HEARING HEARD IN PUBLIC

Transcription

1 HEARING HEARD IN PUBLIC ONCERIU, Meliana Doina Registration No: PROFESSIONAL CONDUCT COMMITTEE August 2015 August 2017 Most recent outcome: Suspended indefinitely * See page 16 for the latest determination Meliana Doina Onceriu, a registered dentist; DMD Iasi 1988; was summoned to appear before the Professional Conduct Committee on 3 August 2015 for an inquiry into the following charge: Charge That being registered as a dentist, your fitness to practise is impaired by reason of misconduct, in that: 1. You did not provide an adequate standard of care to Patient A on 5 October 2011, in that you: a. Failed to obtain informed consent for placing a crown at UR1 2. You did not provide an adequate standard of care to Patient A on 6 October 2011, in that you: a. Prepared UR1 for a crown when it was an inappropriate form of treatment for Patient A's presenting condition b. Over-prepared UR1 3. On 12 October 2011 you did not provide an adequate standard of care to Patient A when providing root canal treatment for UR1, in that you: a. Failed to take a diagnostic working length radiograph b. Failed to adequately seal the root canal c. Failed to take a post-operative radiograph 4. On 12 October 2011 you did not provide an adequate standard of care to Patient A, in that you failed to place a temporary crown on UR1 5. On 18 October 2011 you did not provide an adequate standard of care to Patient A when providing root canal treatment for UR1, in that you: a. Failed to take a diagnostic working length radiograph b. Failed to adequately seal the root canal 6. You did not maintain an adequate standard of record keeping in respect of Patient A's appointments between 5 October 2011 and 18 October 2011, in that: a. On 5 October 2011 you failed to report on a radiograph taken ONCERIU, M D Professional Conduct Committee August 2015 August 2017 Page -1/20-

2 b. On 12 October 2011 you failed to record root canal treatment provided for UR1 c. You inaccurately recorded treatment you had provided on 12 October 2011 as being provided on 18 October 2011 AND, that therefore your fitness to practise as a dentist is impaired by reason of misconduct. Ms Onceriu was not present and was not represented. On 4 August 2015 the Chairman announced the findings of fact to the Counsel for the GDC: Service and proceeding in the absence of the Registrant Mr Ismail: You are representing the General Dental Council (GDC) at the Professional Conduct Committee (PCC) hearing of Ms Onceriu s case. Ms Onceriu is neither present nor represented today. The Committee has seen a copy of the Notification of the Hearing letter of today s PCC hearing dated 17 June 2015 which was sent by Blake Morgan Solicitors, acting on behalf of the GDC, to Ms Onceriu s registered address in Romania by special delivery, first class post and . The letter sets out the date, time and location of today s hearing, as well as the particularised facts of the charge. The Committee is satisfied that this letter complies with Rule 13 of the GDC s (Fitness to Practise) Rules Order of Council 2006 (the Rules). The Royal Mail track and trace service confirms that the item was posted on 17 June 2015 and was delivered to Romania on 25 June 2015, which, the Committee notes, is more than 28 days notice of this PCC hearing. The Committee has received from the GDC a supplemental bundle which contains an dated 19 July 2015 from Ms Onceriu to Blake Morgan Solicitors in which she acknowledges receipt of the documents in respect of today s hearing. Taking all these matters into account, the Committee is satisfied that the GDC has complied with the requirements of service in accordance with Rule 65. The Committee then went on to consider whether to hear this case in the absence of Ms Onceriu, in accordance with Rule 54. You referred the Committee to Ms Onceriu s dated 19 July 2015 to Blake Morgan Solicitors in which she states that she will not be attending or be represented at the PCC hearing of her case. Ms Onceriu cites health problems for her reason for her non-attendance. She further states that she had decided to return to Romania in 2013, where she is currently residing. Finally, in response to a request for further clarification from Blake Morgan Solicitors as to whether she wished to request a postponement for her PCC hearing, Ms Onceriu stated in her dated 29 July 2015 that she did not wish to make such an application. You therefore submitted that Ms Onceriu has voluntarily absented herself from these proceedings and that it would be appropriate to proceed in her absence. You also referred to the serious nature of the allegations against Ms Onceriu, which date back to 2011, and submitted that it is in the public interest to proceed with the hearing. The Committee has considered the submissions you have made. It has accepted the advice of the Legal Adviser. It has borne in mind that the discretion to proceed in the absence of the respondent should be exercised with the utmost care and caution and that it must have in mind the fairness to Ms Onceriu as well as to the GDC. The Committee notes from Ms Onceriu s dated 19 July 2015 to Blake Morgan Solicitors that she states clearly that she does not intend to participate in her hearing due to health concerns. Furthermore, in her dated 29 July 2015, Ms Onceriu s confirms that she does not wish to apply for an ONCERIU, M D Professional Conduct Committee August 2015 August 2017 Page -2/20-

