Fitness to Practice; who’s on the GDC’s naughty and nice lists?
DENTAL BULLETIN, ISSUE 60
The GDC’s own statistical analysis shows us:
– Men are more likely than women to be involved in FTP cases.
– Dentists who have taken the ORE are less likely than those qualified in the UK to find themselves involved in FTP proceedings.
– However, those from the EEA were more likely to come before the GDC.
Of 182 fitness to practice hearings a whopping 18%, 32 dental care professionals, were erased from the register. On the flip side, only 2, just over 1%, were exonerated, with no case to answer found.
Compare this with 2016 when there were just 50 fitness to practice hearings in total, but the number of dental care professionals erased was 30 with no dentist cleared.
Who made the GDC’s naughty and nice lists in 2017?
Sadly the example of dentists being exonerated by the GDC fitness to practice panel in 2017 are few and far between.
One such case involved a dentist accused of charging excessive fees for work done; dishonestly and for financial gain.
Mr Al-Killidar provided Mr A with a treatment plan for implant work in his upper and lower jaw, quoting him £21,900. Mr A was keen to commence the treatment, so a £10,000 deposit was made and CBCT scans and impressions for temporary dentures were taken the same day. The patient was 76 years old, and following that first appointment he failed to attend the surgery, dying 5 months later. Mr A’s family attempted to recover some of the deposit, but upon advice from the BDA Mr Al-Killidar declined to return anymore without a formal request from a probate solicitor acting for the estate.
Over two years later Mr Al-Killidar was contacted by a probate solicitor requesting information regarding what sums were due to the estate from the £10,000 deposit. The correspondence that followed did not cover Mr Al-Killidar in glory, however the upshot was that he confirmed there was £4,200 of credit showing on Mr A’s account. A breakdown of the treatment undertaken was requested, and he confirmed that he had charged £1,000 for an upper surgical guide, £1,000 for a lower surgical guide, £600 for a CBCT scan of the upper arch, £600 for a CBCT scan of the lower arch, £1,600 for interim dentures and £400 for a full case assessment. Mr A had also been charged £600 for failing to attend two appointments, but this was refunded when Mr Al-Killidar became aware of the reasons Mr A failed to attend. The fees in issue related to the surgical guides, CBCT scans and assessment.
There was no suggestion that the original quote was excessive. Instead it was argued that the fees charged for work done on the face of it was far in excess of the practice’s published fee guide. As calculated it was suggested that Mr Al-Killidar’s hourly rate would be in the region of £1,100 per hour. However, Mr Al-Killidar gave evidence that he had in fact spent 240 minutes undertaking the above work, 25% of the time planned for treatment and as such the fees charged were fair and proper.
Ultimately the FTPC held that the amount of time spent on dental work was not determinative of whether a fee is excessive. Fees can vary considerably and relate to the complexity of the case and the experience of the dentist.
In the circumstances the FTPC did not find it surprising that Mr Al-Killidar was before them facing allegations of excessive charging and dishonesty, however, they accepted that the circumstances were unusual and Mr Al-Killidar had had to retrospectively calculate his fees for a part completed treatment. It was accepted that the calculation was clumsy, and whilst the fees were high, they were not in principle excessive.
The allegations were therefore found not proved.
A helpful case for dentist’s working in the private sector. Not exactly a green light for limitless charging, but certainly an acceptance that dental practices are businesses and can be run at the discretion of the principal. Fees will vary hugely according to a wide range of features, not least the skill and experience of the practitioner.
The second case where no misconduct was found related to Mr Peter Garrod. It was alleged that Mr Garrod at an initial appointment had failed to properly record the updating charting of a patient’s teeth, he had also failed to adequately record the history of her symptoms, assessment conducted, diagnosis, report on the periapical radiograph taken or justify the use of antibiotics. At a later appointment he failed to record adequately his discussions with the patient regarding treatment options relating to the UL6 root canal. Mr Garrod admitted all of the charges.
Mr Garrod’s case may well have been assisted by the fact that the patient had become disengaged with the process by the time the matter came before the FTPC. However, the GDC remained neutral as to whether the facts found amounted to misconduct.
The FTPC ultimately found that the omission of certain information amounted to a failure of record keeping as opposed to Mr Garrod’s clinical practice. They relied upon the GDC expert who stated that it was “doubtful that the treatment for the patient would have been significantly different (or the outcomes different), even if these matters had been recorded.” His view was that the failures in his record keeping fell far below the expected standard. But there was no other evidence that his care of the patient was inadequate. Therefore the FTPC found that overall the shortcomings in his record keeping in respect of this particular patient did not amount to misconduct.
