Sept. 1997, Vol. 2 Ed. 1

College of Denturists of BC

College Office Relocation

Since about 1962 the office of the Dental Technicians Board has been located on the Vancouver General Hospital site. Since then we have witnessed many changes: from the Dental Technicians Board to the Dental Technicians and Denturists Board, to the College of Denturists of British Columbia. We also witnessed the deterioration of the building which housed our office. As early as 1989 the government, through the British Columbia Building Corporation, served notice on the Board that the building was to be demolished.

During the negotiations to wind up the affairs of the Dental Technicians and Denturist Board the government agreed to allow the College of Denturists to remain until May 1996, subsequently extended to February 1997. We have now relocated.

Our new office is in a secure three- story building in New Westminster. We chose it for its central location and reasonable lease rates. The space has two private offices, a secretarial area, and room for Committee and Board meetings.

Relocating the office involved packing 39 years of files into more than 60 boxes, equipment, paraphernalia, two aging computers, six file cabinets, two storage units, 25 articulators and an odd assortment of dental technicians' equipment.

Feel free to drop in for a visit if you are in the area.

Please make a note of the new address and telephone/fax numbers:

Schedule of Meetings

All meetings of the Board and its Committees are open to registrants and the public. The Board and the Committees meet on an as needed basis which makes it difficult to publish a schedule of meetings. If you wish to attend any meeting please call Ethel @ (604) 515-0533 and she will make sure that you are informed of the meeting and receive any material that can be sent prior to the meeting subject to the Freedom of Information/ Protection of Privacy Act.

Election of Registrants to the Board

The following are modified election results to reflect the resignation of two members. Ms. Erna Swan resigned subsequent to her election. Mr. John Mayr resigned as an elected member in June. Mr. Mayr will remain as the Registrar for the College.

After one false start the College completed the election of registrants to the Board. In accordance with the

Bylaws nominations were conducted in December 1996 with balloting being completed in February 1997. Mrs. Betty White, a public member of the Board, acted as Chief Electoral Officer and provided the following results.

Eligible registrants 196

Registrants who cast ballots 137

Number of spoiled ballots 7

Total number of votes cast 712

Elected to a three year term

Jim Connolly 104

John Mayr 90 (resigned)

Elected to a two year term

Gary Stewart 86

Ron Postings 81

Elected to a one year term

Ken Manson 74

Erna Swan 57 (resigned)

Other results

Bob Shivji 55

Virginia Thorburn 44

John Moore 44

Frank Ruddy 39

George Hygh 38

Mr. Bob Shivji was appointed to the vacancy left by the resignation of Erna Swan, in accordance with Section 8 of the Bylaws. The other vacancy has not been filled.

The campaign was at times divisive. Now is the time to look forward to what the future holds and combine our efforts to accomplish our mandate: to protect the public interest. In accordance with the Bylaws, nominations will be called for in December 1997 for the required number of elected representatives.

Committees Require Committed Registrants

If you are interested in professional standards and their enforcement, and have time to work on committees please contact the Registrar @ (604) 515-0533. Some committees conduct business on a regional basis. Expenses and a small per diem are paid to members.

Continuing Education Requirements

Reporting Deadline for Continuing Education has been changed.

An active registrant must complete a minimum of 30 hours of continuing education every 3 years with a minimum 5 hours per year. The content must be approved by the Quality Assurance Committee. ( See the attached policy " Pre Approval & Certification of Continuing Education Courses, Programs & Activities)

Sections 44.2 and 45 of the Bylaws have changed the reporting deadline for continuing education. The new reporting date is:

Advertising Services

The Inquiry Committee has been receiving a number of complaints regarding advertising. You are strongly advised to review sections 78 and 83 - 87 prior to doing any advertising. It is your responsibility to be familiar with the Bylaws of the College. If you are not sure about an advertisement send a copy to the College office before placing it. This will allow the appropriate committee to review the information and perhaps save you from a complaint and investigation

Threats to the Registrar

Over the past year the Registrar has received threatening letters. These appear to come from a registrant. The Board considers this type of behaviour as very serious, not only because of possible harm to the Registrar but also because of possible harm to patients from a person exhibiting such inappropriate and potentially dangerous behaviour. The matter has been taken to the police and is under investigation.

