HEARING PARTLY HEARD IN PRIVATE*

Transcription

1 HEARING PARTLY HEARD IN PRIVATE* *The Committee has made a determination in this case that includes some private information. That information has been omitted from the text. ROSS, Alison Registration No: PROFESSIONAL CONDUCT COMMITTEE NOVEMBER 2016 June 2017 Most recent outcome: Suspension revoked and conditions imposed (with a review) and immediate conditions** ** See page 13 for the latest determination. Alison ROSS, a dentist, MFGDP(UK) 2002, BDS Glasg 1996, was summoned to appear before the Professional Conduct Committee on 29 November 2016 for an inquiry into the following charge: Charge (as amended) That, being a registered dentist: 1. At all material times, you were the owner and principal dentist at [redacted]. 2. You provided care and treatment to Patients A and B identified in Schedule 1. 1 Patient A 3. You failed to provide an adequate standard of care to Patient A from 1 August 2014, in that: (a) you failed to make adequate arrangements for the completion of Patient A s crown treatment to UR6 and UR7, which you commenced on 7 August 2014; (b) (c) (d) you failed to make arrangements for the removal of Patient A s temporary crowns in a timely manner; you failed to respond to messages left by Patient A on the Practice s answering machine in the week commencing 1 September 2014, raising concerns about the progress of his treatment; you failed to make any arrangements for the replacement of a temporary crown when Patient A informed you that it had broken on or around 4 September 2014; (e) you failed to contact Patient A in a timely manner or at all on or after 5 September 2014 about the progress of his treatment, when you said you would do so; 1 Please note the schedule is a private document which cannot be disclosed. ROSS, A Professional Conduct Committee November 2016 June 2017 Page -1/17-

2 (f) you failed to make any arrangements for the replacement of a temporary crown when Patient A informed you that it had fallen out on or around 9 September 2014; (g) you failed to contact Patient A in a timely manner or at all on or after 12 September 2014 about the progress of his treatment, when you said you would do so; (h) you failed to respond to a text message from Patient A on 15 September 2014, setting out his concerns about his dental condition and the progress of his treatment; (i) you failed to respond to Patient A s letter left at the Practice on or around 15 September 2014; (j) you failed to respond to a text message from Patient A on 17 September 2014; (k) you failed to provide Patient A with sufficient information about your opening hours. 4. You failed to maintain an adequate standard of record keeping in respect of Patient A s appointments from 1 August 2014, in that you: (a) failed to record adequately a treatment plan on or after 1 August 2014; (b) (c) (d) (e) failed to adequately report on and grade the radiographs taken on 1 August 2014; failed to make a sufficient record of all the stages of crown preparation treatment undertaken on 7 August 2014; failed to record whether any local anaesthetic was used, and any details thereof, during crown preparation treatment on 7 August 2014; failed to record accurately the date of the appointment documented as having taken place on 3 September Y ou failed to respond to Patient A s written complaint, which was delivered to the Practice on or around 15 September Patient B 6. You failed adequately or at all to carry out and/or record the taking of Patient B s medical history on one or more of the dates listed in Schedule You failed adequately or at all to conduct and/or record conducting intra oral and/or extra oral examinations on: (a) 22 March 2012; (b) 16 November You failed adequately or at all to take and/or record taking bitewing radiographs on: (a) 22 March 2012; (b) 16 November 2012; (c) 24 April 2013; (d) 16 January ROSS, A Professional Conduct Committee November 2016 June 2017 Page -2/17-

3 9. You failed adequately or at all to evaluate and/or record your evaluations of radiographs taken on or around: (a) 2 December 2011; (b) 7 December 2012; (c) 8 April You provided inadequate periodontal treatment to Patient B in that you failed to: (a) conduct any or any adequate six pocket charting on: (i) 1 April 2011; (ii) 22 March 2012; (iii) 16 November 2012; (iv) 1 April 2014; (b) provide root surface debridement on or about: (i) 22 March 2012; (ii) 1 April 2014; (c) advise Patient B regarding available treatment options and/or referral to a specialist on 22 March Further and/or alternatively to 10 above, you failed adequately or at all to record the treatment and/or advice. 12. Between 7 November 2013 and 6 December 2013 and in respect of treatment to UR5: (a) (b) you failed adequately or at all to take and/or record one or more periapical x-rays of UR5 that were clinically indicated; you failed adequately or at all to record whether and/or how you had obtained informed consent from Patient B. 13. You failed to record any or any adequate information of appointments which took place on: (a) 1 May 2013; (b) 4 June 2013; (c) 17 July 2013; (d) 21 October You failed adequately or at all to record on (a) 15 May 2013: (i) the nature of the appointment; (ii) whether any treatment was provided; (b) 21 May 2013 the clinical justification and/or material used for the splint at LR2; (c) 24 July 2014: (i) the impressions taken; (ii) restorative work undertaken and/or prescribed. 15. On 1 April 2014 you inappropriately prescribed antibiotics in that antibiotics were not necessary for treatment. 16. You failed to make adequate arrangements for the completion of Patient B s crown treatment to LL3, which you commenced on 24 July ROSS, A Professional Conduct Committee November 2016 June 2017 Page -3/17-

