A N N U A L R E P O R T

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1 A N N U A L R E P O R T C O L L E G E O F D E N TA L H Y G I E N I S T S O F O N TA R I O

2 I N D E X SECTION I Mission Statement... 1 President s Message... 2 Administrative Repor t... 3 Administration Staf f... 4 College Commit tees... 5 Members of Council... 6 COMMIT TEE REPORTS Executive... 7 Executive Par t II... 8 Qualit y Assurance... 9 Registration Complaints Discipline Fitness to Practise Patient Relations Regulations & Bylaws SECTION II FINANCIAL STATEMENTS Auditor s Repor t Statement of Financial Position Statement of Surplus Statement of Operations Statements of Cash Flows Notes to Financial Statements... 31

3 C O L L E G E O F D E N TA L H Y G I E N I S T S O F O N TA R I O M I S S I O N S TAT E M E N T The mission of the College of Dental Hygienists of Ontario is to regulate the practice of dental hygiene in the interest of the overall health and safety of the public of Ontario. É N O N C É D E M I S S I O N La mission de l Ordre des hygiénistes dentaires de l Ontario consiste à réglementer l exercice de la profession d hygiène dentaire de sorte à favoriser l état de santé global et la sécurité du public ontarien. 1

4 M e s s a g e f r o m t h e P r e s i d e n t P e g g y M a g g r a h It is an honour to write the President s Report one last time and to inform you of the 2005 highlights. A lot has happened during this past year. A strategic planning workshop was held in March 2005 that the CDHO Council determined was of great value and appropriate for many reasons. It was during this workshop that Council developed new mission, value and vision statements. All three statements are now considered the building blocks in setting CDHO s future direction. The strategic plan was approved by Council on July 20, 2005 and included a SWOT (Strengths, Weaknesses, Opportunities and Threats) analysis as well as a stakeholder analysis. It discussed the organization s philosophy and direction. Eight long term working goals were developed to provide strategic direction for the organization. These goals will be used in the decision making process to keep the CDHO moving towards its vision. A business plan was also established as the organization determined its short term objectives and strategies. Every organization should strive to continually enhance their operations and communications. For those who can visualize a mountain; we are moving closer to the summit every single day. We will be at the peak someday soon so that all people in Ontario can have the choice of receiving safe, effective and accessible dental hygiene care. On a personal note, I would like to say goodbye to all my colleagues both past and present who I have had the pleasure of meeting over the last eleven years. It truly has been a pleasure getting to know them. So it is time to say farewell, I wish the new Council members the best and I thank those past members for their contribution as well as a special thank you to the administrative staff for their hard work and dedication. I wish Council and the new Executive Committee best wishes and great deliberations in the year ahead! M e s s a g e d e l a p r é s i d e n t e P e g g y M a g g r a h Il me fait grand honneur d écrire pour une dernière fois le Rapport du président et de vous souligner certains événements de l année Beaucoup s est produit durant la dernière année. Un atelier de planification stratégique a été organisé en mars 2005, une séance que le Conseil de l OHDO jugeait de grande valeur et à propos pour plusieurs raisons. C est lors de cet atelier que le Conseil a formulé de nouveaux énoncés de mission, de valeur et de vision. Ces trois énoncés sont maintenant à l origine de la direction future de l OHDO. Le plan stratégique a été approuvé par le Conseil le 20 juillet 2005 et inclut une analyse SWOT (Strengths, Weaknesses, Opportunities and Threats) (Forces, Faiblesses, Occasions et Menaces), ainsi qu une analyse des intervenants. Cette analyse portait sur la philosophie et la direction de l organisation. On y a élaboré huit objectifs à long terme pour fournir une direction stratégique à l organisation. Ces objectifs seront à la base de notre processus de prise de décision de sorte à garder l OHDO en voie de sa vision. Un plan d affaires a également été créé pour déterminer les objectifs et stratégies à court terme de l organisation. Chaque organisation devrait œuvrer à constamment améliorer ses opérations et communications. Pour ceux et celles qui peuvent visualiser la montagne; nous nous approchons un peu plus chaque jour de son sommet. Nous atteindrons bientôt le pic de sorte que chacun en Ontario ait le choix de recevoir des soins d hygiène dentaire sécuritaires, efficaces et accessibles. Personnellement, je voudrais faire mes adieux à tous mes collègues présents et antérieurs que j ai eu le plaisir de rencontrer au cours des derniers onze ans. Il m a fait grand plaisir d apprendre à vous connaître. Au moment où je m apprête à quitter, je désire souhaiter aux nouveaux membres du Conseil mes meilleurs vœux et remercier tous les anciens membres pour leur contribution. Je veux également remercier le personnel administratif pour son dévouement et son travail ardu. Beaucoup de succès au Conseil et au nouveau comité exécutif pour l année à venir et pour des délibérations fructueuses! 2

5 A D M I N I S T R AT I O N During 2005 College Administration continued to implement strategies to comply with the federal Personal Information Protection and Electronic Documents Act (PIPEDA) and the implications for registrants of the provincial Personal Health Information Protection Act (PHIPA). Members of Administration continued to be involved in national, provincial and local committees. R e g i s t r a t i o n S t a t i s t i c s a s o f D e c e m b e r 3 1, General Certificate of Registration 7,025 Inactive Certificate of Registration 384 Specialty Certificate of Registration 402 3