Discipline Surcharge

The Discipline Surcharge has resulted in a great many calls to the office and, apparently, some misunderstanding about the reasons and application of the surcharge.

Hearing costs are dependent on the time required to hear the evidence from both the complainant and the respondent as well as appeals to the Supreme and Appeals Courts. A simple hearing may cost from $5,000 to $8,000. A difficult hearing with challenges to the Courts may cost from $60,000 to $100,000.

The College Board began developing a budget for the fiscal year 1997-98 in 1996. In the development process the Board considered many factors including the fiscal position of the previous Board.

The Dental Technicians and Denturists Board (DTDB) budgeted for a number of hearings each year At dissolution the DTDB had surplus funds of approximately $400,000. A good portion of this represented fees for hearings.

All of the fees charged to registrants are set within the College's Bylaws. To change the fees requires an Order in Council, a process which takes a minimum of 3 months. The College must budget and collect fees for hearings in the event that a hearing is required. If this amount is built into the regular fees paid by registrants a situation similar to that of the DTDB occurs. While it may be good for the College to have a large contingency fund the Board this results in registrants having to pay more than is required in each year.

If the College of Denturists were to include fees for discipline hearings within the regular fees, each active registrant would pay between $1,100 to $1,200 per year.

The College Board opted for a separate fund to reduce the fees that registrants pay each year. The upper limit of the fund has been established at $100,000. The funds will be used solely to cover the costs of hearings and Supreme and Appeals Court challenges. The advantage of this approach is that if the fund is not used registrants will not be charged further fees for hearings. Further the Health Professions Act allows full recovery of costs from a responsible registrant. This may also help to keep costs down.

The Bylaws state that the interest accrued in this account may be transferred to general revenue. In the event the fund is used the interest will not, as a normal course, be transferred from the account. However, if the fund has not been used the interest may be transferred to general revenue in order to contain the fees charged for the administration of the College. Full reporting of fund usage is required each year.

This system represents an innovative approach to budgeting for the costs of hearings. An approach is has been upheld by the Ministry of Health, and the Ombudsman's Office.

Examinations

Practical Exams

The College provided two opportunities for eligible candidates to challenge the practical examination. Seven candidates attempted the exam in December, two were successful. Fourteen challenged in August and all were successful. The Board extends its congratulations to the successful candidates

Further opportunities will be scheduled based on the number of eligible candidates.

Theory Exams

Over the past 18 months the Registration Committee has developed new theory exams. The exams are based on the Standards of Practice, Canadian Denturist Baseline Competency Profile, a job task analysis, and the recent survey of active registrants completed in early 1996.

Twelve candidates attempted the Colleges theory licensure exam; eight were successful. The Board wishes to extend congratulations to the successful candidates.

Further opportunities will be scheduled based on the number of eligible candidates.

If you are an active registrant and wish to assist in the development of the examination database as an item reviewer or item writer please contact the regsitration committee.

Important Information Regarding Inactive Registrants

If you are an inactive registrant there has been a change to the Bylaws which affects you. Under the Rules of the Dental Technicians and Denturists Act a "non practising" denturist had 5 years in which to reinstate to practising status. This has changed. Section 42 of the Bylaws now stipulates that the maximum period of inactivity is 3 years.

If you are an inactive registrant who has been inactive for a period of less than 2 years 6 months you must reactivate within the three year limitation to avoid having to complete licensing examinations.

If you are an inactive registrant who has been inactive for a period between 2 years 6 months and 5 years you must reactivate your license prior to March 31,1998. After that date you will be required to complete licensing examinations.

Many individuals who are retired maintain a license for the sole purpose of receiving mail and other professional information. If this describes your situation please contact the office. We will place your name on the mailing list which will ensure that you receive general mailings from the College. There is no charge for this service.

