NCD Letter to Commission on Dental Accreditation regarding ADA code revision

November 15, 2018

Dr. Sherin Tooks
Director, Commission on Dental Accreditation (CODA)
211 East Chicago Avenue
Chicago, Illinois 60611

Dear Dr. Tooks,

I write to you today to draw CODA’s attention to the recent revision by the American Dental Association (ADA) of its Principles of Ethics & Code of Professional Responsibility, voted on by the ADA House of Delegates on October 22, 2018. The ADA Code now dictates that a dental care provider may not deny care to a patient based on the patient’s disability, and that any provider in need of another’s skills, knowledge, equipment or expertise has an obligation to consult with or refer that patient with a disability to that provider. Accordingly, it is imperative that CODA revise its curricula standards at Standard 2-24 to require that students learn and train in the treatment management of patients with intellectual and developmental disabilities as was recommended by NCD in its letter to CODA dated January 23, 2018.

These revisions to the ADA Code and accompanying Advisory Opinion, passed by the ADA House of Delegates in October 2018, are as follows (additions underscored, deletions stricken through):

4.A.     PATIENT SELECTION.

While dentists, in serving the public, may exercise reasonable discretion in selecting patients for their practices, dentists shall not refuse to accept patients into their practice or deny dental service to patients because of the patient’s race, creed, color, gender, sexual orientation, or gender identity, or national origin or disability.

ADVISORY OPINION

4.A.1.  PATIENTS WITH DISABILITIES OR BLOODBORNE PATHOGENS.

A dentist has the general obligation to provide care to those in need. A decision not to provide treatment to an individual because the individual is infected with Human Immunodeficiency Virus, Hepatitis B Virus, Hepatitis C Virus or another bloodborne pathogen, based solely on that fact, is unethical. Decisions with regard to the type of dental treatment provided or referrals made or suggested should be made on   the same basis as they are made with other patients. As is the case with all patients, when considering the treatment of patients with a physical, intellectual or developmental disability or disabilities, including patients infected with Human Immunodeficiency Virus, Hepatitis B Virus, Hepatitis C Virus or another bloodborne pathogen, or are otherwise medically compromised, the individual dentist should determine if he or she has the need of another’s skills, knowledge, equipment or experience expertise, and if so, consultation or referral pursuant to Section 2.B hereof is indicated.  Decisions regarding the type of dental treatment provided, or referrals made or suggested, should be made on the same basis as they are made with other patients. The dentist should also determine, after consultation with the patient’s physician, if appropriate, if the patient’s health status would be significantly compromised by the provision of dental treatment.

NCD notes that a provider’s ability to provide treatment to patients with disabilities, including intellectual and developmental disabilities, and a provider’s ability to find and confer with a provider that has the education and training to provide treatment to those patients, largely depends on CODA’s affirmative decision to change the relevant standard to help ensure members of the dental profession remain in compliance with their current professional responsibility and ethics requirements.

Thank you for your time and consideration of this issue. Please contact Amged M. Soliman, NCD Attorney Advisor, at asoliman@ncd.gov or 202-272-2116, as needed. We look forward to further discussion on this important issue.

Sincerely,

Neil Romano
Chairman