HEARING HEARD IN PUBLIC

Transcription

1 HEARING HEARD IN PUBLIC PRICHARD, Steven William Registration No: PROFESSIONAL CONDUCT COMMITTEE FEBRUARY 2016 Outcome: Erasure with immediate suspension Stephen William PRICHARD, a dentist, BDS Lond 1967, LDS RCS Eng 1967; was summoned to appear before the Professional Conduct Committee on 1 February 2016 for an inquiry into the following charge: Charge That, being a registered dentist: 1. From approximately 2010 to October 2014 you practised at [REDACTED]. Patient care 2. From approximately August 2011 to August 2014 you provided dental care to Patient A, and: (c) you made no or no adequate record of: (ii) (iii) (iv) (v) (vi) medical history updates; dental charting; periodontal status; soft tissue examination; occlusal parameters; temporo-mandibular joint status; (vii) oral hygiene advice; (viii) treatment plans; (ix) the methodology of oral surgery provided; you made no adequate record of the justification for and/or report on and/or grading of radiographs taken on or around: 27 September 2013; (ii) 18 October 2013; (iii) 7 May 2014; from approximately January 2013 to June 2014 you failed to diagnose caries present at LR3; PRICHARD, S W Professional Conduct Committee Feb 2016 Page -1/14-

2 (d) from approximately January 2013 to June 2014 you failed to diagnose an apical lesion present at LR5. 3. From approximately April 2010 to June 2014 you provided dental care to Patient B, and: you made no or no adequate record of: (ii) (iii) (iv) (v) (vi) medical history updates; dental charting; periodontal status; soft tissue examination; occlusal parameters; temporo-mandibular joint status; (vii) treatment plans. you made no adequate record of the justification for and/ or report on and/or grading of radiographs taken on or around: 10 April 2010; (ii) 15 April 2010; (iii) 29 November 2011; (iv) 18 July 2012; (v) 7 August On or around 26 July 2014 you inappropriately issued a prescription for antibiotics for the use of Patient C: without seeing the patient; without any or any adequate clinical justification. 5. From approximately July 2011 to July 2014 you provided dental care to Patient D, and: you made no or no adequate record of: (ii) (iii) dental charting; occlusal parameters; temporo-mandibular joint status; on occasions between December 2013 and January 2014 you provided a restoration at UR7 which was inadequate in that it was poorly constructed; 6. From approximately 2011 to 2014 you provided dental care to Patient E, and on or around 9 July 2014, you conducted an endodontic procedure but failed to protect the patient by using rubber dam. 7. From approximately July 2010 to July 2014 you provided dental care to Patient F, and: you made no or no adequate record of: dental charting; PRICHARD, S W Professional Conduct Committee Feb 2016 Page -2/14-

3 (ii) occlusal parameters; you failed to provide or plan for any or any adequate treatment for the patient s dental needs as identified on or around 14 July From approximately February 2012 to 2014 you provided dental care to Patient G, and: you made no or no adequate record of: (ii) dental charting; occlusal parameters; from approximately February 2012 to October 2013 you failed to diagnose cavities at: (ii) (iii) (iv) UR6; UR7; UR4; UL8. 9. From approximately September 2010 to 2014 you provided dental care to Patient H, and: you made no or no adequate record of: (ii) (iii) dental charting; periodontal status; occlusal parameters; you failed to adopt any or any adequate overall treatment strategy to address the patient s dental needs. 10. From approximately June 2011 to July 2014 you provided dental care to Patient I, and: (c) you made no or no adequate record of: dental charting; (ii) periodontal status on or around 26 September 2013; (iii) Infection control occlusal parameters; you made no adequate record of the justification for and/or report on and/or grading of a radiograph taken on or around 23 July 2014; you failed to adopt any or any adequate overall treatment strategy to address the patient s dental needs. 11. From approximately 2010 to October 2014, you failed to maintain an adequate standard of cross infection control in that on one or more occasions you: did not wear gloves when treating patients; when not wearing gloves, did not wash your hands between patients; PRICHARD, S W Professional Conduct Committee Feb 2016 Page -3/14-

