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. HOUGHTON, Deborah Elizabeth Registration No: PROFESSIONAL CONDUCT COMMITTEE DECEMBER 2014 Outcome: Erased with immediate suspension Deborah Elizabeth HOUGHTON, a dentist, BChD Leeds 2001, was summoned to appear before the Professional Conduct Committee on 1 December 2014 for an inquiry into the following charge: Charge (amended on 1 December 2014) That being a registered dentist: 1. Amended to read: From March 2007 to February 2011 you were practising in general dentistry at West Parade Dental Care in Lincoln ( the Practice ) and were working under the terms of the Practice s contract with Lincolnshire PCT. 2. You provided treatment and/or made claims for treatment in respect of the patients identified in Schedule A 1. Abuse of Prescribing Privileges Non-dental Prescriptions 3. You issued the following private prescriptions for non-dental purposes: (a) Patient Fluconazole 150mg (7); (b) Patient Fluconazole 150mg (10); (c) Patient Fluconazole 150mg (3); (d) Patient Fluconazole 150mg (5) and Ibuprofen 400mg tds (30); (e) Patient Fluconazole 150mg (3); (f) Patient Zopiclone 7.5 mg (28); (g) Patient Fluconazole 150mg (4); (h) Patient Viagra 25mg (4); (i) Patient Lorazepam 1mg (28); (j) Patient Zopiclone 7.5mg (28); (k) Patient Zopiclone 7.5 mg (28) and Lorazepam 1mg (28); (l) Patient Zopiclone 7.5 mg (28). 4. You issued the following NHS prescriptions for non-dental purposes: (a) Patient Amoxicillin 500mg x 30 and Ibuprofen 600mg x 30; (b) Patient Amoxicillin 500mg x30 and Ibuprofen 600mg x 30; (c) Patient Amoxicillin 500 mg x 30 and Ibuprofen 600mg x 30; 1 Please note that the schedules are private documents and cannot be disclosed HOUGHTON, D E Professional Conduct Committee Dec 2014 Page -1/22-

2 (d) Patient Ibuprofen 600mg x 30; (e) Patient Ibuprofen 600mg x 30; (f) WITHDRAWN; (g) WITHDRAWN. 5. You failed to keep any or any adequate records in respect of the prescriptions you issued for non-dental purposes. Inappropriate & Dishonest Claims Prescription Claims 6. As set out in Schedule 1 claims were made in your name for Units of Dental Activity ( UDAs ) for the provision of prescriptions. 7. You knew or ought to have known that separate claims for UDAs (as set out in Schedule 1) ought not to have been made as the claims split a course of treatment into separate claims and/or you created false dates and entries to support the claim in respect of: (a) Patient submitted ; (b) Patient submitted ; (c) Patient submitted ; (d) Patient submitted ; (e) Patient submitted ; (f) Patient submitted ; (g) Patient submitted ; (h) Patient submitted ; (i) Patient submitted ; (j) Patient submitted ; (k) Patient submitted Incomplete Band 3 Claims Dentures 8. As set out in Schedule 2 claims were made in your name for UDAs in respect of incomplete Band 3 treatment, namely, dentures. 9. You knew or ought to have known that the claims for UDAs (as set out in Schedule 2) ought not to have been made as you had not provided incomplete Band 3 treatment and/or you created false dates and entries to support the claim in respect of: (a) Patient submitted ; (b) Patient submitted ; (c) Patient submitted ; (d) Patient submitted ; (e) Patient submitted ; (f) Patient submitted ; (g) Patient submitted ; (h) Patient submitted Other Claims HOUGHTON, D E Professional Conduct Committee Dec 2014 Page -2/22-

3 10. As set out in Schedule 3 claims were made in your name for UDAs in respect of various dental treatments. 11. You knew or ought to have known that claims for UDAs (as set out in Schedule 3) ought not to claims and/or you created false dates and entries to support the claim including to prematurely close a course of treatment to fall within the UDA year end in respect of: (a) Patient submitted ; (b) Patient 11 (i) submitted ; (ii) submitted ; (c) Patient submitted ; (d) Patient 14 (i) submitted ; (ii) submitted ; (e) Patient 15 (i) submitted ; (ii) submitted ; (iii) submitted ; (f) Patient 17 (i) submitted ; (ii) submitted ; (g) Patient 19 (i) submitted ; (ii) submitted ; (iii) submitted ; (h) Patient 28 (i) submitted ; (ii) submitted ; (iii) submitted ; (i) Patient 53 (i) submitted ; (ii) submitted Your conduct as set out above 7, 9 and/or 11 was: (a) (b) (c) inappropriate; misleading; dishonest in that it was done with the intention of obtaining UDAs that would not otherwise be permitted. AND, by reason of the facts stated, your fitness to practise is impaired by reason of your misconduct. HOUGHTON, D E Professional Conduct Committee Dec 2014 Page -3/22-

