The following are the rules that we as members are proceeding with for the year of 2019. The reasoning/rationale for why we decided to do it this way are described in the Survey results.
There is also a copy of the relevant RCDSO guidelines in an article of the Dispatch that pertain to emergency services for patients and a Word document prepared by Dr. David Diamond (formerly schedule D) that define the different types of emergencies.
Checking the On-Call Messages
To check the on-call messages, you’ll need to call the on-call number (249-879-1072) and when prompted to leave a message, press * and enter the password, 1234, followed by the # key.
Rules and Guidelines
Hours
Monday: 8am to 7pm*
Tuesday: 8am to 7pm*
Wednesday: 8am to 7pm*
Thursday: 8am to 7pm*
Friday: 9am to 5pm
Saturday: 9am to 5pm
Sunday: 9am to 5pm
*From July 1 to August 31, we will end the day at 5pm. Please note that any day you’re on-call, you’re more than welcome to answer the calls beyond what hours we normally run for that day.
Relevant Guidelines
Most relevant statements in the Dispatch article (pg. 22, 23):
- Section 2(18) of the professional
misconduct regulations made under the Dentistry Act, 1991 (Ontario Regulation
853/93) defines professional misconduct as “failing to make arrangements for
emergency dental services for the member’s patients or to advise a patient how
to obtain emergency dental services.” Failure to do so may also expose a
dentist to allegations of patient abandonment. - An emergency protocol should be
developed so that patients who have a dental emergency during regular office
hours may be attended to in a timely fashion. Such patients may be seen by the
dentist of record where possible, or another dentist in the same office, and
should be accommodated either the same day or the next day at the latest.
Which Patients Are Eligible
Our goal with the SDDS on-call service is to manage all patients of record of active SDDS members experiencing after-hours dental issues. Patients that are true dental emergencies must be seen (or referred to Health Sciences North depending on the severity). Patients that are urgent dental situations should be seen, and those with routine, elective, or self-help care can often be managed just over the phone.
Patients of Records
If patients identify themselves to be a patient of record of another office that participates in the SDDS On-Call service, even if they are ODSP/OW/HSO, they should be seen. Additional fees should not be charged to regular patients of record of another on-call office.
If we put up obstacles or refuse to see patients of record of another on-call dentist, the patient can in turn file a complaint against the dentist of record for abandonment (see the Dispatch article). If we all want to rest during the weekends knowing our patients are being taken care of when we’re not there, we need to make sure we’re each doing what we expect of our colleagues.
It is impractical to have an emergency on‐call patient sign any document (i.e., waiver or release form). Patients may be reluctant to sign any such document (could cause them to avoid seeking care) and generally will not feel obligated to sign it or will not read and/or understand it (creates challenges in upholding it in court).
The best practice recommendation is to document in the clinical notes and records, contemporaneous with the event (as done in the course of regular practice record keeping) that the dentist on‐call advised the emergency on‐call patient that the service provided in the particular episode is for the on‐call service as an emergency or triage service and that the dentist is not a dentist of record. We must also advise and document in the clinical notes and records that if this is the case that the on‐call emergency dentist recommends that the emergency on‐call patient seeks out a regular dentist (or dentist of record) along with a comprehensive dental examination (that may include radiograph(s) or other assessments/tests) and suggest that the dentist or any other dentist could be able to see them during regular business hours for a comprehensive examination, diagnosis and treatment planning, etc.
The recommended chart note template is as follows:
The emergency on-call patient was advised that service today was provided only on an emergency on-call basis through the local SDDS component ODA society and specifically that I am not holding out to be the dentist of record. It was recommended that emergency on-call patient requires a regular dentist of record along with a complete clinical oral examination and diagnosis that may include radiographs and other tests.
It was suggested to the emergency on-call patient that I could see them in the future during regular business hours for a new patient complete clinical oral examination, including diagnosis and treatment planning.
OR
It was indicated to the emergency on-call patient that my practice is currently not accepting new patients and that the emergency on-call patient should seek another dentist for a new patient complete clinical oral examination, including diagnosis and treatment planning.