3 adjournment. In the light of these s, the Committee has concluded that Ms Onceriu has voluntarily absented herself from attending this PCC hearing. The Committee has received no compelling reasons as to why it should adjourn this PCC hearing and in any event it considers that no useful purpose could be gained by adjourning. It has also had regard to the public interest, and Ms Onceriu s own interests, in the expeditious disposal of her case, particularly given the age of the allegations. The Committee notes that Ms Onceriu has provided the GDC with her written response to the allegations in an dated 1 December 2014, which it will take into account when considering this case. Accordingly, the Committee has decided that it is fair to proceed in the absence of Ms Onceriu and has therefore exercised its discretion to do so, in accordance with Rule 54. The GDC s case This case concerns Ms Onceriu s treatment of Patient A s tooth at UR1. Ms Onceriu treated Patient A at the Kimberley Family Dental Practice (the Practice) between 5 October 2011 and 20 October At the first consultation on 5 October 2011 Patient A presented with a small chip or a lost filling from the corner of her tooth at UR1. During the course of the four appointments in October 2011 (5, 6, 12 and 18) Ms Onceriu provided a crown and following this, root canal treatment to Patient A s UR1. Patient A attended a walk-in centre for emergency treatment on 15 October 2011 where she was treated by a dentist (witness 1). She attended her final appointment with Ms Onceriu on 18 October Patient A was not satisfied with the treatment provided and therefore she attended another dentist, on 16 November Dentist 1 re-treated the root canal at UR1 on 6 December On 24 November 2011 Patient A wrote a letter of complaint to the Practice. The GDC s case is that the placing of a crown at UR1 was an inappropriate and overly invasive form of treatment for Patient A s presenting condition. It alleges a number of shortcomings in Ms Onceriu s preparation of the crown; the provision of root canal treatment and her record keeping in respect of Patient A s appointments with the Registrant. Ms Onceriu s case The Committee has had regard to Ms Onceriu s statement dated 1 December 2014 to the GDC. It considers that she provides limited information to the allegations against her and appears to be blaming factors such as being placed under pressure by Patient A and the lack of materials and advanced endodontic equipment at the Practice as to her reasons why certain procedures were not done. The evidence In considering the allegations against Ms Onceriu, the Committee has had regard to all the evidence before it. The documentary evidence included the GDC s main prosecution bundle which contained, inter-alia, the signed witness statement of Patient A dated 23 April 2015, her letter of complaint to the Practice dated 24 November 2011 as well as the photographs of her teeth. It notes that Patient A was not called to give evidence in person. The Committee has also had regard to the evidence of Witness 1. He read his signed witness statement dated 16 March In addition, the Committee has had regard to the expert evidence of Mr Kramer, as set out in his report dated 14 May 2015, and confirmed in his oral evidence. The Committee considered that Mr Kramer gave a fair and balanced opinion in respect of the allegations against Ms Onceriu. Furthermore, when asked questions by the Committee Members, Mr Kramer reconsidered his opinion and, on some occasions, modified it. The Committee has accepted the evidence of Mr Kramer, who it felt was a credible and reliable witness. ONCERIU, M D Professional Conduct Committee August 2015 August 2017 Page -3/20-

4 The Committee has considered the submissions carefully. It has accepted the advice of the Legal Adviser. I will now announce the Committee s findings in relation to each charge: 1.(a) 2.(a) Found not proved Patient A s evidence, was that she attended for an appointment on 5 October 2011, complaining of a chipped tooth or having lost a filling of her UR1. Mr Kramer s evidence was the only reasonable options for the treatment of Patient A s UR1 were to take no further action or to provide a filling. He considered that this form of treatment was sufficient and that any other form of treatment would have been unnecessarily invasive. Mr Kramer considered that suggesting any form of treatment other than a filling, or replacement filling, would fall far below the standard expected of a general dental practitioner. Ms Onceriu s explanation, as set out in her representations to the GDC dated 1 December 2014, was that the options for the restoration of the tooth were discussed with the patient, as well as the risks and alternatives. She states: the patient decided to have the crown because she lost in the past her mesial fillings many times from the tooth and finally was fractured. Although there is no record of a diagnosis, the Committee has seen the entry in Patient A s notes for 5 October 2011 which records the following: discussed options, decide crown. Pt happy tcb. There is a further entry for that date, in different handwriting, which records the following: Discussed the alternatives and risks about the treatment that she will undergo. Although it is not clear from these two entries as to whether or not a discussion took place about the option of having a filling, the Committee is satisfied that these two entries indicate that a discussion took place with Patient A as to the risks and benefits of treatment. Patient A confirmed in her witness statement that she agreed to a crown being fitted. In these circumstances the Committee concluded that a range of treatment options may have been discussed before Patient A consented to a crown. The Committee was not satisfied on the balance of probabilities that her consent was un-informed. Found proved The records show that Ms Onceriu advised the patient on 5 October 2011 that the UR1 should be restored by a crown. The records also show that Ms Onceriu took a radiograph of the UR1 on 5 October 2011, which, in the opinion of Mr Kramer, did not indicate any pathology associated with the tooth. Patient A attended the Practice on 6 October 2011 and the UR1 was prepared for a crown. Mr Kramer s opinion was that the only reasonable form of treatment was a filling. He considered that any other form of treatment other than a filling would have been unnecessarily invasive in that a considerable amount of sound tooth tissue would have to be removed in order to provide the treatment. He explained that the provision of a crown would necessitate the removal of a large amount of sound tooth substance and would put the tooth at risk of loss of vitality, with the consequence of the tooth becoming weaker. He described the ONCERIU, M D Professional Conduct Committee August 2015 August 2017 Page -4/20-

