/licensure in Canada or the
United States must provide a letter of
standing from any jurisdiction in
which he/she has engaged in the practice of dentistry. Many other countries
similarly have such requirements. In
Ontario, this requirement is in Section
5 of the Registration Regulation,
Ontario Regulation 832/93 made
under the Dentistry Act, 1991.
The Act requires an applicant to provide details of a proceeding or a finding
of professional misconduct, incompetence or incapacity in order to protect
the public interest.
Due to different terminology, laws,
policies and so forth in the various
Calendar
of Events
Mark Your Calendar
May 15 & 16
Toronto
RCDSO Council*
Westin Prince Hotel
900 York Mills Road
jurisdictions of the world, the College
has experienced some difficulty in
obtaining accurate information, even
from within Canada. That is why at the
June 2002 Council meeting Council
tentatively approved the development
of a universal letter of standing form
that all applicants to Ontario would be
asked to complete, and to provide to
the College. In other words, the regulatory authority from the jurisdiction in
which he/she may have practised in
must complete the form.
Examples of questions that would
now require an answer include:
• whether the applicant has or has had
any terms, conditions, and limitations on his/her license;
• whether the applicant is the subject
Nov. 13 & 14
Toronto
of an active formal complaint, or one
that concluded with some action
being taken;
• whether the applicant is the current
subject of a Registrar’s investigation
or one that concluded with some
action being taken;
• whether the applicant is or has been
the subject of disciplinary charges
and the details therein;
• whether the applicant is or has been
the subject of a Fitness to Practise
hearing or inquiry and the details
therein.
The College would be interested in
receiving comments, pro and con,
from you in this matter. Please have
your response in to us by Friday, March
28, 2003.
You can send your comments to Rob
Lees, Manager, Registration by fax at
416-961-5814, e-mail at rlees@
rcdso.org, or by regular surface mail.
RCDSO Council*
Westin Prince Hotel
900 York Mills Road
Seating is limited so if you wish to attend please let us
know in advance by calling Angie Sherban, Senior
Executive Assistant, at 416-934-5627, toll free at 1-800-5654591, or by e-mail at asherban@rcdso.org.
* RCDSO Council meetings are open to the public, with the
exception of any in camera portion dealing with personnel issues
or other sensitive or confidential material. Meetings begin at
9:00 am. The agenda is available either at the meeting or in
advance on request.
Ensuring Continued Trust
Dispatch • Jan/Feb 2003
41
Discussion of Dental Ethics 101
Case Study on page 30
Patient Seeks a High From Nitrous
Oxide-Oxygen Conscious Sedation
This discussion of the ethical dilemma that was presented
on page 30 focuses on the ethical issues surrounding a
patient’s request to crank it up relative to the use of nitrous
oxide-oxygen. These ethical questions include:
•
•
•
•
Is the dentist the agent of the patient?
Should the dentist provide euphoria on demand?
What is the potential for nitrous oxide-oxygen abuse?
Can nitrous oxide-oxygen administration in the dental
office trigger a relapse for a patient in recovery for substance abuse?
Introduction
Nitrous oxide-oxygen conscious sedation serves an important role in the management of fear and anxiety for dental
patients, and it is commonly used in dental practice.
According to Dr. Stanley Malamed in his text, Sedation: A
Guide to Patient Management, it is presumed to be a safe,
nearly ideal sedative agent that is used to control pain and
anxiety. The benefits of this modality are well-documented
and the disadvantages and contraindications are few.
Should the Dentist Crank it Up?
Is the dentist the agent of the patient? Is he or she obligated to provide treatment when a patient requests or
demands it?
A dentist could perceive his/her primary role as serving the
patients’ needs by fulfilling their requests, whatever those
requests may be. Although this is foreign to our common
understanding of the role of health professionals, a US
expert in dental ethics, Dr. David Ozar, has described this
relationship as the agent model of the dentist-patient relationship, where the dentist acts merely to fulfill the patient’s
requests.
In this distorted relationship, a patient requesting a controlled substance to meet their addiction needs would
receive it from the dentist, without regard for the patient’s
well-being or the profession’s standards, norms or legal
responsibilities.