6 A D M I N I S T R AT I V E S TA F F Diane Colautti, Communication Services Co-ordinator Evelyn Waters, Deputy Registrar Suzanna Tatsis, Administrative Assistant Eleanor McIntyre, Quality Assurance Administrator Fran Richardson, Registrar/Chief Administrative Offi cer Margaret Stevenson, Director, Administrative Services Joyce Quan, Quality Assurance/ Registration Co-ordinator Celine Weeling Lee, Receptionist Jane Cain, Executive Assistant Lisa Taylor, Practice Advisor/ Quality Assurance Administrator 4

7 C O L L E G E C O M M I T T E E S E X E C U T I V E Peggy Maggrah, President Lois Brown, Vice President Gordon Campbell Cathie Mazal-Kuula Karen Tulk F I T N E S S T O P R A C T I S E All Council Members Sharon Cavanagh, Chair Q U A L I T Y A S S U R A N C E Vicky Colbourne, Chair Lois Brown (as of June 2005) Lucy Charbonneau (NC) Kim Christianson-Gagnon (NC) Diane Greenwood Kelly-Ann Macknight Ken Massey Sandra White (until June 2005) R E G I S T R AT I O N Nancy Kitchen, Chair Sharon Cavanagh Kathy Colalillo (NC) Gordon Campbell Moe Fouladi Carole Ono P AT I E N T R E L AT I O N S Kathleen Feres Patry, Chair Pauline Beal * Harry Chadwick Anita Mitsopulos (NC) Shirley Silverman Kay Wetherall R E G U L AT I O N S & B Y L A W S Diane Greenwood, Chair Harry Chadwick Nancy Kitchen Shirley Silverman Kay Wetherall C O M P L A I N T S Ken Massey, Chair Kathleen Feres Patry Moe Fouladi Jill Hicks (NC) Kelly-Ann Macknight Anita Mitsopulos (NC) D I S C I P L I N E All Council Members Carole Ono, Chair Kathy Colalillo (NC) Kim Christianson-Gagnon (NC) * = Until September 2005 NC = Non-Council member 5

8 M E M B E R S O F C O U N C I L Pauline Beal, Public Member (Term ended Sept. 2005) Lois Brown, Public Member Cindy Campbell, Public Member (Appointed Aug. 2005) Gordon Campbell, Public Member Sharon Cavanagh, Professional Member No Photo Available Harry Chadwick, Public Member Vicky Colbourne, Professional Member Kathleen Feres Patry, Professional Member Mohammed Fouladi, Public Member Diane Greenwood, Professional Member No Photo Available Salam Kherdaji, Public Member (Appointed Dec. 2005) Nancy Kitchen, Professional Member Kelly-Ann Macknight, Professional Member Peggy Maggrah, Professional Member Ken Massey, Public Member Cathie Mazal-Kuula, Professional Member Carole Ono, Professional Member Shirley Silverman, Professional Member Barbara Smith, Public Member (Term ended Jan. 2005) Karen Tulk, Professional Member Kay Wetherall, Public Member Sandra White, Public Member 6

9 E X E C U T I V E C O M M I T T E E Peggy Maggrah, President Lois Brown, Vice President Gordon Campbell Cathie Mazal-Kuula Karen Tulk The Executive Committee is charged with the responsibility of acting on behalf of Council between meetings of Council. The Executive Committee met twelve times in the year The Executive Committee reviewed the finances of the College and presented the audited statements to Council for consideration and approval. A strategic planning workshop was held in March 2005 at which time the Mission Statement was updated and the College goals for the next three years were formulated. Access to oral health care continued to be an issue addressed by the Committee. The two Private Member s Bills introduced in 2004, which would have amended the Dental Hygiene Act, 1991 upon Royal Assent, died on the order paper when the House prorogued in September The CDHO hosted an Oral Health Summit on September 16, 2005 as part of the College s commitment to work towards increased access for the public to dental hygiene care. The College participated in the Federation of Health Regulatory Colleges of Ontario (FHRCO) submission to the Health Professions Regulatory Advisory Council (HPRAC) as well as making two College specific submissions. HPRAC is conducting a review of the RHPA, 1991 on a referral from the Minister of Health & Long-Term Care. 7

