Council Highlights for March 8, 2018
The 415th meeting of the RCDSO Council was held in Toronto on March 8, 2018.
RCDSO Vice President Flavio Turchet opened the meeting on behalf of President Ron Yarascavitch.
Registrar Irwin Fefergrad told Council that we continue to be in a time of transition. The Regulated Health Profession Act is seen by many in government to be a statute in need of modernization. That process began last year with Bill 87 and will continue. The aim is to make sure the law functions entirely in the public interest. Irwin noted that the RCDSO has shown leadership by providing that public focus for some years. As a result, we are seen as forward thinking and our advice is sought and followed.
Irwin spoke of the work being done on analyzing data received through complaints. The College engaged an epidemiologist to study patterns in those complaints to understand what they reflect about what the public is thinking about. The data analysis team has conducted a pilot study to create a taxonomy and will now apply those categories to 10 years’ worth of complaints data. To the best of our knowledge, Irwin said, this is the first study in the world on this topic in dentistry. What will this information lead us to do? He said we can expect insights on how to conduct better education and to drive more effective communications. This kind of evidence-based research, with an emphasis on transparency, eligibility and competencies helps demonstrate that we are ahead of the curve.
Looking at the full agenda for the day’s meeting Irwin told Council, “You will be faced with some challenges today; always remember to look at the big picture as you consider your decisions.” He reminded Council that all of their work is scrutinized. Transparency and eligibility are huge issues for government; Council has always been responsive to that, Irwin said, and noted that the commitment to improving transparency and proving the public with the information they need speaks volumes.
Irwin reflected that we cannot know where we will be in June with an election in the offing but that he will be very surprised if RHPA stays the same. In fact, new regulations had arrived from the Ministry of Health and Long Term Care the day before the Council meeting. “We are a nimble, agile college with a caring council,” Irwin said, “and we will continue to get it right.”
In Council business:
Eligibility and competencies
Council approved in principle a motion to amend College By-laws No. 7: “Elections to Council”, No. 8: “Selections to Council” and No. 9 “Non-Council Committee Members” and By-law No. 14: “Disqualifications, General”.
The Executive Committee met jointly with the Elections Committee on February 23, 2017 and jointly recommended that the College consider the issue of eligibility to stand for election to Council or for appointment to committees. Executive and Elections Committee were of the view that Council should again be proactive regarding eligibility requirements to serve on Council and committees to be more in the spirit of the new legislative amendments and the views expressed by Government.
Council agreed that stricter rules are needed with respect to members applying to serve who have regulatory conduct outcomes or ongoing matters (aside from an open complaint), criminal convictions or pending charges, and other situations that are both practically and optically inconsistent with a leadership role with a regulatory body. In addition, as discussed at Council’s August 8, 2017 education session, it is important that people volunteering to serve the College have an understanding in advance of the College’s function and public interest mandate and the expectations and responsibilities of a Council/committee member, which can be accomplished through creating an online training program relating to the duties, obligations and expectations of those wishing to be eligible to be a member of Council or a Non-Council committee member. To achieve this goal, an educational program will be created and the successful completion of the program would be an eligibility requirement for election or selection to Council or the appointment to any committee of the College.
The draft Bylaws will now be circulated for 60 days.
Epidemiology Study – opioids
The Quality Assurance Committee presented the results of a study on patterns of opioid prescribing In Ontario. The College had requested and received narcotics monitoring system data for 2015 and 2016. This data, along with the data received for 2014, was provided to an epidemiologist for analysis.
The results are encouraging and strongly suggest that dental patients in Ontario are getting the right drug, in the right amount and only once. Even over a relatively short time span, the data show a statistically significant decrease in opioid prescriptions and the amount of drugs made available via dentists in Ontario since 2014 – about 4.4% over two years. It is reasonable to infer that this outcome reflects the awareness of prescribers and was supported by the publication of the College’s Guidelines.The College will continue to monitor opioid provider practices in the dental community and promote appropriate prescribing through the use of our Guidelines. In addition, further study of the data may suggest where education is advisable and the College will work with others to help develop appropriate programs across Ontario.
Council approved the recommendation that the report Opioid Prescribing by Ontario Dentists: 2014 -2016 be published by the College. There will be further discussion of the details of the report at the next Council meeting.
In May 2017, Council established a working group to review advertising and related matters, including the College’s Regulations, advertising guidelines and Practice Advisory. The Advertising Working Group held three meetings to try and resolve issues that dentists face with regard to advertising, including how to avoid misrepresentation and providing false information, and handling social media.
