TABLE OF CONTENTS

Agenda................................................................................................ 1

2016 AGM Minutes ............................................................................. 2

President’s Report ............................................................................... 7

Treasurers Report ................................................................................ 10

stFinancial Statement December 31 , 2016 ............................................ 17

Financial Statements ........................................................................... 20

2016 Oral Health Convention Report ................................................... 23

Nominating Committee Report............................................................ 24

By-Laws Committee Report ................................................................. 25

Dental Health Awareness Committee Report....................................... 28

CIDF Report ......................................................................................... 29

Continuing Education .......................................................................... 30

Tariff Committee ................................................................................. 31

Salaried Dentists ................................................................................. 33

Dental Monitoring Committee Report ................................................. 34

APILC Report - Spring 2017 .................................................................. 50

NL Dental Board Report....................................................................... 36

CDA Report.......................................................................................... 46

Questions:

9. OHC 2015 Report. Drs. Jason Noel and Jaqueline Tucker’s report is in the 2016

Annual Report.

10. Nominating committing report. The report is in the 2016 Annual Report. Dr. Amin Alibhai is on the Hospital Committee. Looking for more bodies on the DHAC. We are looking to put together an Ad Hoc committee for Awards and Honors. We’re specifically looking for a chair of the committee. We’ll send this to the bylaws next year to make it official. Dr. Linda Goodyear will chair.

Motion: That the Nominating Committee report be accepted as amended Dr. Gary Butler nominated Dr. Robert Sexton to the bylaws committee

11. NLDB Report. Dr. Paul O’Brien’s report is in the 2016 Annual Report. The Board will keep the radiation equipment. Trying to develop a facility permit and looking at Pharmacy as a model. It will take time but hoping it will be in place by the end of the year. There were about double the complaints this year. Many of these issues would be addressed by the Best Practises booklet. There is a handout provided explaining the different categories of complaints (no action required to high risk). Those that fall under the high risk will be on the website so the public can be aware of the results. Opiate misuse in another issue the NLDB is dealing with. The accreditation process is complete for the college (DA) and they’re good for 4 years.

There were no questions.

12. Standing Committee Reports

Dr. Sexton announced that all the standing Committee reports are in the Annual report. Each committee was itemized and the room was provided with an opportunity to question the chair of the committee. We still need a chair for the hospital services committee. Amendment to the bylaws: Dr. Gary Butler. The amendment is in the 2016 Annual Report. Motion: To accept the Bylaws amendment. Moved/Second: Dr. Gary Butler / Dr. Shane Roberts CARRIED We will be doing a full review of the bylaws. Let the committee know if you have any concerns.

Dr. Sexton asked if there are any questions for any of the reports. There were none.

13. Remarks by the CDA rep. The report is in the 2016 Annual Report. Dr. Linda Blakey highlighted the items of the report and provided the room with what CDA is working on in 2016. Focus on dental benefits. 4 areas of key priorities: partnership, relevance, access and scope. Recent achievements include: site (CDAnet, and iTrans), defending dentists’ interest with Insurance carriers. Also, a systematic review of the MOU.

Dr. Keith Piercey: What is the status of the ereferral system? Dr. Linda Blakey: the CDA secure send is in Beta. We’re taking our time with it so we don’t have a repeat with ereferral.

14. Report from CDSPI. The CDSPI report is in the 2016 Annual report. Dr. Robert

Sullivan highlighted items including MAP, Practice Management, and Mentorship. Risk management items CDSPI handles: business interruption, cybersecurity, malpractice.

Questions: Dr. Paul O’Brien: can you provide details of the 2 cases in BC of dentists going outside their scope of practise and therefore not being covered under malpractice? Dr. Robert Sullivan: In both cases, the dentist gave oral sedation, unlicensed, and the patients didn’t recover. Dr. Brian Kizner: Are we covered for injecting botox? Dr. Robert Sullivan: If you licensed to do it, malpractice will cover. Dr. Robert Sexton: The billion dollar question: are we facing a problem with losing our non-for-profit status? Dr. Robert Sullivan: We’ve been assured we’re doing the right thing. We give to the community. However, we are exposed and it’s a possibility. Dr. Anthony Bloom: We don’t have a specified scope of practise. Who decides? Dr. Robert Sullivan: What’s prudent would be recognized as normal. Dr. Anthony Bloom: This is something the Board may need to address. Dr. Paul O’Brien: We have guidelines so that’s where CDSPI would go to see if the dentist would be within their “scope”.

15. Life Membership award. At the April EC, Dr. Robert F. Furlong was nominated

for the Life Membership Award Motion: The award Dr. Robert F. Furlong the Life Membership award Moved/Seconded: Dr. Jaqueline Tucker / Dr. Toby Gushue Carried

16. Election of Officers/Committee Members. Done as a block. Standing

committees – there were no further additions.

Motion: That the committees be nominated as presented. Moved/Seconded: Dr. Keith Snelgrove / Dr. Gary Butler Carried VP Any other nominations: there were none Moved nominations cease – Dr. Robert Sexton Dr. Paul Hurley is VP Treasurer Any other nominations: there were none Moved nominations cease – Dr. Gary Butler Dr. Pat Redmond is Treasurer Members at large Any other nominations: there were none Moved nominations cease – Dr. Robert Sexton Drs. Zwicker, Alibhai, Roberts are the members at large

17. Radiation Inspections. Mr. Anthony Patey – gov wants to know there is a plan.

There is a plan. Inspections will be done.

18. Principles of Best Ethical Practices. Mr. Anthony Patey discussed the booklet. Before we finalize it, we’d like the members to read it and send us your comments. The Sept. ECM we will finalize it.

Dr. Robert Sexton: page 5 – add dentist to hospital section. Page 6 – do not delegate diagnosis. Yesterday’s HPV course only had 5 dentists out of 50 attendees. Hygienists were ahead of us. How does this impact the CDA’s code of ethics? Dr. Jeff Wells – to Dr. Robert Sexton – I’m keen on health advocacy but there was another course that competed against it. Anthony Patey – we’ll incorporate those recommendations. Dr. Robert Sexton – all presentations will be available on our website. Dr. Paul O’Brien – there is a code of ethics in the bylaws. CDA has no regulatory authority. Dr. Dan Greene: Who’s responsible for radiation inspections? Anthony Patey – ultimately it’s the dentist. The NLDB will provide the report that you will provide to gov. Dr. Paul O’Brien: the owner of the equipment is responsible. Our plan is to do this as a group.

19. Other Business. The timing of the convention: do we keep as is or move it

deeper into summer or the fall? Dr. Paul O’Brien – maybe if this was little later, the newbies could come. Not a concern – the EC will decide.

20. Next Meeting. June 16 at the Sheraton in St. John’s.

21. Closing Remarks. Dr. Sexton reminded members to visit the exhibits, register for

the dinner, pick up the tent card, always have your name tags.

