Dental Hygiene Legislation Oct 2023 .pdf

Legislation The College of Dental Hygienists of Ontario (CDHO) was established with the proclamation of the Regulated Health Professions Act, 1991 (RHPA) and Dental Hygiene Act, 1991 (DHA) on December 31, 1993. http://www. E-laws.gov.on.ca Learning Outcomes I  Understand the significance of th...

Legislation The College of Dental Hygienists of Ontario (CDHO) was established with the proclamation of the Regulated Health Professions Act, 1991 (RHPA) and Dental Hygiene Act, 1991 (DHA) on December 31, 1993. http://www. E-laws.gov.on.ca Learning Outcomes I  Understand the significance of the RHPA, 1991 and the DHA, 1991.  Describe the Health Procedural Code and its significance to the dental hygiene profession in Ontario.  Describe self-regulation, self-initiation, and the order requirement for dental hygiene practice in Ontario.  Understand the Spousal Exception Regulation, changes to Bill 87 – Protecting Patients Act. Bill 171, Bill 70. Self Regulation – Granted in 1991  1991 – 1993 – Transitional Council Committee for CDHO During government Committee hearings, organized dentistry lobbied members of parliament to include the restriction that dental hygienists had to obtain an “order” from a dentist for the client to have scaling and root planning, performed by a dental hygienist. Supervision was not required. However, the “order” effectively continued to tie the provision of dental hygiene services with those of the dentist and made it very difficult for the public to access oral hygiene care in non-traditional settings. Self- Regulation The order requirement was not what was intended under the RHPA, as it negated client choice of practitioner. This was included under Bill 47 – special ministry powers for regulations, in the Employment Standards Act. The CDHO Council Committees from 1994 to 2007 made it a priority to have the legislation amended. Proclamation in September 2007 permitted dental hygienists authorized by the CDHO, to self-initiate preventive oral health care procedures. Self-initiation – was implemented Sept 1, 2007. Self-initiation – rescinded Sept 22, 2023. Since 2007, dental hygienists who have been approved for self – initiation status with the College of Dental Hygienists(CDHO) did not need to receive an order from a dentist to perform the controlled acts of scaling, root planing and curettage of surrounding tissue. Standard for Authorization to Self-Initiate  What does this change mean?  All dental hygienists can now perform the controlled act of scaling and root planing on their own initiative.  Clearance from a physician or dentist is required if any contraindications are present, or if there is any doubt as to the accuracy of the client’s health history. Benefits to the Amendment of the Order Requirement Benefits for the public – mandate of the CDHO is to ensure access to dental hygiene services for the public Greater access to dental hygiene services for individuals; the homebound, elderly ,remote, and institutionalized. Benefits for the dental hygiene profession – provides wider choices for access to the dental hygiene profession – independent dental hygiene practice settings, mobile practices Knowledge skill and ament 7 Knowledge skill and judgment The initial drafts of the RHPA, 1991 and DHA, In 1991 had determined that dental hygienists I had the knowledge, skill and judgment to “self-initiate” their authorized act of scaling teeth and root planing, including curetting surrounding tissue. The final draft included the “order” requirement. Contraindications Regulation for Dental Hygiene Practice. Contraindications Regulation            1. Any cardiac conditions requiring antibiotics 2. Any other condition for which antibiotic prophylaxis is required. 3. An unstable medical or oral health condition. 4. Active chemotherapy or radiation therapy. 5. Significant immunosuppression caused by disease, medications or treatment modalities. 6. Any blood disorders – hemophilia, etc. 7. Active Tuberculosis. 8. Drug or alcohol dependency of a type that might affect treatment safety. 9. High risk infective endocarditis. 10. A medical or oral health condition with which the dental hygienists is unfamiliar with. 11. A drug or combination of drugs that the dental hygienist is unfamiliar with. orthodontic and restorative procedures Orthodontic and Restorative Procedures Authorized acts that require a client specific order. These acts are not included in a standing order or self-initiation CDHO requires a detailed client specific order from the DDS This specific order should be fully detailed in client’s chart. Should include:  Which procedures are to be delivered  Which bands, brackets, wires and ligatures to are be used  When the next appointment rotation should be RCDSO requires DDS to be present for specific orthodontic services client specific order is always required for any orthodontic procedure clientspecific order ie always including emergencies required for any I c procedure Scope of Practice - CDHO The practice of dental hygiene is the assessment of teeth and adjacent tissues and treatment by preventive and therapeutic means and the provision of restorative and orthodontic procedures and services. DH are authorized to perform 3 controlled Acts: 1. Scaling and root planning including curetting the surrounding tissue. scaling and not planning including cutting the surronnery tis ve 2. Orthodontic and restorative procedures. 