4 17. On or after 11 November 2014, you failed to refund or make arrangements to refund Patient B for treatment that was not provided. 18. You failed adequately or at all to respond to Patient B s written complaints or letters dated: (a) 11 November 2014; (b) 15 December 2014; (c) 22 January Failure to have in place adequate indemnity insurance 19. You provided dental services while you failed to hold adequate indemnity insurance for some or all of the periods: (a) 14 July 2012 to 20 December 2012; (b) 30 March 2013 to 10 July 2013; (c) 12 August 2013 to 22 August 2013; (d) 23 July 2014 to 5 February 2015*. Health 20. You suffer from the medical condition set out in Schedule 3. AND, by reason of the facts stated, your fitness to practise as a dentist is impaired by reason of your: misconduct; and/or adverse physical and/or mental health. On 29 November 2016, Mr Collins (Counsel for the GDC) made a submission under Rule 25 on behalf of the GDC. The Chairman made the following response: Mr Collins on behalf of the General Dental Council (GDC), applied under Rule 25 of the Fitness to Practise Rules, to join additional heads of charge to those currently before the Committee. He submitted that the allegations are founded upon similar facts as those already in issue and that Ms Ross has had sufficient notification, having been sent correspondence in relation to the additional heads of charge, dated 27 October Mr Jenkins on behalf of Ms Ross raised no objections. However, he did note an absence of particular records relevant to the new heads of charge. The Committee heard and accepted the advice of the Legal Adviser. The Committee considered the matter carefully. It noted the date upon which Ms Ross was served notice of these additional matters. It was satisfied that she has had sufficient time to consider them; it noted that Mr Jenkins does not object to the new heads of charge being joined to the original heads of charge and that the new allegations are based upon similar facts to those already being considered. The Committee therefore determined to accede to the application and allow the additional allegations to be joined with the allegations currently before it. ROSS, A Professional Conduct Committee November 2016 June 2017 Page -4/17-

5 On 5 December 2016 the Chairman made the following statement regarding the finding of facts: The Committee has taken into account all the evidence presented to it. It has accepted the advice of the Legal Adviser. The Committee heard evidence from Patient A and Patient B. It found both witnesses to be credible. They each gave clear and balanced evidence that appeared to be based in their honest recollection of events. Neither appeared to be motivated to inflate their evidence against you, but instead spoke of their good dental treatment by you. The Committee heard from Ms Vassia Karpeta, the General Dental Council s (GDC) expert witness. In the Committee s view, when giving her expert opinion on your conduct and treatment of your patients, she applied the appropriate standard of the reasonably competent dental practitioner. The Committee found her to be fair and balanced. [IN PRIVATE] The Committee also heard evidence from you. The Committee formed the impression that you are aware of the areas in which you have fallen short. It found your evidence to be helpful and credible. You were not always reliable in your recollection of events, which might be explained by your health condition, or by the effects of the passage of time on your memory and the absence of some records. You made some admissions at the start of the hearing and after hearing the evidence went on to make further admissions. You have maintained as part of your case that some records relevant to a number of the heads of charge are missing. The Committee accepted that evidence and therefore found that a number of heads of charge must fall as the GDC cannot prove that your record keeping was inadequate in the absence of all of your records. You stated that your former practice manager is in possession of the hard drive containing the patient records which she has retained, and has denied you access. The Committee has also been told that when you owned the practice, you used a record system called Software of Excellence whereas the new owners of the practice utilise software called R4. The Committee understands that the patient records were migrated from your old software system onto the new system and that during that process some information is likely to have been lost. Not all of the clinical information has been migrated, in particular, matters held formerly on your self-designed templates. The treatment that was incomplete at the time that you stopped practising has not all been migrated. The Committee accepts this and has borne in mind during its deliberations, that some relevant information is not available. I will now announce the Committee s findings in relation to each head of charge: 1. Admitted and proved. 2. Admitted and proved. 3a. Admitted and proved. 3b. Admitted and proved. 3c. Admitted and proved. 3d. Admitted and proved. ROSS, A Professional Conduct Committee November 2016 June 2017 Page -5/17-