4 (c) (d) (e) (f) (g) (h) (j) (k) Patient charges when not wearing gloves, did not wash your hands after visiting the toilet between patients; did not change gloves between patients; declined fresh gloves when offered them by a nurse; did not change gloves having worn them outside the surgery room between patients; did not change gloves having worn them when visiting the toilet between patients; did not wear a surgical mask when treating patients; used the same towel to wipe your hands and patients faces; used washing up liquid to wash your hands before treating patients; placed a used burr on the sterile rack after using it on a patient. 12. From approximately April 2014 to June 2014 you provided dental care to Patient J, and you charged a fee which was excessive in relation to: a porcelain bonded crown fitted on or around 10 April 2014; a porcelain bonded crown fitted on or around 24 April 2014; 13. From approximately April 2014 to September 2014 you provided dental care to Patient L and you charged a fee which was excessive in relation to a bonded jacket crown fitted on or around 28 May In approximately June 2014 you provided dental care to Patient M and you charged a fee which was excessive in relation to an acrylic denture fitted between 5 and 12 June Your conduct at paragraphs 12 and/or 13 and/or 14 above was: inappropriate; dishonest. And that in relation to the matters set out above your fitness to practise is impaired by reason of: misconduct and/or deficient professional performance. On 4 February 2016 the Chairman made the following statement regarding the finding of facts: Mr Morris, Preliminary Matters Mr Prichard has instructed you to represent him in his absence. No adverse inference was drawn from Mr Prichard s absence from this hearing. PRICHARD, S W Professional Conduct Committee Feb 2016 Page -4/14-

5 Admissions The allegations before the Committee relate to three areas of Mr Prichard s practice; the clinical care and treatment provided to Patients A-I during the period ; infection control practices between 2010 to October 2014; and the fees charged to Patients J-M on or around April-June It is further alleged in respect of the fees charged that Mr Prichard s conduct was inappropriate and dishonest. The allegations in respect of the clinical care and treatment include concerns relating to Mr Prichard s assessments and diagnosis, caries diagnosis and treatment, periodontal monitoring, endodontic practice, radiographic practice, antibiotic prescribing practice and record keeping. You, on Mr Prichard s behalf, made admissions to heads of charge: 1; 2; 3; 4; 5; 6; 7; 8; 9; 10; 11a; 11h; 11i; 12; 13; 14 and 15a. These admissions encompassed all heads of charge relating to the clinical care of Patients A-I. You made limited admissions in respect of Mr Prichard s infection control practice, and admissions that the fees charged to Patients J-M were excessive. It was admitted that that conduct was inappropriate but not that it was dishonest. Findings The Committee has taken into account all the documentary and oral evidence presented to it. The Committee received written witness statements from Dental Nurses A-G. It heard oral evidence by telephone from Dental Nurses B and E and Skype evidence from Dental Nurses A, D, F and G. The Committee also received the written statements of Dental Nurse C and Witness IP, which were agreed. Dental Nurses A-G had all worked with Mr Prichard as dental nurses at various times during the period 2010 to October 2014, on either a regular basis or an ad-hoc basis. The Committee considered each dental nurse sought to give a truthful account and assist the Committee to the best of their knowledge. However it noted a majority of the dental nurses had worked together and the evidence indicated that some issues of concern had been discussed between them during the material times. As a consequence, there are certain statements in the evidence which could be considered hearsay, in that they reference what other dental nurses may have seen or experienced. The Committee has given appropriate weight to those statements, and preferred those accounts which report the dental nurse s direct experience. The Committee also noted that there was no evidence to suggest the witnesses had any motive to appear before this Committee, other than to give a truthful account. The Committee found their evidence to be reliable, credible and honest. In particular, the Committee noted that Dental Nurses A and B had both worked with Mr Prichard over a consistent period on a daily basis and found that their evidence was a reliable and accurate account of their experiences with Mr Prichard. Each dental nurse gave a similar account as to their experience of working with Mr Prichard, and the evidence as a whole provided a background of widespread concerns with Mr Prichard s cross infection control practices which were, in the majority, independently corroborated by at least one or more of the dental nurses. The Committee received a written witness statement and heard oral evidence from Dentist A. Dentist A joined Prichard Dental Practice 12 years ago as a vocational trainee, and bought into the partnership in Dentist A gave evidence about a meeting with Mr Prichard on 5 December 2013 with Dental Nurse A, the practice manager, to address concerns raised by staff members in respect of cross-infection concerns, treatment criticisms PRICHARD, S W Professional Conduct Committee Feb 2016 Page -5/14-

