How To Respond To A Patient Complaint Against A Dentist - Page 2
By Matthew Wilton
What is important for Ontario dentists to understand is that it is now more important than ever to deal effectively with responses to patient complaints.
In Ontario, the ICRC is now articulating in every decision whether a patient complaint identifies a risk of directly affecting patient care or safety or the public interest. If the ICRC identifies clinical issues which require remediation or significant improvement, they will order Ontario dentists to take specified continuing education or remediation courses.
More serious patient complaints may be referred to the Discipline Committee for a hearing. If a complaint is not appropriately dealt with from the outset, this increases the chances of a referral to the Discipline Committee. Dentists will be aware that a conviction for professional misconduct at the Discipline Committee will be published, and will receive wide circulation amongst the dental profession. In Ontario, the RCDS publishes a magazine called “the Dispatch” which includes all Discipline Committee summaries including convictions. When a dentist is convicted of professional misconduct, his or her name typically will appear in the RCDS Dispatch. This has a chilling effect upon a dentist’s referral base.
Another reason for taking patient complaints very seriously from the outset is the negative consequence for dentists of having a Discipline Committee conviction, or even a prior negative Complaints Committee decision, on their record. In Ontario, the RCDS ICRC is permitted to review the dentist’s prior history at the RCDS. Therefore, each complaint, even it if is dismissed by the ICRC, can be reviewed if a similar, subsequent complaint is received.
In Ontario we are seeing the RCDS rely upon a dentist’s prior complaint history in making current decisions in current complaints. If the prior history involves criticism of the dentist’s clinical skills in a particular area, and the current complaint involves that area, it increases the chances that the ICRC will either refer the matter to discipline, or make an order that the dentist must take courses, or appear for an oral caution. For example, if there are three prior decisions involving deficient endodontic treatment, and if the dentist has already been ordered to take continuing education courses dealing with endodontic retraining, then the ICRC is likely to treat that dentist more harshly, because the prior history demonstrates a clinical deficiency in that area.
Transparency amendments have changed the approach to responding to complaints.
As indicated above, in Ontario the RCDS has amended its by-laws effective October 1, 2015. The net effect of the amendments is where the ICRC orders dentists to take continuing education courses, that information will be posted on the Public Register. In order to lessen the risk of this occurring, we have been advising dentists at an early stage of the complaint process to consider immediately taking courses to address clinical deficiencies identified by complaints. For example, if the patient complains about a dentist’s failure to recommend a crown after a root canal treatment and restoration, and if the dentist’s response is that he did have this discussion with the patient, but it is not charted, then we will advise the dentist that he will criticized for this charting error. In Ontario, the ICRC expects that dentists will keep records with respect to informed consent discussions. If the dentist’s records do not record this informed consent discussion, then that dentist will be criticized. Typically, in those circumstances, the dentist will be ordered by the ICRC to take a course in recordkeeping, and perhaps a course in informed consent. Our practice has changed, so that if we identify at any early stage this deficiency in the dentist’s recordkeeping, we will suggest to the dentist that he immediately enroll in a recordkeeping course and informed consent course. In this way, by the time the matter is decided by the ICRC, that dentist has already taken courses that the ICRC would likely order the dentist to take. This will lessen the likelihood that the ICRC will order the dentist to take courses, which in turn will avoid the embarrassment of having this information posted on the RCDS Public Register.
This approach represents a paradigm shift in the way that we address patient complaints. Where it is clear that a dentist has made errors, or not followed standards of practice, we see no sense in waiting for the ICRC to order the dentist to take courses to fix these concerns. In Ontario, the RCDS will assist lawyers who act for dentists in identifying appropriate courses, to address the dentist’s clinical deficiencies. This is why dentists require specialized legal advice to respond to complaints. If the best approach is to acknowledge practice deficiencies, the dentist needs to be assured that the lawyer’s advice to make these acknowledgments is well-founded. You don’t want to own up to practice deficiencies that are not necessarily obvious.
In addition, a dentist convicted of professional misconduct after a Discipline Committee hearing is at greater risk, in the event further patient complaints are received. A dentist who is convicted of professional misconduct more than once will be punished more harshly as a result of the previous conviction.
Are you scared yet? All these factors make it necessary to put your best foot forward, from the outset of the complaint.
Our firms’ approach to patient complaints
Our firm has been acting on behalf of dentists at the RCDS for the last 24 years. Our firm also acts for numerous other professionals, including physicians, lawyers, psychologists, pharmacists, chiropractors and massage therapists. Our firm has assisted dentists in Ontario in hundreds of patient complaints. Our considerable experience acting for dentists has provided our firm with a reasonable level of knowledge with respect to various aspects of dentistry and dental practice. We are not dentists, but we have sufficient experience to be able to spot issues that might not be apparent to lawyers with less experience in the field of dentistry.