If patients identify themselves to be a patient of record of another office that participates in the SDDS On-Call service (see Active Member List), even if they are ODSP/OW/HSO they should be seen. Additional fees should not be charged to regular patients of record of another on-call office.
If we put up obstacles or refuse to see patients of record of another on-call dentist, the patient can in turn file a complaint against the dentist of record for abandonment (see the Dispatch article). If we all want to rest during the weekends knowing our patients are being taken care of when we’re not there, we need to make sure we’re each doing what we expect of our colleagues.
Patients of Non-Participating Members
If a patient is not a patient of record for any dentist that’s a part of our on-call, then the terms of their appointment are up to you and how you operate your office. You can either refuse to see them and encourage them to seek care from any dental office during regular business hours, you can charge additional fees if you’re seeing them outside of your regular office hours, or you can see them as you would any other patient. This applies to all patients – it can be OW/ODSP/HSO patients, patients without a regular dentist, and patients whose regular dentist does not participate in the on-call service.
The guidelines in the RCDSO Dispatch article indicated the following:
“Although a dentist is not obligated to provide treatment for every new patient who contacts the dental office, a patient with a dental emergency should be assessed and either provided treatment or referred to another practitioner or facility capable of treating the patient.”
Any patient in a true emergency (see the definition of a dental emergency in Schedule D) should be assessed by the on-call dentist regardless of whether their dentist participates in the on-call program. The on-call dentist may provide treatment or refer the patient to Health Sciences North, Emergency Department. For situations of urgent or routine/elective dental care, the on-call dentist is not obligated to see that patient if they are not a patient of record of a participating office. If a non-member’s patient has been directed to the services please inform us at sdds.oncall@gmail.com of the particulars so that we may advise the dentist that it is not appropriate to direct the patient to the service.
Whether an office works on an assignment or non-assignment basis is up to the individual offices. We have no authority to dictate how your office operates with collections. In emergency situations where the patient has never been seen before, most elect to go on a non-assignment basis. Remember that if an ODSP/OW/HSO patient of record of another on-call dentist reports to the office with a valid drug eligibility card, they should be seen on an assignment basis as we are not permitted to charge that demographic for services up front.
In the Dispatch article, the RCDSO does state, “The patient’s inability to pay should not be a barrier to appropriate palliative treatment of true emergencies.” If you come across a situation where the patient of an on-call dentist presents with valid insurance and cannot afford to pay for treatment upfront out-of-pocket, it is at your discretion whether you make an exception in that situation, keeping in mind that your financial policies should not be a barrier for patients of record of another on-call practice.
If a patient is not a patient of record for any dentist that’s a part of our on-call, then the terms of their appointment are up to you and how you operate your office. You can either refuse to see them and encourage them to seek care from any dental office during regular business hours, you can charge additional fees if you’re seeing them outside of your regular office hours, or you can see them as you would any other patient. This applies to all patients – it can be OW/ODSP/HSO patients, patients without a regular dentist, and patients whose regular dentist does not participate in the on-call service.
The guidelines in the RCDSO Dispatch article indicated the following:
“Although a dentist is not obligated to provide treatment for every new patient who contacts the dental office, a patient with a dental emergency should be assessed and either provided treatment or referred to another practitioner or facility capable of treating the patient.”
Any patient in a true emergency (see the definition of a dental emergency) should be assessed by the on-call dentist regardless of whether their dentist participates in the on-call program. The on-call dentist may provide treatment or refer the patient to Health Sciences North, Emergency Department. For situations of urgent or routine/elective dental care, the on-call dentist is not obligated to see that patient if they are not a patient of record of a participating office. If a non-member’s patient has been directed to the services please inform us at sudburydistrict.dentalsociety@gmail.com of the particulars so that we may advise the dentist that it is not appropriate to direct the patient to the service.
