DISCIPLINE COMMITTEE OF THE ROYAL COLLEGE OF DENTAL SURGEONS OF ONTARIO
IN THE MATTER OF: A Hearing held pursuant to the provisions of the Health Professions Procedural Code which is Schedule 2 to the Regulated Health Professions Act, 1991, Statutes of Ontario, 1991, Chapter 18 (“Code”)
AND IN THE MATTER OF: the Dentistry Act and Ontario Regulation 853, Regulations of Ontario, 1993, as amended (“Dentistry Act Regulation”)
BETWEEN:
Royal College of Dental Surgeons of Ontario
-and-
Dr. Ricardo Solis
PENALTY REASONS
PANEL MEMBERS:
Dr. Richard Hunter, Professional Member (Chair)
Dr. William Coyne, Professional Member
Dr. Peter Delean, Professional Member
Mr. Ram Chopra, Public Member
APPEARANCES:
Ms. Christine Mainville, for the College
Mr. Matthew Wilton, for Dr. Ricardo Solis
Ms. Luisa Ritacca, Independent Legal Counsel
Heard: May 23, 2019, in person
Decision Date: May 23, 2019
Release of Written Reasons: June 12, 2019
DECISION AND REASONS FOR DECISION – PENALTY AND COSTS
This matter came on for a hearing before a panel of the Discipline Committee (the “Panel”) at the Royal College of Dental Surgeons of Ontario in Toronto on July 20, 2018 and proceeded for nineteen days over the course of several months.
On January 24, 2019, the Panel released its decision on liability. In it, the Panel found that the Member engaged in professional misconduct in a number of different ways, including the Member contravened a standard of practice or failed to maintain the standards of practice of the profession relative to one or more patients, contrary to paragraph 1 of Section 2 of the Dentistry Act Regulation. He recommended and/or provided an unnecessary dental service relative to one or more patients, contrary to paragraph 6 of Section 2 of the Dentistry Act Regulation. He signed or issued a certificate, report or similar document that he knew or ought to have known contained a false, misleading or improper statement relative to one or more patients, contrary to paragraph 28 of Section 2 of the Dentistry Act Regulation. He charged a fee that was excessive or unreasonable in relation to the service performed relative to one or more patients, contrary to paragraph 31 of Section 2 of the Dentistry Act Regulation. He submitted an account or charge for dental services that he knew or ought to have known was false or misleading relative to one or more patients, contrary to paragraph 33 of Section 2 of the Dentistry Act Regulation. He accepted an amount in full payment of an account or charge, that was less than the full amount of the account or charge submitted by him to a third party payer, without making reasonable efforts to collect the balance from the patient, or to obtain the written consent of the third party payer, relative to one or more patient, contrary to paragraph 34 of Section 2 of the Dentistry Act Regulation, and he engaged in conduct or performed an act or acts that, having regard to all the circumstances, would reasonably be regarded by members as disgraceful, dishonourable, unprofessional or unethical, contrary to paragraph 59 of Section 2 of the Dentistry Act Regulation.
Following the release of our decision, the parties re-attended before the Panel to make submissions with respect to penalty and costs.
At the outset of the penalty and costs hearing, the Panel was advised that the parties had reached an agreement on penalty and costs. As such, this phase of the hearing proceeded on an uncontested basis.
Joint Submission on Penalty
A joint submission with respect to penalty and costs was filed. The College and the Member submitted that the panel make an order:
(a) requiring the Member to appear before the panel of the Discipline Committee to be reprimanded within ninety (90) days of this Order becoming final or on a date fixed by the Registrar;
(b) directing the Registrar to suspend the Member’s certificate of registration for a period of twelve (12) months, to be served consecutively, such suspension to commence within thirty (30) days of this Order becoming final;
(c) that the Registrar impose the following terms, conditions and limitations on the Member’s certificate of registration (the “Suspension Conditions”), which conditions shall continue until the suspension of the Member’s certificate of registration as referred to in subparagraph 1(b) above has been fully served, namely:
(i) while the Member’s certificate of registration is under suspension, the Member shall immediately inform the following people about the suspension:
a. staff in the offices or practices in which the Member works, including other regulated professionals and administrative staff
b. dentists with whom the Member works, whether the Member is a principal in the practice or otherwise associated with the practice
c. dentists or other individuals who routinely refer patients to the Member
d. faculty members at Faculties of Dentistry, if the Member is affiliated with the Faculty in an academic or professional capacity
e. owners of a practice or office in which the Member works
f. patients who ask to book an appointment during the suspension, or whose previously booked appointment has been rescheduled due to the suspension. The Member may assign administrative staff to inform patients about the suspension. All communications with patients must be truthful and honest;
(ii) while suspended, the Member must not engage in the practice of dentistry, including but not limited to:
a. acting in any manner that suggests the Member is entitled to practice dentistry. This includes communicating diagnoses or offering clinical advice in social settings. The Member must ensure that administrative or office staff do not suggest to patients in any way that the Member is entitled to engage in the practice of dentistry
b. giving orders or standing orders to dental hygienists
c. supervising work performed by others
d. working in the capacity of a dental assistant or performing laboratory work
e. acting as a clinical instructor;
(iii) while suspended, the Member must not be present in offices or practices where the Member works when patients are present, except for emergencies that do not involve patients. The Member must immediately advise the Registrar in writing about any such emergencies;
(iv) while suspended, the Member must not benefit or profit, directly or indirectly from the practice of dentistry.