5 2.(b) 3.(a) 3.(b) 3.(c) treatment as being unnecessarily aggressive and that the long term prognosis of the tooth would be very poor. The Committee has accepted Mr Kramer s evidence on this matter. In her response to this charge, Ms Onceriu did not address the reasons as to why she preferred root canal treatment and a crown to any other option. Found proved Mr Kramer s evidence was the amount of tooth reduction for the preparation of the crown should be kept to minimum. He explained that there should be a reduction of approximately 1.2mm depth off the mesial, distal, labial and incisal surfaces of the tooth. He drew the Committee s attention to the photographs of Patient A s teeth taken on 12 October 2011 and 15 October 2011 which showed clearly that the reduction appeared to be approximately 3mm. Mr Kramer s opinion was that this demonstrated that the tooth had been grossly over-prepared. The Committee has accepted Mr Kramer s evidence on this matter. In her response to this charge, Ms Onceriu did not address this matter. Found proved Mr Kramer s evidence was that it is standard practice to take a diagnostic working length radiograph with a root canal instrument within the root canal, in order to determine the length to which the root canal should be prepared. There is nothing in the records to show that such a radiograph was taken. The Committee has accepted Mr Kramer s evidence on this matter. Ms Onceriu, in her statement to the GDC dated 1 December 2014, explained that the Practice had sub-standard materials for treatment, or lack of equipment. However, the Committee considers this explanation does not excuse her failure to take a working length radiograph. Found proved Mr Kramer explained that the preparation and sealant should extend to within 2mm of the radiographic root apex and the sealant should completely fill the canal and be contained within it. In his evidence, Mr Kramer referred to the radiograph taken on 15 October 2011 by Witness 1, the treating dentist at the walk in centre, which showed that the sealant point, used to seal the root canal following preparation, extended to between six and seven millimetres beyond the radiographic root apex. Mr Kramer s opinion, which the Committee has accepted, is that allowing sealant beyond the root apex by the amount seen on the radiograph taken on 15 October 2011, indicates a lack of care and attention. In her response to this charge, Ms Onceriu did not address this matter. Found proved There is nothing in the records to show that a post-operative radiograph was taken on 12 October Mr Kramer s evidence was that a postoperative radiograph should have been taken to check the effectiveness of the root canal treatment provided and so as to avoid placing a restoration on a tooth where there were problems with the root canal ONCERIU, M D Professional Conduct Committee August 2015 August 2017 Page -5/20-

6 treatment. 4. Found proved 5.(a) 5.(b) 6.(a) 6.(b) Ms Onceriu stated that the crown was due to be fitted on that date but that the laboratory had requested a new impression. She further stated that she did not cement a temporary crown on UR1 on 12 October 2011 because the patient s gum was very sensitive. Mr Kramer was critical of Ms Onceriu s failure to place a temporary crown on UR1. He explained that leaving the dentine exposed put the tooth and root canal system at risk of bacterial ingress via the dentine with consequent infection developing. He also explained that leaving the tooth without a temporary crown would have meant that it was unsightly and was likely to be embarrassing and uncomfortable for the patient. The Committee has accepted Mr Kramer s evidence on this matter. Found proved The records indicate that Patient A presented in pain and the root canal treatment was re-done on 18 October There is nothing in the records to indicate that a working length radiograph had been taken, or that an electronic apex locator had been used on 18 October In her response to this charge, Ms Onceriu did not address this matter. Found proved In his evidence Mr Kramer referred to the pre-operative radiograph that was taken by Person 1 on 16 November 2011, which showed that some form of root canal treatment had been provided prior to that date in that the appearance of the sealant within the root canal was different to that on 15 October He considered that the end result of the root canal re-treatment was unsatisfactory in that Ms Onceriu had failed to obturate fully the root canal. The Committee accepts Mr Kramer s evidence on this matter. Found proved A radiograph was taken on 5 October 2011 and Ms Onceriu confirms that one was taken so as to check the implantation in the bone of the tooth and the periapical area. However, there is no report of the radiograph in Patient A s notes. Mr Kramer s evidence is that he would have expected to have seen a record of the radiograph having been taken and a comment as to what was seen, in accordance with the Ionising Radiation (Medical Exposure) Regulations [2000] (IRMER). The Committee is satisfied that there is no report on the radiograph taken on 5 October Found not proved The radiograph taken on 15 October 2011 indicates that root canal treatment had taken place on 12 October The notes for the entry for 12 October 2011 record the letters RCT, which, Mr Kramer accepted, could indicate that root canal treatment was provided. In the light of Mr Kramer s concession, the Committee considers that the letters ONCERIU, M D Professional Conduct Committee August 2015 August 2017 Page -6/20-