The agent model is an inappropriate description of the
42
Dispatch • Jan/Feb 2003
dentist-patient relationship because the model ignores the
values of the profession as it functions in our society.
But Alan Norris’s case is not about a patient’s request for
a narcotic analgesic, but rather for a nitrous oxide high.
Should the dentist provide euphoria on demand? What are
some of the issues related to nitrous oxide sedation and
its potential abuse?
Dentists benefit their patients by providing competent care
and sedative agents like nitrous oxide-oxygen that provide a
real benefit for patients by helping manage their fear and
anxiety. Alan experienced several painful dental experiences
as a child and remarked, “This (gas) is the only way I can tolerate dental drilling.” However, when the patient seeks an
immediate high from this modality, the therapeutic benefit
of the drug is exploited.
Side effects of nitrous oxide-oxygen include the possibility
of psychedelic or sexual phenomena. These side effects are
avoided, not sought, in the competent management of this
sedation technique. For example, to avoid allegations of sexual impropriety during nitrous administration, Malamed
recommends that dentists should never sedate any patient
with any technique or sedation without an assistant present
in the room, and that nitrous oxide-oxygen should not routinely be used in concentrations greater that 50%.
These recommendations are consistent with those in the
RCDSO Guidelines on the use of sedation and general
anaesthesia in dental practice that can be found on the
College Web site at www.rcdso.org.
One of the safety features of nitrous oxide-oxygen conscious sedation is that it can be titrated, so that other than
the patient’s breathing, it is the dentist who controls the
dosage. The purpose of titration is to identify the ideal sedation level for each patient, rather than a fixed dose for all.
Malamed has observed that using a fixed dosage for patients
will lead to increased reports of negative reactions to nitrous
oxide-oxygen because many patients will be over-sedated.
Alan has disclosed that he used recreational drugs, especially marijuana, in college, although he didn’t inhale.
Ensuring Continued Trust
Should the dentist ask Alan if he is a substance abuser and
should that effect the dentist’s decision to use nitrous
oxide?
Nitrous oxide has been a substance of abuse since its discovery in 1772 and its potential for abuse and neurologic effects
are well-documented. Nitrous oxide has an abuse potential
because it can produce euphoria. If Alan admits to abusing
drugs, it is the responsibility of the dentist, or any healthcare provider, to recommend professional counselling, and
to avoid prescribing controlled substances that may worsen
the abuse. This sedation technique should be used cautiously with known substance abusers.
Ozar proposes that the ideal dentist-patient relationship is
an interactive model, in which communication and cooperation during decision-making about the patient’s oral
health occurs because both parties acknowledge that each is
capable of choice, and that they both have values that they
are trying to live by. If Alan admitted during these discussions that he is in a recovery program, should that affect the
dentist’s decision to crank it up?
One of the controversies over nitrous oxide is its possible
effect on the patient who is in recovery for alcohol or
other chemical dependency. Can nitrous oxide-oxygen
administration in the dental office trigger a relapse for a
patient in recovery for substance abuse?
Some experts believe that the euphoric effects of nitrous
oxide can inadvertently trigger the familiar sensations of any
psychoactive substance. These sensations can stimulate the
craving for a drink and/or another drug, and potentiate the
relapse of the addiction. Conversations with counsellors in
chemical dependency and well-being programs affirm the
view that there are no studies that support this claim. But
they do describe clients in recovery who have been triggered
by nitrous oxide in the dental office and have relapsed.
While this is a controversial area of discussion, one
thing is clear: Dentists
who provide nitrous
oxide sedation, or prescribe any drug of abuse,
need to stay current on
the treatment of the
drug abuser, addicted
or recovering patient
and how to effectively manage the
patient who is seeking a high.
Conclusion
Dentists are not obligated
to provide a high for patients who
request that they crank up the nitrous oxide-oxygen conscious sedation. The proper goal of this sedative technique is
the control of fear and anxiety through the proper titration
of the ideal sedation level for each patient.
Dentists who provide this sedation technique should be
knowledgeable in treating the drug abuser, addicted or
recovering patient to assure that any further use of nitrous
oxide will benefit and not harm the patient.