4 On 8 December the Chairman made the following statement regarding the finding of facts: Dr Houghton, The Committee has taken account of all the oral and documentary evidence presented in this case. It has considered the submissions of Ms Barnfather on behalf of the General Dental Council (GDC) and those made by Mr Foster on your behalf. The Committee has accepted the advice of the Legal Adviser. In particular he advised that it is for the GDC to prove the facts alleged. The standard of proof is that applicable to civil proceedings, which is on the balance of probabilities. He advised that the standard is met if the Committee is satisfied that, based on the evidence before it, it is more likely than not that what is alleged to have occurred did occur. You do not have to prove anything. At the commencement of the hearing, Ms Barnfather made an application under rule 18 of the General Dental Council (Fitness to Practise) Rules Order of Council 2006 to amend the charge by replacing March 2011 with February 2011 in paragraph 1 and by deleting paragraphs 4(f) and 4(g). Mr Foster did not oppose the application. The Committee granted the amendments. Mr Foster then made substantial admissions to the charge on your behalf. In relation to paragraphs 7, 9 and 11, you admitted that you ought to have known, but denied that you knew, that separate claims for UDAs ought not to have been made; nor did you admit that you created false dates and entries to support the respective You admitted that your conduct in making the claims alleged in paragraphs 7, 9 and 11 was inappropriate and misleading. Witnesses The Committee received written reports from expert witnesses instructed by the GDC, Mr Brookes, General Dental Practitioner and Mr Scott, expert in General Dental Practice probity. It heard oral evidence from Mr Scott. Mr Brookes, in his report dated 2 nd April 2014, provided an opinion on the allegations concerning the issuing of private and National Health Service (NHS) prescriptions for non-dental purposes whilst Mr Scott in his report dated 26 th March 2014 provided an opinion on the allegations of inappropriate claims for incomplete treatment for dentures, inappropriate separate claims for the provision of prescriptions, and inappropriate splitting of courses of treatment. The Committee accepted the opinion of both experts. The Committee received a witness statement dated 10 th April 2014 and heard oral evidence from Dr H, a partner in the practice. It was put to Dr H on your behalf that he bullied you and other members of staff. However you produced no independent evidence to support your assertions. Dr H strongly refuted these allegations and told the Committee that the majority of staff had been at the practice for a considerable amount of time and this indicated that there were no problems with the working relationships in the practice. Dr H s conduct during his evidence to this Committee was inappropriate in that he read part of a confidential report which was on the table before him and which he was not entitled to read. The Committee was satisfied that it was not sufficient substantially to undermine his credibility. For all these reasons the Committee accepted his evidence. The Committee received a witness statement dated 31 st March 2014 and heard oral evidence from Mr W, a partner in the practice. He told the Committee that he had not wanted HOUGHTON, D E Professional Conduct Committee Dec 2014 Page -4/22-

5 you to be a partner and that he did not trust you. The Committee found him to be a straightforward and credible witness. The Committee received a witness statement dated 18 th March 2014 and heard oral evidence from Ms T, your previous dental nurse at the practice. She gave an account of events whilst working with you, and the Committee found her to be honest and credible. The Committee received, with your agreement, witness statements from the following: Mr H, Practice Manager, dated 27 th February 2014, 31 st March 2014 and 4 th December 2014, Ms B, a dental nurse who worked with you at the practice, dated 11 th April 2014, Mr Cottingham, a General Dental Practitioner commissioned by the PCT to review your records, dated 7 th April 2014 Ms Murphy, Project Officer for NHS England, dated 29 th April 2014 Mr Pritchett, an investigator with Counter Fraud Services, dated 19 th March 2014, Patient 6 dated 14 th February 2014, Patient 9 dated 21 st February 2014; and Patient 54 dated 2 nd March The Committee heard oral evidence from you and found it unsatisfactory in many respects. The Committee noted that you have provided an inconsistent account of events since your alleged inappropriate claiming and prescribing came to light. Your explanations when questioned by NHS Counter Fraud differed from your evidence to this Committee. For example your assertion that in transmitting a claim for your mother, you were merely practising the use of the computer software. Your description of the practice atmosphere in your letter to the PCT after the concerns were uncovered differed significantly from your evidence to this Committee, in that in your letter you said that you felt that you were being supported by the other partners and the staff who are behaving in a professional and courteous manner towards me. This is considerably at odds with your evidence before this Committee that you felt isolated and bullied. You described the working atmosphere in the practice as horrendous. During your evidence you told the Committee that you regarded yourself as an NHS dentist. After you completed your evidence the Committee received a statement of your private income between February 2008 and March 2011 which totalled more that a quarter of a million pounds. The Committee found many aspects of your version of events wholly incredible and untruthful for these reasons. Meaning of the word false in paragraphs 7, 9 and 11 of the charge The Committee was advised that the Court of Appeal in the case of Hussain v General Medical Council [2014] EWCA Civ (7 November 2014) considered the meaning of the word false in the context of fitness to practise proceedings. In the light of that judgment the Committee was advised that in the context of the charge that you face, it should interpret false as meaning inaccurate. HOUGHTON, D E Professional Conduct Committee Dec 2014 Page -5/22-