22. Adjournment.

Motions Dr. Anthony Bloom / Dr. Keith Piercey Submitted Anthony Patey Executive Director

President’s Report 2017 It is cliché to say, but “where did the year go?” Hard to believe an entire year as president of the NLDA has gone by. I find myself looking back on it and reflecting on what a busy year it has been. It has been full of both rewards and challenges. I am energized as I look to the next year, and feel confident in saying that the decision made by the NLDA to change to a two year presidency was the right choice. The year started with a challenging situation surrounding the delivery of OMF services in the province. We lost the services of one resident OMF surgeon due to relocation, and had a temporary withdraw from MCP by others. The loss of services was not something that anyone wanted to see happen. However, I’m pleased to report that the delivery of OMF services has been re-instated and we will continue to try and improve the circumstances surrounding the Surgical Dental Health Plan (SDHP) and the provision of OMF services during our next round of negotiations in the coming year. The SDHP has been an historically difficult plan to negotiate. The NLDA has always been, and will continue to be, focused on developing the best plans possible, for all of our government programs, and will do so in the best interest of all NLDA members and patients. The beginning of the fall was marked by our annual campaign aimed toward reaching out to the newer members of our profession. Tony, Paul and myself attended the annual Welcome to the Profession Night at Dalhousie in September. It is always a great event and is an annual reminder of the optimism and excitement that new graduates possess. This event was closely followed by our New Member Orientation program, hosted at the NLDA office. We welcomed members for an enjoyable weekend, during which they were able to meet their new colleagues in the various specialties, as well as in organized dentistry. These programs are very important to help new students, new graduates and new members appreciate and better understand the world of the profession they are joining. During my speech in Gander last year, I spoke of my desire to try and help elevate the level of awareness for dentistry in all of us within the NLDA. Awareness comes in many forms. One form that I would like us all to consider is that of awareness of our fellow members. New members and new graduates are often in need of, and looking for, guidance and advice from their senior colleagues. Whether it be a new associate in your office, or a new member at an AGM, offer them a friendly hello. Let them know that you are there to provide advice if needed, and that you remember the challenges they face. This theme was very evident at a mentorship summit that Tony and I attended just last month in Toronto. Mentoring our younger colleagues can be, and should be, something that all of us take very seriously. In October of last year, Paul and Tony and I attended a Media Training and Government Relations forum hosted by CDA. The sessions exposed us to the types of scenarios we may face when sitting at the negotiating table with government, or when certain media interactions may occur. We will enter a new round of negotiations for our government provided dental

programs in 2017/2018. I feel the seminar has us better prepared for these talks and will make us more effective. As Christmas approached, we looked toward some positive awareness regarding the activities of the NLDA. As a profession, we are focused on providing care for others. As an extension of that mission, the NLDA embarked on a new relationship with The Salvation Army, partnering with them for their annual Christmas dinners in St. John’s and Corner Brook. Members volunteered to tie on an apron and deliver a warm meal and a warm smile to those among us who are less fortunate and in need of help. I believe the two events were received well by those attending the dinners, as well as by our members who provided feedback. We will continue the program next year, and look to add an event in Central Newfoundland as well. So anyone interested in volunteering, please let us know. Throughout the year, the NLDA has been working in partnership with the Heart and Stroke Foundation, the NLMA, the Canadian Cancer Society and the NLDHA, to develop the Count Your Cubes campaign. This was launched in May, and is an effort to bring public awareness to the serious and debilitating effect that the excessive consumption of high sugar drinks is having, not only on our oral health, but on our overall systemic health. The NLDA is pleased to work closely with these other stakeholders to help educate the public and encourage people to make better and more responsible decisions when it comes to their oral and overall health. We have also been busy meeting with the administration at the long term care facility in Pleasantville. We are currently designing a screening process to evaluate the oral health needs of the residents at this facility. When these needs are established, it is our hope, as well as the hope of the other stakeholders involved in the process, that we can bring awareness of the significant access to care problem that exists in these care facilities. We live in an ever aging population, and the need for proper oral health care for seniors and residents of long term care facilities will continue to grow. We need to continue to keep the oral health needs of all vulnerable populations paramount in our decision making and policy development. In February, we held our annual planning day. We had a different twist to the day this year and decided to use it as a means to help focus our approach on our upcoming government negotiations in the fall and next year. We gathered a diverse group of past presidents, past executive committee members, colleagues from CDA, representatives from Dalhousie Dental School, and various members from all of our specialty groups. The group focused on the state of dentistry in the province today and where we would like to be in the future. A full day of facilitated discussion generated some very key directives and action plans that we were able to compile into a visionary paper which will guide our focus during our upcoming government negotiations. Tony, Paul and I presented the paper to the Minister of Health in March, and I believe it was well received. It will be the platform upon which we will build our government relations efforts when we sit with government in the fall and next year, to negotiate our government programs. Thanks to all who participated and provided such valuable input.

We will continue our awareness campaign at the NLDA throughout next year and the years to come. We need to continue to make the public aware of the value of their own oral health. We need to continue to make government aware of the need for improving the dental programs that provide care to the more vulnerable and marginalized individuals in this province. We need to be constantly aware of the ever changing demographics in our society and the ever changing challenges they pose to the delivery of oral health care in Newfoundland and Labrador. And we need to continue to be aware of how the work we do as individual dentists, and as an Association, is received and perceived by our patients and by the public. It has been a very busy year, and I expect next year will be busier. I would like to take this opportunity thank all of the members of the Executive Committee, Dr. Paul Hurley, Dr. Pat Redmond, Dr. Michelle Zwicker, Dr. Amin Alibhai and Dr. Shane Roberts for their continual dedication and unwavering commitment to the NLDA. In addition, I would like to thank our Vice President Dr. Paul Hurley for his support and advice, and for stepping in to cover my duties when I couldn’t be in more than one place at a time. I would like to also thank Tony and Raelene for the amazing job they do working for all of our members and keeping the Association running so smoothly. The members of our association are represented by a great group of people and I am honoured to have worked with them this past year. Thank you all for granting me the privilege to serve as your president. See you at the OHC and AGM in June. Respectfully submitted, Dr. Rob Cochran, President

Fiscal Overview 2016 in review

Membership We have witnessed a net increase of 23 new members in the past three years, not outrageous but definitely trending upward. While the average age of our members is dropping and now stands at 48 years we have 40 members who are over 60 years and 90 over 50 years. Our current ratio is approximately 2,500 patients to each Dentist which is very reasonable when compared to the National ratio of 1,600 to each Dentist. It is very important to note that not all parts are equal with some corners of Newfoundland operating at 3,000 plus to one and others at National levels. Revenue The 2016 year was a back to normal year, all the revenue from the 2015 Convention had been collected and the bills all have been paid. As the work up to the Convention was two years out the last unaffected year would be 2013 so when doing comparative analysis we need to go back three years. The revenue stream over that period grew at just over 3% per year or approximately 11% from 2013 to 2016. The bulk of this increase is a direct result of membership increase and marginal increases in fees. Our Convention revenue was down in 2016 when we compare to 2013 which was also in Gander. Our numbers of attendees were down and consequently our net revenue was down by approximately $25,000. Plus 2013 was a bonus year for non-Convention CEC again tipping the table against 2016. I consider 2016 as the calm after the storm. In reporting revenues you will notice a change in the headings. In past year we had attempted to include all CEC provided in one subhead while the remainder of the revenue from the OHC would be presented separately. This has become impossible as we try to report the related expenditures as where do you place the cost of food against to the CEC or trade show. So all OHC revenue and expenditures are in one subhead; while non- convention CEC will be reported separately. Expenditures There was very little excitement on the expenditure side. Expenditures were flat with the exception of Dental Public Health. In this subhead the EC sponsored a Publicity Campaign on the importance of visiting the Dentist. You will further notice that the loan interest subhead has been removed thereby giving us an expenditure reduction of approx. $5,000. Analysis Overall 2016 was a stable year very much in-line with past years. Our final accounting for 2016 will see a small surplus plus we are projecting an equal small surplus for 2017.

Budget Notes

Revenue Oral Health Convention 2018 OHC is being held in Gander and as such we will see

number at least in line with 2016. A special effort will go in to get the Gander numbers back to 2013 levels.

Continuing Education: This is an area which has seen excellent revenue growth over

the past number of years. However as 2018 will be the first year in the CEC Cycle we do not expect that our revenues will be much above the 2016 levels.

Fee Guide sales While the sale of fee guide had maintained a steady growth

over the past years we have seen a fall in the past three years. Companies do not buy as many copies as they did. We will hold sales at the levels reached in the past three years.

Fee Guide Ads While we maintain a push on selling ad space in the fee guide

however there has been no real increase since 2013 therefore we are holding this number to 2016 levels.

Membership Fees We currently have 211 members registered and expect this to

increase to at least 220 2018. In 2009 the AGM decided that member fees would increase by CPI of previous year. 2017 fee equals $1,988 we will project 220x$1,988 increased by 2% percent to $446,107.