6 3e. Admitted and proved. 3f. Admitted and proved. 3g. Admitted and proved. 3h. Admitted and proved. 3i. Admitted and proved. 3j. Admitted and proved. 3k. Admitted and proved. 4a. Not proved. The Committee accepts your evidence that there was a front sheet in relation to Patient A s records from your practice system that you have been unable to obtain. The Committee further accepts that aspects of Patient A s treatment plan would probably have appeared on the front sheet. The Committee notes that you have tried unsuccessfully to gain access to the missing external hard drive that is currently in your former practice manager s possession, and is being denied to you. It considers that the GDC s case falls on the basis that there cannot be an accurate assessment of your record keeping in the absence of some records. 4b. Admitted and proved. 4c. Not proved. You told the Committee that you would usually make a record of the stages of crown preparation treatment you had undertaken, and that you therefore would have done so on this occasion. The Committee accepts that the stages of crown preparation treatment may appear on the front sheet that is currently missing. It therefore finds this head of charge not proved on the same grounds as 4a. 4d. Admitted and proved. 4e. Admitted and proved. 5. Admitted and proved. The Committee was aided by the definitions of a patient complaint as set out within the GDC guidance Principles of Complaints Handling. The Committee has determined that the written letter from Patient A was a complaint, although he did not describe it as such. You therefore had an obligation as the practice principal to respond to it, even though it was your evidence that you did not personally receive it. 6. Admitted and proved in relation to failing to record the patients medical history. Not proved in relation to the alleged failure to carry out a medical history. The Committee accepts your admission in relation to your failure to record Patient B s medical history. You told the Committee that you were in the habit of taking a medical history and that you would have taken it verbally. ROSS, A Professional Conduct Committee November 2016 June 2017 Page -6/17-

7 On balance the Committee accepts that you were more likely than not to take an oral medical history. It therefore does not find this aspect of the head of charge proved. 7a. Admitted and proved in relation to failing to make a record. Not proved in relation to a failure to conduct adequately or at all an examination. The Committee accepts your admission that you failed to record intra and extra oral examinations. It was your case that as a result of the nature of the treatment you carried out on this date, you would have carried out an intra oral examination. Based on the contents of the record, the Committee is satisfied that you probably carried out an intra oral examination. In respect of the extra oral examination, it was your case that you were in the habit of carrying out such an exam. The Committee accepts your evidence that it was your regular practice and therefore you were more likely than not to have done it. It finds this aspect of the head of charge not proved. 7b. Not proved in relation to a failure to carry out adequately or at all. Not proved in relation to failure to record. 8a. Proved. Based on the contents of the record, the Committee is satisfied that you did carry out an intra oral examination and that you did make a record of it. In respect of the extra oral examination, it was your case that you were in the habit of carrying out such an exam. The Committee accepts your evidence on that front. The Committee accepts your evidence that the records were migrated across from your Software of Excellence to R4. Information relevant to this head of charge may be missing. As a result, it does not find this head of charge proved, in relation to record keeping. Ms Karpeta told the Committee that the last set of bitewing radiographs were taken on 1 April Patient B was high caries risk and therefore should have had bitewings taken every six to nine months. The Committee accepts Ms Karpeta s evidence and finds this head of charge proved in relation to a failure adequately to take and record bitewing radiographs. 8b. Not proved. The records show that there is an entry on 16 November 2012 that refers to xray small film and bitewings and therefore the Committee is satisfied that bitewing radiographs were taken on that date. Whilst the Committee concluded that the record you made of the bitewing radiograph is not adequate, it has borne in mind that there are missing records and as a result finds this head of charge not proved. 8c. Not proved. The Committee accepts your evidence that this was a hygiene appointment and that you were therefore under no obligation to take bite wing radiographs. ROSS, A Professional Conduct Committee November 2016 June 2017 Page -7/17-