7 6.(c) RCT are sufficient for the purpose of the record and accordingly it is not satisfied that this charge is made out to the requisite standards. Found proved We move to Stage Two. The Committee accepts Mr Kramer s evidence that the record of treatment provided on 18 October 2011 is confusing and contradictory in that it appears to combine some of what took place on both 12 and 18 October The Committee considers that it is not credible that all of these procedures as described in the notes could have been carried out on the same day. On 4 August 2015 the Chairman announced the determination as follows: Mr Ismail: Misconduct The Committee has considered whether the facts found proved amount to misconduct. In so doing, the Committee has had regard to the evidence before it, as well as the submissions you have made on behalf of the General Dental Council (GDC). The Committee has accepted the advice of the Legal Adviser. You have referred to the serious nature of the findings, as well as the evidence of Mr Kramer (expert, on behalf of the GDC) where he considered that the failings identified amounted to falling far below the standards to be expected of a registered dentist. You also drew the Committee s attention to the relevant paragraphs of the GDC s Standards for Dental Professionals (May 2005), which, you say, Ms Onceriu has breached. In summary, you have submitted that the findings are serious and amount to misconduct. While noting your submissions, the Committee has exercised its own professional judgement. It has reminded itself of the findings against Ms Onceriu, which concern one patient, Patient A, and one tooth (her UR1). They are as follows: A failure to provide an adequate standard of care on 6 October 2011, in that she prepared UR1 for a crown when it was an inappropriate form of treatment for Patient A's presenting condition. She also over-prepared the UR1. On 12 October 2011 a failure to provide an adequate standard of care when providing root canal treatment for UR1, the cause of which was iatrogenic, in that she failed to take a diagnostic working length radiograph; she failed to adequately seal the root canal, placed gutta percha 6 to 7mm outside the apex of the tooth and she failed to take a postoperative radiograph. On 12 October 2011 a failure to provide an adequate standard of care in that she failed to place a temporary crown on UR1. On 18 October 2011 a failure to provide an adequate standard of care when attempting corrective root canal treatment for UR1, in that she failed to take a diagnostic working length radiograph and she failed to adequately seal the root canal. ONCERIU, M D Professional Conduct Committee August 2015 August 2017 Page -7/20-