Council unanimously approved, in principle, amendments to the College’s Professional Misconduct Regulation. If amended, paragraph 60 of Section 2 would read:
“60. Publishing, displaying, distributing or using or causing or permitting, directly or indirectly, the publication, display, distribution or use of any advertisement, announcement or information related to a member’s practice, which,
- would be reasonably regarded as harming the public’s ability to make an informed choice or negatively affecting the public’s confidence in the profession of dentistry,
- includes information that, a. is false, misleading, fraudulent, deceptive, ambiguous or confusing or likely to mislead or deceive the public because, in context, it makes only partial disclosure of relevant facts, or b. is not true and verifiable
- would be reasonably regarded as suggestive of uniqueness or superiority over another practice or member, or
- is likely to appeal to the public’s fears.”
The proposed amendments will be circulated for 60 days. If approved they will be sent to the Government of Ontario with the request that the Professional Misconduct Regulation be changed to adopt the amendments.
Revised Practice Advisory on Social Media
At the November 16, 2017 Council meeting, the Patient Relations Committee reported that it discussed the College’s current practice advisory, Guidance on the Use of Social Media. The Committee noted that the current advisory, though only two years old, required updating as a result of this quickly evolving area. College staff have now revised and updated the practice advisory to ensure that it reflects current trends and technologies.
Council approved the new practice advisory, now entitled the Professional Use of Social Media. The updated advisory will be published shortly on the College website.
The purpose of the College’s monitoring program is to enforce decisions of the Inquiries, Complaints and Reports Committee and Discipline Committee.
The monitoring fee of $600 per visit was implemented some 15 years ago. This fee was intended to offset the College’s costs and expenses for monitoring visits. When the fee was established, it provided for almost a full recovery of the College’s costs. However monitoring has become more extensive and detailed and costs have risen as a result.
The Executive Committee felt that the general membership should not be subsidizing the monitoring program and proposed that the monitoring fee charged to members be increased from $600.00 to $1,000.00 per visit.
Council approved in principle an amendment to By-Law No. 18:
“Where a member has been ordered to have his or her practice or office monitored as part of a decision of a Committee or panel of a Committee of the College, including without limitation, the Inquiries, Complaints and Reports Committee, the Discipline Committee, the Fitness to Practise Committee or the Registration Committee, or the member has agreed to have his or her practice or office monitored, the member shall pay a fee of $1,000.00 for each practice or office monitoring visit conducted by or for the College.”
The draft Bylaw will now be circulated for 60 days.
Council unanimously approved a recommendation from the Finance, Property and Administration committee that registration fees be increased to meet rising costs.
The most recent registration/annual fee increase was in 2013 for the 2014 and 2015 renewal years, phased in over two years for a total of $400 ($275 and $125, respectively). The previous fee increase was seven years prior, in 2007.
The number and type of services provided by the College as part of our comprehensive statutory mandate have continued to increase year over year. Requirements of new legislation such as the Protecting Patients Act, and a dramatic increase in regulatory activity, have brought additional pressures. Monitoring and complaints are escalating; the prospect of undertaking Infection Prevention and Control reviews, in addition to random inspections in accordance with the new Sedation and General Anesthesia standard, will further grow the College’s expenses.
Over the past five years the College has seen a 64% increase in the number of complaint files processed, which resulted in a 57% increase to the Inquiries, Complaints and Reports Committee (ICRC) panels and a 29% increase in hearing days. The College is now running ten panels of ICRC, with interim suspensions and interim terms, limitations and conditions all legislatively imposed on ICRC. Effective May 30, 2017 the workload has and will continue to increase. Continued investment in committee expenses, prep time, meetings and staff will be required in coming years to accommodate the escalating volume of activity.
To remain in a strong fiscal position and maintain high quality service, Council approved in principle that the College 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 Ontario COLA (cost-of-living adjustment). The increase should take effect for the 2019 license period, which renewal process begins in the fall of 2018. A $75 increase per year over three years would situate the fees where they would be if COLA had been applied each year since 2015. The one-time $125 fee (for a total of $200 in 2019) is required as a one-time correction to support the increased costs and activity over the past four years.
Even with these proposed increases, Ontario dentists will still benefit from the lowest fees for both registration and professional liability protection of virtually any dental regulatory college in the country.