10 E X E C U T I V E C O M M I T T E E - P A R T I I Peggy Maggrah, President Lois Brown, Vice President Gordon Campbell Cathie Mazal-Kuula Karen Tulk The Executive Committee Part II, which deals with matters relating to professional misconduct, met eight times in Concerns that are brought to the attention of the College, but are not considered formal complaints, are referred to the Executive Committee for appropriate action. The following is a summary of those investigations completed by the Executive Committee in There were two investigations ongoing at the end of Professional Misconduct Issues After reviewing information respecting a registrant who had been charged with a criminal offence, the members of the Committee agreed to take no further action as they determined that the offence did not affect the registrant s suitability to practise dental hygiene. In another case, the Committee agreed to discontinue its investigation into a registrant s practice as the Registrant had resigned from the College and signed an Undertaking stating that she would not re-apply for registration. An anonymous complaint was received in However, as there did not appear to be reasonable and probable grounds to pursue an investigation, the Committee directed that no further action be taken. The Committee referred two registrants to the Discipline Committee for issues relating to non-compliance with the College and breaching an Undertaking. Incapacity concerns Two referrals were made by the Complaints Committee to the Executive Committee regarding possible incapacity proceedings. In both cases, the registrants agreed to sign an Undertaking with the College which addressed the issues of concern. Therefore, there was no need to appoint a Board of Inquiry in either case. Referrals from the Quality Assurance Committee There were six referrals from the Quality Assurance Committee to the Executive Committee respecting registrants who were non-compliant with the submission of their professional portfolios to the College. In one case the registrant had not renewed with the College, in two cases, the registrants were granted extensions for submission of the professional portfolio and in the other cases the registrants submitted their professional portfolios and were referred back to the Quality Assurance Committee for further consideration. Illegal Practise Issues The CDHO is committed to ensuring that the public of Ontario are well served in the area of oral health care, and will pursue persons who hold themselves out to be dental hygienists when in fact they are not registered with this College. In 2005, the College investigated two such possibilities. In one situation, the College was unable to secure sufficient information, thus no further action was taken. In a second situation, a registrant was found to be practicing without renewing with the College and while under suspension. The Committee determined that the registrant was to sign an Agreement & Undertaking and attend a Jurisprudence presentation. 8

11 Q U A L I T Y A S S U R A N C E C O M M I T T E E Vicky Colbourne, Chair Lois Brown Lucy Charbonneau Kim Christianson-Gagnon Diane Greenwood Kelly-Ann Macknight Ken Massey The Quality Assurance Committee, a statutory committee of the College of Dental Hygienists of Ontario, is responsible for the implementation and administration of the Quality Assurance Program and for the collection, analysis, evaluation and dissemination of information related to the Quality Assurance Program. The Quality Assurance Committee met three times in The Quality Assurance Program includes the following components. Continuing Quality Improvement Measures Each year, in accordance with the Quality Assurance Regulation, registrants are required to assure the College that they are maintaining a professional portfolio and that they are participating in continuing quality improvement activities sufficient to have the knowledge, skills and judgment to practise in a manner consistent with the CDHO Dental Hygiene Standards of Practice. In the year 2005, the Registrar referred 15 registrants to the Quality Assurance Committee for non-compliance with the Quality Assurance Regulation. Of the 15 registrants requested to submit a professional portfolio, 15 professional portfolios have been received. Of the 15 professional portfolios received 13 have met the assessment guidelines (A.1) 02 are in progress * A1 - Meets Assessment Guidelines - includes Exemptions ** In-Progress - Registrants who are still in the assessment phase - due to deficiencies, no response, resignations, suspensions, inactive status 9

12 Q U A L I T Y A S S U R A N C E C O M M I T T E E... c o n t i n u e d Peer Assessment - Professional Portfolio/Practice Review and Remediation Each year, in accordance with the Quality Assurance Regulation, the Quality Assurance Committee randomly selects registrants to submit their professional portfolios for review by a quality assurance assessor. If, in the review of a professional portfolio, the assessor determines that the registrant s dental hygiene practice is not consistent with the CDHO Dental Hygiene Standards of Practice the assessor may then conduct an On-Site Practice Review. In 2005, 10% or 721 registrants of those registrants holding a general or a specialty certificate of registration were randomly selected to submit their professional portfolios for the 2005 Peer Assessment Professional Portfolio/Practice Review. Of the 721 professional portfolios received: 96% have met the assessment guidelines 04% are in progress * A1 - Meets Assessment Guidelines ** In-Progress - Registrants who are still in the assessment phase - due to deficiencies, no response, resignations, suspensions, inactive status Total Quality Improvement The Total Quality Improvement Component of the Quality Assurance Program through the periodic surveying of registrants is designed to create Dental Hygiene Practice Profiles. In 1995, registrants were surveyed to create a Baseline Practice Profile. This database will be used for ongoing analysis that will allow the Committee to monitor the patterns, trends and changes in the continuing quality improvement activities and practice behaviors of dental hygienists and to evaluate the effectiveness and efficiency of the Quality Assurance Program. In 2003, 84% of the registrants responded to the Total Quality Improvement Survey, Dental Hygiene Practice in Ontario, The purpose of the study was two-fold: to identify and investigate current practice patterns of dental hygienists in Ontario and to examine trends and changes related to the quality of that practice over the past 7 year period. The descriptive analysis of the data derived from the survey with noted key findings and recommendations has been completed. The Quality Assurance Committee approved the findings and recommendations of the study, Dental Hygiene Practice Profile, Ontario 2002 and directed PMJ Consultants to complete the recommendations for further study in In 2004, PMJ Consultants completed the report, CDHO Dental Hygiene Practice: in Ontario The Quality Assurance Committee approved the report. Highlights from this report were published in the February 2005 edition of Milestones. One of the most noteworthy conclusions to this report was the importance of continuing quality improvement activity in the achievement and maintenance of high standards of dental hygiene practice. 10

