1.  New Brunswick is the only province to allow private member’s bills to give health professions the authority to regulate their professions through licensing (entry to practice); standards of practice; disciplinary mechanisms; and continuing education requirements.  One such private member’s bill is the New Brunswick Dental Act of 1985.

2.  The Act has a laudable stated purpose:

“AND WHEREAS it is desirable, in the interests of the public and the members of the dental profession, to continue The New Brunswick Dental Society as a body corporate for the purpose of advancing and maintaining the standard of dentistry in the Province, for governing and regulating those offering dental care and for providing for the welfare of members of the public and the profession;” 

3.  Contrary to the Act’s stated purpose, the Act is written to protect the welfare of the dental practitioners rather than advancing and maintaining the standards of dentistry in the province, governing dental care and providing for the welfare of the public. The Act is in serious need of amendment to reflect current times, practices, technology and societal expectations.

Shortcomings of the Act

Lack of Public Transparency

4. When the Act came into effect in 1985, the internet, social media and digital communication strategies did not exist.  The Act is now 34 years old, and outdated.  New Brunswick societal expectations with respect to transparency have significantly evolved in the period 1985 to 2019. The New Brunswick Dental Society (NBDS) approach to public transparency is to remain in 1985. 

5. Examples of NBDS lack of public transparency includes, but is not limited to the following:
 
      a. NBDS by-laws, rules, dental regulations etc. are not available for public inspection except by appointment to view in person;

      b. The NBDS register, educational register, specialists, register and corporations register, dental assistants register is not available for public inspection;

      c. NBDS fee guide is not available for public inspection, nor the underlying methodology used to develop the fee guide; and

      d. The NBDS Board meetings are closed; the agendas and minutes of these meetings are not available to the public.

6. There are no public records of the NBDS ever disciplining a dentist for professional misconduct; this lack of public records is certainly not the case in other provinces.

7. Examples of cases in Ontario where dentists have been disciplined as a result of findings of professional misconduct include:
       a. providing unnecessary dental service;
       b. providing treatment beyond their competence and expertise;
       c. charging excessive or unreasonable fees in relation to the service performed;
       d. delegating procedures to employees not qualified to perform the procedure;
       e. falsifying records; and
       f. submitting false or misleading accounts.

Royal College of Dental Surgeons of Ontario - Dentists Subject-to-Discipline

8. Examples of cases in Alberta where dentists have been disciplined as a result of findings of professional misconduct include:
       a. displaying lack of knowledge, skill or judgment;
       b. failing to provide appropriate treatment;
       c. failing to refer to a specialist;
       d. failing to obtain informed consent from the patient;
       e. failing to consider patients health issues in treatment planning;
       f. failing to keep appropriate dental records;
       g. exceeding approved levels of sedation; and
       h. prescribing inappropriate prescriptions and dosages.

Alberta Dental Association & College - Hearing Tribunal Decision Summaries

9.   British Columbia also provides transparency into their dentistry disciplinary matters:

College of Dental Surgeons of British Columbia - Public Notification of Complaint and Discipline Notices

10. The NBDS will state that they adhere to the Act, which is true; the Act does not require the NBDS to make any information concerning NBDS activities available to the public. In contrast, the Royal College of Dental Surgeons of Ontario (RCDSO) published their Transparency Principles  and a Report on Transparency, and have taken specific actions to improve transparency.
RCDSO Transparency Principles_Nov 2013
RCDSO Report on Transparency Nov 2013

Lack of Accountability

11. The Act itself does not require the NBDS to be accountable to the public. Examples of NBDS lack of accountability includes, but is not limited to the following: 

a. The appointment of the Board of Directors under the Act does not provide accountability.  Eight of the nine NBDS board members are appointed by a process controlled by the NBDS. The ninth board member appointed by the Minister of Health must be dentist. There is no one on the Board of Directors who is independent of the NBDS;

b. the lay person assigned to the NBDS Complaints and Disciplinary Committees is selected by the NBDS; the selected lay person is not independent;

c. The Act states, “Neither the Society, nor the Board, nor any of the committees of the Board or of the Society, nor any member, officer or employee of any of the foregoing bodies shall be liable for any loss or damage of any kind suffered or incurred by any person as a result of anything done or not done, any proceedings taken, or any order made or enforced by it or them in good faith in the administration of or pursuant to this Act, the previous Act, the bylaws or rules.”  Considering the public is not permitted access to the NBDS by-laws, rules, dental regulations etc., it is near impossible to even know if the NBDS has acted in bad faith?; and

d. The Office of the Integrity Commissioner Province of New Brunswick does not have jurisdiction to investigate the NBDS as NBDS are not designated as a custodian under the New Brunswick Personal Health Information Privacy and Access Act. The Office of the Privacy Commissioner of Canada does not have jurisdiction to investigate the NBDS as they are a provincially regulated organization.

e. The Act legally shields the NBDS from legislative oversight; the NBDS Board of Directors are not accountable to anyone for their actions or lack of actions, including the Minister of Health and the Premier.

Call to Action for New Brunswickers and the Minister of Health

12. It is the responsibility of the Provincial Minister of Health to conduct a review of the Act in order to introduce new "Public" legislation to modernize and resolve the Act's shortcomings of transparency and accountability. New Brunswick must abandon the misguided practice of using "Private" legislation to regulate the health professions; no other province allows this practice.

13. As part of a Ministerial review, it should not be a foregone conclusion that the regulatory authority for dentistry will continue to reside with the NBDS; the review should assess the feasibility of a provincially run agency to be the regulatory authority over dentistry, and/or to expand the mandate of the Office of the Integrity Commissioner to provide legislative oversight of provincial regulatory bodies (e.g. NBDS).