6 Dishonesty allegations The Committee was advised that in order to determine whether the GDC has proved that you were acting dishonestly, it should apply the test set out in the case of R v Ghosh [1982] QB 1053, subject to one modification proposed by Longmore LJ in Hussain v GMC. The test, incorporating the amendment, is that the Committee must first of all decide whether according to the ordinary standards of reasonable and honest dentists what was done was dishonest. If it was not dishonest by those standards, that is the end of the matter and the GDC has failed to prove dishonesty. If the Committee concludes that it was dishonest by those standards it can only find that you were dishonest if it is satisfied that you must have realised at the time that what you were doing was, by those standards, dishonest whether you personally regarded it as dishonest or not. The Committee received character references from dental colleagues at the practice where you have been working since March These references attest to your good character. The Committee was advised that good character cannot by itself provide a defence to an allegation but it is evidence which should be taken into account in your favour. The allegation of dishonesty relates to: making separate claims for the provision of a prescription issued as part of a course of treatment and/or creating false dates and entries to support the claims; making claims for incomplete Band 3 treatment for dentures which had not been provided and/or creating false dates and entries to support the claims; and splitting a course of treatment into separate claims and/or creating false dates and entries to support the claims including prematurely closing a course of treatment to fall with the UDA You have admitted that these claims were inappropriate although you considered them appropriate at the time, and that they were misleading because by splitting a course of treatment you gave the impression that the treatment was complete when it was not. Your case is that you thought that it was legitimate to make a separate claim for prescriptions issued as part of a course of treatment. You had developed a system of using yellow sticky notes as a reminder to enter the separate prescription claims at a later date and you told the Committee that the yellow sticky notes were on your surgery wall for all to see and as such their use was not covert in nature. In relation to the incomplete Band 3 claims, your case is that you were informed by a colleague that you could claim 12 UDAs for incomplete dentures, you found models of incomplete denture work which you had not claimed for and you made NHS claims for the incomplete dentures without confirming the dates of the models or whether the patients were NHS or private patients. The Committee s findings in relation to each head and sub-head of charge are as follows: 1. As amended, admitted and proved 2. Admitted and proved 3. (a) Admitted and proved 3. (b) Admitted and proved HOUGHTON, D E Professional Conduct Committee Dec 2014 Page -6/22-

7 3. (c) Admitted and proved 3. (d) Admitted and proved 3. (e) Admitted and proved 3. (f) Admitted and proved 3. (g) Admitted and proved 3. (h) Admitted and proved 3. (i) Admitted and proved 3. (j) Admitted and proved 3. (k) Admitted and proved 3. (l) Admitted and proved 4. (a) Admitted and proved 4. (b) Admitted and proved 4. (c) Admitted and proved 4. (d) Admitted and proved 4. (e) Admitted and proved 4. (f) WITHDRAWN 4. (g) WITHDRAWN 5. Admitted and proved 6. Admitted and proved 7. (a) Admitted that you ought to have known that separate claims for UDAs for the provision of prescriptions ought not to have been made as the claims split a course of treatment into separate Not admitted that you knew that separate claims for UDAs for the provision of prescriptions ought not to have been made or that you created false dates and entries to support the Proved as charged The Committee found that on the balance of probabilities you knew that the separate claims for UDAs for the provision of prescriptions ought not to have been made. You have worked under the 2006 NHS contract since its introduction, you were the partner responsible for monitoring UDA targets in the practice, and you prepared a hand-out and provided training to staff at the practice in 2008 on the NHS contract. The Committee did not accept your account that you were unclear about these aspects of the 2006 NHS contract. You told the Committee that you thought it was acceptable to make these claims and that your reference in the dental records to the previous treatment indicated the authenticity of the records and the claim. In some HOUGHTON, D E Professional Conduct Committee Dec 2014 Page -7/22-

8 cases you told the Committee that when you noticed that another dentist had an open course of treatment for a patient to whom you had issued a prescription, you knew that your claim would not be transmitted as a separate claim if entered whilst that course of treatment was open. You developed a system of yellow sticky notes as a reminder to enter the prescriptions at a later date. The Committee was of the view that you had to be familiar with the system in order to use it to make separate claims for prescriptions in the way that you did. In relation to whether you created false dates and entries to support the claims, the system requires an entry to be made in the form of details of treatment including inputting any prescriptions in order to generate a claim. You knew that if you entered the prescription on the same date as the treatment you provided, if it was issued during a course of treatment, the system would not generate a separate UDA for the prescription. You also knew that you would have to input the prescription into the system on a separate date to enable the prescription claim to be transmitted. This would also require separate entries to be made. By making entries on the system on a date other than the date on which the prescription was issued, you created false dates and made false entries. 7. (b) Admitted that you ought to have known that separate claims for UDAs for the provision of prescriptions ought not to have been made as the claims split a course of treatment into separate Not admitted that you knew or that you created false dates and entries to support the claims Proved for the same reasons as in 7(a). 7. (c) Admitted that you ought to have known that separate claims for UDAs for the provision of prescriptions ought not to have been made as the claims split a course of treatment into separate Not admitted that you knew or that you created false dates and entries to support the Proved for the same reasons as in 7(a). 7. (d) Admitted that you ought to have known that separate claims for UDAs for the provision of prescriptions ought not to have been made as the claims split a course of treatment into separate Not admitted that you knew or that you created false dates and entries to support the Proved for the same reasons as in 7(a). 7. (e) Admitted that you ought to have known that separate claims for UDAs for the provision of prescriptions ought not to have been made as the claims split a course of treatment into separate Not admitted that you knew or that you created false dates and entries to support the Proved for the same reasons as in 7(a). 7. (f) Admitted that you ought to have known that separate claims for UDAs for the provision of prescriptions ought not to have been made as the claims split a course of treatment into separate Not admitted that you knew or that you created false dates and entries to HOUGHTON, D E Professional Conduct Committee Dec 2014 Page -8/22-