13 R E G I S T R AT I O N C O M M I T T E E Nancy Kitchen, Chair Sharon Cavanagh Kathy Colalillo Gordon Campbell Moe Fouladi Carole Ono The Registration Committee is responsible for reviewing applications for registration referred to the Committee by the Registrar. These applications are referred if the Registrar has doubts about whether the applicant fulfills the registration requirements, is of the opinion that terms, conditions or limitations should be imposed on a certificate of registration or the Registrar proposes to refuse the application. The members of the Registration Committee met nine times in A Panel of the Registration Committee reviewed nine applications from graduates of non-accredited dental hygiene programs and one from a non-accredited restorative dental hygiene program. Two applicants met the requirements to participate in the College s certificate of registration assessments. In seven cases, the Panel determined that the courses of study taken were not equivalent to a recognized accredited dental hygiene program. A Panel also reviewed two applications from graduates who had been found guilty of criminal offences and determined that their behaviour did not affect their suitability to practise the profession. Applicants who are not satisfied with the decision of the Registration Committee may request the Health Professions Appeal and Review Board (HPARB) to hold a review or a hearing. HPARB is appointed by the government and is completely independent of the College. In a review, HPARB reviews the application and supporting documentation in the absence of the parties. In a hearing, both the applicant and the Registration Committee are given an opportunity to bring lawyers, call witnesses to give oral testimony and to make oral submissions. In 2005 two applicants requested a review and one requested a hearing. HPARB upheld the Committee s decision in one of the reviews. The other two matters have not yet been determined. During the normal course of conducting its business, the Committee reviewed and updated its policies and dealt with issues such as granting extensions to applicants from attending a Jurisprudence presentation prior to registration and requests to accept documentation required for registration due to extenuating circumstances. The Registration Committee granted the Ministry of Training, Colleges and Universities request to utilize the CDHO Standards of Practice to develop an assessment tool for dental hygiene programs in Ontario. As the CDHO Standards of Practice is a public document, the members of the Committee had no objection to its use in any manner provided that it was used judicially. However, the Ministry was advised that the standards were not designed for the purpose of assessing a dental hygiene program and that the use of these standards no way endorsed the results of the Ministry s assessment process. A proposed amendment to the CDHO s registration regulation to facilitate the grandparenting provision of the Mutual Recognition Agreement (MRA) made under the Agreement on Internal Trade (AIT), which addresses the movement of goods, services, labour and capital through the removal or reduction of barriers was submitted to the Ministry of Health and Long Term Care (MOHLTC) in October Further to discussions with the MOHLTC, it was agreed that the grandparenting provision should be expanded to include those who were registered on or before January 1, 2004 rather than just on that date. As this was a substantive change to the original amendment, the proposal was circulated to stakeholders for comment and approved by Council in July It is anticipated that this amendment will be passed in In October 2005 Council meeting, the Registration Committee presented further proposed amendments to the registration regulations to ensure that they are current and to ensure consistency and fairness to applicants. Council agreed that the amendments should be circulated to stakeholders and brought back to Council for further consideration in

14 C O M P L A I N T S C O M M I T T E E Ken Massey, Chair Kathleen Feres Patry Moe Fouladi Jill Hicks Kelly-Ann Macknight Anita Mitsopulos The Complaints Committee is mandated to review all formal complaints received by the College. In the course of its investigation, a Panel of the Complaints Committee considers submissions by the registrant and the complainant and all relevant records and documentation. In some cases, the Panel appoints an investigator to interview the relevant parties to the complaint. Based on the outcome of its investigation, the Panel may do one or more of the following: 1. refer a specified allegation of the registrant s professional misconduct or incompetence to the Discipline Committee; 2. refer the registrant to the Executive Committee for incapacity proceedings; 3. require the registrant to appear before it or another Panel of the Complaints Committee to be cautioned; 4. take action it considers appropriate that is not inconsistent with the Act,. (e.g. dismiss the complaint, give written advice or a written caution, recommend upgrading, or refer to the Quality Assurance Committee) Unless the decision involved a referral to the Discipline Committee for professional misconduct or incompetence proceedings or to the Executive Committee for incapacity proceedings, the complainant or the registrant who is the subject of the complaint may request the Health Professions Appeal and Review Board (HPARB) to review the decision. There were no requests for review in However, HPARB concluded its review of a 2004 Complaints Panel s decision and determined that the Panel s investigation was adequate and its decision reasonable. There were five decisions handed down by a Panel of the Complaints Committee in In one case, it was alleged that a dental hygienist acted unprofessionally by interrupting another health care professional in the middle of treatment, resulting in a laceration to the inside of a client s cheek. Subsequent to the investigation, it appeared that the client was likely not injured as a result of the interruption. However, the Panel was concerned that a dental hygienist would proceed to the entrance and/or into an operatory where a client was being treated, unless it was an emergency. Although the members of the Panel understood that the dental hygienist was upset, they were of the opinion that the matter could have been dealt with in a more appropriate and professional manner. Therefore, they directed that the dental hygienist be required to attend before a Panel of the Complaints Committee for a caution. The second case dealt with allegations that a dental hygienist unnecessarily manually cleaned a client s teeth, did not allow the client to rinse during treatment and damaged a tooth. The Panel understood that the use of manual instruments to scale teeth is not uncommon and, in some cases, appropriate. As there was conflicting information respecting the opportunity for the client to rinse during treatment, the Panel determined that, as the client had been a long-standing client, if there was a misunderstanding on this issue, it was an isolated incident and did not warrant further action. The Panel could not find sufficient information to substantiate the allegation that a tooth had been damaged during dental hygiene treatment. The Panel recognized that, on occasion, scaling teeth could dislodge restorations. However, this would not necessarily mean that a dental hygienist fell below the standards of practice. The usual practice would be, if the incident were noticed by the dental hygienist, to inform the client and document the incident in the client record. There was no such notation in the record. As the Panel determined that the information gathered did not raise a specific concern that warranted disciplinary action, they agreed that no further action be taken with respect to this complaint. 12