Revised Recommendation #5 of the Health Professions Council

There have been a number of questions as to the progress regarding increased scope of practice for denturists. In March the Health Professions Council (HPC) submitted its revised recommendation to the Minister of Health. As you may remember after the HPC released its original recommendation on denturism the Minister referred recommendation #5 back to the Council for further review. Recommendation #5 required a denturist to obtain a prescription from a dentist when providing removable partial dentures or removable dentures over implants. The Minister posed eight questionsfor stakeholders, which included interested parties, regulators, and professional bodies. The denturists and dentists were able to reach consensus on a number of issues. On the issues they were not able to reach agreement the Health Professions Council made the decision.

As of this writing the Ministry of Health is developing a Regulation which will meet the requirement of the Recommendation #5. Upon release of the Regulation the Health Professions Act provides for a 90 day consultation period. (See page 10 for the Health Professions Bulletin Report.)

Revenue Projections

Previous Year Current Year

Registered to 3/97 to 3/98

196 denturists 188 active @ $800

20 non-practising denturists 16 inactive @ $200

21 students 18 students @ $50

4 temporary registrants @ $250

Expense Projections

Board Meetings (4 meetings)

Inquiry Committee (7 meetings)

Registration Committee (6 meetings)

Quality Assurance Committee (5 meetings)

Patient Relations Committee (5 meetings)

Executive Committee (4 meetings)

Discipline Committee (6 meetings)

Office Expenses

Contingency Fund

Amount

150,400

3,200

900

1 ,000

TOTAL $155,500

13,140

3,395

1,650

1,825

3,375

1,940

3,150

120,840

6,185

TOTAL $155,500

1997 1996

(12 months) (4 months)

Revenue

Dues 88,073 102,066

Interest 565 269

Fines and hearing fees 18,405 350

Examination fees 5,600 -

Total 112 643 102 685

Expenses

Amortization 2,078 447

Board expenses 16,258 10,560

Committee expenses 36,272 35,391

Insurance 500 -

Legal and accounting 5,960 3,043

Office and sundry 10,659 16,069

Salaries and benefits 68,949 18,272

Telephone 5,741 1,628

Total 146,417 85,410

(Deficiency) excess of revenue over expenses

before other income (33,774) 17,275

Other income

Gain on sale of equipment 1,710 -

(Deficiency) excess of revenue over expenses (32,064) 17,275

Net assets, beginning of period 17,275 -

Net assets, end of period (14,789) 17,275

Inquiry Committee Report

The Committee has been dealing with a number of issues including fraud, advertising, regulation violations, and workmanship complaints. There continue to be two outstanding areas of complaint of concern to registrants:

1. Advertising - The Rules under the previous Act were vague and difficult to enforce. However, the new Bylaws are explicit in their direction and will be enforced. If you are advertising you should consider submitting a copy to the committee prior to printing. Please review the Bylaws and ensure that you comply with its advertising limitations. Some points to consider are at the end of this report.

2. Fraudulent Billing - This means billing for services which you have not performed. The Board is strongly of the opinion that, pending investigation, action will be taken regardless of the amount. It is contingent on each and every registrant to ensure that systems and procedures are in place to see that claim forms are completed properly and the fees are correct.

Continued on page 10

Agreement on Internal Trade and Labour Mobility

On March 14, 1997 a meeting was convened at the invitation of the College of Denturists of Ontario. The purpose of the meeting was to comply with Chapter Seven of the Agreement, which seeks to provide labour mobility throughout the country. The meeting was attended by 35 professional delegates and representatives from provincial and federal government. The discussion covered a wide range of topics and resulted in fruitful discussions between a number of provinces. The College of Denturists in BC has taken the position that its current licensure exams are not barriers to labour mobility and that they will continue to be required of all applicants.

The regulatory authorities for denturists have agreed to explore the possibility of a national exam. Successful completion of such an exam would allow the candidate to practice anywhere in the country within the limitations of the provincial regulation.

Equipment for sale

The College of Denturists received, as a part of the transfer agreement, a great deal of equipment used by the dental technicians for examination purposes. This equipment is for sale to registrants of this College prior to being offered to the public. All equipment is in good condition:

HANUA semi adjustable articulators complete with carrying case, mounting table, and mounting rings.