6 and concerns regarding the fees charged to Denplan patients. He confirmed in evidence he did not see Mr Prichard practise and could not comment directly on his infection control techniques. When questioned in respect of the charge that Mr Prichard used washing up liquid to wash his hands, he gave evidence that this particular concern had not previously been raised with him and it was the first he had heard it. In respect of Denplan patients, he was unable to provide a definitive account of how many Denplan patients he had or provide reliable details as to how many patients were the responsibility of Mr Prichard. The Committee received a written report and heard oral evidence from Dr Keith Marshall, expert witness for the GDC. The Committee found Dr Marshall to be clear, balanced and measured in his approach. He applied the standard of a reasonable dental practitioner, rather than a gold standard. The Committee accepted his evidence. The Committee received a written statement and heard oral evidence from Mr RM, dental adviser with Denplan. The Committee considered Mr RM sought to assist the Committee to the best of his knowledge in respect of Denplan contracts and their operation in dental practices. He informed the Committee that under Denplan contracts dentists are required to set a reasonable charge in respect of laboratory fees and that this charge is payable by the patient. However the Committee considered Mr RM provided a subjective opinion as to what is considered reasonable and could not provide the Committee with any objective criteria against which to measure this. Furthermore, there appeared to be a lack of clarity within the Denplan contract. The Committee considered the facts in the light of the formal admissions and the evidence and found those facts admitted to be proved. In reaching these findings the Committee also noted the evidence contained in the patient records, the agreed and uncontested evidence of IP exhibiting dental laboratory invoices relating to Patients J-M, the evidence of Dr Keith Marshall and the written and oral evidence of the witnesses. In relation to those heads of charge that had not been admitted, the Committee considered the evidence adduced by both parties at this factual stage of its enquiry. The Committee considered the submissions made by Mr Mulchrone, on behalf of the GDC and those made by you, on Mr Prichard s behalf. The Committee accepted the advice of the Legal Adviser. The Committee considered each head of charge separately, bearing in mind that the burden of proof rests with the GDC and that the standard of proof is the civil standard, that is, whether the allegations are proved on the balance of probabilities. The Committee reminded itself that Mr Prichard is not required to prove or disprove anything. In respect of heads of charge 2, 3, 4, 5, 7, 8, 9, 10 and 12 the findings will be announced collectively. I will now announce the Committee s findings in relation to each head of charge: 1. Admitted and Found Proved 2.a 2.d Admitted and Found Proved 3.a 3.b Admitted and Found Proved 4.a 4.b Admitted and Found Proved 5.a 5.b Admitted and Found Proved PRICHARD, S W Professional Conduct Committee Feb 2016 Page -6/14-