15 C O M P L A I N T S C O M M I T T E E... c o n t i n u e d In two other cases relating to concerns of improper infection control procedures, inaccurate charting, inappropriate attitude towards clients and client abandonment, the Panel determined that the matters should be referred to the Executive Committee for incapacity proceedings. The last case dealt with concerns centering around inappropriate dental hygiene treatment, e.g. not measuring pocket depths and not being informed of gum disease. In reviewing the information gathered in this investigation, the Panel had concerns that the dental hygienist did not appear to perform periodontal charting, her communication with clients was not client-centered, outcomes of non-compliance were apparently not properly explained, and that she did not appear to follow the dental hygiene process of care as indicated by her recordkeeping which did not outline a treatment plan. Although the Panel understood her explanation to be that she was not given sufficient appointment time and that the charting forms were outdated, this did not relieve her of responsibility. Initially, the Panel members were of the opinion that their concerns could be addressed through educational measures. However, the dental hygienist appeared to be of the opinion that this was unecessary as she had addressed the issues of concern. The Panel agreed to refer the matter to the Quality Assurance Committee, which will be able to determine whether the dental hygienist meets the current standards of practice and utilizes the dental hygiene process of care. If the Quality Assurance Committee finds any deficiencies, it can require appropriate remediation. 13

16 D I S C I P L I N E C O M M I T T E E Carole Ono, Chair Pauline Beal ** Lois Brown Cindy Campbell*** Gordon Campbell Sharon Cavanagh Harry Chadwick Kim Christianson-Gagnon Kathy Colalillo Vicky Colbourne Kathleen Feres Patry Diane Greenwood Nancy Kitchen Kelly-Ann Macknight Peggy Maggrah Ken Massey Cathie Mazal-Kuula Shirley Silverman Barbara Smith* Karen Tulk Kay Wetherall Sandra White * Until January 31, 2005 ** Until September 2005 ***Appointed September 2005 The Discipline Committee hears and determines allegations of professional misconduct or incompetence against registrants of the College. Either the Complaints or Executive Committee makes referrals to the Discipline Committee. There were three discipline hearings in A summary of the decisions and reasons for each of the respective hearings are included in the Annual Report. A Panel appointed by the Chair of the Discipline Committee conducts the hearing. The possible penalties that the Panel can impose on a registrant who is found guilty are defined in the Regulated Health Professions Act, 1991, (RHPA), and can include one or more of the following: 1. Directing the Registrar to revoke the registrant s certificate of registration. 2. Directing the Registrar to suspend the registrant s certificate of registration for a specified period of time. 3. Directing the Registrar to impose specified terms, conditions and limitations on the registrant s certificate of registration for a specified or indefinite period of time. 4. Requiring the registrant to appear before the panel to be reprimanded. 5. Requiring the registrant to pay a fine of not more than $35,000 to the Minister of Finance of Ontario. The Panel can also require the registrant to pay all or part of the College s legal costs and expenses, the College s costs and expenses incurred in investigating the matter and the College s costs and expenses incurred in conducting the hearing. A party to these proceedings may appeal the decision of the Panel to the Divisional Court of Ontario. 14

17 D I S C I P L I N E C O M M I T T E E... c o n t i n u e d DISCIPLINE PANEL DECISION AND REASONS FOR DECISION (REVOCATION OF A DENTAL HYGIENIST S CERTIFICATE OF REGISTRATION) MARLENE MIZZAU A Panel of the Discipline Committee of the College of Dental Hygienists of Ontario (CDHO) held a hearing in Toronto on March 4, 2005 to determine whether Ms. Marlene Mizzau committed an act of professional misconduct (sexual abuse) when she developed a personal and sexual relationship with a client. Sexual abuse of a client is defined in Section 1.(3) of the Code, as (a) sexual intercourse or other forms of physical sexual relations between a registrant and a client, (b) touching, of a sexual nature, of a client by a registrant, or (c) behaviour or remarks of a sexual nature by a registrant towards a client. It was admitted that Ms. Mizzau carried on a sexual relationship with the complainant while he was her client. Sexual intercourse by a dental hygienist with a client constitutes sexual abuse. Therefore, the Panel determined that Ms. Mizzau committed an act of professional misconduct relating to sexual abuse. The relevant penalty provision of the Code in a sexual abuse case is a reprimand and revocation of the dental hygienist s certificate of registration. A dental hygienist whose certificate of registration has been revoked for sexual abuse that includes sexual intercourse cannot make an application for reinstatement earlier than five years after the revocation. The Panel was aware that a challenge had been made to the courts with respect to the mandatory provision for revocation in the event of a finding of serious sexual abuse. The Ontario Court of Appeal in the Dr. Mussani and College of Physicians and Surgeons of Ontario case upheld the constitutional validity of that mandatory penalty in the face of a challenge that it violated rights under the Charter of Rights. The Ontario Court of Appeal is the highest court in Ontario, and the Panel understood that its role is to apply the law as determined by the courts. The Panel was aware that the relationship with the complainant developed into a spousal relationship and that the complaint was made some years later and only after the spousal relationship had ended. Counsel for the College emphasized in his submission that it was not the position of the College that Ms. Mizzau s conduct was predatory. However, he did submit that the conduct was nevertheless a serious violation of boundaries, which all health professionals have been informed by their Colleges is unacceptable. The Panel was of the view that sexual intercourse with a current client, even if not a predatory act, is a serious crossing of boundaries that was unacceptable. The professional relationship with the client must be terminated, if a dental hygienist wishes to embark upon an intimate relationship with that person. The adoption of zero tolerance policies and mandatory revocation were highlighted by the Court of Appeal in the Dr. Mussani case. The Court summarized a number of important findings and factors. Among the principal factors noted were the following that the Panel considered important in respect to registered dental hygienists, as with other health professionals. (1) the general vulnerability of clients in such relationships; (2) the power imbalance that almost invariably exists in favour of the health professional, thus facilitating easy invasion of the client s sexual boundaries; (3) the breach of trust entailed in such conduct; 15

