Family of Manitoba woman who died after dental procedure says association has 'conflict of interest' issues

Manitoba is one of the last remaining provinces whose dental associations also regulate the profession and investigate complaints against dentists — a structure the family of a young woman who died after a procedure says raises conflict of interest concerns.

Virginia Blatz, 23, was pronounced dead in hospital after she went to see Dr. Ronald Janz at the Boundary Trails Dental Centre in Morden to have her wisdom teeth removed on Nov. 27, 2024, according to a statement of claim filed by her father, Dulaney Blatz.

In the nearly two years since her daughter's death, Victoria Blatz said the Manitoba Dental Association — which is both the provincial regulator and industry advocacy group — has maintained a "code of silence" about its investigation, and that the family has been "kept in the dark."

The family's former lawyer got a letter from the dental association's legal counsel in September, saying information wasn't being shared with them because the organization's registrar is the official complainant under rules set out in the Dental Association Act.

The family filed a separate formal complaint against Janz this spring. They also filed a lawsuit against the dentist , claiming the care he provided to Virginia led to her death. The lawsuit was filed in Manitoba's Court of King's Bench late last month. 

According to the dental association's registry, Janz is restricted in his ability to administer local anesthetic drugs. He is allowed to administer them if he's under supervision. 

The family believes the association's two functions — advocating for the interests of dentists and protecting the public — are brushing up against each other. 

Blatz's parents say they have been 'kept in the dark' about the Manitoba Dental Association's investigation into her death. (Submitted by Dulaney and Victoria Blatz)

"It's a conflict of interest. You've got too much sympathy for when something like this happens…. It has felt that they have advocated solely almost for the dentist and themselves," Victoria said. 

"That whole body really needs to be dismantled, and it needs to be made into a body that reports to the government and to the public, just like they do in other provinces."

Manitoba and New Brunswick are the last remaining Canadian provinces where a single group handles these two roles, Dr. Jack Gerrow, executive director of the Canadian Dental Regulatory Authorities Federation, confirmed in an interview.

• Manitoba family still searching for answers nearly 2 years after daughter died following dental procedure

• Family of Manitoba woman who died after dental procedure files lawsuit

Dulaney said he believes there is a serious "conflict of interest" within this dual-role structure, likening the province's dental association to an "Old Boys club," adding the family's interactions with the group left them feeling frustrated. 

"It needs to be shut down, and we need to put something better in place for Manitobans," he said. 

"Change should have come a long time ago, before Virginia got into that dentist's chair."

University of Toronto bioethicist Kerry Bowman agrees. He says it's "absolutely an inherent conflict of interest" for associations to act as both a professional industry group and a regulatory body.

Bowman believes the two functions largely have "opposite goals" that could cause friction between each other. 

"I think it's very naive to think that these things can be merged," he said.

University of Toronto bioethicist Kerry Bowman says there's an 'inherent conflict of interest' when professional associations also act as regulatory bodies. (Craig Chivers/CBC)

The dental association said in an email to CBC News that "having these two functions within one statutory body does not, in itself, mean an investigation is conflicted or that professional advocacy influences its outcome."

Manitoba's Dental Association Act gives the association regulatory authority in the province, and the group says it "has a duty to protect the public" when it receives complaints. Complaint investigations are "kept separate from the MDA's member services and advocacy activities," the statement said. 

The association said dentists are involved in investigations because their clinical expertise is necessary to discern whether standards of practice were followed. However, it says conflicts — whether actual or perceived — are "identified and managed through disclosure, recusal and exclusion from decision-making."

Manitoba association an outlier within Canada

Dental associations across Canada have been shifting away from this dual role for decades. 

Ontario has long had a separation between the Ontario Dental Association and the Royal College of Dental Surgeons of Ontario. More recently, Alberta's dental association and regulatory college became two distinct groups in 2022, after the government introduced new rules requiring regulators and industry groups to separate. 