8 8d. Not proved. The Committee accepts your evidence that this was a hygiene appointment and that you were therefore under no obligation to take bite wing radiographs. 9a. Admitted and proved in relation to your failure to make a record. Not proved in relation to failing adequately to evaluate. The relevant radiographs are missing from the patient records. You maintain that you took the radiographs and evaluated them. The Committee accepts that it was your usual practice to evaluate radiographs and that you did do so on this occasion. The Committee therefore does not find proved a failure to adequately evaluate the radiographs. 9b. Admitted and proved in relation to your failure to make a record. Not proved in relation to failing adequately to evaluate. The relevant radiographs are missing from the patient records. You maintain that you took the radiographs and evaluated them. The Committee accepts that it was your usual practice to evaluate radiographs and that you did do so on this occasion. The Committee therefore does not find proved a failure to adequately evaluate the radiographs. 9c. Admitted and proved in relation to your failure to make a record. Not proved in relation to failing adequately to evaluate. 10a(i). 10a(ii). 10a(iii). The relevant radiographs are missing from the patient records. You maintain that you took the radiographs and evaluated them. The Committee accepts that it was your usual practice to evaluate radiographs and that you did do so on this occasion. The Committee therefore does not find proved a failure to adequately evaluate the radiographs. Not proved. Ms Karpeta told the Committee that in light of the BPE score, a six point pocket charting was indicated on this occasion. You told the Committee that as per your usual practice, you would have conducted a six point pocket charting. The Committee accepts your evidence on this point. It therefore finds this head of charge not proved. Not proved. Ms Karpeta told the Committee that in light of the BPE score, a six point pocket charting was indicated on this occasion. You told the Committee that as per your usual practice, you would have conducted a six point pocket charting. The Committee accepts your evidence on this point. It therefore finds this head of charge not proved. Not proved. Ms Karpeta told the Committee that in light of the BPE score, a six point pocket charting was indicated on this occasion. You told the Committee that as per your usual practice, you would have conducted a six point pocket charting. The Committee accepts your evidence on this point. It therefore finds this head of charge not proved. ROSS, A Professional Conduct Committee November 2016 June 2017 Page -8/17-

9 10a(iv). Not proved. 10b(i). 10b(ii). Ms Karpeta told the Committee that in light of the BPE score, a six point pocket charting was indicated on this occasion. You told the Committee that as per your usual practice, you would have conducted a six point pocket charting. The Committee accepts your evidence on this point. It therefore finds this head of charge not proved. Not proved. The Committee takes the view that a root surface debridement was clinically indicated as stated by Ms Karpeta in her evidence. However it took the view that it was reasonable not to do so on that date in the circumstances of this individual patient. Not proved. 10c. Proved. The Committee takes the view that a root surface debridement was clinically indicated as stated by Ms Karpeta in her evidence. However it took the view that it was reasonable not to do so on that date in the circumstances of this individual patient. There was an obligation upon you to advise Patient B on the available treatment options. You should also have referred him to a periodontal specialist for a specialist opinion and/or treatment because of his BPE scoring. 11. Admitted and proved. 12a. Proved. You told the Committee that you were relying on a recent periapical radiograph of UR5. During treatment you relied upon an apex locator to establish the working length. You gave evidence that you took a periapical radiograph ten days after the treatment. However the Committee accepted the evidence of Ms Karpeta. It considered that you should have taken a working length radiograph and an immediate post-operative radiograph. This was necessary to establish the quality of the root canal treatment. The Committee therefore finds this head of charge proved. 12b. Admitted and proved. 13a. Admitted and proved. 13b. Admitted and proved. 13c. Admitted and proved. 13d. Admitted and proved. 14a(i). 14a(ii). 14b 14c(i) Admitted and proved. Admitted and proved. Admitted and proved. Not proved. ROSS, A Professional Conduct Committee November 2016 June 2017 Page -9/17-