Investment income With the introduction of the Legacy fund we expect an income

of $10,000 per year to apply to new membership services. Newsletter ads We have reached our max with respect ads so we will not

increase the number for 2018 and hold our projections to the 2016 levels.

Partnership Agreements For 2016 we entered into partnership arrangements with CDSPI,

which includes $13,000 for support at the Convention, CEC Central, all other CEC in the Province and the orientation program. We have also entered into an agreement with the Scotia bank for $7,000, which is not a partnership agreement but rather a bundled purchase by the Scotia Bank. However for the purpose of budget we will refer to the funding as a partnership. We will project to $20,000 for 2018.

EXPENDITURE Advertising The Association has completed the advertising project allocated

in 2016 and has for 2018 reallocated funding to the Public Health Awareness project.

Annual General Meeting We are using the expenditure from Gander 2016 as a guide to determine 2018.

Atlantic Provinces Activities The four Atlantic Provinces have pulled together a committee to help work on issues of common interest. We have allocated a subhead for $2,500 for 2018.

New Member Services While we have not budgeted any new member services in this budget there will be funding from our Legacy fund to cover; a $10,000 expenditure for a new project. These projects will be one-offs and may differ from year to year.

Awards This includes the student and president’s awards plus the committee awards. As we have a new Awards Committee we have added an increase of $500.

Bank Charges The use of the debit machine had pushed the cost for Bank Charges up. A decision in 2008 to not accept debit for member fees has reduced the cost by approx $8,000. At present we still use debit for the Convention and the CE. In 2018 we expect that we will use online banking in line with what we have used in 2016.

Capital Expenditure: By 2018 we may need to look at flooring for the main boardroom. The current flooring is not holding up in response to water coming in on visitor’s boots. Furthermore we need to finish the shelving in the Boardroom and maybe a look at the Boardroom Chairs.

Condo Fees Our fees are $551 per month times 12 and there is no discussion for an increase we will project with caution a 2% increase. $562 per month.

CDA Membership The CDA Board will not be asking for a fee increase for 2018. Based on a membership of 220 we will have an expense to CDA of 220X $537.50 =$118,250. The HST component is included in a separate subhead with all other HST submissions.

Continuing Education CEC on average will cost 60% of revenue therefore if we hold Revenue at $20,000 the cost should be approx. $12,000.

Dental Public Health Based on projects planned by the OHA Committee we have allocated $30,000. It is our objective to get the message out to the general public re visiting your Dentist. We are also including $4,000 to support a toothbrush donation project- bags for conferences and groups to give out.

Donations This is an allocation based on past experience. A $2,000 to the Medquest, plus $1,000 will be allocated from the Legacy fund earnings to a Charity in Central on behalf of the Association.

Hotel and Travel Explained in Appendix A schedule of Events.

Insurance We see no reason for insurance to increase over the 2016.

Lease Equipment There are no plans to lease additional equipment therefore we are holding the expenditure to 2016 levels

Committee Meetings We see no change in the number of Committee meetings therefore we will hold the expenditure below the 2016 levels.

Memberships This amount includes membership in the Chamber of Commerce

Office supplies In light of our intent to increase the development of Brochures for awareness programs we have increased the budget allocation to offset this increase in paper and ink.

Orientation program 2018 will be the eighth year of the program and in 2018 we plan to bring in an outside speaker on practice management to help the new members.

Postage/Courier: Without any planned increase we are increasing by CPI.

Printing We have been able to reduce our overall printing cost by printing our Newsletter in house. We are identifying opportunities for the creation of brochures for distribution to patients.

Professional Fees This subhead includes Computer services, Accounting, Web maintenance, Cleaners, ADT security, furnace maintenance, and other small services. We will hold this to 2016 levels.

Salary/Benefits Increased by CPI assuming a 2% increase over 2016 plus 2% increase over 2017 gives us a $140,149 rounded to $140,000.

Taxes Our property tax is $3460, water $660 and business tax $3381.3 for 2016. We do not see an increase for 2017, however we have built in a growth amount of $500.

Utility Increased by CPI

Revenues Actual 2016 Budget 2017 Budget 2018

Oral Health Convention $128,542.60 70,000.00$ 130,000.00$

Continuing Education $18,856.52 100,000.00$ 20,000.00$ Fee Guide sales $10,196.00 10,500.00$ 10,000.00$ Fee Guide Ads $5,336.00 5,000.00$ 5,000.00$

Membership Fees $432,987.00 437,000.00$ 446,107.00$

Investment income 10,000.00$ 2,500.00$ Miscellaneous 348.23 -$ Newsletter Ads $9,636.00 10,000.00$ 10,000.00$ Partnerships $20,000.00 20,000.00$ 20,000.00$ TOTAL REVENUE $625,902.35 662,500.00$ 643,607.00$

EXPENSES

Advertising $0.00 25,000.00$ -$ OHC Convention/AGM $90,430.68 60,000.00$ 90,000.00$ CDA Conference $3,864.33 -$ Atlantic Prov Activities $462.50 2,500.00$ 2,500.00$ New Membership Services 10,000.00$ -$ Awards $1,937.40 1,000.00$ 2,500.00$ Bank Charges $4,458.93 5,500.00$ 5,000.00$ Capital Expenditures $0.00 10,000.00$ 15,000.00$ Condo Fees $5,858.28 6,600.00$ 6,700.00$ CDA Membership Dues $113,950.00 118,000.00$ 120,000.00$Continuing Education $5,746.93 60,000.00$ 12,000.00$ Dental Public Health $26,789.59 20,000.00$ 34,000.00$ Donations $2,000.00 3,000.00$ 3,000.00$ Hotel and Travel $64,293.89 90,000.00$ 90,650.00$ Insurance $6,818.00 5,000.00$ 7,000.00$ Lease Equipment $2,841.17 4,000.00$ 4,000.00$ Meetings $17,826.20 15,000.00$ 20,000.00$ memberships $1,198.00 600.00$ 2,000.00$ Miscellaneous $828.30 -$ -$ Office Supply $3,343.59 4,000.00$ 4,500.00$ Postage /Courier $4,430.09 6,000.00$ 4,500.00$ Printing $13,272.10 10,000.00$ 15,000.00$ Professional Services $10,864.11 10,000.00$ 10,000.00$ Salary & Benefits $137,401.86 145,000.00$ 140,000.00$Mount Pearl Taxes $7,514.00 8,000.00$ 8,000.00$ Utilities $5,653.04 7,000.00$ 7,000.00$ Orientation Program $6,422.45 10,000.00$ 10,000.00$ HST $32,900.00 25,000.00$ 30,000.00$ TOTAL EXPENSES 571,105.44$ 661,200.00$ 643,350.00$REVENUE OVER EXPENSES $54,796.91 1,300.00$ 257.00$

Dates Meeting Place Attendees Travel & Hotel Per Diem Total

60,500.00$ 30,150.00$ 90,650.00$

Budget 2018

ACCOUNTANT Telephone:(709)364-4881

OHC 2016 Report

The Convention in Gander 2016 went well, but had 25 less attendees than there were in Gander 2013. These numbers were not completely unexpected, as we were in the middle of the CEC cycle. Our surveys from 2016 however, revealed that both the tradeshow and CEC delegates wanted significant changes to the global format of the convention, citing delegate fatigue and lack of continuity within the social program.

Therefore, in an effort to reduce delegate fatigue and improve our social program, we have adjusted the tradeshow and social program for 2017. The tradeshow will begin on a Thursday as usual, but tear down on Friday in the afternoon. This is consistent with the majority of provincial conventions. Thursday will include an Opening Reception to honor Retired and New Members, Golf, and the traditional Pub Crawl.

The alteration to our social program will begin on Friday after the Annual General Meetings (AGMs). The Presidents’ Galas will now clue up by 9pm and will be followed by the Fun Night which has been rebranded as a ‘Kitchen Party’ for the 2017 convention. In the past, after the Galas, most delegates were left ‘wanting more’ out of their evening. And conversely the traditional Fun Night on Saturday evening, after the CEC program had been concluded, left most of the delegates and committee members feeling tired and wanting to go home. This social program change should address both concerns.

