Dentists routinely receive complaints from the Royal College of Dental Surgeons of Ontario (RCDSO). When these notices arrive, it is likely that dentists are unfamiliar with the process and are understandably concerned. The RCDSO typically states that a complaint was filed against the dentist regarding their conduct or actions and a copy of the complaint is attached. The complaint can be from any member of the public, but is frequently from a patient, and at times from another dentist or an investigation by the RCDSO itself. The letter typically requests that within a short period of time, usually 35 days, the dentist provide a written response to the allegations.
The RCDSO website has a detailed set of instructions on how to make a complaint. It states that the College relies on complainants to help protect the public by raising concerns about dentists and their treatment. The website sets out two ways the College can follow up on concerns, either through a complaint investigation or by initiating a registrar’s investigation. The RCDSO also works to ensure complainants understand the process by publishing a brochure on how to make a complaint against dentists in at least 11 languages. It also sets out multiple ways to make a complaint online, email, regular mail, or making an audio or video recording.
A letter advising a dentist of a complaint sets out some initial information about what can happen following a RCDSO complaint. This letter informs dentists that once a written response has been submitted and an investigation into the matter has been completed, the entire file will be provided to the Inquiries, Complaints and Reports Committee (ICRC), which is tasked with objectively reviewing the file and determining the most appropriate course of action.
The dentist is informed that the ICRC has the power to:
- Refer specified allegations of professional misconduct or incompetence to the RCDSO Discipline Committee for a Hearing;
- Make inquiries into a dentist’s capacity;
- Require the dentist to appear before a panel of the ICRC to be cautioned; or
- Take other appropriate action or take no action in the matter.
Under section 25(1) of the Health Professions Procedural Code, the College must investigate and act on all complaints, subject to very limited exceptions. This means that once a dentist has received an RCDSO complaint, regardless of how trivial one may think the complaint may be, and no matter how much a dentist disagrees, action must be taken. The dentist must prepare a written response to the RCDSO complaint. Beyond the time and effort required to respond appropriately, the prospect of professional consequences can put stress on a dentist and their family. A dentist with an RCDSO complaint would be prudent to consider contacting an experienced lawyer who has worked defending RCDSO complaints and can guide a dentist through this unfamiliar territory.
Each RCDSO complaint is unique, and these differences should be considered in the course of preparing a written response. Factors such as the complexity of the care provided, how long ago the care was provided, and the potential that a civil lawsuit will be commenced in relation to the same care, are all matters that may complicate the preparation of a written response to defend an RCDSO complaint. It is often helpful for the written response to include a clear and factual chronology of the events in question.
It is important to appreciate that the RCDSO will likely contact the complainant to confirm the issues being investigated and may take further steps through investigators to gather more information. This may include interviewing witnesses such as dental hygienists, other dentists, and dental clinic staff.
A dentist will likely not have an opportunity to explain in person to the ICRC their decision-making process or the care that was provided to the complainant. In most cases, the written RCDSO complaint response is the only chance to make submissions to the ICRC. For this reason, it is generally important to ensure that all of the complainant’s concerns have been addressed in a dentist’s response to the RCDSO. If the ICRC reviews a dentist’s response to a complaint and notes that it failed to address particular complaints, there may not be a further opportunity to respond before a decision is made.
Where there is merit to a complaint, it may be appropriate to demonstrate in a dentist’s written response to the RCDSO that the dentist has taken appropriate action to ensure that all issues of concern have been corrected. In certain circumstances, demonstrating insight into any possible concerns typically reflects well on the dentist and gives the ICRC the confidence that the dentist genuinely seeks to improve their practice.
In certain circumstances, where the investigator believes that an RCDSO complaint may be able to be resolved without providing the ICRC with written submissions, the investigator may wish to have a verbal conversation with both the complainant and the dentist. Everything provided to an RCDSO investigator is recorded and ultimately submitted to the ICRC in the investigator’s report. In these circumstances, it would be recommended to speak to a lawyer experienced in working with the RCDSO before responding to the College investigator.
Once a dentist’s written response to the RCDSO has been finalized, the dentist should submit it to the investigator. This is often done by a lawyer on behalf of the dentist. Along with the dentist’s response, they should attach all the dental records, assuming consent has been provided by the patient. These records include the patient’s charts, treatment plans, radiographs, ledger cards, etc. The dentist should also provide the regulator with financial information pertaining to the patient, including the financial ledger, receipts, and insurance statements. Even if the ICRC determines that the care provided to the patient was appropriate, it may still evaluate the quality of your dental records. It is important that records comply with the Dental Recordkeeping Guideline.
The RCDSO has taken steps to make regulatory findings more transparent. As a result, the RCDSO is required to include certain findings about a dentist on the Public Register, which can be searched on the RCDSO website “Find a Dentist in Ontario.” Whenever the ICRC refers a complaint to Discipline, orders a caution against a dentist, or orders that the dentist complete a Specified Continuing Education or Remediation Program (SCERP), this information will be posted on the public profile of that dentist. It also includes when a dentist is charged in criminal court.
Some relatively minor complaints may be referred to the RCDSO’s Alternative Dispute Resolution (ADR) process. This typically happens early in the complaint investigation process. The dentist and the complainant must both consent to ADR. If both parties agree, the RCDSO will appoint a facilitator who will attempt to mediate a resolution of the complaint. Any resolution achieved through ADR must still be ratified by the ICRC.
With a serious complaint, the ICRC could impose an “interim order,” which puts restrictions on a dentist’s practice, including a license suspension, while the ICRC investigates the complaint. A serious complaint may also cause the Registrar to appoint an investigator under section 75 of the Health Professions Procedural Code; this investigator has broader powers to gather information than a complaint investigator.
Both the dentist and the complainant have the opportunity to appeal any decision of the ICRC to the Health Professions Appeal and Review Board (HPARB). When a decision is appealed to HPARB, it will consider if the investigation undertaken by the RCDSO was adequate and whether the decision made by the ICRC was reasonable. As part of its review, HPARB will have access to all the documents and information gathered by the RCDSO at the complaint investigation stage, and this information will be disclosed to both you and the complainant.
A complaint made against a dentist at the RCDSO can carry significant consequences. Retaining legal counsel can assist you in preparing your written response and guide you through the process. Complaints to the RCDSO are not uncommon, and they can happen to anyone. A failure to take these complaints seriously can have a negative impact on a dentist, so take the matter seriously, and respond appropriately.
About the Author
Josh Koziebrocki, LLB, BA (Hons), is the principal lawyer and founder of Koziebrocki Law. He represents numerous dentists and has extensive experience dealing with regulatory issues. He can be reached at 416-925-5445 josh@koziebrockilaw.com | www.koziebrockilaw.com