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GDC Watch May 2016

GDC Watch May 2016

During May I spent some time reading the Medical Practitioners Tribunal Service hearings list.  MPTS deliberated issues including inappropriate relationships with patients, physical altercations with patient family members and performing inappropriate intimate examinations of patients without chaperones.  Comparably, the FtP panels of the GDC were reconvened to consider the issues that NHS England probably ought to be dealing with.  Charge sheets were littered with allegation minutiae of the usual failures in record-keeping, and whether bouncing balls made of impression material in corridors might contribute to a finding of misconduct.  It’s not specified if the balls were alginate, addition or condensation-cured silicone, or Impregum, and they may or may not have been bounced in front of colleagues or patients and the date of the alleged bouncing was unknown. But those facts aside, I am sure it was fairly clear-cut!

If anyone is interested like I am in comparing the differences between the MPTS and GDC FtP charge sheets to see how MPTS put theirs into the public domain, let me give you an example:

 

MPTS announcement:
‘The tribunal will inquire (note the inquisitory tone) into the allegation that in April 2014, whilst working as a Specialty Trainee in Obstetrics and Gynaecology, Dr X’s actions towards a patient were not clinically indicated and were sexually motivated’ (and then some further housekeeping information and notes for interested journalists).

 

GDC announcement:
‘Charge (note the accusatory tone) that……..(insert pages and pages of specific individual allegations painting a poor picture of the registrants practice and behaviour)......
And that, in relation to the facts alleged, your fitness to practise as a dentist IS IMPAIRED (note the suggestion that the outcome is already proven) by reason of your misconduct +/- deficient clinical performance’ (and if only deficient clinical performance then perhaps add some dishonesty for good measure).

I know which presentation of the forthcoming hearing sits better with Article 11 (presumption of innocence).   Furthermore, if the charges are not meant to be taken literally (as I am advised they should not be without knowing the relevant context of the case), then it begs the question whether they ought to be made public?   Dishonesty I will touch on later but I feel the GDC ought to be looking at how they present their charges of these public hearings and I believe that a new approach to how the charge is put into the public domain is needed.

But back to last month’s cases of interest of which there were a few:

Interim Orders acted extremely swiftly to curtail two attention-grabbing business ideas with potential to breach GDC standards, or encourage UK registrants to. One related to provision of orthodontic aligners direct to the public without a prior examination and the other was referral incentives for implant treatments referred to a clinic abroad.  Both registrants had conditions imposed clipping their entrepreneurial wings.  I later received an email from another company looking to ‘partner-up’ and offering me payment for helping with certain aspects of their ‘ortho-direct-to-patient’ business.  Possibly the best of both ‘GDC standard-breaching’ worlds in that email, but seemingly no UK-registrant behind it to take through an FtP.

The PSA failed in their appeal of a health-related case.  The PSA alleged that the case was under-prosecuted by the GDC, and that an unduly lenient sanction was given with insufficient reasons.  The registrant, who was placed on conditions by the Health Committee for what appears on reading the determination to be extremely cogent and reasonable reasons, had complied with all the conditions and made huge efforts at remediation.  He was extremely anxious about the prospect of the matter being remitted back for reconsideration and is obviously now very relieved.  He told me that the GDC have been a life-saver to him, and that his case shows how some good can come out of FtP procedures, although the time left in limbo has been tortuous.  Additionally, it is worth giving credit to the GDC for their handling of the appeal, as they described the conduct in broad terms and kept the health condition out of the public view.  The PSA did not however, and some very private material relating to this registrant has now been read out publically in court, which was awfully nice of them.

In the conduct arena, Mr Radeke ‘won’ an appeal in March 2015 against an incorrect PCC decision to erase him over dishonesty and the case was remitted for a new PCC to reconsider the appropriate sanction.  He remained suspended only until the end of May 2016 when the case was finally reheard.  When I say ‘won’ an appeal, this is really in a loose sense of the word.  The wins on appeal are often pyrrhic victories.  Registrants who have gone through FtP and appeals suffer enormously through stress, anguish, accusations (perhaps false), public humiliation, financial turmoil and can still find themselves unemployable after a ‘victory’ not to mention their families breaking down or having to go bankrupt in the meantime.  I do not wish for second that anyone who reads my blog on FtP thinks that any sarcasm or satire is an attempt to trivialise something that I take tremendously seriously and have had, at times, invading my own sleep.  Nonetheless, Mr Radeke’s case involves an unarguably disastrous patient death following treatment, but the original panel had attached incorrect significance to the ASA of the patient prior to treatment and ostensibly decided that the registrant had committed perjury to the coroner; which is a criminal offence.   This case, along with the Kirschner case, suggests to me that dishonesty is something that we need absolute confirmation from the GDC that their selected panel members are capable of handling appropriately, given that the GDC like to levy it at registrants at such a high rate (45% of conduct cases include a dishonesty charge if my memory serves me correctly on that FOI data).  If you are going to accuse, and then find someone guilty of dishonesty, you had better be sure you are getting it right, and that you properly understand the legal test.  Panel member names are redacted from final determinations, but in the interests of transparency ought not those who are the judge have their names kept in the public domain?  We do not see judiciary member names redacted in their judgments.  Perhaps someone in the know can comment on why this is the case?  For those interested in the Radeke appeal judgment to see what the problem was in the PCC decision-making, and it is worth reading just to compare the tone,  it can be found here:

In the ‘no misconduct’ case a registrant was reported to the GDC by the ‘GoodThinkingSociety’ (who profess to ‘encourage curious minds and promote rational enquiry’) for allegedly promoting the dangers of amalgam, misleading patients over the benefits of homeopathy and serving alcohol in the practice, and they are unrepentant about the outcome from the emails I have exchanged with them.  Why this case warranted a full hearing when we have false advertising attracting an unpublished warning in others is not obvious to me.  However, for reasons that evade us registrants who politely entertain patients with ‘alternative’ beliefs, a full hearing was considered justified.  The GDC scored the own goal this month by their appointed expert being shown evidence that changed his opinion at the last minute, and presenting a witness who maybe did not realise they were being engaged as a prosecution witness and seemingly blew the GDC case apart by being extremely supportive of the dentist at the centre of the hearing.  Aside from his obvious incredulity of being called as a witness (I think he may have written to the GDC to complain about the withdrawal of the 15cc of champagne on offer before an examination and then ended up being called) he told the panel that he could make his own mind up on what was good for him…….and if that was a small bottle of champagne before a check up, who are the GDC to say differently?  I am glad to hear that the residual champagne has now been consumed.  Cheers!

Finally, the statistics for May are:

Interim Orders held 17 new hearings and 8 review hearings resulting in:

  • 6 suspensions or suspension extensions;
  • 11 conditions orders or conditions orders extensions;
  • 5 no orders;
  • 2 adjournments/postponements (1 hearing was postponed due to the registrant having toothache);

1 outcome TBC at the time of publication.

Practice committees held 28 new hearings and 6 review hearings resulting in:

  • 1 erasure;
  • 5 new suspensions and 2 suspension extensions;
  • 3 new condition orders, 1 extension of conditions orders and 3 conditions orders being revoked;
  • 3 reprimands;
  • 2 postponements and 6 adjournments;
  • 3 no impairments;
  • 1 registration appeal (granted);
  • 1 restoration hearing (granted);
  • 2 health related hearings with one suspension and 1 set of conditions replaced with a suspension;
  • 1 case of no misconduct.

By registrant type, there were 46 dentists, 11 dental nurses and 2 dental technicians involved in hearings this month.  As far as I could see, only 5 registrants were not present and not represented this month.

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MAY
12
4

GDC Watch April 2016

GDC Watch April 2016

April was a busy month in Fitness to Practise.  Unlike March where there was something for everyone, April saw mainly dentists and dental nurses on the proverbial naughty step.  Of these 21 had their favourite things taken away from them, 29 were put into time out, and 2 were sent to their rooms indefinitely.  Drilling down into the outcomes further, the final statistics for April were as follows:

Interim Orders held 20 new hearings and 15 review hearings resulting in:

  • 18 suspensions or suspension extensions;
  • 12 conditions orders or conditions orders extensions;
  • 4 no orders and;
  • 1 adjournment.

14 registrants were not present +/- not represented at their IOC hearing, and were mostly suspended with a couple kept on conditions.


Practice committees held 29 new hearings and 9 review hearings resulting in:

  • 2 erasures;
  • 6 new suspensions, 1 suspension extension and 1 suspension being revoked;
  • 8 new condition orders, 1 extension of conditions orders and 3 conditions orders being revoked;
  • 1 reprimand;
  • 3 postponements and 2 adjournments;
  • 1 case concluded (the incident was historic and there was no current impairment);
  • 1 no impairment;
  • 2 registration appeals (1 granted, 1 refused);
  • 1 restoration hearing (refused);
  • 4 health related hearings with all registrants kept on suspensions and;
  • 1 no case to answer

By registrant type, dentists were the clear sinners with 57, followed by 15 dental nurses and a single dental technician.

Cases of interest in April

The restoration hearing heard in April was refused for the second time due to a lack of insight by the registrant into why note tampering is serious misconduct rather than a silly mistake.  The GDC request to indefinitely suspend any further applications due to the costs involved, was not upheld by the panel who, like a Buddhist monk in meditation, felt that insight might be obtained at some point, and directed the erased registrant towards obtaining representation and taking relevant courses into ethics and personal responsibility before making any future applications.  Said registrant will no doubt benefit from such wisdom and gain mindfulness as a result of the teaching!