9 support the Proved for the same reasons as in 7(a). 7. (g) Admitted that you ought to have known that separate claims for UDAs for the provision of prescriptions ought not to have been made as the claims split a course of treatment into separate Not admitted that you knew or that you created false dates and entries to support the Proved for the same reasons as in 7(a). 7. (h) Admitted that you ought to have known that separate claims for UDAs for the provision of prescriptions ought not to have been made as the claims split a course of treatment into separate Not admitted that you knew or that you created false dates and entries to support the Proved for the same reasons as in 7(a). 7. (i) Admitted that you ought to have known that separate claims for UDAs for the provision of prescriptions ought not to have been made as the claims split a course of treatment into separate Not admitted that you knew or that you created false dates and entries to support the Proved for the same reasons as in 7(a). 7. (j) Admitted that you ought to have known that separate claims for UDAs for the provision of prescriptions ought not to have been made as the claims split a course of treatment into separate Not admitted that you knew or that you created false dates and entries to support the Proved for the same reasons as in 7(a). 7. (k) Admitted that you ought to have known that separate claims for UDAs for the provision of prescriptions ought not to have been made as the claims split a course of treatment into separate Not admitted that you knew or that you created false dates and entries to support the Proved for the same reasons as in 7(a). 8. Admitted and proved 9. (a) Admitted that you ought to have known that the claims for UDAs ought not to have been made as you had not provided incomplete Band 3 treatment. made or that you created false dates and entries to support the Proved as charged The Committee found on the balance of probabilities that you knew that the claims for UDAs ought not to have been made as you had not provided incomplete Band 3 treatment. You knew that there were some models for incomplete denture work in your possession. You said that you did not check the lab dockets to confirm whether the patient was a private or NHS patient neither did you cross-refer with the paper records which you said were in the loft of the practice. Although your practice is mixed NHS and private as evidenced to this Committee, you said that you assumed that the dentures you found were for NHS patients because you were principally an NHS and HOUGHTON, D E Professional Conduct Committee Dec 2014 Page -9/22-

10 you felt you were entitled to payment for the work done. The Committee found it incredible that a dentist would look at a lab docket without looking at it in detail. This patient, Patient 6, had a consultation with you on 10 th December 2007 and had impressions taken for dentures which he did not proceed with. Patient 6 in his witness statement said that his only visit to your previous practice was on 10 th December When making a claim for the incomplete denture work you entered the date of last visit as 27 th January In relation to whether you created false dates and entries to support the claims, the Committee found that you created fictitious records in order to facilitate the transmission of the claim. 9. (b) Admitted that you ought to have known that the claims for UDAs ought not to have been made as you had not provided incomplete Band 3 treatment. made or that you created false dates and entries to support the Proved as charged The Committee found that you knew that the claim ought not to have been made. The records before the Committee show that the patient did not attend an appointment on 25 th March During your evidence in chief you acknowledged that the treatment you provided to this patient occurred several years before you made the claim for the incomplete denture. You said that you thought the lab work had been paid for and as such you were entitled to the claim. You accepted that it would have been appropriate to inform the NHS Business Services Authority that the incomplete work claimed for was done in You made the claim for incomplete Band 3 treatment on the basis of shellac trays which you found in your surgery. Mr Scott stated in his report that the patient was referred to an implant specialist in 2008 when implants and dentures were provided. The patient attended for a Band 1 scale and polish course of treatment 5 weeks prior to your claim for incomplete denture work. There is no evidence in the records of an intention to provide denture or incomplete denture work from the past. Your claim for the incomplete denture showed a Band 1 charge to the patient with a Band 3 claim for 12 UDAs. The Committee found that you made inaccurate entries on a date on which you did not treat the patient in order to facilitate your claim for incomplete Band 3 treatment. You told the Committee that the dates were not false but were dates on which the records were made. The Committee found that in creating inaccurate dates of acceptance and completion of a course of treatment, you created false dates and made false entries for the purposes of the claim. 9. (c) Admitted that you ought to have known that the claims for UDAs ought not to have been made as you had not provided incomplete Band 3 treatment. made or that you created false dates and entries to support the HOUGHTON, D E Professional Conduct Committee Dec 2014 Page -10/22-

