ODA Peer Review

By Timothy J Edvalson, DMD

Today I’d like to write about a little discussed benefit of your ODA membership:  Peer Review.  I have worked behind the scenes at the constituent and state committee levels for more than 20 years with a dedicated group of dentists and ODA staff who serve to help their fellow dentists and the public resolve differences in anticipated and actual outcomes of treatment.

Peer Review is defined as the evaluation by fellow professionals of diagnostic and clinical treatment outcomes.  The goals of Peer Review are (1) to detect professional problems, (2) devise educational and disciplinary solutions so that the quality of care can improve, and (3) resolve patient-dentist disputes without litigation.

As members of the Oregon Dental Association, we are bound by the ADA code of ethics as well as agreeing to Peer Review evaluation when it is requested by a patient or another dentist.

Most Peer Review requests are initiated by a patient when the outcome of their treatment did not meet their expectations and they feel unable to have their complaint adequately addressed by their provider.  Requests are received at the ODA office by Margaret Torgeson, our ODA staff specialist in processing these requests.  Once the information is assembled, it is reviewed by the State Peer Review chairman (and committee if necessary) to determine if the complaint is within the scope of peer review guidelines.  Once accepted, the request is assigned to a constituent society’s local Peer Review committee for evaluation.

All Peer Review cases are assigned for mediation as a first attempt at resolution.  In this case, the mediator (a member of the constituent committee assigned by the local chairman) reviews all the documents and has a series of conversations with both the patient and the dentist to see if a mutually agreed upon resolution can be negotiated.  I am happy to say that the majority of cases are resolved in this step.  Patients appreciate having their complain heard by an objective third party and dentists have the advantage of explaining their perspective to someone who is also “in the trenches” and knows what it’s like to try to deliver excellent care in situations that are not always ideal. Through mediation, both parties work out a mutually agreed upon resolution.

If a mediated resolution is not attained, then the Peer Review case is presented to the local component Peer Review committee for a formal hearing.  In the hearing, the patient is examined and interviewed by the committee members until all their questions are answered.  The dentist is then interviewed and allowed to explain all the aspects of the case to the committee members.  The committee of 3 or more dentists then makes a decision as to the outcome of the Peer Review Request.  The possible outcomes can be a range of possibilities from finding no fault with the care provided all the way to having the dentist refund all or part of the fees paid for the services in question.  The parties agree in advance to be bound by the committee’s decision and all documents are returned to the ODA staff to process the final decision documents.

While this all sounds like a formidable process, it is much less stressful than litigation and has the added benefit of remaining confidential without any requirements for being disclosed to the National Practitioner Databank or Board of Dentistry review.  If either party in the Peer Review process feels that other evidence was not heard or has legitimate grounds for appeal, the State Peer Review committee reviews these cases.

In practice, I have seen many cases be successfully resolved by Peer Review which otherwise would have ended in some form of litigation and both patients and dentists have been spared the emotional toll and actual cost of going through such an adversarial challenge.  My thanks go out to all who serve on the various local and state committees who dedicate their time and talents to helping us all be better dentists as well as protecting the integrity of the profession and safeguarding the public.

 

Dr. Edvalson maintains a private practice inLake Oswegowhere he has practiced for the past 31 years.  He was a member of the Clackamas County Peer Review committee for many years, serving as its chairman before being asked to join the State Committee and subsequently serve as Chair of that committee since 2009.  He wishes to especially thank Drs. Don Sirianni and Daren Goin (past chairs of the state committee) for mentoring him along the way.

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