Whether an office works on an assignment or non-assignment basis is up to the individual offices. We have no authority to dictate how your office operates with collections. In emergency situations where the patient has never been seen before, most elect to go on a non-assignment basis. Remember that if an ODSP/OW/HSO patient of record of another on-call dentist reports to the office with a valid drug eligibility card, they should be seen on an assignment basis as we are not permitted to charge that demographic for services up front.
In the Dispatch article, the RCDSO does state, “The patient’s inability to pay should not be a barrier to appropriate palliative treatment of true emergencies.” If you come across a situation where the patient of an on-call dentist presents with valid insurance and cannot afford to pay for treatment upfront out-of-pocket, it is at your discretion whether you make an exception in that situation, keeping in mind that your financial policies should not be a barrier for patients of record of another on-call practice.
Answering Calls and Patient Management
Based on the wording of the RCDSO, a patient “should be accommodated either the same day or the next day at the latest.” During the weekdays, there’s no reason that a patient shouldn’t be seen the same day by the dentist on-call. There are two simple rules for being on-call on the weekend:
- There should be no unheard
messages left during the on-call hours of operation (see Hours below) when the
next dentist on-call during the week checks after the weekend. - Patients of record of on-call
dentists that fall into either the emergency or urgent classification need to
be seen the same day or the next day at the latest.
In the specific case of long weekends where you are assigned 3 on-call days (Saturday and Sunday, Monday except in the case of Easter where it’s Friday, Saturday, Sunday), we leave it up to you how you want to run the long weekends as long as the above 2 rules are accomplished!
Treatment
When it comes to treating our on-call colleagues’ patients, your obligations end at palliative care, which means resolving the patient’s pain/problem until they can be seen by their regular dentist. If the patient chooses to complete treatment with you, that is acceptable, but the patient should never be pushed to commit to treatment or “poached” from the other office in the interest of generating billing.
Screening and treatment should be limited to the immediate problem. When treatment is rendered, every effort should be made to forward relevant radiographs and records to the dentist of record. We are all dental professionals, and when seeing patients from another office, professional courtesy is mandatory! We should never be throwing each under the bus!
Assignment of On-Call days
The following are the ground rules that we’ve set for the on-call service this year:
- Random assignment.
- All days and weekends should be covered.
- Anyone doing a holiday weekend or multiple weekends this year will not be required to do a holiday or multiple weekends the following year.
- We will always seek out volunteers willing to take extra days first before assigning second weekends to members.
- Weekdays will be assigned randomly to a degree, but we will try to give priority to on-call dentists’ requests for certain days of the week where their office is already open longer hours.
Rules for Trading / Giving Away
Trading is allowed. It should be a fair trade, ie. a weekend for weekend or a weekday for a weekday. When a trade is agreed upon, an e-mail needs to be sent by one of the trading dentists to sudburydistrict.dentalsociety@gmail.com with the other dentist involved in the trade cc’d in the e-mail.
When the list of assignments is released, if you are unable to fulfill your obligations that weekend or during certain weekdays, the onus is on you to trade the day.
In order for the on-call service to work, we need to make sure our weekends are covered. All we’re asking is for everyone to take one weekend a year. Being on-call one weekend a year allows us to take every other weekend off for the year. Therefore, on an official level, we’re not supporting giving away on-call weekends this year. We expect all members to fulfill their obligations of answering the service the days that they’re on-call. Unofficially, if you decide to give your day away and the person you give your day away to doesn’t answer, we will hold you accountable, so our hope is that you’re either do your part and fulfill your obligations, or you better give your day away to someone you trust 100%!
Monitoring and Enforcement of the On-Call Service
Members
SDDS on-call members are expected to follow through with their commitment to answer calls on days that they are assigned. All member offices are called the week they’re on-call to remind them of their upcoming on-call responsibilities. Call logs from the on-call service are checked daily to ensure that the office listed as on-call answered calls that day. Any office that fails to answer is reported to the SDDS on-call executive. From there, an investigation is conducted to see what happened.
