External review urges complete overhaul of the way health professional regulation is conceived and delivered in B.C.

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      A British expert on professional standards has highlighted some troubling findings about the way dentists are regulated in B.C.

      Harry Cayton, chief executive of the Professional Standards Authority in the U.K., was appointed last year by Health Minister Adrian Dix to conduct a review.

      In a report released today, Cayton has recommended that no dentist should be allowed to run for the board of the College of Dental Surgeons of B.C. if they are the subject of a complaint that's under investigation.

      He also believes that no dentist who's been the subject of a complaint that's been upheld should be permitted on the board or any college committee.

      In addition, Cayton stated: "The board should remove itself from involvement in the complaints process and should not attempt to influence or interfere in complaints in any way."

      Cayton also identified flaws in the Health Professions Act, which sets the parameters for other self-regulating professions.

      "It is my conclusion, however, that changes to the HPA alone will be insufficient to create the flexible, public focussed, team-based and efficient regulatory system needed to support the delivery of safe healthcare in the future," he wrote. "A complete overhaul of the way health professional regulation is conceived and delivered is required."

      In a government news release, the health minister thanked Cayton for writing a "comprehensive report".

      “The findings of this review will assist the college in restoring public trust in the college," Dix said. "Putting people first is a primary concern for the ministry and the full implementation of these recommendations will help strengthen the college's ability to deliver on its mandate to protect the public.”

      He also tweeted a message that the government has directed that all of Cayton's 21 recommendations be implemented.

      Inquiry ordered in response to controversies

      Last year, Dix ordered the external review under the Inquiry Act in response to concerns being expressed about the college; it licenses and regulates dentists and certified dental assistants.

      This came after the Globe and Mail had reported allegations of "sexually inappropriate comments" by the then college registrar and CEO to two female dentists at a convention two years earlier.

      The board reportedly initially accepted the man's explanation that this never occurred. The following month, however, the registrar and CEO resigned.

      Cayton's inquiry involved more than 40 interviews with former and present board members of the college. Under the Health Professions Act, the college has a mandate to serve and protect the public, and 11 of its 23 board members are appointed by the B.C. government.

      Ten of the 23 board members are dentists who are elected by the membership. Two other directors are certified dental assistants.

      Cayton's report noted that only 40 percent of dentists and seven percent of CDAs bothered voting between 2014 and 2018.

      The report also mentioned a lack of trust between some board members and staff at the College of Dental Surgeons of B.C.

      Even though the resignation of the former registrar and CEO was "foreseeable", according to Cayton, the board had no plan to respond.

      He pointed out that there was no new job description and no timetable for recruitment.

      That's not all. Cayton also stated there was "no regard taken for the impact of the acrimonious departure of an experienced regulatory CEO on the staff team with whom he had worked for five and a half years".

      In fact, Cayton revealed, it took several months for a contract to be completed with the acting registrar, Dr. Chris Hacker.

      "The Board should be grateful to the staff team for their resilience in maintaining the College business against a background of mistrust, arguments, lack of planning and dysfunction within its elected and appointed leadership," Cayton wrote. "It is primarily the staff who over the last two years or more have ensured that public protection has been a focus of College activity."

      Health Minister Adrian Dix ordered an inquiry last year when controversy was swirling around the College of Dental Surgeons of B.C.

      Regulation is not independent and transparent

      The external reviewer also disclosed in his report that dentists who are subjects of complaints are allowed to run for the board and be elected—even while the complaint is under consideration.

      "This undermines the regulatory role of the College," Cayton wrote.

      The 21 recommendations to address various issues, including amending the Health Professions Act to enhance transparency and fairness for registrants, complainants, and the public.

      That includes moving to "fully appointed boards combining health professionals and members of the public in equal parts".

      "However, the appointment process as currently operated in British Columbia is not independent, transparent, [and] competency based," Cayton stated. "It cannot be relied upon at the present time to take on a broader role."

      In addition, he recommended that boards be reduced in size, ideally to between eight and 12 people, with terms extended to three years and renewable for another three years.

      In one section of the report, Cayton noted that the College of Physicians and Surgeons of B.C. requires licensing of facilities that provide light or moderate IV sedation. However, this isn't the case with the College of Dental Surgeons of B.C.

      Cayton suggested that the two regulatory bodies "meet to agree a shared approach and inspection regime and to ensure mutual confidence in the safety of patients".

      He also pointed out that one patient who made a submission asked for anonymity "because of fear of rejection or retaliation by other health professionals treating them in the future".