We are front-line Oral Health care providers, licensed by the Alberta Dental Association and College (ADA&C), to practice in Alberta as Dentists and Dental Specialists.  We are petitioning to express our concerns with the new Professional Liability Insurance Program being forcibly mandated by the ADA&C. The ADA&C has recently imposed our obligatory subscription to this program under the threat of non-issuance of 2022 licensure and Practice Permits. This program is being implemented without adequate consultation and far too close to the registration/license renewal deadline for 2022.

Historically (>30 years), dentists and dental specialists in Alberta have purchased Professional Liability (malpractice) insurance through an independent not-for-profit insurer (CDSPI). Previously, registrants have been able to provide the ADA&C with proof of adequate coverage as one of the requirements for annual practice permit renewal. The details of the CDSPI 2022 program were released on December 3rd. CDSPI has 60 years of Canada wide actuarial based experience with dental and dental specialty Professional Liability insurance, The ADA&C has virtually none.

On December 6th the ADA&C Council at an “in camera” urgent meeting, enacted a significant change in ADA&C regulations. This change was not transparently submitted to ADA&C members/registrants for review or comment. This non-inclusive regulation change now forces all Alberta 2022 registrants to subscribe to a Liability Program that many feel is inadequate in coverage, has several other identifiable deficiencies and compares poorly in coverage and terms, to the 2022 CDSPI program being offered across Canada. We feel this puts the Public of Alberta, our profession, and ourselves as care providers, at unnecessary risk.

The ADA&C Council has unilaterally removed access for Alberta licensed dentists and dental specialists, to a more robust CDSPI malpractice insurance Program. They have done this through executive resolution on December 6th, 2021. This ADA&C action has tied the 2022 licensure and Practice Permit issuance of all dentists and dental specialists in Alberta to their forced, concomitant purchase of the ADA&C administered Professional Liability Insurance Program (PLIP). There are many concerns being communicated from Alberta’s dentists and dental specialists regarding both the adequacy of the Program and with the non-accountable process by which the ADA&C has implemented the program. 

Annual practice permit renewals for dentists and dental specialists are due on Dec 31, 2021. We are being forced in undue haste, to subscribe to and purchase a Professional Liability insurance program that many feel is inadequate to protect us as care providers, and more importantly, the Alberta patients that require our care and who we are privileged to serve.

Here are the key issues:

1. Our primary concern is the known inherent conflict of interest respecting the ADA&C conjointly managing a Professional Liability Program and engaging in its’ primary mandate of Practice Standards development and enforcement, Continuing Education, Site Inspections, Complaints and Disciplines management. By example, if a complaint does arise against a member, information collected by the legal team representing the licensed member, through the in-house PLIP, could theoretically also be internally accessed by the regulatory College’s administrators or lawyers.  This type of conflicted activity has been identified in other regulatory jurisdictions and has been used to reduce payouts on claims (i.e., acting in the dentists’ rather than in the patients’ interest).

There are indications that the ADA&C has entered into discussions or actual agreements with agents, brokers and/or insurers respecting a financial “kick-back” mechanism tied to claims experience and a potential percentage return of subscriber premiums to the ADA&C. If accurate, this adds another rather unsavory conflict of interest which has not been transparently disclosed to registrants/members by the ADA&C. These conflicts can only serve to negatively distract the ADA&C from its primary regulatory College mandate of Public Protection.

It was confirmed to members in an email on December 15th, 2021 that this PLIP will continue to operate under the College (once the ADA&C splits) and be a part of the Annual Permit Renewal Process. The College of Physicians and Surgeons of Alberta does not sell or mandate its own insurance due to the above conflicts, and nor should the Alberta Dental Association & College. We would like to continue to be able to obtain our malpractice insurance from an independent 3rd party, as this is in the best interests of the public and the members. 

2. The ADA&C PLIP coverage is potentially inadequate given the Shared Aggregate Claims Limit of $25,000,000. This coverage is shared by all 2900 Alberta registrants. This could leave patient's unable to collect upon their entitled settlements. Under our current CDSPI malpractice insurance plan, there is no group aggregate limit. This is a huge discrepancy in available coverage.