8 A failure to maintain an adequate standard of record keeping in that on 5 October 2011 she failed to report on a radiograph taken and she inaccurately recorded treatment you had provided on 12 October 2011 as being provided on 18 October The Committee has been assisted by the expert evidence of Mr Kramer in judging whether or not there is misconduct. In his report dated 14 May 2015 he referred to the guidelines which were relevant in this case, including the guidance issued by the Faculty of General Dental Practitioners of the Royal College of Surgeons in He considered that the only appropriate form of treatment was a filling or a replacement filling and that by suggesting any other treatment would have been unnecessarily invasive, in that a considerable amount of sound tooth tissue would have to be removed in order to provide the treatment. Mr Kramer was clear in his evidence that Ms Onceriu s actions in placing a crown at UR1 when it was an inappropriate form of treatment for Patient A s presenting condition (with the UR1 presenting as symptomless) fell far below the standard expected of a general dental practitioner. He described this form of treatment as being unnecessarily aggressive and explained that it would be detrimental to the condition of the tooth and its long term prognosis. He further explained that the trauma suffered by the tooth as a result of the preparation should have been avoided. Mr Kramer was also critical of the standard of care in respect of the provision of root canal treatment on 12 October 2011, as well as Ms Onceriu s failure to place a temporary crown on UR1, which he said put the put the tooth and root canal system at risk of infection. The Committee concurs with Mr Kramer s opinion The Committee has had regard to the following paragraphs of the GDC s Standards for Dental Professionals, which it considers Ms Onceriu has breached: 1.1: Put patients interests before your own or those of any colleague, organisation or business. 1.3: Work within your knowledge, professional competence and physical abilities. Refer patients for a second opinion and for further advice when it is necessary, or if the patient asks. Refer patients for further treatment when it is necessary to do so. 1.4: Make and keep accurate and complete patient records, including a medical history, at the time you treat them. Make sure that patients have easy access to their records. 5.1: Recognise that your qualification for registration was the first stage in your professional education. Develop and update your knowledge and skills throughout your working life. 5.2: Continuously review your knowledge, skills and professional performance. Reflect on them, and identify and understand your limits as well as your strengths. 5.3: Find out about current best practice in the fields in which you work. Provide a good standard of care based on available up-to-date evidence and reliable guidance. The Committee notes that this case concerns one patient in respect of her treatment of one tooth and that the events in question took place during the course of several consultations in October However, it has had regard to the serious nature of the findings against Ms Onceriu, her breaches of relevant guidance and Mr Kramer s opinion that in a substantial number of areas, Ms Onceriu s conduct fell far below the standard to be expected. The Committee is concerned that her actions placed Patient A at risk of harm and that she caused irreversible damage to Patient A s UR1. You submitted that Ms Onceriu had mutilated a healthy tooth. The Committee agrees. The consequences for Patient A s tooth ONCERIU, M D Professional Conduct Committee August 2015 August 2017 Page -8/20-

9 were life long. In addition, the Committee is concerned that a number of the failings were in respect of elementary skills of dentistry. The Committee has heard that Patient A sought emergency treatment on 15 October Accordingly, the Committee is satisfied that the findings against Ms Onceriu amount to misconduct. Current fitness to practise The Committee next considered whether Ms Onceriu s fitness to practise is currently impaired by reason of her misconduct. In so doing, it has had regard to the submissions you have made on behalf of the GDC as well as Ms Onceriu s s to the GDC dated 1 December 2014 and 19 July In her dated 1 December 2014 Ms Onceriu states that she has discussed this case with her adviser from the Medical Protection Society. She makes the point that she will be very careful about her notes and will ensure that she allocates a longer time in which to treat her patients. Ms Onceriu also makes reference to her doing courses in risk management and root canal treatment, which, she says, gave her a better understanding in the process of communications and treatment of her patients. In her dated 19 July 2015 Ms Onceriu states that she was included in a risk management action plan from 24 May 2012 when she was a dentist in Nottingham. She also states that the evidence of her attendance at relevant courses was presented in her CPD folder. However, the Committee has received no certificates of her attendance at relevant courses and you confirmed that as of today s date, the GDC has not received this information. You refer to the serious nature of the findings, the absence of any remediation and the lack of any evidence of insight demonstrated by Ms Onceriu. You say that these factors give rise to risk of patient harm. Finally, you say that Ms Onceriu has breached one of the fundamental tenets of the profession in that she failed to put Patient A s interest first. In summary, you submit that Ms Onceriu s fitness to practise is currently impaired. The Committee has had regard to the serious nature of the findings against Ms Onceriu. It has received no evidence of her remediation of the shortcomings identified in this case, such as certificates of Continuing Professional Development (CPD) or a reflective log. In addition, the Committee has concerns about Ms Onceriu s lack of insight into her treatment of Patient A. In her statement to the GDC dated 1 December 2014, Ms Onceriu refers to the fact that she felt under pressure from the patient to complete the treatment. However, she has not shown any understanding as the serious clinical errors she made in respect of her treatment of Patient A or indeed offered an apology for the pain and suffering she caused her. In the Committee s view, Ms Onceriu has sought to minimise her failings in this case. The Committee is not satisfied that she has any insight into her conduct. Furthermore, there is no documentary evidence of any remediation of the shortcomings identified in this case, save for Ms Onceriu s brief reference to her having attended courses. The Committee is not satisfied that Ms Onceriu has even begun the process of remediating her failings in this case. Taking all these factors into account, the Committee has concluded that Ms Onceriu currently poses a risk to patients and therefore this raises a risk of repetition of her failings. The Committee has further considered the wider public interest, in particular the need to declare and uphold proper standards of conduct and behaviour, so as to maintain public confidence in the profession. The Committee has found that Ms Onceriu has breached relevant guidance and that she failed to provide an appropriate standard of care to Patient A. Ms Onceriu s treatment of Patient A was inadequate, resulting in harm to the patient. In these circumstances, the Committee considers that public confidence would be undermined if a finding of impairment were not made. ONCERIU, M D Professional Conduct Committee August 2015 August 2017 Page -9/20-

