This publication is emailed out to members and posted online on the College’s website
within two working days after each Council meeting. It covers some of the key highlights of Council business. We welcome your feedback. If you have questions about any of these
items, please contact RCDSO Registrar Irwin Fefergrad at 416-934-5625, toll-free at 1-800-
565-4591, or by email at email@example.com.
The 416th meeting of the RCDSO Council was held in Toronto on June 14, 2018.
RCDSO President Ron Yarascavitch opened the meeting. He spoke of access to care as a priority for the College. A recent survey conducted by College staff looked at access for people on social assistance and the results were very positive. Ontarians seeking dental care using programs such as ODSP and Healthy Smiles generally do not face a barrier in accessing care. About 80% of general practitioners surveyed said they accept social assistance patients; the numbers among specialists were also good. But it is clear that the working poor and their dependants fall between the cracks; they are not eligible for social assistance and do not have insurance coverage.
Our staff working group has proposed an Access to Care Symposium in the Spring of 2019. The general purpose of this symposium will be to try and identify what are the problems around access to care. The aim is to attract speakers who can help us understand what the problems are and suggest some creative solutions.
Registrar Irwin Fefergrad began by noting the passing of RDCSO public member Derek Walter. Derek’s wife and daughters attended the Council dinner. The Deliberation Room at the College has been renamed in Derek’s honour.
Irwin reminded Council of their duty to act in the public interest and to put patients first in everything they do. He said it takes a courageous and wise council to act in the public interest and praised Council for continuing to do so. He noted that the candidate eligibility course will soon be online. The course will be a requirement for those wishing to serve on Council or on Committees and will help potential committee members have clear understanding of the roles and responsibilities before getting involved. (You can see the course here.)
Acting in the public interest was the common theme for virtually every issue at Council today, Irwin said. Those issues include:
- Our report on opioid prescribing patterns. The data shows a statistically significant reduction in opioid prescribing, helped by education and public awareness provided by the College. But this issue will be an ongoing challenge for future councils to wrestle with.
- A data-driven approach to studying complaints data. The project will help us better understand how to address concerns through Quality Assurance and continuing education. Irwin said that he has been asked to speak to a number of different bodies on this ground-breaking approach.
- Substantial revision to our sedation and general anesthesia standards. A working group charged by Daniel Haas has made substantial significant recommendations aimed at protecting patients.
- Infection prevention and control. A working group chaired by David Segal, including hospital practitioners, public health representatives and other colleges, looked at how IPAC systems can be improved and made coherent with public health requirements. The aim was to create a clear standard and provide useful guidance.
Irwin reminded Council that “wisdom is not just expertise, it is balance, including emotional balance. Good judgement is based on facts but acknowledges uncertainty. He suggested Council continue to use analysis from all perspectives, not just one lens and to exercise “the courage to compromise and to act”.
Executive Committee made several recommendations regarding by-law amendments and appointments. At its March 8, 2018 meeting, Council approved in principle by-law amendments to tighten the eligibility requirements for Elected and Selected Council Members and for Non-Council Committee Members. The changes would make a member permanently ineligible for election or selection or to serve as a non-Council member:
- where the member had been found guilty as an adult under the Criminal Code (Canada) or an offence under the Controlled Drugs and Substances Act (Canada);
- where the member had been found guilty of professional misconduct by the Discipline Committee or a discipline committee in any jurisdiction related to dentistry or any other profession; or
- where the member is the subject of an Undertaking provided to the College in connection with a fitness to practise issue.
On reflection, the Executive Committee determined that there may be instances where it would be unfair to prevent a member from seeking to serve the College. For example, if a member gave the College an Undertaking related to a health condition and had been fully compliant for many years, would it be appropriate to exclude the member from fulfilling leadership roles in the College? Similarly, what about a member who at 18 was found guilty of possession of marijuana or another minor offence and who had no further difficulties with the law or the College since that time?
General Legal Counsel was asked to prepare amendments to the bylaws that would create a mechanism for members to be able to apply to be made eligible by a Committee of the College, in some specific circumstances, where they found themselves otherwise ineligible as a result of certain of the eligibility requirements.
The proposed amendments were approved by Council.
Appointments and expenditures
Council approved the appointments of Ram Chopra as a member of the Quality Assurance Committee, Mano Kanagamany as a member of the Finance, Property and
Administration Committee, and Richard Hunter, Sandy Venditti and Elizabeth Wilfert to the newly-created Pension Governance Committee.