7 6. Admitted and Found Proved 7.a 7.b Admitted and Found Proved 8.a 8.b Admitted and Found Proved 9.a 9.b Admitted and Found Proved 10.a 10.c Admitted and Found Proved 11.a Admitted and Found Proved 11.b Found Proved The Committee noted that whilst the evidence of Dental Nurse B, who was Mr Prichard s regular nurse during the material time, raised other concerns as to Mr Prichard s cross infection control practices, she did not refer to a specific concern that Mr Prichard did not wash his hands between patients. However, the Committee also considered the evidence of Dental Nurse A and Dental Nurse D, who both worked as Mr Prichard s dental nurse on a number of occasions during this period. They gave evidence that they witnessed him not washing his hands between patients. Nurse A stated: If Mr Prichard was seeing a family, he would rarely wash his hands between each family member. This is corroborated by Nurse D s experience. She confirmed that Mr Prichard not washing hands between patients was a problem she experienced. The Committee accepted this evidence. The Committee was satisfied on the balance of probabilities there was at least one or more occasions when Mr Prichard did not wash his hands between patients. It found this head of charge proved. 11.c Found Not Proved The Committee noted this allegation is particularly serious, and carries significant implications for patient safety if it did indeed occur. As such, the Committee reminded itself there must be sufficient evidence to establish this on the balance of probabilities. The Committee noted the only direct evidence relating to this head of charge is the written and oral account of Dental Nurse D. In her witness statement she stated she saw Mr Prichard not wash his hands after going to the toilet, and it happened more than twice. Under cross-examination she informed the Committee the bathroom had separate washing facilities outside the door, and she did not see Mr Prichard wash his hands at these facilities, which led her to believe he did not wash his hands before seeing a patient. Whilst the Committee considered Dental Nurse D sought to give an honest and truthful account of her experience, the Committee allowed for the chance she may have been mistaken as to what she had seen. The Committee noted that on the description of the practice, that there were additional washing facilities in the practice which he could have used, or due to the busy nature of the practice that Dental Nurse D may have missed witnessing him wash his PRICHARD, S W Professional Conduct Committee Feb 2016 Page -7/14-

8 hands. The Committee also took into account the absence of any reference to this practice in the witness statements of the other dental nurses. The Committee was of the view that if such a practice had been noticed it would certainly have been discussed amongst staff members. The Committee cannot be satisfied on the balance of probabilities that Mr Prichard did not wash his hands after visiting the toilet between patients when not wearing gloves. 11.d Found Proved The Committee considered the consistent accounts of Dental Nurse A, Dental Nurse B and Dental Nurse E who gave evidence that Mr Prichard did not change gloves between patients on more than one occasion. Dental Nurse A stated If Mr Prichard was seeing a family, he would rarely change gloves between each family member. Dental Nurse B, who worked with Mr Prichard three to four times a week on average, stated I also had concerns about Mr Prichard not changing gloves between patients. Dental Nurse E further supported this evidence. She stated Mr Prichard would sometimes wear the same pair of gloves for a whole set of check-ups. The Committee accepted this evidence, and found on the balance of probabilities this head of charge proved. 11.e Found Proved The Committee considered the consistent accounts of Dental Nurse B and Dental Nurse E who gave evidence that Mr Prichard declined fresh gloves when offered them by a nurse. The Committee accepted this evidence, and found on the balance of probabilities this head of charge proved. 11.f Found Not Proved The Committee noted the evidence in relation to this head of charge was a statement made by Dental Nurse E. She stated He would sometimes do things around the Practice wearing his gloves and then treat patients. The Committee noted that although there were a number of nurses who corroborated that Mr Prichard was seen around the Practice wearing gloves, there is no additional evidence apart from Dental Nurse E s statement, that he then treated patients wearing the same gloves. On the balance of probabilities the Committee did not consider this head of charge proved. 11.g Found Not Proved The Committee found this head of charge not proved for the reasons set out above in relation to 11c. 11.h Admitted and Found Proved 11.i Admitted and Found Proved 11.j Found Not Proved PRICHARD, S W Professional Conduct Committee Feb 2016 Page -8/14-