10 Having regard to all of these matters, the Committee has determined that Ms Onceriu s fitness to practise is currently impaired by reason of her misconduct. Sanction The Committee next considered what sanction, if any, to impose on Ms Onceriu s registration. It recognises that the purpose of a sanction is not to be punitive, although it may have that effect, but to protect patients and the wider public interest. The Committee has also had regard to the GDC s Guidance for the Professional Conduct Committee, including Indicative Sanctions Guidance (April 2015) (the Guidance). It has applied the principle of proportionality, balancing the public interest with Ms Onceriu s own interests. You have submitted that the appropriate sanction is the suspension of Ms Onceriu s registration for a period of 12 months and with a review hearing to take place before the expiry of the order. The Committee has received no submissions from Ms Onceriu on this matter, save to note that she is not currently practising in the United Kingdom and has returned to live in Romania. The Committee has considered the range of sanctions available to it, starting with the least restrictive. In view of the serious nature of Ms Onceriu s conduct, her lack of insight and the absence of any remediation, the Committee has determined that it would be inappropriate to conclude this case without taking any action in respect of her registration. Likewise, the Committee has concluded that it would be insufficient to reprimand Ms Onceriu. The Committee considered whether to impose conditions on Ms Onceriu s registration. It has borne in mind that any conditions imposed would have to be clear, workable, measurable and enforceable. The Committee considers Ms Onceriu has engaged with the GDC on a limited basis, despite being invited to engage on numerous occasions. Further, it is clear from her recent correspondence to the GDC that she has not accepted any shortcomings in respect of her practice and instead she has sought to blame other circumstances. Given her lack of insight into her conduct and her limited engagement with the GDC, the Committee has concluded that conditions would not be sufficient or workable. The Committee therefore considered whether to suspend Ms Onceriu s registration. In so doing, the Committee has borne in mind that although her engagement with the GDC has been limited, she has, nevertheless, been in contact with it. Furthermore, this case concerns one patient only over a period of about a month. Nevertheless, the Committee has borne in mind her lack of insight and the risk of her repeating her behaviour. It also considers that her conduct represents a serious falling short of the standards expected of a dentist. Accordingly, the Committee considers it necessary to protect patients interests and is in the public interest to suspend Ms Onceriu s registration for 12 months with review. This period of time is the maximum time this Committee can suspend her registration. It is satisfied that this period of time is sufficient for Ms Onceriu to reflect on her conduct and to demonstrate that she has understood the seriousness of the matters found proved. The Committee considered the sanction of erasure but concluded that given the circumstances of this case, including her engagement, albeit limited, with the GDC, such a course of action would be disproportionate. A Committee will review Ms Onceriu s case at a resumed hearing to be held shortly before the end of the period of suspension. That Committee will consider what action to take in relation to her registration. She will be informed of the date and time of that resumed ONCERIU, M D Professional Conduct Committee August 2015 August 2017 Page -10/20-

11 hearing. It considers that a Committee reviewing Ms Onceriu s case would find it very helpful to receive the following: Evidence of reflection as to what she has learnt about her behaviour and the issues identified in this case. Steps she has taken to address the issues identified in this case. Independent evidence that Ms Onceriu has undertaken appropriate professional development courses in relation to the shortcomings identified in this case. Testimonials from any employer for whom she has worked, or is working. Unless Ms Onceriu exercises her right of appeal, her registration will be suspended 28 days from the date when notice of this determination is deemed to have been served upon her. The Committee now invites submissions from you as to whether Ms Onceriu s registration should be suspended immediately, pending the taking effect of its substantive order. Decision on immediate order Mr Ismail: Having directed that Ms Onceriu s registration be suspended, the Committee went on to consider whether to impose an order for immediate suspension in accordance with Section 30 of the Dentists Act You, on behalf of the General Dental Council (GDC), have submitted that such an order is necessary in the light of the Committee s findings. The Committee has considered the submissions you have made. It has accepted the advice of the Legal Adviser. It is aware that the order for suspension does not come into effect until the end of the appeal period. In all the circumstances, the Committee has determined that it is necessary for the protection of the public and is otherwise in the public interest to impose an order for immediate suspension on Ms Onceriu s registration. The Committee has decided that it would be inconsistent to allow Ms Onceriu the opportunity to continue to practise during the intervening appeal period, given the reasons set out in its previous determination. The effect of the foregoing determination and this immediate order is that Ms Onceriu s registration will be suspended from the date on which notice of this decision is deemed served upon her. Unless Ms Onceriu exercises her right of appeal, her registration will be suspended for a period of 12 months. Should Ms Onceriu exercise her right of appeal, this immediate order for suspension will remain in place until the resolution of the appeal. That concludes this case. On 18 August 2016 at a review hearing the Chairman announced the determination as follows: Service of Notice of Hearing The Committee was informed at the start of this hearing that Miss Onceriu was not in attendance nor was she represented. In her absence, the Committee first considered whether the notice of this hearing had been served in accordance with rules 28 and 65 of the General Dental Council (Fitness to Practise) Rules Order of Council 2006 (the Rules). ONCERIU, M D Professional Conduct Committee August 2015 August 2017 Page -11/20-