Council approved an expenditure not to exceed a total of $200,000 (including taxes) ($115,000for capital expenditure and $85,000 for operating costs), to revise the current office space at 6 Crescent Road, Toronto.
Council also authorized the holding of a symposium on “Access to Oral Healthcare” to determine and analyze the problems associated with access to oral care and to hopefully provide a forward-thinking constructive approach to those problems.
Standards and Guidelines
Three new documents were approved in principle and will now be circulated for comment:
- The revised Standard of Practice on the Use of Sedation and General Anesthesia in Dental Practice contains numerous changes. A new introduction speaks clearly to both dentists and the public about the key goal of providing a wide margin of safety for all patients, which may be achieved by setting high standards for training, careful patient selection and preparation, monitoring, equipment and emergency drugs, as well as continuing education. This is of particular importance for the safe treatment of children, as they have reduced physical reserves and impairment may occur rapidly. The revised Standard also describes the Ontario model for the administration of parenteral moderate sedation, deep sedation and general anesthesia, which requires a sedation or anesthetic team composed of a minimum of three individuals with specified training and responsibilities.
- A new Standard on Infection Prevention and Control in the Dental Office. Because of the importance of IPAC to safe patient care, it was felt that the proposed document should be rebranded as a Standard, and that the College should be clear about its expectations for dentists, who must ensure that recommended IPAC policies and procedures are carried out in their offices.
Significant changes include a new introduction which emphasizes the importance of IPAC to safe patient care. It also notes that the College is only one component of a larger system in Ontario to protect the health and well-being of patients, and that we have collaborated with PHO and the MOHLTC to ensure our standards and advice to dentists and the public are coherent and consistent with their guidance and checklists for dental practices. Dentists are reminded that they must have specific written IPAC policies and procedures, as part of their Office Manual. In addition, a template for an office manual has been developed and will be linked to the proposed Standard.
- Guidelines on the Diagnosis and Management of Temporomandibular Disorders. Changes in this revised version include a new title, simplified to address temporomandibular disorders (TMDs), which encompasses related musculoskeletal disorders. A new introduction emphasizes that patients have an important role to play. Patients must be informed of, and assume responsibility for, their part in their own care. This includes changing or reducing lifestyle risk factors that contribute to TMDs and treatment failure. Ultimately, the success of treatment will depend on how well the patient accepts and follows a new daily routine.
Patient Relations Committee
Council approved two proposals from PRC. The first will have the College withdraw its participation in the McGill University project “A Multi Sector Partnership to Investigate and Develop Policy and Practice Models to Dismantle “Rape Culture” in Universities (Also known as IMPACTS: Collaborations to Address Sexual Violence on Campus)”. The Committee felt that the project goals and the College’s goals are not in alignment.
In addition, Council approved a new practice advisory on Maintaining a Professional Patient-Dentist Relationship.
Council approved the RCDSO Audited Financial Statements for the year ended December 31, 2017 as presented. The financial picture for the RCDSO is very good and Council agreed that the College is in a strong financial position for the future.
The Registration Committee reported on a request from a member to create a new class of Certificate of Registration. The desire is to allow retired members wishing to provide charitable treatment abroad to do so. There was a request that there be no fee for this class of certificate.
The Committee said it was aware that requests of this nature had been made before and that previous Registration Committees had not been prepared to recommend that Council take this action. The current Committee agreed with this view. However, during Council discussion, there was consensus that some solution to allow for charitable work should be found. The Registration Committee agreed to do further research into the matter and consider whether there might be a solution.
Council approved in principle changes to By-Law 18: Fees at its March 8, 2018 meeting. The primary driver is the year over year increase in the number and type of services provided by the College as part of our comprehensive statutory mandate.
The recommendation was for the College to increase registration/annual fees by
$200 for 2019 fees and $75 for each of 2020 and 2021 fees, thereafter followed
by annual increases based on the Ontario Consumer Price Index (CPI). By
2021 this will situate the fees where they would be if CPI had been applied
each year since 2015.
Information on the proposed increase was circulated to 111 stakeholders and 9774 members. No comments were made during the circulation period that would influence any changes. As a result, Council approved the fee increase as originally proposed.
Further information on some of the issues described above and an opportunity to provide feedback will be available on our consultation page, www.rcdso.org/whoweare/consultations.
The next Council meeting will be held in Toronto on Thursday, November 15, 2018.