10 14c(ii) You told the Committee that this information was contained within the front sheet of Patient B s record. The Committee accepts that this record is missing. This head of charge is therefore not proved. Not proved. 15 Proved. You told the Committee that this information was contained within the front sheet of Patient B s record. The Committee accepts that this record is missing. This head of charge is therefore not proved. The Committee accepts the evidence of Ms Karpeta that the antibiotics you prescribed were not necessary for treatment. You told the Committee that you were attempting to meet the patient s expectations, however you also appeared to accept that the antibiotics were not clinically necessary. The Committee therefore finds this head of charge proved. 16 Admitted and proved. 17 Admitted and proved. 18a. Admitted and proved. 18b. Admitted and proved. 18c. Admitted and proved. 19a. Admitted and proved. 19b. Admitted and proved. 19c. Admitted and proved. 19d. Admitted and proved. 20. Admitted and proved. We move to Stage Two. On 6 December 2016 the Chairman announced the determination as follows: Ms Ross, The Committee found that you failed to provide an adequate standard of care to Patient A from August 2014 and Patient B from April With regards to Patient A, your record keeping fell short in a number of respects including inadequate reporting on and grading of radiographs and a failure to record whether anaesthetic was used and any details of it during crown preparation treatment. With regards to Patient B, on a number of occasions you did not record medical histories, intra and extra oral examinations, evaluation of radiographs, details of periodontal treatment, what to took place at a number of appointments and clinical justification and material used for a splint at LR2. You also failed to make adequate arrangements for the completion of Patient A s crown treatment, and the removal or replacement of his temporary crowns. You did not respond to his messages or to his complaint. ROSS, A Professional Conduct Committee November 2016 June 2017 Page -10/17-

11 You provided inadequate periodontal treatment to Patient B, you inappropriately prescribed him antibiotics and you failed to make adequate arrangements for the completion of his crown treatment. You also failed to refund money paid to you by Patient B for treatment that you did not provide. You did not respond to his written complaints or letters. You also failed to discuss treatment options or refer for specialist treatment with respect to the periodontal condition. Furthermore you provided dental services while you did not have in place adequate indemnity insurance for four periods of time between 2012 to [IN PRIVATE] MISCONDUCT The Committee first considered whether the facts found proved amounted to misconduct. In considering the matter, the Committee exercised its own independent judgement. It had regard to the following standards contained within the publication Standards for the Dental Team (30 September 2013): 1.7 Put patients interests before your own or those of any colleague, business or organisation. 1.8 Have appropriate arrangements in place for patients to seek compensation if they suffer harm. 2.3 Give patients the information they need, in a way they can understand, so that they can make informed decisions. 5.3 Give patients who complain a prompt and constructive response. 7.1 Provide good quality care based on current evidence and authoritative guidance. 9.1 Ensure that your conduct, both at work and in your personal life, justifies patients trust in you and the public s trust in the dental profession. Your conduct in treating patients during periods when you lacked appropriate indemnity cover is of grave concern to this Committee. The Committee considered your failure to make adequate arrangements for the completion of Patient A and Patient B s treatment and to respond to their queries and complaints to be further areas in which your conduct fell short of that expected of a reasonably competent dentist. Your failures in relation to record keeping and the inadequate standard of aspects of the treatment you provided to Patients A and B are also serious matters. Breaches of professional standards do not automatically result in a finding of misconduct. However the Committee is satisfied that the facts found proved taken cumulatively, and bearing in mind the period of time over which they occurred, amount to serious breaches. Your failings were wide ranging and were a departure from the standards expected of a reasonably competent registered dentist. The Committee is satisfied that they would be viewed as deplorable by fellow professionals and do amount to misconduct. IMPAIRMENT In relation to misconduct The Committee considered whether your fitness to practise is currently impaired by reason of your misconduct. It exercised its own independent judgement and bore in mind its duty to ROSS, A Professional Conduct Committee November 2016 June 2017 Page -11/17-