Not long after, a dental nurse who was not engaging in her on-going hearing relating to failures in decontamination procedures, was kept on suspension by the panel.   She had not turned up again; perhaps having realised that she could earn as much if not more as a domestic cleaner given the average wage of a dental nurse, with the added bonus of not having to be answerable to a regulator.  I need to do some further reading into whether the Fitness to Practise Rules have any mechanism to bring an on-going cycle of hearings for the above scenario to an end.  Let us not forget there is no statutory limit to the amount of money that can be collected from registrants to be spent on Fitness to Practise hearings.

Interim Orders met to discuss keeping a registrant who was in prison for fraud and false accounting on a suspension.  If this is not a waste of everyone’s time and money I am not sure what is, unless there is scope for him to be employed as a prison dentist without an interim sanction.

My other conundrum this month with Interim Orders is in their role of risk assessment and the concept of innocent until proven guilty.  By putting the allegations against a dental nurse as a statement of fact (‘misappropriation of funds’ into a personal account including the practice name, the exact amount of money and number of patients involved) into the public domain is she going to be able to have a fair hearing?  It rather reads like the IOC have accepted her guilt, yet there is no mention of any admission or criminal conviction for this alleged theft in the public determination.

Experts were on good form throughout April.  When we thought we’d seen the last of them after Dental Protection’s reassurance that there is no legal or regulatory requirement for it, the dreaded failure to record LA batch numbers were back, making it into a charge sheet via GDC expert witness Conor Mulcahy.  Perhaps someone can point him in the direction of this useful position statement for any future cases:  http://www.dentalprotection.org/uk/publications-resources/updates/briefing-documents/2015/11/09/local-anaesthetic-batch-numbers

Aside from the batch numbers of local anaesthetics, sadly there were no other particularly curious or intriguing charges put forward this month.  There were however, some thought-provoking conditions in one case which restricted the registrant from sending abusive or offensive communications.   One of the erased registrants was in jail having been convicted of fraud and deception, and the other was voluntarily not present but faced a raft of serious clinical deficiencies which were found proved, including using a block of bone that had dropped on the floor on a patient.

In the ‘No case to answer’ case, expert witness Robert Bland scored an own goal and had his evidence set aside by providing superficial evidence, changing his mind at a late stage on fundamental matters relating to the case, and most importantly exhibiting a ‘lack of impartiality’ by failing to include ‘evidence that was potentially exculpatory’ to the registrant.  This registrant and his wife are seriously considering leaving the profession despite the no case to answer verdict; this is exactly why the GDC must be taken to task for the style and method of its prosecution of cases over many years, and for the failings in its expert witnesses.  I’d also like to make the point here that pathologist Alan Williams who failed to disclose potentially exculpatory evidence in the Sally Clarke cot deaths case, was later found guilty of serious professional misconduct and banned from court work for 3 years.  The past 12 months have now seen 3 cases slung out because the experts appointed by the GDC have shown a lack of impartiality.  Experts also need to remember they are not immune from a civil lawsuit, and frankly it is probably only a matter of time until one is sued, or sanctioned.

Whilst I am on the subject of bias, it also isn’t appropriate for experts to advertise themselves in a manner that suggests they are employed by, or otherwise working as an expert witness purely on behalf of the GDC.  You cannot be impartial if you only do work for one side and I am amazed that this has not yet been picked up on and challenged by any registrants’ legal teams.

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Recent Comments
Bill Inness

Comment

Vikki I can only thank you for the time and effort you have put into this blog. It is very revealing.
Thursday, 12 May 2016 09:15
Vimal Hathiramani

well done

superb
Thursday, 12 May 2016 11:13
Paul Cole

Comment

"Interim Orders met to discuss keeping a registrant who was in prison for fraud and false accounting on a suspension. If this is ... Read More
Thursday, 12 May 2016 12:48
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5

GDC Watch March 2016

GDC Watch March 2016

 

I have been keeping an eye on the cases emerging from the Fitness to Practice and other committees of the General Dental Council [GDC] for some time, I am sure other GDPUK readers will be interested to know what goes on each month. So, the aim will be to write summary monthly, in what we hope is a short lived blog.

Monthly breakdown of case types and outcomes

The month of March saw 59 hearings scheduled after one was moved back to start in April.  There was 1 registration appeal which was granted.  Of the remaining cases, 18 were new Practice Committee hearings, 6 were Practice Committee review hearings and 2 were health cases.  Interim Orders held 14 new hearings and 18 review hearings.  Broken down by registrant type, there were 48 dentists, 4 dental nurses, 4 dental technicians, 2 hygienists and 1 clinical dental technician involved in hearings.

