Now I ask...What should I do?
Some have said, "Life's too short, get over it and move on."
To them I say, I'd be shirking my professional responsibility if I didn't disclose this ethical violation of our Association Bylaws.
Some have said, "What's the use, you're not going to change the system."
To them I say, I'm not trying to change the system, I'm simply stating the facts of this event; much as Evidenced Based Dentistry is founded. I'm only expecting the Indiana Dental Association to recognize and abide by the ADA Code of Ethics.
Some have said, "This doesn't look right to me, but the IDA's Attorney said they didn't do anything wrong."
To them I say, generally, the IDDS peer review committee followed the rules - what concerns me is ethics. For example, peer review committee members are to excuse themselves if they have a social relationship with the dentist under review. I would expect a peer review committee member with 9 years of experience, who is also the committee chair, to know the rules. The IDDS didn't violate any legalities. This issue is specific to the Code of Ethics Section 4.C and 4.C.1. The IDA's Attorney isn't authorized to make determinations regarding ethical violations; only dentists make that determination.
Some have said, "I really don't know anything about Peer Review but the IDA says the members of peer review committees are experts and wouldn't experts know what's ethical?"
To them I say, There is no expert qualification to be a peer review committee member. The ADA conducts orientation workshops and provides literature to train members in the procedures of peer review. IDA peer review members are selected by other members; much like an invitation to join a study club.
Some have said, "What's the big deal, I see patients for second opinions all the time and the ADA Code of Ethics says I have the authority and responsibility to tell them my opinion of the efficacy and quality of another dentist's treatment, right?"
To them I say, Right! and the ADA's much regarded Ethical Moment addressed that topic in 2005 and I've provided a reference to that article: Is It Ethical To Criticize Other Dentist's Work?
http://jada.ada.org/cgi/reprint/136/6/812 . Within the body of the article the authors emphasize,..."It is ethically wise to apply a strong burden of proof requirement to ensure that the statement is informed and totally justifiable."
You see, that pesky Justifiance Section 4.C and the Advisory Opinion 4.C.1 keeps coming up in the discussion of ethics. So we're back to the question, 'Does the Peer Review Examination Form support the Findings contained in the Letter of Resolution?' See my Post dated 1.1.11.
Some have said, "OK, so you're granted an Ethics Hearing and the Ethics Committee says you're right, then what?"
To them I say, The Bylaws of the Association provide the guidelines when the ADA Code of Ethics is violated. Again, the ethics violation is issuing a public statement that is unsupportable. My peer review case is no different than rendering a second opinion, as discussed in the Ethical Moment article previously referenced. While we're on this subject, the IDA Executive Director and the IDA's Attorney have maintained that after a period of 30 days a case cannot be reopened. However, in my review of the ADA Peer Review rules, I'm unable to locate any statements to that affect, therefore I suspect it is a discretionary Policy of the Indiana Dental Association. Is there a statute of limitation pertaining to ethical violations?...In my opinion that answer is NO, and I can only trust you agree!
Some have said, "I'm very troubled about this situation but I know some of the dentists and they are personal friends, good dentists & I believe they mean well. I just don't feel comfortable getting involved."
To them I say, I also believe the volunteers who serve on the peer review committees are well intentioned. I also believe the IDA Executive Director and his staff are sincere and they have been completely professional in their communications with me. The only questionable experience with the IDA was related to Mr. Jerry Jenkins' action during a March 2010 Statewide Peer Review Workshop. I sent this letter following that meeting to address my objections.
Douglas M. Bush
Executive Director
401
W. Michigan St
W. Michigan St
Ed Rosenbaum
Director of Professional Services
Richard Jones, DDS, MSD
IDA Council on Peer Review Chair
Jerry Jenkins, Esq.