11 Proved as charged You created an entry on the computer records for an examination of Patient 9 on 25/01/2010 with no details of diagnosis or treatment plan. You then created a treatment plan dated 27/05/2010 with entries about the patient s oral condition. Patient 9 stated in his witness statement that he last attended the practice in November 2007 and joined a new practice in December He also stated that he recalled impressions being taken in 2007 for the repair of his dentures. Your evidence to the Committee was that you saw a lab docket for a special tray which looked like work for an incomplete denture and you thought you were entitled to payment for the work. You told the Committee that you did not notice that the lab docket showed the year The Committee found that you knew that the claims for the incomplete dentures ought not to have been made. It also found that the computer records you created for Patient 9 in 2010, a patient who last attended in 2007, for the purposes of making a claim for work which may have commenced in 2007 were inaccurate and as such false. 9. (d) Admitted that you ought to have known that the claims for UDAs ought not to have been made as you had not provided incomplete Band 3 treatment. made or that you created false dates and entries to support the Proved as charged You created an entry on the computer records for an examination of Patient 21 on 25/01/2010 with no details of diagnosis or treatment plan. You then created a treatment plan dated 27/05/2010 with entries about the patient s oral condition. Patient 21 did not attend an appointment on either of these dates. Mr Scott stated in his report that according to the computer records, Patient 21 last attended on 07/11/2008. Your evidence was that you felt you were entitled to payment for the work done so far. You did not provide the Committee with a satisfactory explanation for why you did not look back at the records to confirm that the work had not been claimed for in the past. 9. (e) Admitted that you ought to have known that the claims for UDAs ought not to have been made as you had not provided incomplete Band 3 treatment. made or that you created false dates and entries to support the Proved as charged Patient 24 is your mother and you told the Committee that no lab work was available for her as you gave it to her, and you were unable to take steps to recover it. However you insisted that the work had been done. Mr Scott stated in his report that an examination took place in March 2010, a claim for this as Band 1 was submitted on 6 th April A Band 3 claim was submitted in 25/05/2010 showing a date of acceptance of 28/03/2010, a date on which the patient did not attend the practice. The entry in this regard was false as no lab work was available, despite the entry you placed in the records that lab work could be viewed. 9. (f) Admitted that you ought to have known that the claims for UDAs ought not to have been made as you had not provided incomplete Band 3 treatment. HOUGHTON, D E Professional Conduct Committee Dec 2014 Page -11/22-

12 made or that you created false dates and entries to support the Proved as charged Patient 25 is your deceased Grandmother who never attended the practice. You told the Committee that you treated Patient 25 during a domiciliary visit to her care home. The Committee received evidence in the form of a death certificate that she died on 3 rd March You created an entry on the computer records for an examination of Patient 25 on 21/01/2010. You then created a treatment plan dated 27/05/2010 with entries about the patient s oral condition. However even if the treatment was provided in the way you stated, her death pre-dated the inception of the new NHS contract by 3 years and your claim by 7 years. The Committee found that you knew that the claim ought not to have been made and you created false dates and false entries to facilitate your claim for incomplete denture. 9. (g) Admitted that you ought to have known that the claims for UDAs ought not to have been made as you had not provided incomplete Band 3 treatment. made or that you created false dates and entries to support the Proved as charged The records seen by the Committee all show that this patient was treated throughout as a private patient and therefore your submission of a Band 3 claim for incomplete denture work was wholly inappropriate. 9. (h) Admitted that you ought to have known that the claims for UDAs ought not to have been made as you had not provided incomplete Band 3 treatment. made or that you created false dates and entries to support the Proved as charged Patient 54 in her witness statement said that she last attended the practice in 2007 as an NHS patient when she was provided with a denture. You created an entry on the computer records for an examination of Patient 54 on 26/02/2010 with no details of diagnosis or treatment plan. You then created a treatment plan dated 27/05/2010 with entries about the patient s oral condition. The records show that the denture was fitted on 18 th December 2007 and paid for on 31 st December Your evidence was that you found a set of models in your drawer, you saw the initials for Patient 54 and you assumed that they related to this patient and made the claim. You said that in fact it related to a male patient. However there is no evidence before the Committee of another male patient with the same details as Patient 54. The Committee found that on the balance of probabilities you knew that the claim ought not to have been made. It also found that you created fictitious dates of acceptance and completion in 2010 for a patient who last attended the practice in 2007; you provided a false treatment plan giving a clinical description which was not based on any examination of the patient in Mr Scott noted in his report that there is a record of unsatisfactory denture initially provided on 04/09/2007, rejected by the patient on 18/10/2007. HOUGHTON, D E Professional Conduct Committee Dec 2014 Page -12/22-

13 10. Admitted and proved 11. (a) Admitted that you ought to have known that the claims for UDAs ought not to Proved as charged A crown was claimed on 24/02/2010. A second Band 3 claim for the same tooth was submitted two days later. The Committee did not accept your evidence that this was a genuine error because the records show that the course of treatment for the provision of the crown was closed on 24/02/2010. In order to justify another claim, a new treatment plan needed to be created deliberately. On the balance of probabilities, the Committee was satisfied that you knew that the claim ought not to have been made. 11. (b) (i) Admitted that you ought to have known that the claims for UDAs ought not to Proved as charged The Committee accepts that the claims cited in 11(b) to 11(i) which you admitted doing are examples of you either splitting a course of treatment or closing a claim early to make it fall within a particular UDA year. It is clear that these entries were inaccurate and thereby false and for reasons the Committee has given previously, it is satisfied that you knew the correct procedure. 11. (b) (ii) Admitted that you ought to have known that the claims for UDAs ought not to Proved as charged for the same reasons in 11(b)(i). 11. (c) Admitted that you ought to have known that the claims for UDAs ought not to HOUGHTON, D E Professional Conduct Committee Dec 2014 Page -13/22-