3. Prescribing, dispensing, or selling a drug designated in the regulations. Regulated Health Profession Act, 1991 (RHPA) Is the framework for the entire health profession sector Minister of Health and Long Term Care - Sylvia Jones Law Case law (common law) based on decisions by the courts. A set of past rulings by judges and tribunals that meet respective jurisdiction rules for formality to be cited as precedent. Discipline Hearings – refer to previous hearing decisions to decide on hearing outcomes – based on statement of facts. Statutes (Act) Federal or Provincial Legislature Examples – Healing Arts Radiation Protection Act (HARP), PIPEDA – Personal Information Protection and Electronic Documents Act Dental Hygiene Act, 1991 Separate Statute, only dealing with issues related to the regulation of the profession of dental hygiene i Statues can authorize the making of further laws through regulations and by-laws without going back to legislature i again. Examples of regulations under the Dental Hygiene Act Registration RegulationRegistration Regulations I Examination Regulation Examination Regulations Professional Misconduct Regulation Professionalmisconduct Quality Assurance Regulation Patient Relations Regulation Contra-indication Regulation I The Health Professions Procedural Code Schedule 2 (or Appendix) of the RHPA Outlines the Common duties and procedures for all 26 health colleges It Identifies responsibilities for college council and the 7 mandatory statutory committees for each college 7 Mandatory Regulatory Committees that all Health Colleges must have in place.  Registration Committee  Quality Assurance Committee  Fitness to Practice Committee  Inquires, Complaints and Reports Committee (ICRC)  Discipline Committee  Patient Relations Committee  Examinations Committee Health Procedural Code  The Health Professions Procedural Code (Code), which is Schedule 2 to the Regulated Health Professions Act, 1991, sets out the practical rules for the regulatory colleges regarding : • • • • • • • • • • registering members handling complaints conducting investigations carrying out discipline hearings handling fitness to practise hearings quality assurance program patient relations program mandatory reporting funding for victims of sexual abuse by members appeal processes regarding registration and complaint decisions Regulatory Colleges are bound through by-laws Administrative in nature and deal with: Elections for College Council Establishing College Committees Fees for registration, clinical examinations rules and regulations Appointment, role and duties of the Registrar/CEO When there is proposal to change a by-law, it must go out for stakeholder consultation to allow review and comment. Decisions are guided by…….. 1. 2. 3. 4. 5. Regulated Health Professions Act Dental Hygiene Act Health Procedural Code By-laws Policies RHPA & DHA establish Mandatory Regulatory Activities that Colleges must have in place.  Registration  Complaints Process  Investigations and Discipline (ICRC)  Incapacity (Fitness to Practice)  Quality Assurance Program  Examination Process  Patients Relations Program Self-Regulation Fundamental Aspects  Controlled Acts No one, including dental hygienists, is permitted to perform a controlled act without legal authority. Controlled acts are procedures that could cause risk to a client, such as scaling and root planing or restorative & orthodontic procedures, and prescribing medicaments as per the regulation. Use of Title  To practice dental hygiene in the province of Ontario, a person must be registered with the CDHO. Only registrants of the CDHO can legally use the title "dental hygienist“. All Dental Hygienists have an obligation to cooperate with the College of Dental Hygienist of Ontario (CDHO) This could be required for an investigation, inquiry or assessment as per the Regulated Health Profession Act (RHPA). Duty to Cooperate – Dental Hygienist  Respond to College communication in a timely manner  Provide access to College investigators or assessors into     work practice and client records Not conceal, withhold, or destroy documents related to an investigation Provide information to the College that is required for the public register (business address, telephone number, etc.) – TRANSPARENCY REQUIREMENTS Attend cautions