A peer review committee, comprised of SFVDS member-dentist volunteers, evaluates all available evidence pertaining to each dispute and follows specific procedures (listed below) to make a fair and impartial determination. The parties involved are then notified of a committee’s decision by a letter of resolution. If any party to a review can factually demonstrate that a procedural error may have occurred, or that the decision was not based on available facts, an appeal to the Council on Peer Review at the CDA may be requested. This appeal must be mailed within 30 days of the date the letter of resolution is sent. Any decision of an appeal panel is final and binding.
Peer Review Procedures
All disputes that are evaluated within the peer review system must include the following procedures:
- The responsibility for conducting a review will be that of the SFVDS and the California Dental Association.
- The patient must sign a Patient Agreement Form prior to review. (The dentist, by virtue of his/her membership in the SFVDS and the CDA, has already agreed to be bound by a peer review decision.)
- An Authorization for use and Disclosure of Health Information must be signed by the patient so that a review committee may legally obtain a patient’s records.
- Unless the treatment in question cannot be evaluated (i.e., treatment has been redone and/or altered), the patient will be examined by a panel of at least three dentists.
- The patient will be given an opportunity to present any additional comments, usually at the time of the patient examination.
- The dentist is allowed to meet with the review committee if he/she chooses.
- All other involved parties (subsequent consulting/treating dentists, insuring entities) will be contacted for additional evidence if available.
- The peer review committee will evaluate all evidence available (patient examination results, radiographs, information from subsequent consulting/treating dentists, etc.), and make a final determination. This will be communicated to all involved parties in the form of a letter of resolution.
- Involved parties will be provided an Appeal Criteria, if applicable, at the time the letter of resolution is provided.
Although the peer review system can satisfactorily resolve the majority of complaints received, there are limitations which may make a complaint inappropriate for the system.