The above discussion is reprinted from the Texas Dental Journal with the
permission of Dr. Thomas Hasegawa, Baylor College of Dentistry, Dallas,
Texas. A full reprint of Dr. Hasegawa’s discussion paper can be obtained by
contacting Peggi Mace, Communications Director at 416- 961-5610, or toll
free at 1-800-565-4591, or by e-mail at pmace@rcdso.org.
Dental Laboratory
continued from page 24
acceptable standards. If a dentist supervises the commercial laboratory, members should look for the signature or
Ontario Dental Association (ODA)
stamp of the supervising dentist.
If the invoice or document does not
properly identify the supervising RDT
or dentist, members should take precautionary measures to determine if a
qualified practitioner was on-site during the design and/or fabrication of the
dental appliance.
If in doubt, members should call
CDTO at 416-438-5003, toll free at 1-877Ensuring Continued Trust
391-2386.
If you have any questions about this
article, please call Dr. Michael Gardner,
Assistant to the Registrar, Dental, at
416-934-5616, toll free at 1-800-5654591, or by e-mail at mgardner@
rcdso.org.
Dispatch • Jan/Feb 2003
43
Consolidated
College
College By-laws
NowBy-laws
Now On-line
THE COLLEGE NOW HAS ITS CONSOLIDATED BY-LAWS ON-LINE. JUST GO TO OUR WEB
SITE AT WWW.RCDSO.ORG, CLICK ON THE WORD BY-LAWS IN THE MENU ON THE LEFT
HAND SIDE OF THE SCREEN. PAPER COPIES OF THE BY-LAWS ARE AVAILABLE ON
REQUEST.
Please contact Aurore Sutton, Communications Assistant,
at 416-961-6555, ext. 4303, toll free at 1-800-565-4591, or
by e-mail at asutton@rcdso.org. In the future, as new by-
laws are passed, or amendments made, they will be available immediately on-line, and available in paper format on
request.
Mailbag continued from page 39
Thanks for Help In Hour of Crisis
Dr. Cameron Clokie and I wanted to take
this opportunity to thank the College and the Registrar Irwin
Fefergrad for your help in this hour of crisis that our graduate
training program in oral and maxillofacial surgery is currently facing. Today, on December 21, 2002, as the rest of the
Ministry of Health was winding down for its holiday season,
we received official notification from the Toronto General
Hospital’s adminstration at 3:49 pm, that effective January 1,
2003, all oral and maxillofacial surgery access to operating
rooms at the Toronto General Hospital would be suspended
until April 1, 2003. This meant both elective and emergent
care. They had instructed us that if we have a patient requiring treatment in an operating room, then they must be transferred to another hospital. They were making no exceptions.
Dr. Clokie and I responded immediately by calling the
College Registrar first to help us resolve issues of grave
importance with regards to patient care and safety, standards of care, the future of the residency program, and the
future of the fine women and men potentially involved in
their training.
in touch with one of Canada’s foremost health-care and class
action lawyers to help mediate in this grave situation.
This assistance and advice, as always in our past dealings,
has once again proven to be invaluable. We are indebted to
Mr. Fefergrad for his counsel. The dental profession is
extremely fortunate to have someone of his talent as its registrar here in Ontario.
I thank you once again.
George K.B. Sandor, Md, DDS, FRCDC, FRCSC, FACS
Director, Graduate Program in Oral and Maxillofacial Surgery
Associate Professor, University of Toronto
Co-ordinator, Oral and Maxillofacial Surgery
The Hospital for Sick Children
The Bloorview MacMillan Children’s Centre
The Registrar responded quickly and immediately. He met
with us personally. He directed us to the appropriate media
channels to help us begin to make our case. He helped us get
44
Dispatch • Jan/Feb 2003
Ensuring Continued Trust
Your Change of Address Is
Important Information
Each member of the College is required by law to report
In order to ensure accuracy, all changes must be received
the address of his or her primary place of business. This
in writing. Please forward changes by mail or by fax using
address is then available to the public from the College
the form below.
Register. A member must report any change within 30 days
of the change occurring.
By Mail:
Registration
Royal College of Dental Surgeons of Ontario
6 Crescent Road
Toronto, ON M4W 1T1
By Fax:
416-961-5814
You may choose to designate another address as your
preferred mailing address for College communications. This
second address is not available to the public.
Surname
Given Names
RCDSO Registration No.