18 D I S C I P L I N E C O M M I T T E E... c o n t i n u e d (4) the injury to the victim, both physical and emotional, that often results from sexual abuse, including the harmful effects on future care caused by the victim s inability to place trust in other health professionals; (5) the fact that sexual abuse tarnishes public trust in the entire profession. Although the Court was dealing directly in that case with sexual abuse by a medical doctor, the prohibition of sexual contact by health professionals and their clients applies to all of the health professions in Ontario under the Code. Indeed, the Court acknowledged the application of these principles to all health professions. Furthermore, the CDHO adopted a zero tolerance policy, which was known or should have been known to Ms. Mizzau. The CDHO has published in Milestones and other educational brochures and guidelines materials related to the prevention of sexual abuse. Therefore, the Panel determined: 1. That the Certificate of Registration of Ms. Mizzau be revoked commencing on March 4, That Ms. Mizzau appear before the Panel to be reprimanded. The Panel made no order against Ms. Mizzau as to costs. The Panel recommended that any future panel of the Discipline Committee approve her application for reinstatement provided that she successfully complete a refresher course acceptable to the Registrar within an 18-month period prior to returning to active practise. A future Panel, of course, is not bound by what the Panel recommended, and must itself determine whether it is then appropriate to reinstate her certificate of registration. SUMMARY OF DECISION AND REASONS FOR DECISION RAJWANT GIRN In a hearing held on October 24, 2005 Ms. Rajwant Girn was found guilty of professional misconduct under paragraphs 30 (failing to reply), 36 (failing to carry out an undertaking), 42 (contravening the legislation) and 47 (unprofessional misconduct) of the professional misconduct regulations. Under the quality assurance regulations, registrants are required to comply with the requirements of the quality assurance, which include: (a) developing and maintaining a professional portfolio, (b) annually participating in continuing quality improvement activities sufficient to indicate that s/he continues to have and to apply in her/his dental hygiene practice the knowledge, skills, judgment and attitudes required to practice dental hygiene in compliance with the College s standards of practice and ethics, (c) accurately and completely documenting those activities in her/his professional portfolio, and 16

19 D I S C I P L I N E C O M M I T T E E... c o n t i n u e d (d) cooperating with an assessment of her/his professional portfolio, quality improvement activities and practice to evaluate her/his knowledge, skills, judgment and attitudes. Ms. Girn acknowledged that, in the past, she had consistently failed to cooperate with the Quality Assurance Committee and with the College as a whole and had breached her verbal agreements and written undertaking to the College. However, Ms. Girn had recently taken the following steps to bring herself into compliance with the Quality Assurance Program and with her formal written undertaking. Her previous issues with compliance related to her difficulties in prioritizing College-related communications and juggling her personal and professional life. Ms. Girn admitted that her many failures to communicate with the College and her previous non-compliance with the requirements of the College s quality assurance regulations constituted professional misconduct. The Panel wanted to make clear that compliance with Quality Assurance Committee obligations was a fundamental obligation of the profession. It was not just a matter of a filing requirement - not just a technical breach of the Rules. Quality Assurance Committee obligations are strongly connected to client care. The CDHO s Quality Assurance Program of which the Professional Portfolio is a component, requires the dental hygienist to: Reflect upon one s own performance in the provision of patient care Identify areas of performance that require improvement Develop Continuing Quality Improvement (CQI) activities These requirements are essential to ensure that the dental hygienist maintains and improves her/his level of competence through the continuous acquisition of knowledge, skills and judgment. The Panel was dismayed to learn that this matter of non-compliance with the College spanned such a long period of time. During this period the Registrar provided numerous opportunities for Ms. Girn to respond and comply, which she failed to do. This failure to comply was a clear indication that she failed to understand the importance of not only responding to the College, but ensuring compliance with the submission of the professional portfolio upon request. This was a serious breach of conduct. The Panel did note that there was no allegation and no evidence before it that this had translated into a failure to maintain standards of patient care in any particular case. The Panel also considered the following mitigating factors: * There was a prompt admission of misconduct by Ms. Girn * She made genuine efforts to address the issue of her misconduct * Ms. Girn showed remorse * This was Ms. Girn s first time before the Discipline Committee. There was no prior record of misconduct. Therefore, the Panel accepted a joint submission on order as follows: 1. that the Registrar suspend Ms. Girn s certificate of registration to practice for a period of four weeks to commence on October 25,