14 11. (d) (i) Admitted that you ought to have known that the claims for UDAs ought not to 11. (d) (ii) Admitted that you ought to have known that the claims for UDAs ought not to 11. (e) (i) Admitted that you ought to have known that the claims for UDAs ought not to 11. (e) (ii) Admitted that you ought to have known that the claims for UDAs ought not to 11. (e) (iii) Admitted that you ought to have known that the claims for UDAs ought not to 11. (f) (i) Admitted that you ought to have known that the claims for UDAs ought not to HOUGHTON, D E Professional Conduct Committee Dec 2014 Page -14/22-

15 11. (f) (ii) Admitted that you ought to have known that the claims for UDAs ought not to 11. (g) (i) Admitted that you ought to have known that the claims for UDAs ought not to 11. (g) (ii) Admitted that you ought to have known that the claims for UDAs ought not to 11. (g) (iii) Admitted that you ought to have known that the claims for UDAs ought not to 11. (h) (i) Admitted that you ought to have known that the claims for UDAs ought not to HOUGHTON, D E Professional Conduct Committee Dec 2014 Page -15/22-

16 11. (h) (ii) Admitted that you ought to have known that the claims for UDAs ought not to 11. (h) (iii) Admitted that you ought to have known that the claims for UDAs ought not to 11. (i) (i) Admitted that you ought to have known that the claims for UDAs ought not to 11. (i) (ii) Admitted that you ought to have known that the claims for UDAs ought not to 12. (a) Admitted and proved 12. (b) Admitted and proved 12. (c) Not admitted but proved The Committee is satisfied that a reasonable and honest dentist would have no hesitation in concluding that your actions in manipulating the claims process to claim UDAs to which you were not entitled was dishonest. HOUGHTON, D E Professional Conduct Committee Dec 2014 Page -16/22-

17 In deciding whether you knew that what you were doing was dishonest, the Committee has taken into account the fact that you carried out what is clearly a sophisticated deception over a relatively lengthy period. It has considered your explanation that your health impacted on your thinking processes but has discounted this as a valid explanation particularly as there is no evidence that any health issue impacted on your practice as a dentist clinically. In particular in relation to the prescription claims the Committee has noted that your yellow sticky notes system required considerable concentration to achieve the intended result. Additionally the suggestion by you that it was proper to claim for treatment provided to your grandmother seven years after her death and three years prior to the introduction of the 2006 NHS contract, demonstrates a clear dishonest intention on your part. For all these reasons the Committee has decided that you were well aware that your actions were dishonest. We move to Stage Two. On 10 December 2014 the Chairman announced the determination as follows: Dr Houghton, Having made its decision on the facts alleged, the Committee heard submissions on misconduct, impairment and sanction from Ms Barnfather on behalf of the General Dental Council and from Mr Foster on your behalf. The Committee carefully considered the mitigation bundle presented on your behalf at this stage. It accepted the advice of the Legal Adviser. Background Between March 2007 and February 2011 you practised at the West Parade Dental Care Practice (the Practice) first as an Associate and then as a Partner from You provided National Health Service (NHS) dental treatment under the terms of the Practice s contract with Lincolnshire PCT. You also provided private treatment to patients. In 2010, concerns were raised with Dr H, one of the partners, about your practice. This led to a Quality and Outcomes Framework (QOF) audit being commenced in the Summer of 2010, in relation to prescribing patterns. Dr H and Dr W, partners at the practice, who gave evidence to this Committee, stated that it was agreed that the QOF audit would be conducted by way of peer review. Despite this, you carried out an audit of your own records and presented it as a true reflection of the records. The practice decided to proceed as planned and carried out its own audit of your records. Significant differences were identified between your prescribing audit, and that carried out by the practice. For example, it was noted that for the period reviewed, you stated in your audit that you had prescribed antibiotics in 58 cases whereas the practice audit identified 108 antibiotic prescriptions. The practice audit also revealed that the dosages and quantity of the antibiotics prescribed were higher than recommended. As a result of these findings, the practice carried out a review of your patient records. It was discovered that some claims for treatment had been made when patients had not attended the practice according to the appointment record and there appeared to be a high number of claims made just before the end of the Unit of Dental Activity (UDA) year. Following a meeting with you in October 2010, the partners referred their concerns to the PCT. The facts found proved fall into two categories: HOUGHTON, D E Professional Conduct Committee Dec 2014 Page -17/22-