Saturday will still provide a full CEC program with no planned social activities that evening. This will allow for some needed rest during the remainder of the weekend before returning to the realities of work.

Respectfully Submitted 2017 Oral Health Convention Committee Dr. Shane Roberts, Chair Dr. Rob Furlong

Report of the Bylaws Committee 2017

At the 2016 Annual General Meeting, the Executive Committee requested that the Bylaws Committee review the current Bylaws and make recommendations to it for possible revisions. The Bylaws Committee has completed its review and presented its findings to the Executive Committee. The following is a summary of the revisions accepted by the Executive Committee. Article 8 FEES Section 3 - Life Members New wording "There shall be no fee for Life Members" is added to the end of this Section Existing Section 3 - Supporting Members: Is renamed Section 4 - Supporting Members........ Section 4 - Student Members: Is renamed Section 5 - Student Members........ Article 11 ELECTIONS Section 1 - Clause 5 The second sentence is modified to read " in the event that no candidate receives a majority of the votes cast, the candidate receiving........." Article 12 DUTIES OF OFFICERS Section 1 - President New Clause 7 to read " Cast a deciding vote in the event of a tie at Meetings of the Executive Committee"

Section 5 - Members-at-Large Is adjusted to read "Article 10, Section 3" ARTICLE 14 STANDING COMMITTEES Addition of new number 9 - Awards Committee SECTION 3 - BYLAWS COMMITTEE (B) Duties 2. The words " and the NLDA's The Principles of Best Ethical Practice" are added to this Section Section 9 - Awards Committee (A) Members of the Committee The Committee shall consist of the three most recent NLDA Past Presidents willing to serve, the current President and a Member at Large elected for a one year term at the Annual General Meeting. The Chair of the Committee shall be the Past President in their third year. (B) Duties (1) The Awards Committee shall advise the Executive Committee with respect to the recognition of the contributions of NLDA members. The Committee shall also be responsible for recommendation as it relates to non-NLDA Awards. Examples would include: CDA Awards Dental School Awards College Awards, PFA, and similar Government Awards, Order of Newfoundland. (2) The Committee shall meet by whatever means it wishes at the call of the chair. (3). The Committee shall report to the Executive Committee 90 days prior to the AGM. (4). The Committee may add new awards through recommendation to the Executive Committee

Article 18 AMENDMENTS The word "Secretary" in the second line is replaced with the word "Executive Director". Further down, the words "or Secretary" are removed. Article 25. INCORPORATION (New) Section 6 Incorporated dental practices are governed by the "Professional Dental Corporations Regulations" in the Dental Act 2008 c. D-6.1 The Committee also presented several topics to the Executive Committee for discussion and direction. These included: A Contingency Fund Proxy Votes The Dental Act Regional NLDA Branches Powers of Association Membership Quorums Code of Ethics The Executive Committee did not recommend any changes to the Bylaws regarding these issues. Respectfully submitted: Dr. Gary Butler Dr. Marina Sexton Dr. Keith Snelgrove Dr. Bob Sexton

AGM Report for the Dental Health Awareness Committee

With another year behind us, the Dental Health Awareness Committee has continued its mandate of community outreach and public promotion of oral health initiatives. Participation in the Kids Expo, support for the Association for New Canadians, and small group oral health presentations were activities in which our members participated again last year and will continue to do so in the coming year. New initiatives involving a picture/cover contest, a sugar reduction awareness bookmark campaign with the provincial libraries, a free Zumba/healthy living session for kids and the promotion of a sugar reduction challenge were part of this year’s oral health awareness activities. In the coming year, we also hope to start a “loot bag” project whereby a set budget of the Oral Health Awareness funds are allocated to the purchase of NLDA-branded “loot bag” giveaways (i.e., toothbrushes) for use by members throughout the province for small group presentations and oral health promotions.

As in the past, membership support and participation in the past year’s activities and in the coming year’s efforts is greatly needed. Anyone who is interested in assisting in oral health promotion initiatives is encouraged to contact the NLDA.

Sincerely,

Dr. Margot Hiltz, o- hair of the Dental Health Awareness Committee

Dr. Dr.

The mission trip to Haiti this year, as you may have read in our article for Bits and Bites (so capably written by Drs Shahin and Mulrooney) was a rich and rewarding experience for both the dentists and the patients alike. Everything fell into place rather well and the only complaint I heard was that the dentists would have liked to have worked harder! It seems that we are becoming quite proficient in our organizational ability, with the team in full operation within a few hours after our arrival. Our hosts at Stines foundation rolled out the welcome mat as is their modus operandi, the food was as usual perfectly delightful, and the whole mission a rich cultural experience. Our visit to Bassin Blue was too short and we were treated with every kindness. The highlight was a feast and a dance performance of the village children where CIDF was showered with symbolic gifts of fruit and food. CIDF is now well known for its work in this remote part of the country. Thanks to our supporters we took over close to $8000 of supplies including a new sterilizer. The ability of our dentists to work in these difficult conditions but yet maintain our standards of care is to be commended. The clinic in St Marc's is running well and the director of the hospital there is most anxious to increase the capacity of the facility. I spent some time there delivering supplies, listening to their concerns and exploring ideas. We also presented the clinic with a new ultrasonic scaler. A huge thank you to so many of you who have given to the foundation in time, materials and money, it is so reassuring. CBC has taken a great interest in our work over the years the foundation has been in operation. They are always eager to hear of our missions and have been very helpful in championing our cause. I think our mission work demonstrates to all the interest and commitment of our profession to those who are less fortunate. Lastly I cannot thank enough, Colleen O’Keefe of Noseworthy Chapman for her assistance with all the tax and accounting she so patiently attends to on our behalf. It is so kind of her to do this at no charge. Please remember that CIDF has no paid staff and any donations to the foundation go directly to our work and is of course tax deductible. This was my tenth visit to Haiti and it is a great privilege to represent our profession in this capacity. Thank you all so much. Respectfully submistted by Dr. Stewart Gillies, President

NLDA Continuing Education Report 2016-17

Over the last year the NLDA has provided 20 continuing education courses, these include:

Date Topic Speaker Location

June 9, 2016 HPV and Oropharyngeal Cancer Dr. Catherine Popadiuk Hotel Gander

June 9, 2016 Ouch...That Hurts When I Dr. William Paveletz Hotel Gander

June 9, 2016 Trials and Tribulations of 3rd Molars Dr. Peter Stefanuto Hotel Gander June 9, 2016 Clinical Success In Implants Dr. Tony Crivello Hotel Gander

June 9, 2016 The Bacterial Twitterverse Dean Swift Hotel Gander

June 9, 2016 Did You Have Your Fiber Today Dr. William Paveletz Hotel Gander June 9, 2016 Tax Planning Bill Budgell Hotel Gander

June 10, 2016 Pathology Review Dr. Rebecca Woodford Hotel Gander

June 10, 2016 Periodontics Today Dr. Tony Crivello Hotel Gander

June 10, 2016 Eating Disorders Paul Thomey Hotel Gander

June 10, 2016 CPR Heart & Stroke Hotel Gander

June 11, 2016 Restorative Results Dr. Frank Milnar Hotel Gander June 11, 2016 First Tooth First Visit Dr. Trang Nguyen Hotel Gander June 11, 2016 Silent Killer - Periodontal Disease Jo-Anne Jones Hotel Gander June 11, 2016 The Bacterial Twitterverse Dean Swift Hotel Gander Nov 19, 2016 Prosthodontics in the 21st Century Dr. Effrat Habsha St. John's Feb 18, 2017 Everyday Endo (CEC West) Dr. Sheldon Best Corner Brook

Respectfully Submitted, Dr. Robert Furlong Chair Dr. Sneha Abhyankar Dr. Patrick McCarthy Dr. Renee Mulrooney

