Another Troubling Fitness to Practise Case
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- Published: Friday, 09 February 2024 09:31
- Written by Peter Ingle
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The GDC’s problematic fitness to practise process has become an open sore in their relationship with registrants. Now, another case has emerged showing repeated fundamental failures, letting down not just the dental professional involved, but the public who are denied access as another experienced practitioner departs their service.
In this instance two particularly egregious features are recognisable from other FTP cases. One is the determination to add the charge of dishonesty to any clinical error or failing, and the other is the GDC’s determination to press on with its pursuit of a registrant, even when the principal heads of charge have to be abandoned. It is hard to explain why such diminished cases are not quietly dropped, unless their continuation is down to a combination of attempted self-justification and vindictiveness.
The hearing, which was conducted remotely, involved a very experienced dentist who during a general anaesthetic case involving multiple extractions, had wrongly removed a permanent tooth. The initial charges included; relying on an eighteen month old radiograph, extracting the tooth despite the allegation that, “it was easily identifiable as an adult tooth,” and then failing to discuss this with colleagues, the patients family, or refer to it in the discharge letter dated two days later.
This culminated in a fourth head of charge, that the dentist had been; in breach of their duty of candour, misleading and dishonest. This was by far the most damaging, with dishonesty usually considered to be beyond remediation, and when found by the panel often leading to erasure.
At the beginning of the proceedings in front of the panel, the GDC’s Counsel asked that of the four heads of charge three including the most damaging fourth one accusing the dentist of dishonesty, be dropped. This followed submission of an expert report prepared on behalf of the dentist, which in this instance the GDC appointed expert witness generally accepted. Indeed the GDC expert also opined that a further aspect of the remaining charges, “when it was easily identifiable as an adult tooth” was not so.
As a result the dramatically edited charge sheet now focussed upon the dentist’s reliance on an eighteen month old radiograph, extracting the wrong tooth, and failing to identify that error. The failure to identify the error presumably occurred while still in theatre with an anaesthetised patient and possibly further surgery to complete.
The dentist had been in practice for over 40 years and had no previous FTP history. There had been an incident some years before when the dentist had incorrectly extracted a deciduous tooth. At that time they had promptly followed the duty of candour process.
The GDC Counsel insisted that notwithstanding the reduction in scope, the GDC’s position was that the remaining facts, admitted and found proved, were sufficiently serious to warrant a finding of misconduct. He quoted from the current Standards to support his case. He did accept that since the incident almost five years before, the dentist had actively engaged with the fitness to practise process, including providing a witness statement and evidence of their reflections. He also noted the positive testimonials submitted on their behalf which, he said, contained some comments in relation to their clinical practice. Despite this, his stated position was that it required a finding of impairment, otherwise public confidence in the dental profession and the regulatory process would be undermined.
In what could be used as near perfect example of ‘Catch 22’ the GDC Counsel asked the Committee to take into account that the accused was no longer in active practice as a dentist. As a consequence there did not appear to be any evidence before the Committee of how they had corrected their failings in practice. After all, they had been unable to show that they had undertaken a similar procedure to the one featured in the case without incident.
Counsel for the dentist told the Committee that the dentist admitted that they caused harm to the patient and that the harm was irreversible. Further, the incident and the associated probity allegations had a profound impact on them as a person and as a dentist. He outlined the work the dentist had done since in respect of the identified deficiencies. The dentist had already undertaken not to do any general anaesthetic extraction work in future. He emphasised that the incident had a significant impact on the dentist, and highlighted the evidence indicating how shocked they were when the mistake was brought to their attention, and how difficult it had been to have colleagues they knew and had worked alongside considering that they possibly lacked probity. The dentist had left their position at the Healthcare Centre not long after. The dentist then worked in General Dental Practice for a little over a year, but had ceased that work because of their concerns about the then ongoing questions about their probity. The impact of this case had been devastating.
Counsel also submitted that the other incident should not be seen as adding to the risk of repetition, since it was an entirely different set of circumstances which did not relate to the removal of a permanent adult tooth. It was not part of any fitness to practise history and it should not be weighed in the balance during the Committee’s considerations.
Based upon the incorrect removal of a permanent tooth and resulting permanent harm the Committee found that there had been misconduct. Importantly, the Committee did not find the dentist’s fitness to practice impaired.
In coming to this conclusion they took into account the dentists full engagement with the process as well as their repeated apologies throughout the witness statement and written reflections. The Committee also noted the circumstances at the time of the extraction under general anaesthetic; the printed radiograph was not dated, and there was no access to the computer records in the theatre. The Committee also agreed with the dentists Counsel and did not see the previous “very different incident” as relevant. As a result the Committee placed no weight on that information in terms of the risk of repetition.
There is much about the conduct of the GDC throughout this case that should concern registrants.
Firstly, the GDC’s continued eagerness to pursue charges of dishonesty, apparently as a “bolt on” to increase the pressure on registrants, and then push for a more severe sanction.
Secondly, the fishing expedition approach that saw an attempt to attach a dissimilar and already resolved incident, to the one under consideration.
Thirdly to carry on regardless, even once most heads of charge had to be dropped, determined to try and get a “win.”
Then there is the matter of the emphasis placed on the radiograph, which was on paper, undated, and with no means of checking. What would happen if clinicians refused to proceed in similar circumstances whenever they encountered them?
Lastly in this case the existing Standards were used to try and get a GDC result. This, despite the GDC’s dental adviser recently suggesting that they “do not go through the silver booklet now.” How much more will the GDC use the proposed new “flexible” Standards to further their FTP cases?
The result is a dentist with decades of service, who already recognised and deeply regretted their error and has been subjected to years of stress, especially over the unsubstantiated dishonesty charges. They have now left clinical dentistry. The public, patients, and registrants all lose, once again.
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