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Peer review a win for dentists and patients

January 07, 2013

By Kelly Soderlund, ADA News staff

A dispute with a patient over his or her dental care can prove frustrating to everyone involved.

Tensions are high, fingers are pointed and many times, both parties come to a standstill. The patient's instinct may be to seek legal assistance, but it's important for him or her to be aware of a more economical and helpful path to a resolution.

Dr. Bauman
“From the patient's point of view and the dentist's point of view, it's best to adjudicate the complaint through the peer review process,” said Dr. Jeffrey Galler, chair of the Council on Peer Review and Quality Assurance Committee for the New York State Dental Association. “From a patient's perspective, they want the complaint taken seriously, evaluated fairly, impartially and expeditiously and, if justified, have their fee returned. Dentists want their work to be evaluated by unbiased peers and, in the event of an adverse finding, limit their financial liability to only the money paid by the patient. The dentist would also like for the incident to never be recorded in the National Practitioner Data Bank.”

Peer review is offered to members through most of the state dental societies. Each state has a unique program and rules that it follows.

“Having peer review available is a wonderful membership benefit,” said Dr. Mark Bauman, chair of the ADA Council on Membership. “Electing to go through the peer review process could potentially save a member the difficulties of going through a malpractice lawsuit. It pays for their membership many times over.”

In New York, around 200 complaints are submitted each year, Dr. Galler said, and of those, about 50 are rejected. Unacceptable complaints typically focus on a fee dispute instead of the appropriateness or quality of care. The committee also rejects complaints against dentists who are not members of the tripartite.

A patient who's dissatisfied with his or her treatment has several options to remedy the situation. But none are as easy or can provide as many benefits as peer review, Dr. Galler said.

In New York, a patient could file a complaint with the Office of Professional Discipline of the State Education Department, which issues dentists their licenses in New York. Even if the dentist is exonerated, the investigation process is stressful and the patient doesn't benefit because the patient's money is not returned, Dr. Galler said.

The patient could also file a malpractice lawsuit but that's also not necessarily in the best interest of the patient or the dentist, Dr. Galler said. For the dentist, in addition to being time consuming and stressful, the liabilities are greater and he or she could be reported in the national databank.

It's not a better process for patients, Dr. Galler said. Their attempts to redress their grievances depend on a jury of nondentists who will examine evidence provided by expert witnesses and attorneys skilled at defending their clients.

“Plus, most of these complaints don't involve enough money for a lawyer to be interested in taking the case,” Dr. Galler said. “Peer review is clearly the best way to go.”

The road to peer review typically starts when a patient calls the local or state dental society to complain about a dentist or treatment they received, Dr. Galler said. The dental society will mail the patient information explaining what peer review is and a contract the patient can fill out if he or she is interested in pursuing peer review.

If the patient sends the contract back, the dental society will begin the process to determine whether the case is acceptable for peer review, he said. If it is, a mediator is assigned and that person calls both the dentist and the patient to determine whether the dispute can be resolved without going through the clinical review process, Dr. Galler said.

“Fifty percent of all cases accepted for peer review are resolved through mediation,” Dr. Galler said.

If the dispute can't be resolved in mediation, the case is heard by three dentists, who make a final ruling on whether the patient has a meritorious claim. Almost every case is settled within 30-60 days, Dr. Galler said.

“Complaints are handled expeditiously, impartially and confidentially in a calm, considerate and nonconfrontational atmosphere,” Dr. Galler said. “After going through our peer review process in New York, there is a definitive, final resolution to the complaint.”

The ADA and the state and local dental societies have used peer review as a recruitment tool to attract dentists to join organized dentistry. The ADA suggests that peer review be offered to both members and nonmembers.

“Peer review is a membership benefit of, for and by members,” Dr. Bauman said. “Not only would a dentist want a potential patient dispute resolved by peer dentists, but hopefully by tripartite members whom they might know and trust that they are following the ethical guidelines of the ADA.”

Dr. Galler plans to have a local member of the Peer Review Council visit every dental residency program in New York this year to present a simulated peer review hearing. He plans to do the same thing at various component dental society meetings. He's also initiating a program where every year, he'll present a simulated hearing to every senior class in every dental school in the state.

“The purpose of these presentations is to teach what the peer review program is all about. It's also to emphasize that this process is only available to members through their state and local dental societies and it's just one of the many benefits of joining organized dentistry,” Dr. Galler said. “And it teaches the residents and students how to avoid some of the common pitfalls that dentists commit that leads them to become the subject of a peer review complaint.”