9 Dental Nurse E, Dental Nurse F and Dental Nurse G gave evidence that they believed Mr Prichard used washing up liquid to fill his individual soap dispenser that he would use to wash his hands before treating patients. When cross-examined in relation to this all three dental nurses confirmed that they had not directly seen Mr Prichard fill up his dispenser with washing up liquid, or seen washing up liquid containers in the vicinity of the dispenser. Dental Nurse E stated she believed it was washing up liquid because of the colour, whilst Dental Nurse G said the smell and Dental Nurse F referred to its thickness and smell. The Committee noted the evidence of Dentist A, who told the Committee he had not been informed of this particular concern before it was put to him by you in this hearing. The Committee further noted the record of the meeting held with Mr Prichard in December 2013 during which a number of concerns were raised, and there is no reference to washing up liquid in the notes of this meeting. The Committee could not be satisfied on the balance of probabilities that it had been established that the material Mr Prichard was using to wash his hands was washing up liquid. Accordingly it found this head of charge not proved. 11.k Found Not Proved Dental Nurse B, Dental Nurse F and Dental Nurse G gave evidence that Mr Prichard would use burrs on a patient and replace the burr in the same rack where the sterile burrs were being kept. However, they also gave evidence in oral cross-examination that they would ensure all the burrs in the rack where the used burr had been placed were then sterilised. Whilst Mr Prichard s approach appeared to the Committee to be inefficient, as all burrs were subsequently sterilised it could not be satisfied that Mr Prichard had failed to maintain an adequate standard of cross infection control through his actions. Accordingly it found this head of charge not proved. 12.a 12.b Admitted and Found Proved 13. Admitted and Found Proved 14. Admitted and Found Proved 15.a Admitted and Found Proved 15.b Found Not Proved The Committee accepted in heads of charge that the fees charged to the Patients J-M were significantly more than the laboratory invoices for these items, and were excessive in comparison. The Committee next considered whether Mr Prichard s conduct in making these charges was dishonest. The Committee was referred to the case of R v Ghosh [1982] Q.B and the case of Kirschner v General Dental Council [2015] EWHC 1377 (admin) in relation to dishonesty and the modified two part test which it must apply when reaching its decision on this charge. First is the objective test; whether according to the ordinary standards of reasonable and honest dentists what was done by Mr Prichard was dishonest. If it was dishonest by those PRICHARD, S W Professional Conduct Committee Feb 2016 Page -9/14-

10 We move to Stage Two. standards then secondly, the subjective test should be applied and the Committee had to consider whether Mr Prichard must have realised that what he was doing was, by those standards, dishonest. The Committee noted that dishonesty is a positive act and cannot occur by error or negligence. The Committee considered Mr RM s evidence, which demonstrated that requirements on dentists under Denplan contracts had changed over time, and that dentists had modified their practice in most instances to respond to these developments. He gave evidence that under current Denplan contracts dentists are required to set a reasonable charge in respect of laboratory fees and that this charge is payable by the patient. He also gave evidence that Denplan had conducted a survey of dentists in order to gather informal data as to their understanding of how to impose these charges. There were varied results. Whilst approximately one third of the dentists polled applied the principle of only charging the laboratory fee, the other two thirds used a variety of different approaches, some of which appeared to be consistent with the registrant s approach. The Committee therefore took into account there seemed to be a broad scope of what a dentist may consider reasonable under the Denplan contract. The Committee noted the evidence of Dentist A and the records of the meetings held with Mr Prichard in December 2013 and August 2014 to discuss charges under the Denplan contracts. The Committee considered the contemporaneous records of these meetings show Mr Prichard stating his opinion as late as August 2014 that his method of charging was acceptable under Denplan. He states he is going to contact Denplan to find out. The Committee has not been provided with any evidence that Mr Prichard knew and understood the requirements of the Denplan contracts, and deliberately imposed a higher charge in excess of what he considered was the permitted fee. The evidence instead demonstrates that Mr Prichard had adopted and followed a particular practice over a long period of time, without questioning whether this practice was up-to-date and in keeping with the relevant contract. The Committee was not satisfied on the balance of probabilities that Mr Prichard dishonestly charged the excessive fees. Accordingly, it found this head of charge not proved. On 5 February 2016 the Chairman announced the determination as follows: Mr Morris, Mr Prichard s clinical care and treatment of nine patients between 2010 and 2014 fell below an acceptable standard in a number of respects, including in the areas of assessment and diagnosis, caries diagnosis and treatment, periodontal monitoring, endodontics, radiography, antibiotic prescribing and record keeping. Further, Mr Prichard failed to maintain an adequate standard of cross infection control. On one or more occasions between 2010 and 2014: PRICHARD, S W Professional Conduct Committee Feb 2016 Page -10/14-