12 The Committee received a copy of the Notification of Resumed Hearing which was dated as sent to Miss Onceriu s registered address via International Tracked and Signed on 15 July The notification was also sent to Miss Onceriu via on the same date and a download receipt shows that it was received and downloaded on 21 July The Committee had sight of an extract from the Royal Mail Track and Trace service which states the item was delivered on 22 July Miss Onceriu has also been in correspondence with the GDC via in relation to this hearing. In all the circumstances, the Committee was satisfied that the notice had been served on Miss Onceriu in accordance with the Rules. Proceeding in the absence of Miss Onceriu: The Committee then considered whether to exercise its discretion under Rule 54 to proceed in the absence of Miss Onceriu. The Committee heard the submissions made by Miss Headley on behalf of the General Dental Council (GDC). It accepted the advice of the Legal Adviser. The Committee bore in mind that it must exercise its discretion to proceed with the utmost care and caution. It also bore in mind the overall fairness of the proceedings to both parties, as well as the public interest in the timely review of this case. Miss Headley drew the Committee s attention to correspondence between the GDC and Miss Onceriu regarding this hearing. Miss Onceriu ed the GDC on 9 August and 17 August 2016 and her Skype details were provided along with a contact telephone number. Miss Onceriu had stated that she had a health issue in her of 9 August 2016 but subsequently provided her Skype details to allow her to attend the hearing remotely. Attempts were made prior to the start of this hearing to contact Miss Onceriu via Skype and telephone. The telephone number provided by Miss Onceriu was not a valid number and Miss Onceriu has not responded to attempts to contact her via Skype. Miss Headley submitted that notwithstanding Miss Onceriu s request to attend this hearing, given there has been no request for an adjournment and Miss Onceriu has not made herself available for the hearing, it would be appropriate to proceed in the absence of Miss Onceriu. Furthermore, if this matter was not reviewed today the GDC would lose jurisdiction over the case and Miss Onceriu would be returned to the register unrestricted when the current suspension order expires. The Committee had before it documents provided by Miss Onceriu, which it could consider as part of the review process. These included a letter setting out her view of the circumstances which led to the charges considered by the previous PCC and evidence of some continuing professional development undertaken since the last hearing. The Committee had regard to the information before it and concluded that an adjournment of this hearing would serve no useful purpose; it was not satisfied on the information before it that Miss Onceriu would attend on a future occasion. The current order is due to expire on 3 September 2016 which would not enable the GDC to relist this matter for consideration. The matters due to be reviewed at this hearing relate to serious findings made by the previous Professional Conduct Committee (PCC). The Committee was aware that this hearing was ONCERIU, M D Professional Conduct Committee August 2015 August 2017 Page -12/20-

13 scheduled to start at 09:30, as per the notice of hearing. Attempts were made prior to the start of the hearing to contact Miss Onceriu and the hearing did not commence until after 10:30 with no contact made between the GDC and Miss Onceriu, despite her having the contact details of the GDC and having made previous contact. Further, the Committee was aware that the onus was on Miss Onceriu to ensure that her contact details are correct and it concluded that all attempts had been made to contact her, including via telephone and Skype. Having weighed the interests of Miss Onceriu with those of the GDC and the public interest, including a review taking place expeditiously, the Committee decided to proceed in Miss Onceriu s absence. Decision on Review: This is the first review of a suspension order initially imposed on Miss Onceriu s registration, following the decision by the PCC in August 2015 for a period of twelve months with a review. This hearing was convened pursuant to Section 27C (1) of the Act to review the current suspension order, which is due to expire on 3 September At the initial substantive hearing in August 2015 the PCC considered allegations relating to whether Miss Onceriu s fitness to practise was impaired by reason of misconduct. At that hearing the Committee found: A failure to provide an adequate standard of care on 6 October 2011, in that she prepared UR1 for a crown when it was an inappropriate form of treatment for Patient A's presenting condition. She also over-prepared the UR1. On 12 October 2011 a failure to provide an adequate standard of care when providing root canal treatment for UR1, the cause of which was iatrogenic, in that she failed to take a diagnostic working length radiograph; she failed to adequately seal the root canal, placed gutta percha 6 to 7mm outside the apex of the tooth and she failed to take a post-operative radiograph. On 12 October 2011 a failure to provide an adequate standard of care in that she failed to place a temporary crown on UR1. On 18 October 2011 a failure to provide an adequate standard of care when attempting corrective root canal treatment for UR1, in that she failed to take a diagnostic working length radiograph and she failed to adequately seal the root canal. A failure to maintain an adequate standard of record keeping in that on 5 October 2011 she failed to report on a radiograph taken and she inaccurately recorded treatment you had provided on 12 October 2011 as being provided on 18 October The PCC in August 2015 found that Miss Onceriu s fitness to practise was impaired by reason of misconduct and imposed a suspension order for 12 months with a review. In making that decision the Committee gave the following reasons: Accordingly, the Committee considers it necessary to protect patients interests and is in the public interest to suspend Ms Onceriu s registration for 12 months with review. This period of time is the maximum time this Committee can suspend her registration. It is satisfied that this period of time is sufficient for Ms Onceriu to reflect on her conduct and to demonstrate that ONCERIU, M D Professional Conduct Committee August 2015 August 2017 Page -13/20-