a. The Member may arrange for another dentist to take over their practice during the suspension period. If another dentist assumes the practice, all of the billings of the practice during the suspension period belong to that dentist. The Member may be reimbursed for actual out-of-pocket expenses incurred in respect of the practice during the suspension period.
b. The Member is permitted to sign and/or submit insurance claims for work that was completed prior to the suspension.
c. The Member must not sign insurance claims for work that has been completed by others during the suspension period;
(v) the Member shall cooperate with any office monitoring which the Registrar feels is needed to ensure that the Member has complied with the Suspension Conditions. The Member must provide the College with access to any records associated with the practice that the College may require to verify that the Member has not engaged in the practice of dentistry or profited during the suspension; and
(vi) the Suspension Conditions imposed by virtue of subparagraphs 1(c)(i)-(v) above shall be removed at the end of the period that the Member’s certificate of registration is suspended.
(d) directing that the Registrar also impose the following additional terms, conditions and limitations on the Member’s Certificate of Registration (the "Practice Conditions"), namely:
(i) requiring that the Member successfully complete, at his own expense, a one-on-one course in the College’s Guidelines in Dental Recordkeeping (including the retention of records), Financial Recordkeeping, the Healing Arts Radiation Protection Act, the ALARA principle, and the justification for prescribing radiographs and interpretation, approved by the College, and provide proof of successful completion in writing to the Registrar within twelve (12) months of this Order becoming final;
(ii) requiring that the Member successfully complete, at his own expense, the ProBE Program on Professional/Problem-Based Ethics, to be completed with an “unconditional pass” within twelve (12) months of this Order becoming final;
(iii) the Member’s practice shall be monitored by the College by means of office visit(s) by a representative or representatives of the College at such time or times as the College may determine with advance notice to the Member, during the period commencing with the date of the finalization of this Order and ending twenty-four (24) months from the College receiving proof of the Member’s successful completion of the course(s) referred to above, or until the Inquiries, Complaints and Reports Committee is satisfied that the Member has successfully completed the monitoring program, whichever date is later;
(iv) that the Member shall cooperate with the College during the office visit(s) and further, shall pay to the College in respect of the costs of monitoring, the amount of $1,000.00 per office visit, such amount to be paid immediately after completion of each of the office visit(s);
(v) that the representative or representatives of the College shall report the results of those office visit(s) to the Inquiries, Complaints and Reports Committee of the College and the Inquiries, Complaints and Reports Committee may, if deemed warranted, take such action as it considers appropriate;
(vi) the Practice Conditions imposed by virtue of subparagraphs (1)(d)(i)-(ii) above shall be removed from the Member's certificate of registration upon receipt by the College of confirmation in writing acceptable to the Registrar that the courses described in subparagraphs (1)(d)(i)-(ii) above have been completed successfully;
(vii) the Practice Condition imposed by virtue of subparagraph (1) (d)(iii) above shall be removed from the Member's certificate of registration twenty-four (24) months following receipt by the College of confirmation in writing acceptable to the Registrar that the requirements set out in subparagraphs (1)(d)(i)-(ii) above have been completed successfully, or upon receipt of written confirmation from the Inquiries, Complaints and Reports Committee that the Member has successfully completed the monitoring program, whichever date is later.
(e) that the member pay costs to the College in the amount of $200,000.00 in respect of this discipline hearing, such costs to be paid in full by September 1, 2019.