Tariff Committee Report and Summary of Recommendations

The Tariff Committee met on Tuesday, September 20, 2016 to discuss items of relevance and the annual fee guide recommendations. This year there were many messages from members, the insurance industry, and administrative staff, requesting specific fee guide revisions, as well as queries asking for clarification of what the specific codes covered for some procedures. We also have the addition of a new specialty in Newfoundland and Labrador – Oral Medicine, which will need a fee guide for appropriate billing and insurance reimbursement purposes. After a thorough review of the national trends, and the economic report provided by Anthony Patey, it is very clear that this year we must increase fees more than the rate of CPI. The 2016 Provincial Budget added significant cost burdens to all small business, with the most obvious increase being a 2% hike in HST. This is a real cost that we are unable to pass on to our patients, as we do not charge our patients HST. More recently we have lost one of our major local dental suppliers, as they were absorbed by Henry Schein. This will, no doubt, have an effect on competitive pricing of supplies and larger items. CPI was forecast at 2.0% to 2.1% for 2016 into 2017. Taking all of this into consideration, a general increase in the General and Specialists Fee Guides of 3.0% was recommended. The only code that differed was the code for Limited Oral Examination and Diagnosis for the New Patient (01201) and Recall Patient (01202). The fee for these two codes was well below the fee for emergency and specific exam codes. While we were in agreement that often these limited exams take much more time, the differential was almost 20% between limited exams and specific/emergency exams. It was recommended that these two codes be increased by 5.0% (an increase of just over $2.00). The oral surgeons were asking for the inclusion of codes pertaining to Botox injections, for therapeutic and cosmetic purposes, as well as a broader list of codes related to Cone Beam Computerized Tomography. These codes already exist in the USC&LS so the addition of these codes was relatively simple. The codes suggested were reviewed by the practitioners requesting the additions, and they were in agreement with the appropriateness of the codes. The Tariff Committee recommended:

- Addition of codes to the General Fee guide and Specialty Fee guide from the 07000 Radiographs, Cone Bean Computerized Tomography (CBCT) grouping: 07010 up to and including 07043 from the USC&LS . The fees for these codes should be listed as i.c.

- Addition of codes to the Specialty Fee guide only from the 96300 Injections Aesthetic – Administration of Aesthetic Neuromodulators (E.G. Botulinum Toxin Type A) and 96400 Injections Aesthetic – Administration of Aesthetic Dermal Fillers: 96301 up to and including 96409. The fees for these codes should be listed as i.c.

- The codes for therapeutic injection are already covered in our fee guide under Injections, Therapeutic – 96201 to 96203.

Due to comments from the membership about issues with Scaling and Polishing codes and associated fees, there is a request that, for example, two units of scaling/polishing equal in fee two single units of scaling/polishing. The committee did not have any concerns with this

suggestion. It was recommended that the single unit fee be the basis of the fees for the half units and multiple units for the Polishing, Scaling, and Root Planing codes. The insurance industry drew our attention to some typos within the Fee Guide that had general headings associated with fees. For example, Wax-Up, Diagnostic heading has an associated i.c. in the guide. Prior to finalizing the guide, we do verify to the best of our ability that the errors are amended. There was also significant work done by the USC&LS committee to streamline the code descriptions and remove redundancies within the guide. These revisions are supplied to us yearly and were included in the Fee Guide. The Oral Medicine Fee Guide was based on the fee guide used in British Columbia, at the request of the new specialist. The committee reviewed this guide to find codes within our own General and Surgical Fee Guide that were consistent with the descriptors used within the BC Specialists Guide. The new specialist is content with the fees listed in the BC guide, so these fees were used in her new guide. Many emails are received asking for clarification of the appropriateness of a specific code, or asking for help finding the most applicable code in complicated situations. Most of this comes down to education and communication, therefore the committee recommended some regular Newsletter articles similar to those posted in the BC and Ontario dental association journals. These articles would focus on common coding questions, and perhaps a small “Did You Know?” paragraph regarding the fee guide and often missed items, to help our membership sort through these issues on their own. The inclusion of this type of communication may also have the effect of minimizing altercations with the insurance industry. The membership survey was discussed. In general, it has become very difficult to engage members in participating in this survey. Many small suggestions considered. It is not an uncommon problem, and will require constant creative thinking to find the answer. During a recent meeting between CLHIA and the CDA, the insurance representatives were constantly reminded that the Fee Guides are not to be considered guides to a standard of care, but simply tools to communicate most effectively the procedures being performed. It is important to continue to stress that this Fee Guide is produced as a tool or framework for members to build their own fee schedule. It is a GUIDE only, and is as useful as you wish it to be. I would like to thank my committee members – Dr. Derrick Batten, Dr. Shane Roberts and Dr. Rob Furlong. The committee works well, and meetings are always productive and effective. I also need to thank Anthony Patey for his constant guidance and attention, and Ms. Raelene Keating for her diligence and accuracy when updating the fee guide. Respectfully submitted, Tariff Committee Dr. Michelle Zwicker, Chair Dr. Shane Roberts Dr. Rob Furlong Dr. Derrick Batten

Dental Monitoring Committee

2016 Report

The DMC had a busy 2016. We continue to review cases and are

preparing to become more involved with the audit process.

Two members of the NLDA Executive attended two seperate meetings

in order to understand the review process better.

It was shown that adjudication does consider severity and merit,

however the current trend within government does place great

emphasis on the most financially vulnerable.

The committee will try to be more inclusive in reporting our results.

We will include the number of providers submitting cases and their

geographic locations.

Thank you to Ed Williams for providing and organizing the cases and to

Kelly Hynes and Derrick Batten for their continued support of the

committee.

Respectfully submitted:

Dr. Marjorie MacDonald, Chair

Dr. Kelly Hynes

Dr. Derrick Batten

Dr. Vinay Jerath

Dr. Paul O’Brien, Secretary - Registrar

Board Meetings:

In 2016 the Board held regular meetings January 16, 2016, May 25, 2016, September 17, 2016 and an AGM on September 17, 2016.

Dental Board Membership:

Dr. Harry Simms Chair - Dentist

Dr. Sneha Abhyankar Vice- Chair -Dentist

Dr. Tony Bloom Dentist

Dr. Jerome Johnson Dentist

Vacant Dentist

Mrs. Paula Parsons Registered Dental Assistant

Mr. Craig Finch Registered Dental Technician

Mrs. Joan Lamswood Public Representative

Mr. Martin Harty Public Representative

REGISTRATION AND LICENSING as of January of 2015 and 2016

2015 2016

General Dentists 177 185

Specialists 30 27

Dental Assistants 217 236

Dental Technicians 37 34

FINANCIAL REPORT

2016 presented new challenges to the Board particularly in the area of radiation safety. The Radiation Project took on new dimensions as OHS set a deadline of December 31, 2016 for survey and listing of radiation equipment. The Board agreed to undertake oversight of the project by entering a contract agreement with Biolantic Services that covered the period July 2016 – December 2017.

Fees ranged from $138 for single units to $273 for CBCT. Travel costs were absorbed by the Board when offices cooperation was acceptable. The total travel costs to the Island and Labrador were $16,715.62 for the period ending December 31, 2016. Total invoices during the same period were $84,7643.12 with $3,904.00 accounts receivable. There are no accounts payable.

The three year cycle for office inspections ended as of December 31, 2016 with all but a few offices being visited. This year’s costs were much reduced to $8,525.24.

Grants and fees to CDAC, CDRAF and LMS Prolink have shown significant increases particularly from CDRAF where an Executive Director has been hired.

ELECTION REPORT 2016

The 2016 Board Election saw the return of Drs. Tony Bloom and Harry Simms as Board Members. Dr. Peter Stefanuto was elected as a new member. Unfortunately Dr. Stefanuto was to leave us last fall and now we require another election in the spring of 2017 to replace him.

Dr. Gary Butler has finished his long standing commitment as a Board Member but we hope to keep him busy for future board activities and look forward to doing so.