20 D I S C I P L I N E C O M M I T T E E... c o n t i n u e d 2. that the Registrar suspend two weeks of the suspension order in paragraph 1 and that Ms. Girn shall only be required to serve the remaining two weeks of the one-month suspension if she failed to comply with the remainder of this order. If any dispute shall arise between Ms. Girn and the College, as to whether she is in breach of a provision of this order, the dispute shall be remanded to a Panel of the Discipline Committee for further adjudication. The parties shall have the opportunity to make full submissions to the Panel before it renders a decision. If, thereafter, the Panel determines that Ms. Girn has breached a provision of this order, then and only then shall she be required to serve the remaining two weeks of her four week suspension, to commence on a date to be fixed by the Registrar of the College. 3. that Ms. Girn shall appear before a panel of the Discipline Committee this day to be reprimanded and the facts of the reprimand shall be recorded in the register. 4. that the Registrar impose the following specified terms, conditions and limitations on the certificate of registration of Ms. Girn: (i) For a period of two years, commencing on the date of the Discipline Panel s Order, Ms. Girn shall reply appropriately and within 30 days to a written inquiry made by the College that requests a response. 5. that Ms. Girn shall pay the amount of $3, in costs to the College at the rate of $ per month, starting on the 15th day of the first month after completing the first two weeks of her suspension. At any time, Ms. Girn shall be at liberty to increase the amount of her monthly payment, solely at her discretion. Ms. Girn waived her right of appeal and the reprimand was administered by the Panel. SUMMARY OF DECISION AND REASONS FOR DECISION GWENDOLYN RINGROSE In a hearing held on November 21, 2005, a Panel of the Discipline Committee found Ms. Gwendolyn Ringrose guilty of professional misconduct under paragraphs 30 (failing to reply), 36 (failing to carry out an undertaking), 42 (contravening the legislation) and 47 (unprofessional conduct) of Section 15 of Ontario Regulation 218/94 as amended. Under the quality assurance regulations, registrants are required to comply with the requirements of the quality assurance program. Those requirements include the following: (a) developing and maintaining a professional portfolio, (b) during every year participating in continuing quality improvement activities sufficient to indicate that the Registrant continues to have and to apply in her or his dental hygiene practice the knowledge, skills, judgment and attitudes required to practice dental hygiene in compliance with the College s standards of practice and ethics, (c) accurately and completely documenting those activities in the Registrant s professional portfolio, 18

21 D I S C I P L I N E C O M M I T T E E... c o n t i n u e d (d) co-operating with an assessment of her professional portfolio, quality improvement activities and practice to evaluate the Registrant s knowledge, skills, judgment and attitudes, and (e) complying with directions for remediation made by the Quality Assurance Committee. Ms. Ringrose consistently failed to co-operate with the Quality Assurance Committee and with the College as a whole and breached her verbal agreements and formal written undertaking to the College. The Panel wanted to make clear that compliance with the Quality Assurance Program was a fundamental obligation of the profession. As the Panel had stated in another case, it was not just a matter of a filing requirement, nor is a failure to comply or just a technical breach of the rules. The Quality Assurance program is very important and strongly connected to safe and effective client/patient care. It is critical that Ms. Ringrose, and all registrants, recognize this connection. The CDHO s Quality Assurance Program of which the Professional Portfolio is a component, requires the dental hygienist to: Reflect upon one s own performance in the provision of patient care Identify areas of performance that require improvement Develop Continuing Quality Improvement (CQI) activities The Panel considered that the penalty would serve as a specific deterrent to Ms. Ringrose and as a general deterrent to other registrants of the profession. These requirements are essential to ensure that every dental hygienist maintains and improves her/his level of competence through continuous acquisition of knowledge, skills and judgment. The fact that the Quality Assurance Committee identified areas of concern requiring remediation (jurisprudence, record keeping and infection control) clearly indicated the need for Ms. Ringrose to make improvements, not only to comply with legislative requirements but even more importantly to ensure safe and effective patient care. Aggravating factors in this case included the repeated failure to co-operate with the Quality Assurance Committee, after numerous opportunities to comply, extended over a five year period. Ms. Ringrose breached her verbal agreements and written undertaking to the College, suggesting a failure to comprehend the connection between continuing quality improvement activities and competent, safe and effective patient care. The Panel also took into consideration that: a) there was no previous finding of misconduct against Ms. Ringrose by the Discipline Committee, b) she acknowledged her misconduct by pleading guilty and c) that she was going through difficult personal and family circumstances which was offered as an explanation but not a justification for her conduct. While the Panel sympathized with her personal problems, it noted that the College was very reasonable and patient in dealing with her over the lengthy period of noncompliance with the Quality Assurance Committee. However, dental hygienists like other health professions must abide by their obligations, even in trying personal times, if they wish to continue to practice. It is important that this message be loud and clear. Therefore, the Panel accepted a joint submission on order as follows: 1. that the Registrar suspend Ms. Ringrose s certificate of registration to practice for a period of four weeks to commence on a date fixed by the Registrar in January of

