B.C.'s College of Dental Surgeons has been ordered to take another crack at an investigation into a dentist accused by a former colleague of up to $1.1 million worth of overtreatment and overbilling.
In a decision posted last month, the province's health professions review board claimed the college's probe into the complaint might be termed "investigation lite" because — among other things — the two investigators who looked into the file failed to speak to a key witness.
The review board serves as an appeal body for people who are not satisfied with the results of a complaint to a regulatory decision.
The decision is the latest development in a battle between duelling dentists who used to share an office space; neither man is named.
The complainant — Dentist A — said he became worried in 2013 after speaking with a certified dental assistant who had resigned from Dentist B's practice because "she felt she had no other choice but to quit" over concerns about what she saw as unnecessary procedures.
Those concerns were renewed when Dentist A saw one of Dentist B's former patients.
Dentist A filed a complaint containing his own analysis of 40 of the other man's patient files, a comparison to other dental practices and contact numbers for two of his former office mate's former assistants.
The procedure in question involves the use of unneeded pins and composite surfaces to treat cavities.
Dentist A claimed to be in possession of billing records that "show potential overtreatment or overbilling for pins and billed tooth surfaces exceeding $1,100,000, most of which was over a seven year period."
But he said the college investigators never asked him for his evidence.
According to the review board's decision, the first investigator on the file did no "substantive analysis" of the evidence.
The second investigator didn't speak to the former assistants or patients. The investigator asked Dentist B for complete records pertaining to 22 patients — but in the end only relied on nine of the files that had been provided by Dentist A.
The second investigator concluded that while Dentist B may have performed one procedure in an "unconventional fashion," he had since "altered his practice philosophy to be in keeping with current thinking."
"None of the practices I have become familiar with in cases where unethical and/or overbilling have occurred are present in this file," the investigator wrote.
Following the complaint, Dentist B signed an agreement in 2019, consenting to take a "more tough topics in dentistry" course for dental professionals.
But Dentist A wasn't satisfied with the result — and went to the review board.
According to the decision, the College of Dental Surgeons has now opened a complaint against Dentist A.
"As is evident, the complainant expended considerable personal resources to further the investigation into this matter. As a result of some of those efforts, the college has initiated a complaint against him," which remains outstanding.
"(The college) has on this review sought to characterize the complainant's efforts as reflecting 'an inflated view of his own role' and an attempt to 'usurp' the college's role."
'What precisely did she observe?'
Dentist B attacked Dentist A for disclosing patient records to others and accused him of being motivated by an "improper purpose."
He also claimed that the allegation of malpractice was "deserving of rebuke" and said Dentist A had an unfounded claim of $420,000 against him.
The chair of the review board panel, Douglas Cochran, noted that one of Dentist B's former assistants said she did not want to be part of the investigation. But he said the college should have reached out to the second woman.
"If the (certified dental assistant) did quit her job due to overbilling/unnecessary treatment concerns, this is an extreme step for an employee who has taken considerable time and expense to qualify for this employment. It would not be a decision taken lightly. What precisely did she observe?" Cochran wrote.
"Given the information that was available to the investigator and the inquiry committee, the failure to inquire … is striking."
Cochran also said he was "troubled" by the report's apparent suggestion that because Dentist B had changed his practice — the matter was concluded. Dentist A said the college should have looked into the "ethics" of keeping the money charged for the treatments.
"If the retention of fees improperly billed is not of regulatory concern to the inquiry committee, it needs to say so directly," Cochran wrote.
In a statement, the college of dental surgeons said the complaint would be referred back to its inquiry committee as directed. But any further investigation undertaken will be confidential.