12 protect the public as well as safeguard the public interest and public confidence in the profession. The Committee first considered whether your failings were remediable. The Committee determined that they were capable of remediation. It had regard to the continuing professional development (CPD) courses that you have undertaken in a number of areas, including complaints handling, communication, periodontal disease, and ethical implications for record keeping. It had regard to the supportive testimonial provided by your former practice principal dated 25 November 2016, in which he attests to your fastidiousness and adherence to guidelines during the time that you worked for him up to The Committee also took account of a letter from the British Dental Association Benevolent Fund dated 28 November 2016, which states that you expressed a positive attitude and determination to meet the GDC requirements. You have begun the process of remediation and you appear to be gaining a degree of insight into your failings. However you have only taken a few initial steps. Furthermore, the most concerning elements of this case relate to you having practised without indemnity for a prolonged period of time. During that time you were aware that you were not indemnified, and you contacted a number of organisations to try and secure cover. You clearly knew that you needed indemnity cover and yet you continued to treat patients. You carried out thousands of courses of treatment whilst not indemnified and potentially put many patients at risk of being unable to make any claims that they may have been entitled to. It is clear to the Committee that you placed your interests and the interests of your business above those of your patients. The Committee is not satisfied that your shortcomings have yet been remedied, nor is it satisfied that your misconduct will not be repeated. The Committee has determined that your fitness to practise is currently impaired. It makes this finding on the basis that there are further steps that you must take in order to remediate your clinical failings. Such a finding is necessary in order to mark the seriousness of your conduct in treating patients without indemnity cover, and to declare and uphold proper standards and thereby preserve public confidence in the profession. In relation to health [IN PRIVATE] SANCTION The Committee considered what sanction, if any, to impose upon your registration. It bore in mind that the purpose of a sanction is not to be punitive, but rather to protect patients and the wider public interest. During its deliberations, the Committee applied the principle of proportionality and balanced the public interest with your own interests. The Committee considered whether it would be sufficient to conclude the case with no further action. However it determined that in light of the serious findings it has made, the risk to the public that it has identified, and bearing in mind the possible impact upon the reputation of the profession, concluding the case would not be appropriate. It next considered whether to issue you with a reprimand. It determined that a reprimand would not serve to protect patients, nor would it mark the seriousness of your misconduct in leaving patients with unfinished treatment and working without indemnity. ROSS, A Professional Conduct Committee November 2016 June 2017 Page -12/17-

13 It next considered whether conditions of practice could be formulated that would address your failings as identified in this case and address the concerns. It determined that, although it could formulate workable and measurable conditions that would serve to address the clinical and health concerns identified, your attitudinal failings in relation to you practising without indemnity could not be addressed with conditions. It took the view that conditions would not be sufficient to uphold the reputation of the profession or to maintain standards. The Committee has determined that the appropriate and proportionate sanction in this case is one of suspension. A period of suspension will serve to mark the seriousness of your misconduct and safeguard public confidence in the profession. In light of your adverse health, the insight that you have shown and the steps you have taken so far to address your failings, the Committee took the view that erasure would be disproportionate. Your registration will be suspended for a period of six months. Shortly before the end of that period the case will be reviewed. Decision on immediate order The Committee considered the submissions made by Mr Collins and Mr Jenkins. It accepted the advice of the Legal Adviser. Mr Collins invited the Committee to consider the imposition of an immediate order of suspension on your registration for the protection of the public and otherwise in the public interest. Mr Jenkins made no objection. The Committee determined that an immediate order is necessary in this case for the protection of the public and is otherwise in the public interest for the same reasons as given for the substantive order. The effect of the foregoing determination and this order is that your registration will be made subject to an order of suspension with immediate effect. If you choose to appeal the substantive decision this immediate order of suspension will remain in place until the resolution of that appeal. If no appeal is pursued, the immediate order will remain in place for 28 days, following which the substantive order will take effect. On 16 June 2017, at the review hearing the Chairman announced the determination as follows: Ms Ross, This is a resumed hearing pursuant to Section 27C of the Dentists Act 1984 (as amended) ( the Act ) to review the order of suspension for 6 months which was imposed on your registration by the Professional Conduct Committee (PCC) in December At the commencement of the hearing, the Committee heard a joint application from Ms Headley on behalf of the General Dental Council (GDC) and from Mr Jenkins on your behalf that the hearing should proceed in private pursuant to Rule 53 of the General Dental Council (Fitness to Practise) Rules The Committee accepted the advice of the Legal Adviser. It determined that it was in the interests of protecting your private life to proceed with the hearing in private. ROSS, A Professional Conduct Committee November 2016 June 2017 Page -13/17-