BOARD ROLES AND RESPONSIBILITIES

1. Each year as a Board we must review our mandate to the public interest. Yearly it seems that some new issue appears on the horizon. This year, the Board, having met the initial challenges of radiation surveys and the near completion of an office visit cycle the Board is once again required to take on a new role in the developing crisis around opioid abuse. Meetings are held every second month and progress has been made to the development of a new Act by legislative affairs of DOHCS. The medical profession in the province has produced an on-line program requirement for licensure related to proper prescribing in the fight to control over prescribing. The Board must consider what steps it should take and also what relationship the dental profession will have to the requirements in the new Act.

2. The ever changing landscape of CDRAF brings dental regulatory authorities another concern around governance that seems forever at the forefront of the profession. The present model of CDRAF has at times been too politicized with little accomplished following large, cumbersome, and expensive meetings. A future direction seems to be evolving for CDRAF that its management will be by the Executive Director of CDRAF and the Registrars of the provinces.

The consequence of such an increased role for Registrars will undoubtedly fall greater strain on the smaller provinces. Present demands on Registrars, calls for commitment to now 5 meetings a year and quarterly teleconferencing. Once the new structure is finalized each jurisdiction will have to re-evaluate what their overall commitment will be.

3. The responsibility of the Dental Assisting Regulators has included the work of a consortium of DARA seeking a willingness of dental assisting regulators to work towards acceptance in each province of a commonality of the scope of practice of other jurisdictions. Recognition of a candidate’s scope is particularly important when applicants of the other jurisdiction have an expanded scope that previously not been included in the receiving jurisdiction’s scope.

4. National Dental Examining Board. Discussions are currently under way between CDRAF and NDEB in relation to a common credential verification system for all provinces. A draft has been presented to all DRAs and one would expect it ratified in the near future.

5. National Dental Assisting Examining Board. Changes in the location and frequency of Clinical Practice Evaluations for non- accredited applicants may be in future plans once each jurisdiction is advised on how greater efficiencies can be found in the process.

6. A final note on the problem with dental technicians. The problem involves a creeping weakening of the standards required for licensure. The present model leaves a serious gap between what the Board can attest to and what is being presented as prima facia evidence for licensure in a system that is not controlled by truly verifiable qualifications of applicants. The bar continues to be stretched lower when affidavits from dentists are asked to be acceptable for meeting the requirement for licensure especially when the dentist is unknown to the Board. This on-going problem stems primarily from candidates unable to licence elsewhere and using labour mobility to get licensure to which they would not otherwise be entitled.

FINAL NOTES ON 2016

Keyin Dental Assisting program has once again met CDAC requirements for Accreditation. Yet again there have been no increase in fees for all categories of licensure CDAC fees will see a modest increase in 2017 CDRAF will see a substantial increase in fees for 2017 The continued payment of individual malpractice for all dental assistants

REPORT ON THE COMPLAINTS AUTHORIZATION COMMITTEE 2016

In 2016 the number of complaints increased from 12 in 2015 to 20 in 2016. In last year’s report mention was made of the appropriate use of “Cautions”. The Board’s most recent meeting addressed this issue and the thinking of members was that before any further action of reporting “Cautions” on the Board’s website, government must be consulted. An approach has been made to legislative affairs and the indication is that the present legislation does not envision any such publication of cautions. Further advice on the issue alluded to the possibility that government would base any amendment on the

principles of the 1996 White Paper on Discipline which covered a multiple of disciplines. This is a similar response previously received about any amendments to professional incorporation; the application of an umbrella approach for all.

In summary for 2016:

Under Review: 5 files

Mediation: 4 files

No Action: 2 files

Counselling: 3 files

Dismissal: 6 files

Cautions: 2 files

Restricted: 1 file

FILE NO: 1

Parents expressed their concerns over the management of their 8 year-old son when visiting a dentist needing emergency care and removal of a tooth. Previous history showed another dentist using nitrous oxide had earlier failed to fulfill this same extraction. The tooth was removed by the present dentist but whether the distress was more due to nervousness of the patient rather than the dentist’s approach is rarely easily determined by the committee. The dentist, having many years of experience and no previous complaints, weighed heavily on the committee’s decision. The committee however did find fault on the issue of dental record-keeping. When the parent asked for a copy of her son’s dental record they realized correctly that the record was deficient as to what happened, what drugs or medications were used and any instructions that were given. The committee agreed the record did not meet the requirements set out by the Board and counselled the dentist. Included in the counselling was the requirement that the dentist take an on-line course in dental record keeping.

FILE NO. 2(A)

A cancer patient complained following discussions with other health care providers that the attending dentist failed to meet the standard of care for cancer patients in the province. Also, the patient further complained that they had not been adequately informed as to the progress of their treatment.

Investigation of these allegations found that initially a long standing low grade tumor had been diagnosed following biopsy and a pathology report from another jurisdiction. First treatment of the lesion was the attempted removal 24 days later in another province. There was a preliminary report two weeks later that the cancer may not have been entirely removed. It was another month before there was a final post-surgical pathology report determining that further treatment and follow up care would be required to take place in this province. The investigation determined the attending dentist’s office

failed to verify transmission of this of the referral appropriately. Also there was no indication that the patient was provided a progress update before the information was transmitted to the local cancer service. The lines of communication were apparently managed inadequately. Included in this mismanagement was the treatment in another province and subsequent transfer of information. The committee felt this was not desirable but determined the patient did agree to seek treatment in the other province. An agreement had been signed also to also seek emergency care if needed in that other province. No emergency care appeared to be needed. Also, the patient had previously been appointed to be seen in this province post-surgically but cancelled that appointment. Finally, when the patient sought to change to providers operating solely in this province, no reference was made back to the original dentist.

Subsequently, the committee found it was an omission on the part of the original dentist to properly verify delivery of a referral for follow up care at the earliest opportunity. For this reason the CAC believed that sanction of the dentist was warranted and a “Caution” was given. The dentist subsequently must provide a proper verification system that determines that referrals are transmitted immediately. The dentist must also submit; for the purpose of monitoring, a fulsome report to the Registrar of all cases in their practice of cancer patients over the next 2 years and beyond as required by the Board.

FILE: NO. 2(B)

A representative of the Cancer Clinic in the province also made a complaint on behalf of the clinic alleging the failure of the dentist in (FILE NO. 2) properly advise the patient as to their options for providers and place of treatment. A further assertion that the dentist did not intend to recognize the requirements of the patient for follow-up care and a referral to the Cancer Care Clinic in this province was not accepted by the CAC. The committee did accept, as stated in the previous file, that patient communication and a referral was not executed satisfactorily. The Cancer Care Clinic subsequently made an allegation to the office of the Minister that the CAC did not exercise due diligence in adjudicating this file or the previous file. The body of reasoning given was the failure to do interviews with the Cancer Care representative and the patient and the over reliance on dental records and information provided by complainants and respondent.

The meeting of government officials with the registrar explored the reasoning behind the decisions of CAC. The investigation of the case was discussed but the issues of patient freedom of choice, labour mobility, the willingness of government to send patients out of province in similar circumstances was also addressed.

And, finally, although all treatment in this case occurred in another province one must ask why, given all the concerns expressed by the complainants, no complaint; either by the patient, or the Cancer Care Clinic of this province was filed in the province where treatment took place? The committee felt that the as all information provided was generated from one source that the Caution and requirements issued in 2(A) was sufficient.

FILE: NO. 3

A physician practising in the province alleged possible incompetence on the part of a provincially licensed dentist concerning treatment provided in another province. The treatment received occurred following a referral by a medical specialist in this province. On returning to this province the patient experienced problems although they had agreed when necessary to return to the province where treatment took place. The attending dentist did provide follow-up care which was limited partially by not having hospital privileges in this province. The dentist presently is restricted by the Board from providing major oral surgery in this province unless hospital privileges are in place.