Mr Garrod was however reminded of the importance of making and keeping contemporaneous, complete and accurate patient notes.
But what has happened to those who have not been so lucky.
Two dentists fell foul in respect of patient confidentiality and as a result were erased from the dental register.
Dr Petrus Snyman was charged with failing to adequately store the dental records of patient LS, failing to respond to requests for information by LS’s solicitor and failing to respond to requests from the Information Commissioners Office (ICO). There were also charges of misleading and dishonesty conduct in that Dr Snyman lied to the ICO about sending the documents to LS’s solicitor. In relation to the latter charges the GDC was referred to the new test for dishonest when making their decision. Dr Snyman did not attend the hearing but by email dated 12th October 2017 accepted the allegations and confirmed he had no questions for the witnesses. Dr Snyman had retired by the time of the hearing and this may be partly why he didn’t take part in the proceedings.
Given Dr Snyman’s own admissions, it is not surprising that the FTPC found all allegations proven. The question was then whether the allegations amounted to serious misconduct that impaired his fitness to practice. When considering this the FTPC ask whether the registrant has shown insight into their conduct and taken remedial action. The FTPC found that failing to store LS’s dental records did not amount to serious misconduct, as it was an isolated incident. However, all other charges were found to be serious misconduct. The FTPC went on to find that whilst Dr Snyman had shown some remorse, as he was not present they could not assess his insight and whether remedial action had been taken. As such the FTPC found Dr Snyman’s fitness to practice was impaired and erasure was the appropriate sanction.
2. Dr John Mew
Dr John Mew was alleged to have sent an email containing the confidential information of two patients, requesting that the recipients forward on the email to other colleagues. This was not the first time Dr Mew had been before the FTPC, this was his fourth hearing and the email had been sent after his fitness was found to be impaired due to clinical issues. The FTPC found that he had sent the email in retaliation against one of the patient’s mother’s for raising concerns. In respect of the other patient the FTPC found that confidentiality had in fact been waived. However, the retaliation was clearly an aggravating factor in this case and it was found that Dr Mew’s misconduct was serious and impaired his fitness to practice. Dr Mew was again not present at the hearing.
The GDC take patient confidentiality very seriously; we have discussed this topic before in our dental bulletins. In May next year new data protection laws will come into force, which every practice will need to be prepared for to avoid being called before the FTPC.
The largest number of erasures came from criminal convictions
3. Laura Ramsey
Dental nurse convicted of speeding, possession of a class A drug (cocaine) and failing to give a blood sample.
Dental nurse convicted of assault.
5. Dean Garnett
Dental technician convicted of drinking and driving. He was also being investigated due to health concerns in respect of his fitness to practice.
6. Jade Forrest
Dental nurse convicted of theft and possession of a controlled drug. She was also charged with self-administering Midazolam at work. There were also issues with Miss Forrest’s fitness to practice on medical grounds.
Dental nurse convicted of making false representations to make gains, forgery and obtaining money by deception.
Dentist convicted of drink driving and driving a mechanically propelled vehicle under the influence of alcohol.
Dental nurse convicted of theft from her employer and failing to comply with a community order;
With the exception of Victoria Maund and Nidal Abusara Darwich, the other registrants did not attend their hearings or make any representations to the FTPC. All failed to inform the GDC about their convictions. This failure to inform the GDC of the conviction is a significant aggravating factor in terms of assessing what insight a registrant had into their actions and their honesty and integrity. If you are facing a police investigation, you can find guidance in our article ‘Police investigation; the dos and don’ts if you want to stay a dentist’.
10. Peyman Pezeshki
Finally, it will come as no surprise that Peyman Pezeshki was struck off for sending inflammatory emails to the GDC accusing them of being a criminal organisation. This was not the first time he had been before the FTPC for threatening and unprofessional behaviour. He did not attend his hearing or make representations; he had stated in an email he no longer recognised the GDC and maybe that was why.
If you are facing a fitness to practice hearing or need advice about conduct issues, do not hesitate to contact our team on 0207 388 1658 or by email at email@example.com.
Julia Furley, Senior Barrister, and Laura Pearce, Senior Solicitor