Blatz's parents filed a lawsuit regarding her death in Manitoba's Court of King's Bench in late September. (Submitted by Dulaney and Victoria Blatz)

Last year, Manitoba's western neighbour, Saskatchewan, saw the College of Dental Surgeons of Saskatchewan start the process of splitting into two independent organizations.

The Manitoba government has slowly been shifting health professions in the province to regulation under the Regulated Health Professions Act, which was proclaimed in 2014. 

The province started talks with the dental association last year to bring industry oversight under the act, a provincial spokesperson said in a statement to CBC News. 

The legislation doesn't allow regulatory colleges to also serve as professional advocacy groups, the province said. 

The act already governs a handful of health professions in the province, including doctors, nurses, registered psychiatric nurses, audiologists, speech language pathologists and paramedics. All health professions in Manitoba will eventually be regulated under the act. 

Process of splitting to start next year: association

Health Minister Uzoma Asagwara told reporters on Oct. 7 that shifting regulation of the dental sector to the act is about "enhancing accountability" and "supporting transparency" among health professions, suggesting it will ultimately make care "better and safer" for Manitobans. 

"You separate the regulatory body from the more advocacy arm of the organization. So previously, where lines might seem a little blurry, there's clarity that's created," the minister said, adding the move is "modernizing the way that these organizations function."

The dental association said it has informed the province it plans to start the formal transition to the act in 2027. The association expects the process to take between two to three years.

Manitoba Health Minister Uzoma Asagwara speaks to reporters during a media scrum on Oct. 7. Asagwara says shifting regulation of the dental sector is about 'enhancing accountability.' (Randall McKenzie/CBC)

Once it completes the shift, dental regulation and public protection would become the responsibility of a separate body called the College of Dentists of Manitoba. Meanwhile, the association would keep its name and remain a professional organization representing dentists in the province.

Bowman, the Toronto-based bioethicist, said he believes it's "wise" for governments to step in and encourage more division between these roles, particularly at a time when patient trust in medical professionals has been dwindling. 

"Patient trust matters. The vast majority of patients …, when they become aware that these two things are merged — regulatory and professional — they're very concerned that this is not a proper assessment of their circumstances at all, and that it's not objective," he said. 

Bowman said divorcing the regulatory and advocacy sides of the association will take time and effort to get it right, but he believes the move will buoy public confidence. 

"I'm not going to say it's going to solve all problems, but it's going to increase trust," he said. 

"They really have to be separated."

Lengthy investigation a 'denial of justice'

University of Manitoba ethicist Arthur Schafer said the investigation into Virginia Blatz's death is taking so long that it "almost passes the boundary of belief," calling the more than 22-month delay a "denial of justice."

Schafer said the family and the wider public are entitled to know what happened and who is responsible. Without these answers, Manitobans will lose confidence in the association, he said.

"Dentists depend upon public trust — all health-care professionals do. They can't practise their profession unless they're trusted by the public. If the dental association is so lacking in transparency when things go wrong …, then it will soon lose the trust of the public," he said.

"Families are entitled to know, and the public is entitled to know what went wrong, whether anyone was blameworthy, whose responsibility — if anyone's — it is for this tragedy."

University of Manitoba ethics expert Arthur Schafer says the public will lose trust in the dental association if they believe it's not being transparent. (Submitted by Arthur Schafer)

The dental association said in a statement that it "recognizes the profound loss Virginia Blatz's family has experienced" and "continues to carry out its responsibilities under the Dental Association Act."

The organization said it's "bound by legal, privacy, and procedural-fairness obligations that limit what it can say before the process reaches its public stage" in order to "protect the integrity of the investigation and the fairness of the process for all involved."

These obligations are "not a means of avoiding accountability," the association said.

If Virginia's case moves on to a formal inquiry, the hearing will generally be open to the public, unless there's any legally required restrictions, the statement said.

The dental association said it will share more information "as soon as it is legally permitted and procedurally appropriate."