22 D I S C I P L I N E C O M M I T T E E... c o n t i n u e d 2. that the Registrar suspend one week of the suspension ordered in paragraph 2 and that Ms. Ringrose shall only be required to serve the remaining week of the suspension if she fails to comply with the remainder of this order. If any dispute shall arise between Ms. Ringrose and the College, as to whether she is in breach of a provision of this order, the dispute shall be remanded to a Panel of the Discipline Committee for further adjudication. The parties shall have the opportunity to make full submissions to the Panel before it renders a decision. If, thereafter, the Panel determines that Ms. Ringrose has breached a provision of this order, then and only then shall she be required to serve the remaining week of her suspension, to commence on a date to be fixed by the Registrar of the College. 3. that Ms. Ringrose shall appear before a Panel of the Discipline Committee this day to be reprimanded and the facts of the reprimand shall be recorded in the register. 4. that the Registrar impose the following specified terms, conditions and limitations on the certificate of registration of Ms. Ringrose: (i) Successful completion, in the opinion of the Registrar, of an ethics and jurisprudence course acceptable to the Registrar, at her own expense, by February 28, that Ms. Ringrose shall pay the amount of $3, in costs to the College at the rate of $ per month, starting on the 15th day of the first month after completing the first three weeks of her suspension. No interest will accrue on the outstanding amounts so long as they are paid on time. At all times, Ms. Ringrose shall be at liberty to increase the amount of her monthly payment, solely at her discretion. Ms. Ringrose waived her right of appeal and the reprimand was administered by the Panel. 20

23 F I T N E S S T O P R A C T I S E C O M M I T T E E Sharon Cavanagh, Chair Pauline Beal* Lois Brown Cindy Campbell*** Gordon Campbell Harry Chadwick Vicky Colbourne Kathleen Feres Patry Diane Greenwood Nancy Kitchen Kelly-Ann Macknight Peggy Maggrah Ken Massey Cathie Mazal-Kuula Carole Ono Shirley Silverman Barbara Smith** Karen Tulk Kay Wetherall Sandra White * Until September 2005 ** Until January 31, 2005 *** Appointed September 2005 The Fitness to Practise Committee hears and determines allegations relating to registrants who may be incapacitated and thus, may be suspended from practise or have terms, conditions or limitations imposed on their Certificate of Registration. There were no referrals to the Fitness to Practise Committee in If the Registrar believes a registrant may be incapacitated, she shall make the appropriate inquiries and report the results to the Executive Committee. The Executive Committee will then notify the registrant if it intends to appoint a Board of Inquiry. If there are reasonable grounds to believe a registrant is incapacitated, the Board may require the registrant to submit to a physical or mental examination. The Board of Inquiry reports to the Executive Committee and gives a copy of any reports to the registrant. The Executive Committee may refer the matter to the Fitness to Practise Committee and/or may impose an interim order directing the Registrar to suspend or impose terms, conditions or limitations on the registrant s certificate of registration. If a Panel of the Fitness to Practise Committee holds a hearing and determines that a registrant is incapacitated, the Panel shall make an order directing the Registrar to do any one or more of the following: revoke the registrant s Certificate of Registration; suspend the registrant s Certificate of Registration; impose specified terms, conditions and limitations on the registrant s Certificate of Registration for a specified or indefinite period of time. A party to these proceedings may appeal the decision of the Panel to the Divisional Court of Ontario. 21

24 P AT I E N T R E L AT I O N S C O M M I T T E E Kathleen Feres Patry, Chair Pauline Beal* Harry Chadwick Anita Mitsopulos Shirley Silverman Kay Wetherall * Until September 2005 The mandate of the Patient Relations Committee is to develop and implement a program that includes two distinct components: 1) measures for preventing or dealing with sexual abuse of clients/patients and 2) to inform the public about the importance of oral health and the dental hygienists responsibilities within health care. The members of the Patient Relations Committee met four times in In 2005, at the request of the Ministry of Health and Long Term Care (MOHLTC), the Committee presented an amendment to the CDHO s proposed regulation on Funding for Therapy and Counselling to include language similar to that of the Medicine Act, As this was considered a substantive change to the original amendment, the proposal was circulated to registrants and stakeholders for comment. At its July meeting, Council accepted the Committee s recommendation to forward the proposed amendment to the MOHLTC for approval. It is anticipated that the regulation will be passed in The CDHO guideline respecting Professional Boundaries for Dental Hygienists in Ontario and its brochure respecting the Prevention of Sexual Abuse of Clients were reviewed and updated by the Committee The Committee proceeded with the development of a Registrants Handbook intended to act as a resource for registrants. The Council approved the College s participation in a public education strategy by the Federation of Health Regulatory Colleges of Ontario (FHRCO). The communication strategy will promote the recognition and the value of regulatory health colleges to the public of Ontario through a five-phase strategy each phase building on the previous one and will be rolled out over a three year period. The Committee developed criteria for committee projects/activities which will be utilized when assessing the variety of initiatives that are presented to the Committee. In addition, the Committee reviewed past projects/activities and identified and prioritized the target audiences that will be given consideration when future projects are addressed. 22