One dysfunctional health-care regulatory body — the College of Dental Surgeons of B.C. — is likely going to prompt a revamp of the entire Health Care Professions Act.
Health Minister Adrian Dix released an inquiry report Thursday that found the dental surgeons’ oversight body came up well short on general performance. The author — British adviser Harry Cayton — recommended a major overhaul and also suggested significant upgrades to the act governing 20 other colleges that regulate health professions.
The biggest issue will be consolidation of all the colleges into a much smaller number. There are colleges for massage therapists, midwives, podiatric surgeons and four separate ones in the field of dental care.
The 21 separate bodies have as few as 78 members.
Putting patients first is the priority, but amalgamation is very much on the table. The trend toward team-based care makes the existence of numerous separate and sometimes isolated colleges questionable. Three separate nursing colleges were merged recently and it was considered successful.
In an unusual move, B.C. Liberal MLA Norm Letnick and Green Party MLA Sonia Furstenau were named to a steering committee to be chaired by Dix to consider renewal of the health regulatory framework.
Cayton’s scrutiny of the College of Dental Surgeons produced 21 recommendations to improve its performance. Dix accepted all of them immediately and has issued a directive ordering the body to start implementing them.
The inquiry was considered rare and significant. Dix ordered it a year ago in response to concerns.
Cayton measured the body against 28 widely accepted standards and found it was meeting 17 of them.
“It’s not a disaster, but it’s a serious flaw,” he said. Cayton also referred to a history of internal strife.
Although there have been recent changes, he said: “A concern for the well-being of dentists rather than a single-minded focus on patient safety and public protection is still a part of college culture.”
Among his recommendations, he said the board must mend its relationship with its professional staff. It should remove itself from the complaints process and should not attempt to influence or interfere in complaints in any way.
Several recommendations centre on ethics and conflicts of interest. Dentists under investigation for complaints should not stand for election to the board. Elected members should step down until a complaint is resolved in their favour.
Generally, he called for much more focus on patients and public safety, rather than on the members of the organization.
He said a previous strategic plan the body put out scarcely mentioned the word “patient.” The current one, written after the concerns prompted the review and an earlier overhaul, is much more focused on the public.
“The board of the college has not been a happy, well-managed or constructive governance body for several years.”
At one point, there was so much mistrust that board members didn’t want the secretary taking minutes of their private meetings.
Cayton also noted an “unacceptable level of discourtesy” toward staff, who were being publicly reprimanded and challenged on their competence.
The strife inevitably resulted in hiring lawyers, and Cayton said the college has spent $320,000 in the past three years protecting its own interests, compared with $91,000 protecting the public interest.
Sustained office warfare between factions of dentists has been underway for years.
“A small number of dentists are active and vocal in their criticisms,” Cayton found. They object to any attempt to issue new standards and guidance.
“If their belief is that as professionals they can be trusted to behave well without the guidance or supervision of the college, that is hardly borne out by the intemperate and sometimes abusive language they use or the extreme opinions they express.”
On the broader picture of health-professions oversight, he said the number of colleges raises questions about common sense. Britain has nine, compared with B.C.’s 21.
The current act is decades old, and Cayton said it is vague about accountability for patients’ well-being.
With Dix himself on a steering committee with all-party representation, and with the dental college as an example of how things can go wrong, it looks as if a big reform is coming.