18 1. Issuing private and NHS prescriptions to members of your family and a colleague for non-dental purposes; and 2. Making inappropriate, misleading and dishonest claims against the NHS. These inappropriate claims can be classified into the following: a. Making separate claims for UDAs for the provision of prescriptions issued as part of a course of treatment, thereby splitting a course of treatment into separate claims and creating false dates and entries to support the claims; b. Making claims for UDAs in respect of incomplete Band 3 treatment (dentures) and creating false dates and entries to support the claims; c. Making claims for UDAs in respect of various dental treatments thereby splitting a course of treatment into separate claims and creating false dates and entries to support the claims, including the closure of courses of treatment prematurely, to fall before the UDA The Committee found proved all the facts alleged in the amended charge including that your conduct was dishonest in making claims to the NHS for UDAs which you were not entitled to receive. Misconduct The Committee first considered whether the facts found proved amount to misconduct. Ms Barnfather informed the Committee that you have no previous fitness to practise history with the GDC. She submitted that you made a series of dishonest claims for your own financial advantage, including falsifying patient records, thereby deliberately exploiting a system which relies heavily on the probity of dentists. She stated that you issued prescriptions which were far outside the scope of dental practice. These prescriptions included drugs with side effects which are outside your training as a dentist. Ms Barnfather submitted that your actions were serious and undoubtedly amount to misconduct. She referred the Committee to the GDC s Standards Guidance applicable at the time of these events, Standards for Dental Professionals (May 2005) and in particular paragraphs 1.1; 1.3; 1.4; 6.1; 6.2 and 6.3. Mr Foster acknowledged that the Committee may have no difficulty with making a finding of misconduct. The Committee found proved that in relation to the private and NHS prescriptions for nondental purposes, you prescribed drugs such as Fluconazole, Zopiclone, Viagra, Lorazepam, Amoxicillin and Ibuprofen to members of your family, and to a colleague. Mr Brookes, General Dental Practitioner, in his expert report to the Committee dated 2 nd April 2014, on the prescribing allegation, stated that you were prescribing: without an identified need or good clinical justification; outside of normal dosage and duration; without indicating the dosage, frequency or duration of medication; without making and keeping accurate and complete records. HOUGHTON, D E Professional Conduct Committee Dec 2014 Page -18/22-

19 The GDC Scope of Practice advises that dental professionals should only carry out a task or type of treatment or make decisions about a patient s care if they are sure that they have the necessary skills. The GDC Guidance on responsible prescribing (January 2008) recommends that dentists should not prescribe drugs other than to meet the identified dental needs of [their] patients. [Dentists] must make an appropriate assessment of [their] patient s condition, prescribe within [their] experience and competence and keep accurate records of treatment. The Guidance also states that part of prescribing drugs responsibly means prescribing only where you are able to form an objective view of your patient s health and clinical needs Dentists who prescribe drugs for themselves and those close to them may not be able to remain objective and risk overlooking serious problems, encouraging or tolerating addiction, or interfering with care or treatment provided by other healthcare professionals. Other than in emergencies, you should not therefore prescribe drugs for yourself or for anyone with whom you have a close personal or emotional relationship. You told the Committee that you wrote the prescriptions for members of your family because they liked to keep a stash of these medicines and also that you liked to help people out. You made no records of the prescriptions you issued and there is no evidence of any clinical need identified by you which necessitated prescribing these medicines. The inappropriate claims found proved by the Committee were repeated, systematic, and serious, spanning a considerable period of time. You inappropriately claimed for prescriptions in circumstances when an existing course of treatment was open or when the prescription should have been included as part of a course of treatment previously provided, or when the patient did not attend the practice. You split courses of treatment inappropriately by claiming for each episode of treatment instead of including all the elements in a single course of treatment; you created false dates and entries to support your claims including entering false dates of acceptance and/or completion. In some cases you split a course of treatment so that the treatment would fall before the UDA On at least 8 occasions you claimed for starting, but not completing, Band 3 courses of treatment involving the provision of dentures. In each case you entered a false date of acceptance on the claim and in some cases concealed the fact that the patients had not attended the practice for a number of years, or were receiving private treatment. The Committee was of the view that you devised a sophisticated method of manipulating the system to obtain payment for UDAs which were not due to you. It was also of the view that your conduct was pre-meditated with the intention to defraud the NHS. Given the raft of inappropriate and dishonest claims found proved, including the inappropriate private and NHS prescriptions for non-dental purposes, the Committee was in no doubt that your actions amount to misconduct. Impairment The Committee next considered whether your fitness to practise is currently impaired by reason of your misconduct. In reaching its decision, it exercised its own independent judgement. Ms Barnfather submitted that your failings in relation to the non-dental prescribing may be remediable but there is a risk of repetition giving your attitude as displayed in your oral evidence. She stated that you showed a complete lack of appreciation of the risks involved in your actions and on occasion you offered as justification the assertion that other dentists prescribed in the same manner. Ms Barnfather submitted that your dishonest conduct is not so easily remediable. She stated that the need to declare and uphold standards of conduct in the profession requires a finding of current impairment. HOUGHTON, D E Professional Conduct Committee Dec 2014 Page -19/22-