11 - he did not wear gloves when treating patients and did not wash his hands between patients; - he did not change gloves between patients; - he declined fresh gloves when offered them by a nurse; - he did not wear surgical mask when treating patients; and - he used the same towel to wipe his hands and patients faces. On dates in 2014 Mr Prichard charged three patients fees which were excessive. The Committee heard the submissions made on behalf of the General Dental Council (GDC) by Mr Mulchrone, and those made on Mr Prichard s behalf by you. The Committee accepted the advice of the Legal Adviser. The Committee had regard to the Guidance for the Practice Committees, including Indicative Sanctions Guidance, effective 1 October Misconduct There is no statutory definition of misconduct but it is generally accepted that misconduct connotes a serious falling short of the standards reasonably expected of a dental professional. In assessing whether the facts found proved amount to misconduct, the Committee had particular regard to the following principles from Standards for Dental Professionals, dated May 2005 and in force until the end of September 2013: 1.1 Put patients interests before your own or those of any colleague, organisation or business. 1.4 Make and keep accurate and complete patient records, including a medical history, at the time you treat them. 4.1 Co-operate with other team members and colleagues and respect their role in caring for patients. And from Standards for the Dental Team, in force from 30 September 2013: 1.4 You must take a holistic and preventative approach to patient care which is appropriate to the individual patient A holistic approach means you must take account of patients overall health, their psychological and social needs, their long term oral health needs and their desired outcomes You must provide patients with treatment that is in their best interests, providing appropriate oral health advice and following clinical guidelines relevant to their situation. You may need to balance their oral health needs with their desired outcomes. If their desired outcome is not achievable or is not in the best interests of their oral health, you must explain the risks, benefits and likely outcomes to help them to make a decision. 1.7 You must put patients interests before your own or those of any colleague, business or organization 6.1 Work effectively with your colleagues and contribute to good teamwork. PRICHARD, S W Professional Conduct Committee Feb 2016 Page -11/14-

12 6.5 Communicate clearly and effectively with other team members and colleagues in the interests of patients. 7.1 Provide good quality care based on current evidence and authoritative guidance. The Committee accepted the uncontested expert opinion that overall Mr Prichard s failings fell far below the standards reasonably expected of him. His failings involved a large number of cases spread over a considerable period of time. The evidence before the Committee was that patients had suffered actual harm over a long period as a result of his poor clinical management. Mr Prichard was under a duty to know what was required of him and to apply it in practice. He failed to observe that duty. In the Committee s judgment, there has been a serious departure from accepted professional standards and some of his clinical failings were so serious as to breach fundamental tenets of the profession. His conduct would be regarded as deplorable by fellow members of the profession. Accordingly, the Committee finds that the facts found proved amount to misconduct, which was conceded on Mr Prichard s behalf. For the avoidance of doubt, the Committee does not address the issue of deficient professional performance in the light of its finding of misconduct. Impairment In assessing whether Mr Prichard s fitness to practise as a dentist is currently impaired by reason of his misconduct, the Committee had regard to whether his misconduct is remediable, whether it had been remedied and the risk of repetition. The Committee also had regard to the wider public interest, which includes the need to uphold and declare proper standards of conduct and behaviour, so as to maintain public confidence in the profession and this regulatory process. Mr Prichard has no other fitness to practise history in an otherwise long and unblemished career. He did not attend this hearing to give evidence, nor has he supplied any material to demonstrate steps taken to address the serious and wide ranging failings identified in this case: there was no evidence of remediation. There was also little evidence as to Mr Prichard s insight into the seriousness of his misconduct and the steps that he would need to take to address it. In relation to his excessive charging of patients, he accepted that this was an inappropriate thing to do but there was no evidence that he had made any form of restitution. As part of the factual inquiry Mr Prichard made a number of admissions, but these were mostly incontrovertible in the light of the clinical records (or lack of them) and expert evidence. At this stage of proceedings you conceded on behalf of Mr Prichard that his fitness to practise is impaired by reason of misconduct and that he apologised for that misconduct. Mr Prichard s clinical failings are by their nature remediable. However, there is no evidence of his willingness to address them or of insight. So far as willingness to address these failings is concerned, the Committee acknowledges that Mr Prichard has now retired. However, in the Committee s judgment his failings were also attitudinal. He had taken a complacent and somewhat arrogant approach to cross infection control and to the need to maintain and develop his skill and knowledge. PRICHARD, S W Professional Conduct Committee Feb 2016 Page -12/14-