A further observation of CAC was that during the healing process the patient was specifically instructed on the wearing of supporting dental work and apparently was not in compliance with this requirement.

As the CAC did not find cause or reason to sanction the dentist based on the care provided in this province it dismissed the complaint. This disposition applied only to issues relevant to this province

The Registrar’s investigation determined further that this matter is the subject of an investigation in the province where the treatment was undertaken the results of which will be made known to the Board.

FILE:NO. 4

The CAC reviewed an allegation concerning the removal of an impacted lower second bicuspid the removal of which evidently led to the apical root fracture of an adjacent tooth. The committee determined that while the patient did consent to the removal of this tooth the risks for removal of an otherwise a symptomatic tooth were not well given. The review of all information having been done, the committee was of the opinion that there were grounds that the respondent had engaged in conduct deserving sanction. The Respondent was required by the committee to establish a proper framework for informed consent.

FILE:NO. 5

The patient complained that the work done by the dentist; basically to improve their dental esthetics failed to meet a reasonable standard of care. A review of photographs and models and the apparent effort provided by the dentist to satisfy the patient was undertaken. The patient subsequently had visited a dentist in another community and was thereafter referred out of province to a prosthodontic specialist.

The decision of the Registrar to attempt mediation of the problem met with a degree of success as the dentist agreed to subsidize 2 further trips to the prosthodontist for remedial work. The patient wasn’t completely happy with this option given what she felt was an unprofessional attitude of the dentist eventually but accepted the compromise. The complainant signed off on a release of further action.

FILE: NO.6

A patient alleged that Labrador Grenfell Health should be liable to cover a significant costs associated with remedial work done following care provided by LGH dentists. The allegation in particular sought compensation for root canal treatment that failed. In the opinion of the committee treatment could have been managed by the original dentist given their background and expertise. The patient however opted for other treatment options and given that the respondent had no option in determining care the CAC dismissed the allegation as not meeting the standard of a care. The patient was advised of the reasoning and the CAC did not feel it was in any position to dictate LGH policy.

FILE: NO.7

Patient was unhappy when they visited a dental office and felt uncomfortable when someone (other than the dentist) asked preliminary questions related to the office visit. The dentist was advised of the patient concerns and the outcome left to the dentist to resolve. The office policy did not appear to contravene any standard of care.

FILE: NO. 8

Patient wrote concerning post endo enamel fracture. Patient was provided with reasoning and an explanation of what had happened but patient never responded to the committee past their first letter of complaint.

The investigation of the matter absolved the dentist of any further responsibility. The CAC’s review did determine that the dentist gave a discount because the patient had insurance. This is improper and discriminatory based solely on the holding of insurance. The dentist was advised to cease and desist in such discounts.

FILE: NO. 9

The parent of a child complained when two recently restored teeth were necessarily removed within an extremely short period of time. The treatment plan as reviewed by CAC indicated several restorations and the committee questioned the advisability of restoring the two teeth in question. The dentist was counselled that particular care need be taken in explaining to parents the poor prognosis of restoring such teeth. The parent was particularly upset with the repetition of treatment including the use of N2O; and the fact that they were again charged a fee. Although the dentist contended they had followed outlined procedures they were advised that the straw that probably broke the camel’s back was the imposition of yet another fee so close in time. Although not a substantial fee better PR would have dictated a write –off of the fee. The dentist eventually did so as advised by the CAC. The rest of the complaint was dismissed given the rational for treatment provided by the dentist.

FILE: NO. 10

A parent presented at the Board office to discuss the bill they received which caused them great concern. Part of the problem arose wherein their spouse had provided incorrect information regarding

the costs. Apparently a 2 ½ year old required treatment on 26 teeth. There was a question as to whether root canals were appropriate in such cases. Eventually the Registrar reviewed the complete file with the parent and dismissed the need for further action based on the apparent acceptance by the parent of the circumstances.

FILE: NO.11

A patient complained about costs and follow up care when an orthodontic case was transferred from one general practitioner to another. After advising the new practitioner of the problem the patient called the Registrar to advise they were satisfied things had been worked out. No further action was taken.

FILE: NO.12

The Board received a complaint that dentist who attempted to provide patient care in a hospital bed failed to provide adequate care and failed to adhere to infection control standards form managing sharps. The complainant was acting on behalf of their elderly parent with a proper release to do so. The complainant, a registered nurse, was present during the surgical procedure of removing a partially buried root while the patient was in a hospital bed. The outcome was traumatic to the patient and left them with a difficult retreatment from an oral surgeon. The apparent infection control contravention occurred when the dentist failed to follow proper recapping or discarding procedures when leaving the site and another health care worker was subsequently injured.

The CAC considered such inadequate treatment to be a serious risk to the treatment of elderly compromised patients and noted the complainant felt that the dentist was at best unsympathetic. In such cases patients need to be seen and treated in a proper environment and should only do otherwise in dire circumstances. The respondent was, in the opinion of the committee, demonstrably lacking judgement in dealing with adults in general as evident in this case and in the respondent’s history.

It was the decision of the committee therefore to restrict the respondent from treating adults which are not normally within their scope of practice to concentrate on that area of practice which the Board is presently monitoring.

FILE:NO. 13

A patient complained they were charged fees above and beyond fees suggested in the fee guide. The committee reviewed the file and decided that the patient was charged high fees. The patient did not ask for a predetermination. The dentist should not have charged the fees without some explanation given the preamble of the fee guide. When extra costs are involved such as travel costs patients should be advised of such issues of compensation.

The CAC suggested to the dentist that they should structure a preamble to inform patients of the variables of their billing policies. The committee further advised that the dentist consult with the Registrar further on this matter. The dentist has since removed themselves from this practice.

The patient was advised to be better informed and not make assumptions on what their costs will be by analyzing their insurance package. Further they were advised to not wait till a collection agency calls before addressing their concerns.

FILE: NO 14(A)

A parent of a patient with Aspergers complained their privacy was compromised when a dentist referred their son to a specialist. The Registrar first reviewed the allegation and suggested that the privacy commissioner would be the appropriate place to address this. The CAC agreed they saw no concern and dismissed this allegation.

FILE:NO. 14(B)

The same parent as in FILE 14 (A)on being referred to the specialist alleged discrimination by the specialist. The Registrar suggested that if they felt they were the subject of discrimination perhaps their complaint should be through the Human Rights Act. Following investigation of the patient’s dental record the CAC found the facts that the patient /parent had a very poorly attended record over time and but that the present dentist (specialist) had only seen the patient once. The specialist had suggested that the patient having a long history with another specialist much closer to home would be better served going there.

The CAC reminded the specialist that if they did not wish to treat the patient because of their attendance record or other reasons appropriate these reasons should be stated in a letter and offer emergency treatment till the parent finds another provider. The CAC dismissed this allegation also.

FILE:NO.15

The parent of a child complained that a dentist removed the wrong teeth and caused harm to future orthodontic treatment. The review of records indicated that in fact two permanent teeth were removed in error and that subsequent orthodontic treatment would be more difficult.

The dentist was misled when they failed to properly identify the teeth the orthodontist advised. The referral record was not in the chart but the CAC determined that the dentist should not have proceeded without further due diligence.

The CAC found reason to believe that the dentist failed to meet the standard of care required in this case and counselled that treatment in following another’s treatment plan requires even greater diligence than shown here.

The Committee subsequently directed the dentist to contact the complainant to reach an agreement in resolving the matter.

UNRESOLVED COMPLAINTS FROM 2016

There are 5 unresolved complaints mostly due to difficulty getting information from distance and reviewing other records. A couple of the complaints have basically been disposed of but are in connection with some other activity so given the circumstances they should be resolved together.

ubmitted

Mission The Canadian Dental Association is the national voice for dentistry, dedicated to the promotion of optimal oral health, an essential component of general health, and to the advancement and leadership of a unified profession

Vision

A Healthy Public - A Strong Profession - A United Community

Priorities

Knowledge – to capture, organize and disseminate relevant knowledge and information to Corporate Members and key stakeholders.