Decision
In regard to the finding that the Member committed professional misconduct, the Panel orders as follows:
(a) The Member is required to appear before the panel of the Discipline Committee to be reprimanded within ninety (90) days of this Order becoming final or on a date fixed by the Registrar;
(b) The Registrar is directed to suspend the Member’s certificate of registration for a period of twelve (12) months, to be served consecutively, such suspension to commence within thirty (30) days of this Order becoming final;
(c) The Registrar is to impose the following terms, conditions and limitations on the Member’s certificate of registration (the “Suspension Conditions”), which conditions shall continue until the suspension of the Member’s certificate of registration as referred to in subparagraph 1(b) above has been fully served, namely:
(i) while the Member’s certificate of registration is under suspension, the Member shall immediately inform the following people about the suspension:
a. staff in the offices or practices in which the Member works, including other regulated professionals and administrative staff
b. dentists with whom the Member works, whether the Member is a principal in the practice or otherwise associated with the practice
c. dentists or other individuals who routinely refer patients to the Member
d. faculty members at Faculties of Dentistry, if the Member is affiliated with the Faculty in an academic or professional capacity
e. owners of a practice or office in which the Member works
f. patients who ask to book an appointment during the suspension, or whose previously booked appointment has been rescheduled due to the suspension. The Member may assign administrative staff to inform patients about the suspension. All communications with patients must be truthful and honest;
(ii) while suspended, the Member must not engage in the practice of dentistry, including but not limited to:
a. acting in any manner that suggests the Member is entitled to practice dentistry. This includes communicating diagnoses or offering clinical advice in social settings. The Member must ensure that administrative or office staff do not suggest to patients in any way that the Member is entitled to engage in the practice of dentistry
b. giving orders or standing orders to dental hygienists
c. supervising work performed by others
d. working in the capacity of a dental assistant or performing laboratory work
e. acting as a clinical instructor;
(iii) while suspended, the Member must not be present in offices or practices where the Member works when patients are present, except for emergencies that do not involve patients. The Member must immediately advise the Registrar in writing about any such emergencies;
(iv) while suspended, the Member must not benefit or profit, directly or indirectly from the practice of dentistry.
a. The Member may arrange for another dentist to take over their practice during the suspension period. If another dentist assumes the practice, all of the billings of the practice during the suspension period belong to that dentist. The Member may be reimbursed for actual out-of-pocket expenses incurred in respect of the practice during the suspension period.
b. The Member is permitted to sign and/or submit insurance claims for work that was completed prior to the suspension.
c. The Member must not sign insurance claims for work that has been completed by others during the suspension period;
(v) the Member shall cooperate with any office monitoring which the Registrar feels is needed to ensure that the Member has complied with the Suspension Conditions. The Member must provide the College with access to any records associated with the practice that the College may require to verify that the Member has not engaged in the practice of dentistry or profited during the suspension; and
(vi) the Suspension Conditions imposed by virtue of subparagraphs 1(c)(i)-(v) above shall be removed at the end of the period that the Member’s certificate of registration is suspended.
(d) directing that the Registrar also impose the following additional terms, conditions and limitations on the Member’s Certificate of Registration (the "Practice Conditions"), namely:
(i) requiring that the Member successfully complete, at his own expense, a one-on-one course in the College’s Guidelines in Dental Recordkeeping (including the retention of records), Financial Recordkeeping, the Healing Arts Radiation Protection Act, the ALARA principle, and the justification for prescribing radiographs and interpretation, approved by the College, and provide proof of successful completion in writing to the Registrar within twelve (12) months of this Order becoming final;
(ii) requiring that the Member successfully complete, at his own expense, the ProBE Program on Professional/Problem-Based Ethics, to be completed with an “unconditional pass” within twelve (12) months of this Order becoming final;
(iii) the Member’s practice shall be monitored by the College by means of office visit(s) by a representative or representatives of the College at such time or times as the College may determine with advance notice to the Member, during the period commencing with the date of the finalization of this Order and ending twenty-four (24) months from the College receiving proof of the Member’s successful completion of the course(s) referred to above, or until the Inquiries, Complaints and Reports Committee is satisfied that the Member has successfully completed the monitoring program, whichever date is later;
(iv) that the Member shall cooperate with the College during the office visit(s) and further, shall pay to the College in respect of the costs of monitoring, the amount of $1,000.00 per office visit, such amount to be paid immediately after completion of each of the office visit(s);
(v) that the representative or representatives of the College shall report the results of those office visit(s) to the Inquiries, Complaints and Reports Committee of the College and the Inquiries, Complaints and Reports Committee may, if deemed warranted, take such action as it considers appropriate;
(vi) the Practice Conditions imposed by virtue of subparagraphs (1)(d)(i)-(ii) above shall be removed from the Member's certificate of registration upon receipt by the College of confirmation in writing acceptable to the Registrar that the courses described in subparagraphs (1)(d)(i)-(ii) above have been completed successfully;
(vii) the Practice Condition imposed by virtue of subparagraph (1) (d)(iii) above shall be removed from the Member's certificate of registration twenty-four (24) months following receipt by the College of confirmation in writing acceptable to the Registrar that the requirements set out in subparagraphs (1)(d)(i)-(ii) above have been completed successfully, or upon receipt of written confirmation from the Inquiries, Complaints and Reports Committee that the Member has successfully completed the monitoring program, whichever date is later.