14 The Committee also heard an application by Ms Headley under Rule 29 to vary the order of proceedings today. Mr Jenkins did not object to the proposed approach and submitted that it was a pragmatic one to adopt. The Committee accepted the advice of the Legal Adviser. It determined to allow Ms Headley to outline her case initially and suspend making her final submissions until all the evidence had been heard. Background In December 2016, a PCC found that you failed to provide an adequate standard of care to Patient A from August 2014 and Patient B from April With regards to Patient A, your record keeping fell short in a number of respects including inadequate reporting on and grading of radiographs and a failure to record whether anaesthetic was used and any details of it during crown preparation treatment. With regards to Patient B, on a number of occasions you did not record medical histories, intra and extra oral examinations, evaluation of radiographs, details of periodontal treatment, what to took place at a number of appointments and clinical justification and material used for a splint at LR2. You also failed to make adequate arrangements for the completion of Patient A s crown treatment, and the removal or replacement of his temporary crowns. You did not respond to his messages or to his complaint. You provided inadequate periodontal treatment to Patient B, you inappropriately prescribed him antibiotics and you failed to make adequate arrangements for the completion of his crown treatment. You also failed to refund money paid to you by Patient B for treatment that you did not provide. You did not respond to his written complaints or letters. You also failed to discuss treatment options or refer for specialist treatment with respect to the periodontal condition. Furthermore, you provided dental services while you did not have in place adequate indemnity insurance for four periods of time between 2012 to [Private Information] That Committee was of the view that your conduct in treating patients during periods when you lacked appropriate indemnity cover was of grave concern. It considered that your failings in the standard of treatment you provided to Patient A and Patient B including your record keeping failings were also serious matters and amounted to misconduct. In relation to impairment, the previous Committee was of the view that your remediation of your misconduct was in its early stages and further steps needed to be taken by you in order to remedy your clinical failings. It also found the seriousness of your misconduct warranted a finding of impairment in the public interest. [Private Information] Today this Committee has comprehensively reviewed your case. It has also taken account of the submissions made by Ms Headley on behalf of the GDC and those made by Mr Jenkins on your behalf. The Committee accepted the advice of the Legal Adviser. Current Impairment In considering whether your fitness to practise is currently impaired, the Committee noted that this was a matter for its own independent judgement. It also considered that its duty was to protect the public, declare and uphold proper standards of conduct and competence and ROSS, A Professional Conduct Committee November 2016 June 2017 Page -14/17-

15 maintain public confidence in the profession. The Committee was referred to the cases of Ibrahim V GMC; Bamgbelu v GDC; Yeong v GMC; Cohen v GMC; and CHRE v NMC and Paula Grant. In relation to the misconduct found previously, the Committee noted your Practitioner Action Plan formulated with the support and guidance of your National Education Scotland (NES) Mentor. In your plan, you identified a number of areas to address which included Record keeping, Review of GDC Standards, Treatment planning, Antibiotic prescribing, Ethics and complaints handling, Basic Life Support and Medical Emergencies, Radiography, Review of Scottish Guidelines and Ongoing CPD. The Committee noted the comments by your coach/mentor, Mr Graham Orr in the Completion at the End of Programme/Sign off. He stated that Alison has met all targets we have agreed throughout the mentoring process. She has summarised the learning from each of the courses attended. Her reflective commentary demonstrates insight into shortcomings in her earlier practice and intentions to practise in an appropriate manner on her return to work. [Private Information] In the same document, you stated I am content having completed this stage of the process. I thoroughly understand the objectives and the necessity for continuing and heavily participating in the process of remediation. The Committee also noted your CPD certificates which reassured it regarding your remediation. In a letter dated 16 June 2017, Ms Nevin of NHS Education for Scotland Dental CPD confirmed that CPD courses were NES approved and part of your remediation plan. Ms Nevin stated She has produced reflective notes under her action plan with the guidance of her mentor Graham Orr I can confirm she has engaged with the remediation process as outlined in the action plan. In your oral evidence, you told the Committee that by treating patients without having indemnity cover in place, you let your patients down, you placed them at risk and you recognise now that you should have ceased practising immediately. You told the Committee that it was a grave error and you apologised to the Committee. You assured the Committee that should you find yourself in a similar position, you would cease treating patients until your insurance was reinstated. The Committee found you to be a honest, credible and reliable witness. It accepted your evidence. The Committee was of the view that you have demonstrated complete insight into your misconduct in treating patients without adequate indemnity and your clinical failings. It noted that you had completed your objectives in your action plan ahead of schedule. The Committee was content that you had appropriately addressed the failings found proved in your practise. It determined that your fitness to practise is not currently impaired by reason of misconduct. [Private Information] Disposal The Committee next considered what action, on this first review under S 27C to impose on your registration. It reminded itself that the purpose of any sanction is not to be punitive although it may have that effect. The Committee bore in mind the principle of proportionality. It carefully considered the GDC s Guidance for the Practice Committees, including Indicative Sanctions Guidance (October 2016) ( the PCC Guidance ). ROSS, A Professional Conduct Committee November 2016 June 2017 Page -15/17-