Advocacy – to protect, promote and advance the dental profession.

Practice Support – to support Corporate Members in dealing with practice management issues.

Partnerships – working with Corporate Members

Advocacy Against the Taxing of Health and Dental Benefits

Given the impact that the taxing of health and dental benefits would have on Canadians and on the delivery of health services, the CDA undertook to coordinate a major national grass-roots advocacy campaign and organize strategic alliances with various stakeholder groups in order to influence the federal government not to tax those benefits. In 2016, CDA undertook the work related to the design of the campaign and the build-up of the national coalition against the tax. The advocacy campaign was launched in December 2016 and was fully implemented in January 2017.

Priority Projects

In addition to its ongoing activities, the CDA Board has identified five priority projects for implementation in the short to medium-term.

1. Future of the Profession – Recommendations to CDA and corporate Members to foster the strategic adaptation of the profession to a changing environment

2. Insurance Audits - The development of best practices for claims validation

3. Claims Transmission - Maintain CDA’s position in the electronic claims market

4. Secure Send - Provide a user-friendly, electronic, secure document sending system

5. People with Disabilities – Develop advocacy and program strategies to enhance access to oral health care by people with disabilities

Key Activities – Knowledge

• Environmental Scan: produced the 2016 edition • State of Oral Health in Canada: launched a new companion publication to the

CDA Environmental Scan for external audiences • FDI Congress and Parliamentary Meetings: contributed to the development of

global position statements • Oasis: published daily online postings of practical articles that support the

clinical work of dentists • CDA essentials: produced 16 issues of the CDA magazine (8 English – 8 French) • JCDA.ca: continued to operate the JCDA.ca website to house the online peer-

reviewed scholarly journal that contributes to the body of knowledge of the profession

• Seal Program: developed a new marketing strategy for the program which will be launched in 2017

• Dental Aptitude Test: conducted two exams and is collaborating with ACFD on developing an enhanced test

Key Activities – Advocacy

• Taxing of Health and Dental Benefits: as a top priority, developed a series of collaborative advocacy tools and a network of strategic alliances with other organizations to oppose the taxing of health and dental benefits by the federal government

• Sugar Reduction: established contacts with third party organizations to collaboratively develop a public education campaign on sugar reduction

• Small Business Tax Rate: gathered intelligence and established a network of possible allied organizations for the development of advocacy plans

• Days on the Hill: conducted the 2016 edition of Days on the Hill • NIHB Review: ongoing liaison with the AFN and the NIHB

• First Visit/First Tooth: ongoing coordination of the education program • COHR: planned and organized the 2016 symposium which focused on children • Media response: on a priority and daily basis, responded in a timely manner to

all media inquiries • Media monitoring: on a daily basis, prepared a summary of media stories with

an oral health component • Trust and Value: continued to coordinate the Trust and Value Working Group

composed of a representative of each of the Corporate Members

Key Activities - Practice Support

• Claims Transmission: maintained CDA’s position in the electronic claims market • Secure Send: developed a user-friendly, electronic, secure document

transmission system for testing with Corporate Members • Insurance Audits: agreed to have CDA develop a framework for audits • NIHB Guide for Providers: as a priority, produced a guide for distribution to CMs • Practice Support Service Website: integration of ‘Secure Send’ and the

expansion of the electronic national list of dentists • CDA Digital ID: managed the operation of the CDA Digital ID • Dental Benefits Issues: liaised with CLHIA and individual carriers on many dental

benefits issues • Refugees: gathered intelligence on the Federal Government’s program and

communications on the specifics of the program to CMs • USC&LS: Published the 2017 edition, convened a Code Review Working Group to

address codes identified as problematic by stakeholders and ongoing liaison with CMs

• Electronic List of Dentists: maintained the registration process through the development of the validation procedure for the CDA Digital ID on the practice support web site

• Privacy Booklet: produced a privacy booklet which is now available for distribution through the CMs

• CDAnet program: coordinated the operations of the program including the helpdesk

Key Activities - General

• MOU Review: implemented the final stage of the review • Joint Conventions: held a very successful convention with BCDA in March 2016,

liaised with ODA for the 2017 joint convention and with DAPEI for 2018 • Affiliate Memberships: conducted annual campaign for membership in Quebec

• NDEB relationship: implemented a framework for an interface committee for ongoing discussions of issues of common interest 6

• Board Education: maintained services of external expert on governance for education sessions with the CDA Board

• Students: continued to provide secretariat services to the Federation of Canadian Dental Students Associations (FCDSA) and provide general coordination support

• Survey of Canadian Dental Schools: conducted annual survey of dental schools • Common Membership Database with Corporate Members: liaised with

Corporate Members on this matter

As you can see, the CDA is working behind the scenes for you, the dentists of Newfoundland and Labrador to enable our practices to run as smoothly as possible and to allow access to care to as many people as possible. I am fortunate to be part of this process.

Respectfully submitted,

Dr Linda Blakey DDS

Atlantic Provinces Insurance Liaison Committee Report Spring 2017

In 2016, the Atlantic Provinces Insurance Liaison Committee continued with the same representatives from New Brunswick (Dr. Thomas Priemer), Prince Edward Island (Dr. Brian Barrett), and Newfoundland (Dr. Michelle Zwicker), with Dr. Michelle Zwicker from Newfoundland continuing to stand as Chair of the committee. The NSDA felt it was necessary, with the ongoing activities of APILC, to have a more static member, and Dr. Steve Friars was added to the group as the representative from Nova Scotia. We maintained that our goal would continue to be one of education of the Atlantic membership regarding ongoing insurance issues, providing prompt response to matters that required specific attention. Ultimately, the focus of the group has been on Insurance Audits, as tactics from insurance companies continue to be imposing and administratively disruptive in the dental practice. In September of 2016, APILC was invited to participate in the APDEC meeting in Halifax. The committee used this as an opportunity to identify specific goals for the coming year, with the input of the four Atlantic Province’s Presidents and Executive Directors. Three projects were identified, and specific duties were assigned amongst the members of APILC, and the four Atlantic Dental Associations:

1. The necessity of a concise Guide to Understanding Dental Benefits was tabled. It was stressed that we should poll other provinces to see what documents were readily available, in order to provide a template for our own document. During our subsequent discussions with members of the ODA, their guide was provided as a starting point. Upon review, it was determined that this ODA guide was an excellent resource. It was passed to the NSDA for revision to make it more appropriate for Atlantic Canadian dentists.

2. With the goal of providing resources to Atlantic Canadian dentists who may wish to make the transition to Non-Assignment, the ACDQ provided us with their Non-Assignment Kit to review and consider. It was decided that this was something we would look at more closely. The APILC received permission to modify this Non-Assignment Kit for our own use. Revision is almost complete, with the final piece being a Legal Viewpoint of Non-Assignment. This document was given to the Dental Associations for review by their legal departments. All other documents have been modified and await approval and final development by APDEC.

3. It was stressed that a central databank of information on insurance issues and noteworthy articles be created in order to further our goal of education of the Atlantic Canadian membership. It is important for such a databank to be highly accessible and active. This databank could be used by the associations to add articles to their

newsletters, provide quick news bites to their membership, and provide updates on what is happening nationally with respect to third party payers.

As an aside, with the CDA working on a National statement with respect to Insurance Audits, it will become very important to develop clear guidelines surrounding informed consent and the release of patient information. There are numerous opinions, but no clear cut rules on who requires the consent, and who should be requesting it. This issues varies based on jurisdiction and professional organization. The members of APILC look forward to the creation of usable documents and guides, for our members, that help us all navigate the complex issues that the insurers will continue to throw in our direction. Respectfully submitted, Dr. Michelle Zwicker – Newfoundland and Labrador Dental Association, Chair – APILC Dr. Thomas Priemer – New Brunswick Dental Society Dr. Brian Barrett – Dental Association of Prince Edward Island Dr. Steve Friars – Nova Scotia Dental Association