Previous Practice Address
New Practice Address
Street
Street
City
Province
Phone
Fax
Postal Code
City
Province
Phone
Fax
E-mail
E-mail
Effective Date
Signature
Previous Home Address
New Home Address
Street
Street
City
Province
Phone
Fax
Postal Code
City
Province
Phone
Fax
E-mail
E-mail
Effective Date
Signature
Ensuring Continued Trust
Postal Code
Postal Code
Dispatch • Jan/Feb 2003
45
Outreach
to Members
College
College Registrar Irwin Fefergrad
(centre) was a guest speaker at the
2002 annual fellowship dinner of the
Academy of Dentistry International,
the American College of Dentistry
and the International College of
Dentists on November 6, 2002 in
Toronto. Other featured speakers
were (left) former RCDSO Registrar
Dr. Roger Ellis, secretary-treasurer of
the American College of Dentistry,
and (right) Dr. Don Stewart, host and
regent of the Academy of Dentistry
International.
Important Notice on Holding
Oneself Out To The Public As Being
Specially
Trained/Certified
IT HAS COME TO THE COLLEGE’S ATTENTION THAT SOME DENTISTS WHO ATTEND
COURSES AND RECEIVE CERTIFICATES HAVE BEEN INFORMING THE PUBLIC OF SUCH
CERTIFICATION.
The College wishes to remind all dentists that the use of the
term “certified,” or in fact, any other form of that word, by
dentists other than those who have registered with the
College as specialists under the Regulated Health Professions
Act, could be considered as providing misleading information to the public.
46
Dispatch • Jan/Feb 2003
If you have any questions about this matter, please contact Dr. Fred Eckhaus, Assistant to the Registrar, Dental at
416-934-5624, toll free at 1-800-565-4591, or by e-mail at
feckhaus@rcdso.org.
Ensuring Continued Trust
Substance Abuse Focus of Education
Session During Executive Committee Orientation
RCDSO President Cam Witmer (left) thanks
Dr. J. C. MacMillan (right) at the end of
Dr. MacMillan's powerful presentation on
substance abuse and dependency during
Executive Committee's orientation on January 24 in Toronto. Dr. MacMillan is one of
North America's leading addiction counsellors and specializes in working with healthcare professionals. His presentation was designed to help sensitize both the Committee
and complaints/investigaton staff to the
unique situation of health-care professionals
with dependency problems.
President’s Message
enced a new sense of excitement and pride in being a
continued from page 4
member of this Council.
We invited stakeholders from across the province: facility
administrators, public health dentists, physicians, dentists,
consumer advocates, and representatives from the major
service provider groups in the sector. The enthusiasm was
electrifying. There was a tremendous appreciation and recognition that this was the first organized effort ever to co-ordinate such a wide multidisciplinary approach to finding solutions to provide oral health care for these special people.
There is no question that finding solutions will be complex
and difficult. As dentists we must take ownership of this issue
and seize the initiative. The College is doing just that.
I believe that our actions on these two issues alone demonstrate that as a regulatory college we are here to protect and
serve the public, and to guide all dentists in the delivery of
oral health care.
Finally, I want to share with all the dentists in this province
two of the fundamental principles that will guide me during
my term as President. I believe that the success of this and
any College is founded in these fundamentals.
1. It is my belief and commitment that the President, the
Executive Committee and this Council must operate and
function with an open and visible agenda at all times.
2. It is my belief that recommendations from the President,
from the Executive Committee, and ultimately from
Council, must be the result of fair, full and open consultation at all levels.
By following this course, I strongly believe we have the
potential to enter into the golden age in the history of this
College.
Le mot du président
groupes principaux de fournisseurs de services dans le
suite de la page 5
secteur. L’enthousiasme était
extraordinaire. Ce tout premier effort organisé par le Collège,
et visant à coordonner une telle approche multidisciplinaire
afin de régler les problèmes de disponibilité des soins dentaires pour ce segment de la population, fut fortement reconnu et apprécié par tout le monde.
Il est évident qu’apporter des solutions sera complexe et
difficile. En tant que dentistes, nous devons nous attaquer à
ce problème et faire preuve d’initiative. C’est exactement ce
que fait le Collège.