directed by the Complaints Committee or Discipline Committee DH who fails to Cooperate – Professional Misconduct Dental Hygienist have an Obligation to ……  Participate in the Quality Assurance Program  Avoid Sexual or Other Abuse  Be fit to practice (Incapacity)  Numerous other duties are set out in the legislation – being competent, honest, maintaining client confidentiality, accurate record keeping, obtaining consent from clients to proceed with care, manage conflict appropriately, effectively communicate on all levels of engagement www.cdho.org Mandatory Reporting Requirements Not a breach of confidentially of client information when dealing with abuse or neglect. Dental Hygienist - should obtain legal advice if involved in a mandatory reporting situation. Under the RHPA -Sexual Abuse reporting (30 days or sooner)  Touching, behaviours or remarks in a sexual nature between registered health practitioner and a client/patient when you know the name of the alleged abuser ( its mandatory to report).  When aware of professional misconduct, incapacity or incompetence of a registered health care professional – mandatory to report.  Under Child and family Service Act,2017 - Child (under 16) needs protection - report to Children's Aid Society if child is suffering from abuse or neglect. Nursing Home Act – Elder Abuse -nursing home resident is being neglected or suffering harm, improper care or treatment – Reasonable ground to suspect neglect Report to the Nursing Home Director Case law – “Duty to Warn” – an identifiable person or group is at risk of harm or death from another person – must report to legal authorities or intended victim. Mandatory Reporting You have been working with your client, Maria, for some time and you and she have developed a good rapport. On one visit, Maria seems quite subdued. After your attempts at small talk don’t work, you ask her what is wrong. Maria bursts into tears. After regaining her composure, she tells you that her family physician conducted an improper breast examination. She describes what occurred and it certainly sounds like an unusual breast examining technique to you. You know the identity of the physician from her file. What are your legal obligations? CDHO, 2010 Shot of Phy Neglect of a Child’s Oral Health You work in public health. On a school visit you see Laura, a child you also saw last year. Last year you reported to the parent(s) that Laura should be seen by a dentist to diagnose a suspected cavity. The parents have not followed up on this recommendation and the child is now presenting with an apparent abscess. CDHO, 2010 Aid came child What do you do? CIDHO Some thoughts to consider….  A mandatory report is not a breach of confidentiality about a client. You are required to report even when your client does not want you to make the report.  Significant consequences can occur when a mandatory report is not made. In some cases, you can be prosecuted and fined up to $25,000 in Provincial Offences Court. Generally, it is professional misconduct to fail to make a mandatory report. You can be sued for any harm that results.  Example – Physician failed to report patient that was unsafe to drive, and the driver harmed someone in a motor vehicle accident – sued for more than ½ million dollars. “reasonable grounds to believe”. “Reasonable grounds” refers to objective information, not personal belief. If the facts are present, a report must be made even though you might not believe the facts to be true. “Reasonable grounds” - mere rumour or gossip does not constitute reasonable grounds (e.g., a dental assistant telling you over coffee that everyone knows Dr. Green sleeps with his clients). However, you do not need hard evidence either. For example, information from someone who did not personally observe the event is fine as long as it contains some specifics that would support the truth. CDHO, 2010 Concept of Boundaries Creating a Professional Distance with Clients. In order to remain objective with your clients and not confuse them as to your role and intent, it is important to maintain ―professional distance. Kind of like “conflict of Interest” except it is about feelings rather than money or profit. Setting the Boundaries Maintaining clear and firm boundaries with clients is essential to avoid conduct that could be perceived as sexual intent. When or if a client initiates such behaviour by telling a joke or engaging in flirtatious behaviour, politely but firmly put a stop to it to protect yourself. Other protective measures include: To avoid any misinterpretations, do not make suggestive or seductive comments or gestures. ■ Do not take a sexual history except to the extent that it is clinically indicated. ■ Do not comment on a client’s body or sex life. ■ Never date a client; do not provide care for a partner who is not considered your spouse. ■ Avoid or at least limit