20 Mr Foster accepted on your behalf that the Committee would have little difficulty in finding current impairment given the nature of the facts found proved. The Committee was of the view that the non-dental prescribing may be capable of remediation. It received your Personal Development Plan (PDP) which included audits in clinical record keeping and prescriptions for antibiotics. The Committee noted that you are actively mentored by the principal of the practice where you now work. It also took account of the notes of your meetings with Mr Wright, Dentists in Difficulty Advisor, and the reports written by your mentor, Mr Bright. The Committee concluded that you have gone some way towards remediating your inappropriate prescribing failings and the likelihood of repetition is minimal in this respect. However, the Committee noted that there was a lack of sufficient reflective material demonstrating your understanding of why prescribing for non-dental purposes was criticised. The Committee considers that dishonesty is not easily remediable and you have demonstrated no remorse or insight. Your evidence to the Committee revealed a lack of acknowledgement and responsibility as well as a tendency to obfuscate when questions were put to you. The Committee found that your oral evidence was often not credible, and even untruthful at times. It appeared from your oral evidence that your initial reaction to challenge was to blame others rather than accept responsibility. The Committee could not rely on your integrity as a professional. The Committee noted that Mr Bright in his letter dated 25 th April 2013 stated that I did not realise that the allegations were so serious that it could jeopardise inclusion on the NHS dental list. It considers that this reflects the level of seriousness you placed on the issues when you reported them to Mr Bright and demonstrates the level of your insight. Your selfreflection in your personal development plan demonstrates no insight into the dishonest failings. There has been no acknowledgement before this Committee by you of your dishonesty or of its wider implications for the profession. The Committee considers that there is a high risk of repetition of your failings in the absence of any evidence of your insight. The Committee also considers that the need to uphold proper professional standards and to maintain public confidence in the profession would be undermined if a finding of impairment were not made in this case. Given the severity of the dishonest findings, the lack of insight, and considering their effect on the wider public interest, the Committee concluded that your fitness to practise is currently impaired by reason of your misconduct.. Sanction Having found your fitness to practise to be impaired by reason of your misconduct, the Committee next considered what sanction, if any, to impose upon your registration. It reminded itself that the purpose of sanctions is not to be punitive although they may have that effect. The Committee bore in mind the principle of proportionality and its duty to protect the public and declare and uphold proper standards of conduct and behaviour so as to maintain public confidence in the profession. It carefully considered the GDC s Guidance for the Professional Conduct Committee (November 2009)(the Guidance) as referred to by Ms Barnfather. The Committee was of the view that its findings are so serious that the wider public interest would not be protected if the case were to be concluded with no further action. For the same reasons it concluded that a reprimand would be inappropriate. HOUGHTON, D E Professional Conduct Committee Dec 2014 Page -20/22-

21 The Committee then considered whether to impose conditions on your registration. Mr Foster proposed that conditions would exceptionally be the appropriate disposal in this case. The Committee was of the view that conditions could address the failings relating to nondental prescribing, but where there is dishonest conduct and a lack of insight into such conduct, there are no conditions that could adequately address the public interest concerns that arise from such findings. The Committee noted that there are currently conditions relating to your inclusion in the performers list and that you have been working without further concerns about your prescribing or claiming pattern. It also noted that your registration is currently subject to interim conditions. Nevertheless, the Committee s findings in relation to dishonesty are such that no conditions could be formulated to address the wider public interest issues. The Committee then considered whether a period of suspension would adequately address the wider public interest concerns arising from your dishonest conduct. It took account of the 2009 Guidance particularly at paragraph 40. Your dishonest conduct is in the Committee s view damaging to your fitness to practise and public confidence in dental professionals such that removal of your professional status is the appropriate outcome. You have demonstrated no remorse, acceptance or insight into your conduct. Your evidence to this Committee on oath was not credible and at times involved a degree of confabulation. Paragraph 42(e) of the Guidance states that Patients, employers, colleagues and others have a right to rely on registrants integrity. Important choices about treatment options and significant financial decisions can be made on the basis not only of registrants skill but also of their honesty. Dishonesty, particularly when associated with professional practice, is highly damaging to a registrant s fitness to practise and to public confidence in dental professionals. Given the Committee s conclusions that this was a systematic and carefully thought out process which required a high level of concentration, and in the absence of remorse or insight, the imposition of a sanction of suspension is not sufficient or appropriate. Although erasure from the register will remove your ability to practise dentistry, the Committee considers that the wider public interest far outweighs your own interest. As a consequence the Committee has determined to direct that your name be erased from the Dentists Register pursuant to section 27B(6)(a) of the Dentists Act 1984, as amended. The Committee will now invite submissions on whether an immediate order should be imposed in this case. Dr Houghton, The Committee has taken account of the submissions made by Ms Barnfather on behalf of the General Dental Council (GDC) and those made by Mr Foster on your behalf. It has accepted the advice of the Legal Adviser. Taking into account the Committee s findings in relation to inappropriate prescribing, it is of the view that there is a potential risk to patients if an immediate order of suspension was not made. It has also determined that given the serious nature of the findings made, public confidence in the profession and the regulatory process would be undermined if an immediate order of suspension was not made. Accordingly the Committee has determined to make an order of immediate suspension. The effect of the foregoing direction and this decision is that your registration will be suspended forthwith and unless you exercise your right to appeal, the substantive direction HOUGHTON, D E Professional Conduct Committee Dec 2014 Page -21/22-