If a dentist is determined to have failed to answer calls on an assigned day, the dentist will be assigned a “strike,” with each individual day missed counting as a strike. After 3 strikes, the member will be suspended from the service for a period of 3 months. Strikes will remain on record for a rolling 24-month period. Continued infractions can lead to escalating penalties, including longer suspensions or even permanent dismissal from the service. During suspension, the offending office will be classified as a non-member office, and they will be monitored as outline below for non-members.
Non-Members
Non-members using or instructing their patients to inappropriately use the on‐call service is considered to be unprofessional and unethical behavior. The SDDS has the right to periodically call non-member offices after hours to ensure they are not directing patients to the SDDS on-call service.
In the event that a non-member office is found to be directing patients to the on-call service, initial efforts will focus on directly contacting (either verbally or in writing) the offending non-member and informing them that they should govern themselves accordingly and not use the SDDS on-call service while not participating as an active member. Repeated detailed evidence of a pattern of misbehaviour can result in this being brought to the attention of the College Registrar directly as it falls within sections 18 and 59 of the Dentistry Act (1991) (see below). Normally an investigation by the RCDSO is tripped by a patient complaint to the College, however, the Registrar on reasonable and probable grounds can order investigation regarding possible incompetence and/or professional misconduct, taking into account all the circumstances. Communication of the names of patients must maintain confidentiality.
A sample complaint may look like the following:
On March 3, 2019, patient A.J. was referred to the SDDS on‐call service by their dentist, Dr. X. Dr. X is not part of the on-call service and does not have any way on his recorded office message for his patients of record to contact him directly for afterihours emergency dental care.
All participating dentists have access to a list of dentists that are participating in the on-call service. A patient of record calling in from a non-participating dentist’s office does not have to be seen by the dentist on-call. If the dentist on-call decides to refuse treatment to that patient, the patient will be informed that their dentist does not participate in the service. While participating dentists certainly won’t encourage patients to file complaints against their dentist of record, the patient would have every right to do so as their dentist would have failed to have made emergency dental service arrangements for the patient.
Relevant Sections of the Dentistry Act (1991)
O. Reg. 853/93 (Professional Misconduct) sets out the following relevant sections:
2(18). Failing to make arrangements for emergency dental services for the member’s patients or to advise a patient how to obtain emergency dental services
2(59). Engaging in conduct or performing an act that, having regard to all the circumstances, would reasonably be regarded by members as disgraceful, dishonourable, unprofessional or unethical.
Common Voicemail Message
“You have reached Dr. Dentist’s office. The office is currently closed. If you would like to leave a message for our office, please stay on the line. If you are experiencing a dental emergency, we participate in a group on-call service. Please contact the on-call service at 249-879-1072. Please leave your name, telephone number, your regular dentist’s name, and a brief description of your problem. The service is monitored Monday through Thursday from 8:00 a.m. to 7:00 p.m. and Fridays, weekends, and holidays from 9:00 a.m. to 5:00 p.m. only. For serious dental emergencies requiring immediate attention such as uncontrolled bleeding, difficulty with breathing or swallowing, or severe facial trauma, please present to Health Sciences North, Emergency Department, located at 61 Ramsey Lake Road, Sudbury, Ontario.”
Specialists
Specialists may direct their patients to the on-call service provided they leave their personal contact information on their voicemail message as well. Ideally, each specialist is to provide a list of guidelines that they want members of the on-call service to follow when treating their patients.
Miscellaneous Concerns and Recommendations
Anyone on sick leave/maternity leave that is not working as a dentist should be exempt from the on-call service. If it happens at some point after the list is assigned, we will ask for volunteers to take the assigned days, but otherwise we will accept that those days will go uncovered.
Seeing patients while working alone is not recommended. To be part of the on-call service, we expect members to be available to see patients and have staff there to assist them at any point during the hours of operation for the on-call service. Your office health and safety policies should be designed to allow you to see patients on-call without jeopardizing your safety.
While we will do our best to ensure that all days are covered, as a backup, if a day is not covered, members may still want to consider leaving a direct contact number for their patients to reach them.