self-disclosure. ■ Detect and deflect clients who attach themselves to you emotionally. ■ Document any intimate talk, touch or exposure in the client chart. Touching Principles for the DH  Never make assumptions  Show respect to client  Respect cultural diversity  Maintain client’s dignity  Always obtain consent for care  Respect that client’s can change their mind about I the care planned  Never place instruments on client chest CDHO, 2010 Boundaries to Protect the DH Client abuse of the dental hygienist – this happens! document, document, document. Dealing with confidentiality concerns; such as requests from spouse of client, parent of client about information they are not entitled to know– difficult situations. Scenarios Client could be physically, emotionally or verbally abusive to the dental hygienist due to having mental health issues. A client could have medical issues when a client has psychological, personal or emotional issues – mild behaviour can be resolved. Abuse from a client that is moderate, consistent and repetitive – DH should terminate care, transfer the client (discontinuation of professional services – Professional misconduct Regulation) Professional Misconduct Regulation DH will want to be sure that the transfer of the client is made in accordance with the professional misconduct regulation: 11. The DH will not discontinue services that are needed unless, i i. the client requests the discontinuation, ii. alternative services are arranged, or iii. the client is given a reasonable opportunity ` to arrange alternative services Bill 87 - Protecting Patients Act, 2017  Amended the RHPA and Other health related statues related to sexual abuse  Task Force – to address sexual abuse  Sexual Abuse is still prevalent, most complaints are     female College of Physicians & Surgeons (CSPO) – responsible for ½ complaints, Physiotherapists, Message Therapists. Issue - alleged perpetrators are supported in the system Complainants are not supported and being re-victimized Societal issue – people are not intervening, reporting cases or taking them seriously Bill 87 – changes  Discipline cases – fast tracking sexual abuse, mandatory suspension immediately after complaint, if found guilty mandatory revocation  Enforcement of mandatory reporting  Zero tolerance Major Themes of Bill 87  Increased Transparency by Regulatory organizations  Increased Ministerial Power – ministry can step in at anytime.  Sexual Abuse Amendments  Interim Order Powers by ministry Treating a Spouse in Dentistry 2014 – Bill 70  Ontario Dental Association Announces Spousal Treatment is Now Permitted in Ontario - Oral Health Group  Bill 70 is a private members bill created to amend the Regulated Health Professions Act (RHPA) so that health care providers could treat their spouse. CDHO Website- Homework CDHO Website – under for the Public TabDiscipline Decisions Marlene Catherine Mauzza 2005 – Discipline case Melissa Kaprolos 2017/2023– Discipline case Alexandru Tenase 2018 – Discipline case Review these…….  https://youtu.be/5l1LgKKcO0I  https://www.cdha.ca/cdha/News- Events_folder/News_Releases/tag/2019/Dental_Hygie nists_Call_for_Exemption_on_Treatment_of_Spouses. aspx Spousal Exception Regulation Toronto | Oct 08, 2020 In 2015, the CDHO submitted a Spousal Exception Regulation to the government which would permit dental hygienists to treat their spouses without it constituting sexual abuse as long as the dental hygienist was not engaged in the practice of the profession when the sexual conduct occurred. The regulation was passed by the Ontario government on October 8, 2020. The definition of a “spouse” for the purposes of this regulation is very narrowly defined in the Health Professions Procedural Code of the Regulated Health Professions Act, 1991 (RHPA), and includes only (a) a person who is the member’s spouse as defined in section 1 of the Family Law Act (i.e., a person to whom the member is married), or (b) a person who has lived with the member in a conjugal relationship outside of marriage continuously for a period of not less than three years. The passing of this regulation into law means that dental hygienists are now permitted to treat their spouses but only where the member's spouse actually meets the statutory definition of “spouse” (i.e., is a person to whom the member is married or with whom the member has been living in a conjugal relationship continuously for at least three years) and where the sexual relationship is kept entirely out of the office setting. While treating a spouse, the dental hygienist must follow all of the professional formalities and maintain the professional distance that the dental hygienist would for any other client. Treating a sexual partner who does not meet the definition of a spouse under the RHPA will continue to be considered sexual abuse References  http://www. E-laws.gov.on.ca  www.cdho.org