Interim Orders handed out 8 new suspensions and 8 continuation of suspensions, placed 1 registrant on conditions and kept 7 on conditions.  One suspension was revoked, 1 suspension was downgraded to conditions and 5 cases had no order.  Of the new suspensions 6 of the 8 registrants were not represented and not present.

The Health Committee suspended 1 registrant and placed another on conditions. The Practice Committee erased 1 registrant, issued 2 suspensions, 2 extensions of suspension, and placed 2 registrants on conditions whilst 2 had their conditions extended.  Four suspension orders were revoked, 3 reprimands were given, 3 cases were adjourned, 3 registrants were found not impaired, 1 case was referred back to the Investigating Committee, and in 1 case no misconduct was found. 

March’s cases of interest

The erased registrant was neither present nor represented, but the case mainly related to failing to take appropriate radiographs, failures in treatment planning and record-keeping, lacking indemnity cover whilst treating patients on 4 days, and a failure to cooperate with the GDC.

In the ‘No Misconduct’ case the registrant essentially faced charges which related to not providing an estimate of costs for root canal treatment (although he did not actually invoice the patient for any of the treatment provided), not informing the patient of the risks of the proposed treatment and therefore failing to obtain informed consent. In fact, the registrant had only provided emergency treatment to try to relieve pain and infection.  This was ultimately not successful and the tooth was removed by another dentist. The patient/witness actually complained to the GDC about something else, but this was not worthy of any charges so how this case actually came about is not clear from the determination.  Despite having a confused recollection at times, the patient was still described to be a credible witness. Another matter which is not clear in the determination is why there were 3 experts involved - 1 for each party and a joint expert statement.   The registrant admitted all the charges, but the panel found some aspects not proved and despite both the GDC and defence counsel accepting misconduct and impairment, the panel found neither on the basis that the treatment was emergency in nature rather than a definitive RCT procedure, and the failings not so serious as to be considered deplorable.  A happy outcome here with the lesson of not assuming that because you have not charged a patient they won’t complain about you.   

The case referred back to the Investigating Committee involved fissure sealants on a single patient, which the GDC-appointed expert Professor Deery (who is a paediatric dentistry consultant and Dean of Sheffield School of Clinical Dentistry) had concluded were appropriate after he had examined the patient, and that wear on the patient’s teeth was due to erosion rather than damage caused by the registrant.  It was submitted that this evidence would change the view of the IC and that no realistic prospect of a finding of misconduct existed, begging the question did one exist in the first place?  How the case came about, and on what the basis of the patient complained is not explicit in the determination but it is implied that the registrant may have perhaps been accused of creating damage in which to place fissure sealants or otherwise creating unneeded work for themselves.  This case highlights the inherent issues with the lack of a clinical examination until a late stage, (if at all) in the FtP process and how assessors and experts creating charges purely on clinical records is a flawed concept.  This case will have involved a significant waste of registrants’ money in reaching a Practice Committee that could have perhaps have been avoided with an earlier examination of the patient. Hopefully with the recruitment of dentally-qualified caseworkers cases like this can be avoided in future.

Mr N, who was neither present nor represented, was suspended following his hearing which included 73 individual heads of charge, many of which had several sub-headings.  The GDC-instructed barrister may have missed Jonathan Green’s presentation at the Dental Protection Study Day last October where he stated that no over-drafting of allegations would take place following the embarrassment of the Kirschner case.  In the determination the GDC-appointed expert, Professor Morganstein seems to advise that linings ought to be placed under amalgam restorations.  With no representation there is no means of contesting such a view even though many GDPs would now not line amalgams, nor is there any conclusive evidence that they need to be.  Professor Morganstein is apparently the Dean of the dental school at the University of Buckingham (I know what you are thinking…. and I’ve not heard of it either).  I feel this case nicely highlights the problem with the GDC using experts who are focused on academia or in specialist practice opining on GDPs, and is directly contributing to the stealthy moving of standards in an upwards direction.

 

Finally, the long-running Carew case which I have been watching with interest due to the charge of:

·         you failed to adequately record the clinical reason why a try-in was required……

has left me somewhat disappointed as this charge was withdrawn on day 1 of the hearing. It looks like we will never get to find out why this element of record-keeping was considered to have been essential.  

 

 

 

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Recent Comments
Anthony Kilcoyne

GDC cases monthly comment & an...

This is a great initiative Vicky and actually, in the public interest, I believe the GDC should welcome it too, if it's serious ab... Read More
Wednesday, 20 April 2016 09:41
Victoria Holden

Thank you

Thank you for the positive feedback Tony. I hope the blog is well-received by all parties as I believe there is a lot we can all ... Read More
Wednesday, 20 April 2016 10:47
Ruth Dening

GDC watch blog

Thank you for this, you must have spent a lot of time on it. It is really interesting to see what's happening.
Wednesday, 20 April 2016 17:37
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