Je pense que notre plan d’actions en ce qui concerne ces
deux problèmes démontre à lui seul notre détermination, en
tant qu’autorité de réglementation, à protéger et servir le
public, et à guider tous les dentistes dans l’administration des
soins dentaires.
En conclusion, je désire faire part à tous les dentistes de
cette province de deux des principes fondamentaux qui me
guideront durant ma présidence. Je crois que le succès de ce
Collège, et de tout autre, repose sur ces principes fondamentaux.
1. Je crois et je m’engage à ce que le président, le Comité exécutif et ce Conseil agissent et procèdent toujours selon des
intentions claires et précises.
2. Je suis convaincu que les recommandations du président,
du Comité exécutif, et du Conseil, doivent découler d’un
processus juste et ouvert de concertation à tous les niveaux.
En appliquant ces principes, je crois fermement que nous
sommes en mesure d’entrer dans l’âge d’or de l’histoire de ce
Collège.
Ensuring Continued Trust
Dispatch • Jan/Feb 2003
47
From the Registrar’s Office
A Buzz of Excitement At the
College As New Council
and Committees Swing
Immediately Into Action
College Will Continue To Lead With Sound,
Proactive Leadership
Irwin Fefergrad
THERE IS A BUZZ OF EXCITEMENT EVERYWHERE AT THE COLLEGE AS WE BEGIN TO
WORK WITH THE NEWLY ELECTED COUNCIL AND COMMITTEES. WE ARE OFF THE
GROUND RUNNING. COUNCIL JUST MET IN MID-JANUARY, AND BY THE END OF
JANUARY THE EXECUTIVE COMMITTEE HAS ALREADY MET TWICE, COMPLAINTS
COMMITTEE HAS HAD ITS ORIENTATION, AND THE DISCIPLINE COMMITTEE MET FOR A
TWO-DAY ORIENTATION THE FIRST WEEK OF FEBRUARY.
Willingness to serve at the College has
never been higher. There were elections
in six of the 12 districts. As well, there
were over 80 applications for noncouncil committee positions. There
was also a number of applications for
the Professional Liability Program
Committee. This level of interest is
unprecedented in the recent history of
the College.
It is due in part no doubt to the outstanding example of leadership set by
our outgoing President Dr. Eric Luks
and the previous Council. Their forthright actions made this College an
important and exciting place to be.
The commitment, dedication, and
the care and concern of the new
Council and committee members is
palpable. As the new team moves into
place, it is a safe prediction that selfregulation continues to be in good
hands. There is no question the College
will continue to offer sound, proactive
leadership under the experienced guidance of our new president, Dr.Cam
Witmer.
I am reminded of an interesting article in a recent issue of the Harvard
Business Review. It said that leadership
starts with truth. An organization, or in
our case, a Council that is proactive,
that is involved in doing, will beget
progress. An organization that spends
too much time evaluating, sending
things for endless review and discussion, creates stagnation and paralysis.
Or, as one business guru summed it
up, we are describing “the principled
and purposeful organization.”
There is much talk these days about
corporate leadership. Leadership, I
think, can be summed up by three key
48
Ensuring Continued Trust
Dispatch • Jan/Feb 2003
The commitment,
dedication, and the care
and concern of the new
Council and committee
members is palpable.
characteristics: honesty, transparency
and fairness. It means setting goals that
aim for greatness and not mediocrity. It
means reminding ourselves of our core
values, and in particular, of our belief
systems and sticking to those, and not
pledging or mortgaging our honour. It
means building trust every day of the
week. It means encouraging risk-taking
decisions, after getting the information, and assessing the consequences
of not taking the decision.
It means caring, being sensitive,
compassionate and understanding.
I look forward with great anticipation to this era of dynamic leadership
from the College in the health-care regulatory field. I wish us all the best of
luck and good fortune in the two years
ahead.
P.S. With the new year, and a new
Council, we have also new College
offices. The renovations are almost
complete, and we invite you to drop
by and visit. The coffee is always on,
and we would be delighted to see
you. Just give Paul Harrison, our
Director of Finance, Property and
Administration, a call at 416-9345620, toll free at 1-800-565-4591
and he will give you a guided tour.
And when you are here, drop by my
office on the 5th floor. I look forward
to meeting you.