Partner, Baker Daniels
Thomas Barrick, DDS
Associate Professor IUSD
CEBJA/ADA
Principles of Ethics and Code of Professional Conduct
Thank you for allowing me to participate in the March 12th, 2010 Peer Review/Mediation Workshop sponsored by the IDA. I was advised by Ed Rosenbaum prior to the meeting via e-mail: “…be aware that specifics of your case (or any other peer review case) will not be discussed”. It was my intention to honor that admonition and I couched my inquiries and comments to reflect general information related to Policies and Procedures of Peer Review. During this meeting I was targeted and silenced by Mr. Jenkins for my questions, which I felt appropriately reflected, the understanding I had reached with Mr. Rosenbaum prior to this meeting regarding my participation. I have reviewed the day’s Agenda and my notes and I would like to share my experience and thoughts from the proceedings:
Mediation – First Step in Process
Richard Jones, DDS, MSD
Question by Dr. Batton: Is a Patient restricted in the distribution/publication of a Letter of Resolution?
Answer by Dr. Jones: NO, a Letter of Resolution is a Public Document but is not admissible in a Court of Law in Indiana
Question by Dr. Batton: Is the Panel member’s examination of the patient characterized as comprehensive or cursory?
Answer by Dr. Jones: Neither, the examination is limited in scope but detailed in nature. It would be considered a Limited-Detailed Examination.
Hearing Panel – Second Step in Process
Thomas Barrick, DDS
Question by Dr. Batton: In a Panel case involving a Removable Prosthesis, how is the Denture(s) in question verified as to be fabricated by the involved Dentist?
Answer by Dr. Barrick: There is no contact between a Dentist and Patient at the examination. Origin can’t be verified.
Questions by Dr. Batton: In a Panel examination, is the involved Dentist permitted to know who the Panel examiners are? And if there appears to be a conflict of interest, what is the appropriate action?
Answer by Dr. Barrick: Yes, the Panel members who will examine the case are provided to the involved Dentist prior to the Patient’s examination and the Dentist has the option to exclude an examiner if the Dentist feels there is conflict.
Question by Dr. Batton: Do each of the three Panel examiners complete a separate Peer Review Examination Form?
Answer by Dr. Barrick: Yes, there are three PREF’s for each case.
2008 and 2009 Activity Report
Ed Rosenbaum, IDA Director of Professional Services
Mr. Rosenbaum distributed the above referenced reports and discussed the details of the Peer Review Methods and Outcomes.
Comment: I asked Mr. Rosenbaum if he had the IDA Peer Review Methods and Outcomes reports for years 2000 – 2007 available.
Answer by Mr. Rosenbaum: No
Comment: I had those reports and I reviewed the statistics for the years 2000 – 2007. I suggested a discussion was pertinent as the Outcomes could possibly imply partiality in the rendering of Peer Review decisions.
Comment: Mr. Jenkins interrupted the discussion between me and Mr. Rosenbaum to interject the premise by which I was allowed to attend the Workshop and that I should abide by the agreement.
Throughout the Workshop, questions were accepted and answered by the various presenters from the members in attendance. And there were instances where Peer Review case specifics were discussed by the group of attendees. I submit my questions and comments were restricted to the Policies and Procedures of Peer Review and did not compromise the Pre-Workshop gag-order pronounced by Mr. Rosenbaum. If the IDA demonstrates otherwise, I will issue a letter of apology to the Association and my fellow Colleagues in attendance. If the IDA doesn’t provide exception to my statements; I would request that they submit to me a letter of apology from the Association and Mr. Jenkins for inappropriately singling out my comments during this meeting. I am happy to see that the IDA is making an effort to disseminate information regarding the peer review process. However, based on the answers provided by the presenters detailed above and other discussions throughout the day, I believe that there is still much work to be done to provide a fully informed and fair process what will benefit the member dentists and their patients. It is my hope that my persistence in approaching this topic with you will result in a more complete conversation, which could benefit all parties involved. As always I would welcome the opportunity to speak with you in greater detail regarding these concerns.
Sincerely,
Phil Batton DDS
To this I say, impartiality is the keystone of the peer review process and should be discussed openly. There is no place for censorship in Organized Dentistry. (See my Post: Who is Reviewing Peer Review?) I want to again emphasize, I witnessed several participants at the Workshop asking questions specific to peer review cases they had managed or were currently managing.
Of the Officers, Trustees and Members of the IDA I ask, "What should you do?"
To you I say, "Summon the courage to perform your professional duty. It is your Ethical obligation."