(e) that the member pay costs to the College in the amount of $200,000.00 in respect of this discipline hearing, such costs to be paid in full by September 1, 2019.
Reasons
The Panel concluded that the proposed penalty was appropriate in all the circumstances of this case. It therefore accepted the Joint Submission and ordered that its terms be implemented.
The Panel was satisfied that a reprimand and 12-month suspension, which will be made public on the College’s register will act as both a specific and general deterrent. It sends a clear message to all members of the profession that the College will not tolerate members performing unnecessary dental services, submitting false, excessive or unreasonable claims and failing regularly to collect co-payments.
The imposition of the terms, limits and conditions will help protect the public. While under suspension, Dr. Solis must not engage in the practice of dentistry. Prior to and upon his return to the practice, he is required to take courses in Radiation Protection, Recordkeeping and Ethics. In addition, once he returns to practice, the Member’s office will be monitored for 24 months to ensure that he is meeting professional standards.
Rehabilitation of the Member is met by the successful completion of the mandated courses and the office monitoring.
When considering the appropriateness of the penalty, the Panel considered penalties ordered from previous disciplinary hearings and both aggravating and mitigating factors. The Panel was satisfied that the Joint Submission was fair and reasonable.
Aggravating factors include the several years in which the misconduct persisted. As well, the deliberate pattern of the Member’s misconduct and the fact the misconduct was committed for the Member’s financial benefit added to the aggravating factors present. The level of dishonesty was substantial and Dr. Solis’s misconduct was strongly related to inadequate and possibly harmful patient care.
The fact that this was the first appearance of the Member before the Discipline Committee and that he agreed to the proposed penalty by way of a joint submission were considered by the Panel as mitigating factors.
The College’s costs were substantial mainly due to the length of the hearing. The large volume of documentary evidence and the number of witnesses also contributed to the significant costs to conduct the hearing. As a result, the Panel accepted $200,000 as appropriate. This represented approximately one third of the College’s costs.
Reprimand
At the conclusion of the hearing, the Member confirmed his decision to waive his right to appeal. The panel delivered its reprimand immediately following the announcement of its decision on penalty. A transcript of the reprimand is reproduced as Schedule A.
I, Dr. Richard Hunter, sign these Reasons for Penalty and Costs as Chairperson of this Discipline Panel and on behalf of the majority of the Panel Members.
SCHEDULE “A”
REPRIMAND
Dr. Solis, as you know, this Discipline panel has ordered you to be given an oral reprimand as part of the sanction imposed upon you. The reprimand should impress upon you the seriousness of your misconduct.
The fact that you have received this reprimand will be part of the public portion of the Register and, as such, part of your record with the College.
You will be given an opportunity to make a statement at the end of the reprimand if you wish.
The panel has found that you have engaged in multiple acts of professional misconduct. You contravened a standard of practice or failed to maintain the standards of practice of the profession relative to one or more patients. You recommended and/or provided unnecessary dental services relative to one or more patients. You signed or issued a certificate that you knew or ought to have known contained a false, misleading or improper statement relative to one or more patients. You charged a fee that was excessive or unreasonable in relation to the service performed relative to one or more patients. You engaged in conduct or performed an act or acts that, having regard to all the circumstances would reasonably be regarded by members as disgraceful, dishonourable, unprofessional or unethical.
Your professional misconduct is a matter of profound concern. It is completely unacceptable to your fellow dentists and to the public. You have brought discredit to the entire profession and to yourself. Public confidence in this profession has been put in jeopardy.
Of special concern to us is the fact that the professional misconduct in which you engaged has involved 14 charts that were missing or incomplete. As you know, three of us on this panel are dentists and understand that our records may be incomplete from time to time, but find it incomprehensible that one-third of your requested records were either missing or deficient. We found that you or your staff exposed patients to x-rays that were unnecessary. Although we can’t quantify any harm that may come to your patients, we know that exposure to excessive ionizing radiation is detrimental to patient’s wellbeing.
The panel is extremely disappointed that you fell into the habit of allowing billing for treatment not performed for your own financial benefit. This erodes public confidence in the profession which affects all of us.
As I advised you earlier, you will now be given an opportunity to make a comment if you wish to do so. This is not an opportunity for you to debate the merits of the correctness of the decisions we have made.
Thank you for attending today. We are adjourned.