16 The Committee first considered whether to revoke the suspension order and allow you to return to unrestricted practice. [Private Information] The Committee then considered whether to revoke the suspension order and replace it with a direction for conditional registration. It noted that you have engaged fully with your NES mentor and undertaken the recommended courses towards your remediation. The evidence of the remediation you have undertaken assures the Committee that you would comply with conditions. The Committee concluded that carefully drafted conditions would be workable, appropriate and sufficient to protect patients and to uphold the wider public interest, in the circumstances of this case. The Committee therefore determined to terminate the suspension and impose conditions on your registration for a period of 18 months pursuant to section 27C (1)(c) of the Dentists Act 1984, as amended. It considers that the 18-month duration is necessary given the length of time that you have not practised dentistry. It will also allow you time to find an appropriate dental position and settle back into the clinical environment. The conditions as they will appear against your name in the Dentists Register are as follows: PUBLIC 1. She must notify the GDC promptly of any professional appointment she accepts and provide the contact details of her employer or any organisation for which she is contracted to provide dental services and the Commissioning Body on whose Dental Performers List she is included or Local Health Board if in Wales, Scotland or Northern Ireland. 2. She must allow the GDC to exchange information with her employer or any organisation for which she is contracted to provide dental services, and any Postgraduate Dental Dean/Director, reporter, workplace supervisory or educational supervisor referred to in these conditions. 3. She must inform the GDC of any formal disciplinary proceedings taken against her, from the date of this determination. 4. She must inform the GDC if she applies for dental employment outside the UK. 5. She must allow the GDC to exchange information about the standard of her professional performance with those people currently involved in her retraining and supervision. 6. At any time she is employed, or providing dental services, which require her to be registered with the GDC; she must place herself and remain under the supervision of a workplace supervisor nominated by herself, and agreed by the GDC. 7. She must allow her workplace supervisor to provide reports to the GDC at intervals of not more than 3 months. 8. She must keep her professional commitments under review and limit her dental practice in accordance with the advice of her workplace supervisor. PRIVATE 9. [Private Information] 10. [Private Information]. ROSS, A Professional Conduct Committee November 2016 June 2017 Page -16/17-

17 11. [Private Information] 12. [Private Information] 13. [Private Information] 14. [Private Information] PUBLIC 15. She must not engage in dental practice as a sole practitioner. 16. She must only undertake any out-of-hours work or on-call duties with the agreement of her workplace supervisor. 17. She must inform within one week, the following parties that her registration is subject to the conditions, listed at 1 to 16, above: a) Any organisation or person employing or contracting with her to undertake dental work; b) Any locum agency or out-of-hours service she is registered with or applies to be registered with (at the time of application); c) Any prospective employer (at the time of application); d) The Commissioning Body on whose Dental Performers List he is included or seeking inclusion, or Local Health Board if in Wales, Scotland or Northern Ireland (at the time of application). 18. She must permit the GDC to disclose the above conditions, 1 to 8 and 15 to 17, to any person requesting information about her registration status. The order will be reviewed prior to the end of the 18 month period. Decision on immediate order of conditions The Committee took account of the submissions made by Ms Headley on behalf of the GDC that an immediate order should be imposed on your registration. Mr Jenkins did not oppose the application. He submitted that it was logical to impose an immediate order of conditions. The Committee accepted the advice of the Legal Adviser. The Committee noted that this decision is a matter for its own independent judgement. Having determined to terminate the suspension and impose conditions on your registration, it considered that it would be in your interest for the conditions to take effect immediately. The Committee therefore determined, pursuant to Section 30 (2) of the Dentists Act 1984, as amended, that an immediate order of conditions is necessary for the protection of the public, is otherwise in the public interest and in your own interest. The effect of the foregoing direction and this order is that your registration will be subject to the same conditions as the substantive conditions with immediate effect and unless you exercise your right to appeal, the substantive direction of conditions for 18 months will take effect 28 days from when notice is deemed served on you. Should you exercise your right to appeal, this order for immediate conditions will remain in place pending the resolution of any appeal proceedings. That concludes the case for today. ROSS, A Professional Conduct Committee November 2016 June 2017 Page -17/17-