3. The ADA&C program gives mention of a $2,000,000 cost limit per claim up to a $4,000,000 Personal Aggregate Claim limit, per policy period.  In contrast, with the 2022 CDSPI program the individual claim cost is posted at $3,000,000 per claim and gives the option of available coverage up to $25,000,000 to $75,000,000 as a Personal Aggregate Claim Limit. This is also a huge discrepancy in available coverage.

4. Those dentist and dental specialists privileged by AHS to provide urgent and emergent patient care in AHS hospitals and AHS contracted Non-Hospital Surgical Facilities (NHFS) are required to carry minimum coverage of 10M personal aggregate, and 5M per claim, as mandated by their Medical Staff bylaws and AHS contracts. The ADA&C engaged no consultation with Hospital-based or NHSF care providers or AHS. The mandated ADA&C PLIP currently appears to be inadequate to meet this minimum coverage requirement. These dentists and dental specialists provided crucial services including, on-call coverage for facial trauma, life-threatening facial infections, triage/consultation/treatment for head and neck cancers, primary and secondary cleft lip and palate surgery, pediatric dentistry for medically complex children and adults, treatment of maxillofacial pathology, and post-ca oral rehabilitation/reconstructive services. How can these complex services be delivered without adequate Liability coverage?

5. Patients have 2 years from reaching adulthood to file liability claims against healthcare providers. This ADA&C program would leave many providers that are routinely treating children (especially pediatric dentists and oral & maxillofacial surgeons) exposed to claims well beyond their retirement or death. (Up to 20 years). There is a concern that under the terms of this ADA&C PLIP program, upon retirement or death, there would be inadequate “Tail” liability coverage in place for claims stemming from prior practice activities. There is mention of a 5-year coverage limit from cessation of practice, with the option to purchase an additional 5 years of coverage. In contrast, the program offered by CDSPI, covers claims arising during the period of previous liability following cessation of practice or death, indefinitely. This indefinite duration of the CDSPI policy is vastly superior for those retiring and is also very important in ensuring patients receive their entitled settlements from dental professionals who are no longer licensed or alive. 

6. Concerns have been raised respecting “tied-selling”/ “coercive-selling” of insurance. Under this new ADA&C Program, registration/licensure, and practice permit issuance has been made forcibly contingent upon the concomitant purchase and subscription to the ADA&C PLIP program. “This appears to be in violation of the Insurance Act Section 509 (1) (b). Under that same Section 509 (2) it is stipulated that “no person may…induce any person to forfeit or surrender or allow the lapse of any policy of insurance". The ADA&C in a September 14th “update” to members appears to have violated this provision in the Insurance Act by the following: “…If you get an incidental renewal reminder from CDSPI for your professional liability insurance, please call CDSPI to remove this from your products. You will not need to renew your CDSPI coverage at the end of the year, as you will be automatically enrolled in ADA&C Professional Liability Insurance Program.”

Given the major inadequacies of the ADA&C PLIP, as outlined above, the forced removal of the freedom to choose a Professional Liability provider that the individual practitioner feels meets the needs of their practice activities and the needs of their patients for adequate liability coverage, is felt to be ill conceived, unfair, non-transparent, non-accountable, unjust, conflicted in mandate, and potentially unlawful, by many of the ADA&C’s members/registrants.

Our concerns could be promptly and easily solved by the ADA&C providing the ability to opt-out of this forced ADA&C Program for 2022 and by ensuring that a registrant provides proof of equal (or superior) Professional Liability insurance from a provider of their choosing.

Alternatively, forcing the ADA&C to delay implementation of the PLIP, until the full completion of the Bill 46 legislated separation of the Association and College mandates, (June 2022) would hopefully allow for adequate open and inclusive, consultation with membership as to their actual nuanced Professional Liability (malpractice) insurance needs is requested.

Individually and collectively, we respectfully ask for your ministerial oversight and intervention in this important matter so that Alberta’s dentists and dental specialists can continue to deliver care with adequate Professional Liability insurance protection in place for both provider and patient, in the Public Interest.