$ 300

DENAR MARK II semi adjustable articulators complete with face bow, transfer jig, mounting table, mounting rings, and carrying case

$ 400

Crescent style plain line articulators $25

Tripod reline jigs $35

Advertising Issues and Complaints

The Inquiry Committee has received numerous complaints during the past year regarding advertising. The majority of these complaints relate to inappropriate advertising, and not misleading forms of advertising. Unfortunately, however, both the Registrant and the Client suffer.

Any marketing undertake by registrants in respect to their professional services must be in accordance with the recently approved College of Denturists' bylaws, section 78.

The three areas most often brought forward on complaint are:

· Discount, coupons etc. (Section 78.4)

A registrant must sufficiently describe the services and product that is being discounted, e.g. What type of teeth, acrylic. Is this a discount off your regular office product?

· Company names (Section 78,5, a)

When advertising under a corporate name, the registrant must also use their name, e.g. window sign, paper advertisements, etc.

· Using a former registrant's name (Section 78.5.b)

A registrant, after purchasing an office from another registrant, may not advertise the former registrant's name, unless s/he advertises the name in their ad as "office formerly operated by..."

Points to consider in the advertising decision process.

Clearly identify the intended target audience (using various demographics). The words used in the ad copy, the placement of the ad, and the type of media must always satisfy the needs and preferences of the target audience to be cost effective.

Specify the objectives of your advertising program. (New or reminder ads?)

Set the budget for advertising. (Word of mouth is the most effective form.)

Write the copy. (Have a client pretest the copy for understanding and readability.)

Select the right media (print, broadcast, outdoor, transit, specialty, radio, TV).

Schedule the advertising (same day each time or maintain a low level all year?).

Evaluate the advertising. Post-test the advertising, make any needed changes.

Council Clarifies Recommendations on Expanded Scope of Practice for Denturists

(Reprinted from the Health Professions Bulletin)

In 1993, the Health Professions Council conducted an investigation of denturism in response to an application from the Denturists Association of British Columbia. The Council determined that the designation of denturism was in the public interest and recommended an expanded scope of practice for denturists which would allow denturists to provide removable partial dentures and dentures-over-implants on the written prescription of a dentist who has examined the patient and determined the appropriate prosthesis to be fitted. This recommendation was based on the Council's conclusion that although denturists have the necessary knowledge, skill and expertise to make and fit both removable partial dentures and dentures-over-implants, their training does not qualify them to examine and assess the appropriate prosthesis for individual patients. After considering the Council's recommendations, Cabinet approved the designation of denturism under the Health Professions Act and gave approval in principle to the expanded scope of practice. This expanded scope of practice would be implemented after the Council had provided further recommendations pertaining to the implementation of this prescription system.

Earlier this year, the Health Professions Council submitted additional recommendations regarding implementation of the prescription system for removable partial dentures and dentures-over-implants.

After considering further submissions from denturists, dentists and dental technicians, the Council was satisfied that denturists can safely provide removable partial dentures and removable dentures-over-implants with certain limitations.

These limitations include the following:

denturists must be specially qualified; a full prior examination by a dentist is required; a prescription must include a full description and design of the appliance and a warning regarding any parts of the oral environment which should not be interfered with, a one year shelf life for a prescription; and - a patient must be referred to the prescribing dentist for a final examination.

In the Council's view, the groups involved in providing dentures (dentists, dental technicians and denturists) are capable of working together in accordance with the prescription process now that the terms of the process have been clarified.

Implementation of the Council's recommendations would require amendments to the existing Denturists Regulation. Once Cabinet has had an opportunity to consider these recommendations, any decision to proceed with changes cannot be implemented until a draft regulation has been circulated publicly for a minimum period of three months.

Consent Agreements

Two agreements were concluded with registrants since the last newsletter.

· Mr. Oleg Gavrilko accepted that he billed for services which were not performed, specifically a major repair. As a condition of the agreement Mr. Gavrilko paid to the College a $500 penalty and $350 in costs.