13 In the absence of any remediation and insight, there remains a high risk of repetition should Mr Prichard decide to return to practice. Indeed, his practice is likely to be the same as it was before, with a real risk of harm to patients. Further, Mr Prichard has acted in a way which is capable of bringing the profession into disrepute. Public confidence would be seriously undermined if a finding of impairment were not made, given the seriousness of the clinical failings, the period of time over which they occurred, the number of patients involved, the attitudinal aspects of those failings, the complete lack of both remediation and insight and the high risk of repetition. Accordingly, for these reasons, the Committee finds that Mr Prichard s fitness to practise is impaired by reason of his misconduct. Sanction The purpose of a sanction is not to be punitive, although it may have that effect, but to protect the public and the wider public interest. In deciding what sanction, if any, to impose, the Committee balanced the aggravating and mitigating factors in this case. It considered in ascending order of seriousness each sanction available to it. In mitigation, the Committee accepted that Mr Prichard is of good character with a long and otherwise unblemished career. To conclude this case with no further action or a reprimand would be wholly inappropriate, given the need to protect the public and the seriousness of Mr Prichard s misconduct. Misconduct of this nature demands a greater sanction. The Committee considered whether conditions of practice could be formulated to be workable, measurable and proportionate. It determined that they could not, given that Mr Prichard had not actively engaged in these proceedings, is not currently practising and has stated he has no intention of resuming practice in the future. Further, conditions of practice would not be sufficient to mark the seriousness of Mr Prichard s misconduct and his attitudinal failings. The Committee next considered whether to direct that Mr Prichard s registration be suspended. There had been a sustained failure on the part of Mr Prichard to engage in any kind of reflective practice and self-criticality. A number of failings that had been found proved were in areas of concern that were pointed out to him by his staff. He chose not to make any significant and consistent alterations to his practising habits. There have been extremely serious failures in the areas of record keeping, clinical management and cross infection control. Over a period of years patients were put at real risk of harm and some suffered actual harm. Mr Prichard had breached the trust those patients placed in him by not treating them properly and by neglecting their clinical needs. He has demonstrated a persistent lack of insight and there is a real risk of repetition. Having regard to the totality of the circumstances, Mr Prichard has acted in a way which is fundamentally incompatible with continued registration. A period of suspension would not be sufficient given the seriousness of the misconduct, the complete lack of remediation and insight and the real risk of repetition. Accordingly, the Committee directs that Mr Prichard be erased from the Register. The Committee now invites submissions on the question of an immediate order. PRICHARD, S W Professional Conduct Committee Feb 2016 Page -13/14-

14 The Committee is satisfied that it is necessary for the protection of the public and is otherwise in the public interest, to order that Mr Prichard s registration be suspended under s 30(1) of the Dentists Act In reaching its decision the Committee balanced the public interest with Mr Prichard s interests. It would be inconsistent with the decision the Committee has made not to make an immediate order. The effect of this order is that Mr Prichard s registration shall be suspended forthwith. Unless he exercises his right of appeal, his name will be erased from the Register in 28 days time. If he exercises his right of appeal, this immediate order will remain in force pending the resolution of the appeal proceedings. The interim order is hereby revoked. That concludes the case. PRICHARD, S W Professional Conduct Committee Feb 2016 Page -14/14-