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How does the Protecting Patients Act affect dentists?


In May 2017, the Ontario government passed Bill 87, the Protecting Patients Act (PPA), which strengthens the sexual abuse and transparency provisions of the Regulated Health Professions Act (RHPA), our governing legislation. The PPA also changes how the College is required to deal with complaints, investigations and discipline matters.

Some of the amendments to the legislation are now in force, while others have yet to be proclaimed. Here’s an overview of the changes that will have the greatest impact on dentists.

Changes now in force

Register

Through its Transparency Initiative, the College recently expanded the information it makes available to the public on the register. Many of those proactive changes found their way into the new legislation. However, the PPA went further.

Some of the new register requirements include posting:

  • The date of every referral to the discipline committee and a copy of the specified allegations of professional misconduct, until the matter is finally resolved.
  • Any reprimand given by the Discipline Committee to a dentist.
  • Undertakings/acknowledgements entered into by dentists as part of an Inquiries Complaints and Reports Committee (ICRC) or Discipline process.
  • In discipline cases where no finding of professional misconduct was made, the result and the reasons why no finding was made are posted for 90 days.
  • Where a dentist is deceased, the date of death, if known.

In addition:

  • Cautions and Specified Continuing Education and Remediation Programs (SCERPS) are no longer removed after a specified period of time, and may only be removed by the Registrar upon application and consideration of specified criteria under the legislation.
  • There shall be no gender-based terms, conditions and limitations on a dentist’s licence to practice.

Interim orders

Previously, the ICRC could make an interim order to suspend or impose terms, conditions and limitations on a dentist’s licence to practice after it had referred specified allegations of professional misconduct to the Discipline Committee or an allegation of incapacity to the Fitness to Practise Committee. The interim order would remain in effect until final disposition of the matter.

However, the PPA now provides the ICRC with the power to make an interim order at any time following the receipt of a complaint or upon the appointment of an investigator. The ICRC can only make such an order if it is of the opinion that the dentist’s conduct exposes or is likely to expose patients to harm or injury or, in the case of an incapacity inquiry, the dentist’s physical or mental state exposes or is likely to expose patients to harm or injury.

Mandatory revocation

Prior to the amendments made by the PPA, the acts of sexual abuse that would result in mandatory revocation included: sexual intercourse with a patient; genital to genital, genital to anal, oral to genital or oral to anal contact with a patient; masturbation of the patient by a dentist; and encouraging a patient to masturbate in the presence of the dentist.

The list of acts of sexual abuse that will result in mandatory revocation has been expanded to include: touching of the patient’s genitals, anus, breasts or buttocks.

When a dentist’s licence to practice is revoked by the Discipline Committee for any of these acts, the dentist is not eligible to apply for reinstatement for a minimum period of five years.

Mandatory suspension

Where a panel of the Discipline Committee finds a dentist guilty of sexual abuse for acts that would not otherwise result in a mandatory revocation (see above), a suspension of the dentist’s licence to practice is required. For example, if the sexual abuse consisted solely of remarks of a sexual nature, the penalty must include a suspension.

Mandatory reporting obligations

When a dentist has reasonable grounds to believe that another regulated health care professional has sexually abused a patient, they are required to file a report in writing to the registrar of the regulatory college to which the alleged abuser is registered.

The PPA increased the fine for failure to report sexual abuse to a maximum of $50,000, previously a maximum of $25,000.

Changes that will come into force on a future date

Definition of ‘patient’ related to acts of sexual abuse

The PPA provides a new definition of ‘patient’, in relation to an act of sexual abuse. A patient will be defined to include any individual who was a dentist’s patient within one year from the date on which the individual ceased to be the dentist’s patient or a longer period of time if the Minister of Health passes a regulation to that effect. In addition, the Minister will have the power to make a regulation that would establish criteria that determines whether an individual was a dentist’s patient in relation to an allegation of sexual abuse.

Expanded duty to report

When enacted, dentists will be required by the PPA to report to the College’s Registrar any membership in, and/or findings of professional misconduct made by any other professional regulatory body inside or outside of Ontario. In addition, dentists will be obligated to advise the Registrar if they have been charged with any offence, including any bail conditions. RCDSO already requires detailed reporting by dentists under the College by-laws through its annual renewal process, but this information will soon be required by the legislation.

Minister’s new regulation-making authority

The Minister of Health now has the authority to make regulations, at any time in the future, respecting:

  • composition of college committees and panels;
  • qualification, selection, appointment and terms of office for committee members;
  • added functions for the College’s Patient Relations Committee;
  • requirements for the investigation of complaints or reports involving allegations of sexual abuse;

The College is in full compliance with the changes that are now in force and is well on its way to developing recommendations for implementation of the pending changes to the governance model.

We will continue to keep dentists informed of legislative changes as they occur.