There aren’t a lot of specifics about what prompted it, but a wholesale overhaul of the regulatory framework that covers more than 100,000 health professionals is in the works.
Unrest at the College of Dental Surgeons of B.C. prompted the investigative inquiry that was released last week. It reported on a fundamental problem over the understanding of who the college is supposed to serve — its own dues-paying members or the public.
But the inquiry by British professional-standards expert Harry Cayton went beyond the dentists. It recommended an overhaul of the legislation that governs 20 other health professions.
The goal is to make it clear across the spectrum that the answer to the above question is: The colleges have to put the public first.
The inquiry was announced a year ago, the same day Health Minister Adrian Dix stepped into the long-running arguments at the dental surgeons’ body. He named five new board members, all of them public, as opposed to professional.
And all the appointees happened to be senior health bureaucrats. It effectively put the college under trusteeship in all but name. The announced goal was to introduce “stability.”
Cayton’s inquiry was announced “in response to a series of unrelated complaints.” It was described as a rare and significant step.
He spent several months probing the college and reported last week on a deeply dysfunctional operation in which different factions were warring with one another. The situation improved after the board changes and during his review.
But the underlying issue of prioritizing members’ interests versus the public’s occupied much of his attention.
He commented on a persistent perception by members that “the college exists for the benefit of dentists, that it is a club rather than a regulator.”
Cayton said a small number of vocal critics in the membership objected to new standards and guidance and the unfairness of the complaints process.
“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,” he wrote.
He also noted that “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.”
The most serious case he mentioned was from 2015, when a disciplinary panel decided not to cancel the registration of a dentist who three years earlier had “permanently brain-damaged a young woman through his own deliberate acts.”
The dentist provided deep sedation when not authorized to do so, and botched it. He got a three-month suspension and a fine.
Cayton also remarked on another case outside of dentistry — last year’s notorious use by a Victoria naturopath of rabid-dog saliva as a remedy for a young autistic patient.
The naturopath withdrew from practice after the controversy, but Cayton provided more details on how the college that is supposed to regulate that group performed.
It issued a brief public notice last November saying: “After a collegial discussion, the registrant was allowed to resign from the college with no action taken on grounds that they did not agree with the standard in question.”
Cayton said the explanation renders professional regulation meaningless.
“If it is a defence to say after the event: ‘I didn’t agree with the standards,’ then both registration and standards are pointless.”
He advocated a change in emphasis in the legislation. Although it includes language about serving and protecting the public, Cayton considered it vague and wants it more focused on putting the public first.
Practitioners should be considered registrants, not “members” of their college, he said. He acknowledged that would remove professional self-regulation, but said it is necessary.
“Unlimited self-regulation has in general proved itself unable to keep patients safe or to adapt to changing health-care provision and changing public expectations.”
Colleges need to separate entirely from professional associations. The public needs more say in regulation, and the government needs to pay more attention to who it selects to sit on the boards of the colleges.
An unusual steering committee — Dix and MLAs from the B.C. Liberal and Green caucuses — will preside over the rewrite.