· Mr. Ken Biddle accepted that he advertised as an active registrant while not registered within that category. As a condition of the agreement Mr. Biddle accepted a reprimand and agreed to refrain from similar behaviour in the future.

Health Profession Corporation

Part IX of the Bylaws provides an opportunity for Corporations which provide and/or advertise services to register with the College. At this time the requirement to register is voluntary, however it is anticipated that future amendments to the Bylaws will make the registration of corporations mandatory.

The Model Bylaws, as provided by the Ministry of Health, propose the registering of corporations. The reason is to prevent non-registrants, persons who do not have the same ethical responsibilities to patients as a registrant has, from being in a position of decision making for the corporation.

Here is why you may wish to register while the program is voluntary.

· Initial corporate registrants will be given priority for corporation names.

· Registered corporations will have priority over non-registered corporations clinic names. In other words if corporation registers its name and a non-corporate registrant operates a clinic with a name which is the same or so closely resembles the name of the registered corporation that it is likely to confuse or mislead the public the non-corporate clinic must cease from using that name.

· In the event that two corporations attempt to register similar names the corporation which was the first to be incorporated will be deemed to have ownership of the name.

Immediate Dentures

The Health Professions Council (HPC) as part if its investigation, was encouraged by the College of Dental Surgeons to review the provision of Immediate Dentures by denturists.

In its investigation the HPC reviewed comments from all parties and , in its revised recommendation #5 have suggested that the regulation be amended to prohibit denturists from inserting immediate dentures, that is inserting dentures immediately after extraction of teeth. This does not intend to restrict or prevent denturists from manufacturing dentures prior to extraction, nor caring for post extraction patients, but specifically inserting dentures into a patient's oral cavity immediately after the extraction pending post extraction follow-up by the dentist.

The Articulator is the newsletter of the College of Denturists. Information is meant to be as accurate as possible. In the event of a disagreement the Act, Regulation and/or Bylaws will prevail.

Letters to the Editor are welcome.

John Mayr

Editor

The Articulator

Registration Committee

The Registration Committee is responsible for the approval of educational programs for the College, including those for denturists who may wish to provide partial dentures and dentures over implants once the amended Regulation has been passed. To date three programs have been submitted. All have been approved. These courses will qualify interested denturists to challenge the licensure exam of the College and do not ensure licensure. The three programs are offered by:

The Denturist Association of BC

Harvard University, Boston MA

Newlands Study Club

Under the Health Professions Act the Registration Committee has the authority to determine the standards required to ensure public protection. The process for reviewing program submissions is multi-tiered. First, the submission must completely outline the course and identify learning outcomes and objectives. The outcomes and objectives are then compared to the Standards of Practice and the Canadian Denturist Baseline Competency Profile. The outline must specify how the objectives will be met, or if objectives are not met, the reasons. Finally, the Registration Committee develops and administers the qualifying examinations for licensure.

The examination for licensure of partial dentures and dentures over implants will not take place until such time that the Ministry of Health has published the Regulation.

Until registrants successfully complete the examination it remains illegal to provide partial dentures directly to the public. Dentures over implants are not specifically restricted

within the current Regulation and are therefore considered within the current scope of practice. The College Board, however, strongly advises registrants to comply with the limitations recommended by the Health Professions Council. That includes working with written prescriptions, and working closely with the surgical specialist. Further, ensure that patient records meet or exceed the requirements of the Bylaws.

Section 74 of the Bylaws stipulates the following requirements for patient records:

Each registrant must keep, for each patient:

the name and address of the patient history, findings, treatment, and instructions regular progress reports a record for the date each patient was seen records for each financial transaction, and any other information required by government, agency, or law.

Records should be a chronological, detailed recording which would allow a third party to have a good understanding of the complete practitioner/patient interaction. Detailed up-to-date records are a valuable resource when the original owner wishes to transfer ownership of the practice to another active registrant.

Patient records are just that, the patient's records. Section 75 of the Bylaws provides for patients' access to their records. By law you are required to provide a copy of a record to a patient who requests it.