CONFIDENTIAL ASSESSMENT AND REVIEW OF TREATMENT (CART)
The Confidential Assessment and Review of Treatment (CART) program is a valuable VDA member benefit that provides qualified dental practices with an added layer of legal protection when reviewing certain patient care incidents.
CART applies to three types of qualified incidents:
- Adverse events
- Near misses
- No harm events
In a lawsuit, both sides are typically required to share information during discovery, including internal communications and quality assurance reviews related to the incident. For practices that qualify for the CART program, those internal discussions and reviews may become protected, privileged communications — similar to attorney-client privilege.
This protection allows practices to conduct honest, thorough evaluations of incidents while continuing to improve patient care, office policies, and clinical processes.
Eligibility Requirements
To participate in the CART program, all dentists within the Virginia dental practice must be current VDA members.
CART FAQ
What are VDA’s Confidential Assessment and Review of Treatment (CART) Guidelines?
VDA’s CART Guidelines were adopted by VDA’s Board of Directors in 2024 to establish protections for quality assurance, quality of care, or peer review committees (“Confidential Committees”), which are entitled to limited confidentiality by means of a statutory privilege granted in Virginia Code § 8.01-581.17(iii). The proceedings, minutes, records, and reports of such a Confidential Committee, together with all communications, both oral and written, originating in or provided to such a committee, are considered privileged.
Who is eligible to establish a Confidential Committee under the CART Guidelines?
Only active VDA members in good standing are eligible to establish a Confidential Committee. This requirement includes practices, in which all dentists must be a VDA member to participate.
How can a dental practice establish a Confidential Committee?
The VDA has templates available to approved practices that may be used by VDA members to establish a committee and peer review/quality assurance process. The Committee may be established only pursuant to the VDA’s CART Guidelines.
What is the scope of review by a Confidential Committee?
The Confidential Committee should perform the following functions for each calendar year: i) a review of selected patient charts or electronic health records of each dentist with a sample size reasonably determined by the Committee, and ii) a review of the quality of healthcare delivered to patients. The performance of annual “ongoing reviews” does not preclude the use of focused or targeted reviews intended for a specific clinical and quality improvement purpose. These more purposeful reviews could include the review of patient charts within a certain disease or procedural category and a comparison of documented treatment to the then-current benchmark standards.
In the event an issue arises relating to the quality of care provided to a patient, the Confidential Committee may gather data, investigate, conduct analysis, coordinate all responses, and/or recommend and initiate corrective action as necessary. These reviews may identify adverse events, near misses, and no harm events, and allow for analysis on how such things may be prevented moving forward.
What sort of information is protected?
Communications, both oral and written, originating in or provided to a Confidential Committee, are protected and granted statutory privilege. This would include data and analysis on reviews described above, root cause analyses, expert witness reports, and reports of interviews by risk managers.
What is the value of such protection?
The workings of a Confidential Committee are not discoverable in a malpractice lawsuit. This privilege may be overcome only if a plaintiff proves “good cause,” and a judge orders the production of the workings. This “good cause” standard is a high bar and is rarely granted by a judge. It is important to note, however, that health records, factual statements about an incident, and oral communications made within 24 hours of an incident are discoverable and not privileged.
Learn More About CART
Schedule a call with Ryan Dunn, CEO of the Virginia Dental Association, to learn more about how CART can be implemented in your practice.
Get Started with CART
Submit your practice information to determine if all your doctors are current members and to qualify your practice to receive the implementation guidelines and resources developed by the VDA.