14 she has understood the seriousness of the matters found proved. The Committee considered the sanction of erasure but concluded that given the circumstances of this case, including her engagement, albeit limited, with the GDC, such a course of action would be disproportionate. A Committee will review Ms Onceriu s case at a resumed hearing to be held shortly before the end of the period of suspension. That Committee will consider what action to take in relation to her registration. She will be informed of the date and time of that resumed hearing. It considers that a Committee reviewing Ms Onceriu s case would find it very helpful to receive the following: Evidence of reflection as to what she has learnt about her behaviour and the issues identified in this case. Steps she has taken to address the issues identified in this case. Independent evidence that Ms Onceriu has undertaken appropriate professional development courses in relation to the shortcomings identified in this case. Testimonials from any employer for whom she has worked, or is working. Today Miss Headley referred the Committee to the documentation before it and outlined the background of the case. She submitted that given the intermittent engagement from Miss Onceriu and the lack of evidence from her regarding the recommendations made by the previous PCC there remains a risk of repetition of the misconduct found in She submitted that Miss Onceriu s fitness to practise remains impaired. Miss Headley referred the Committee to the available sanctions and invited the Committee to consider all the circumstances of this case when reaching any decision. She submitted that in all the circumstances of this case, were the Committee to find that Miss Onceriu s fitness to practise remains impaired, the appropriate sanction is that of extending the suspension order for a further period of 12 months. Miss Headley submitted that this period would be appropriate given the lack of insight demonstrated by Miss Onceriu and the seriousness of the misconduct found in 2015 which is still to be addressed by her. The Committee accepted the advice of the Legal Adviser. The Committee was of the view that the misconduct identified was remediable, but there was very little evidence that Miss Onceriu had taken steps to address the identified misconduct. Miss Onceriu has only sporadically engaged with the GDC and has been uncontactable for the purpose of remotely attending this hearing, thus the information for it to consider during this review has been limited. The Committee had sight of correspondence from Miss Onceriu which, in its view, whilst containing a limited apology demonstrated a continued lack of insight, further attempts to shift the blame for her actions onto others, and a distinct lack of accountability for her own misconduct. She wrote: You ask me for the evidence of reflection of what I have learned about my behaviour and the issues identified in this case. I cannot give you these data gentlemen; all these are deeply in my soul, I am marked by the judgment cruelty and by the injustice of your system. ONCERIU, M D Professional Conduct Committee August 2015 August 2017 Page -14/20-

15 The continuing professional development that Miss Onceriu had provided evidence of either predated the initial PCC hearing or was of limited value in addressing the misconduct found and did not include any details of what was involved in the training. The Committee had no references or testimonials from Miss Onceriu and the apology given by her was only limited in its expression of remorse and focussed on the impact on her rather than the patient involved. The Committee was of the view that, given the lack of insight and remediation there remains a real risk of repetition of the misconduct in this case. The Committee concluded, based on the information before it, that on both grounds of public interest and public protection Miss Onceriu s fitness to practise remains impaired by reason of misconduct. The Committee then considered what, if any, sanction to impose in this case. The Committee was aware of the range of sanctions available to it and that it must consider the sanctions in order starting with the least serious. The Committee was aware that it should have regard to the principle of proportionality, balancing the public interest against Miss Onceriu s own interests. The public interest includes the protection of the public, the maintenance of public confidence in the profession, and declaring and upholding standards of conduct and performance within the profession. The Committee noted its powers under section 27C(1) of the Dentists Act 1984 (the Act). The Committee had the power to extend the current order for a maximum period of 12 months. Alternatively, it could allow the order to lapse on expiry, revoke the suspension order or replace the order with a conditions of practice order for up to 3 years. The Committee first considered whether it would be appropriate to allow the current order to lapse at its expiry or to revoke it with immediate effect. The Committee considered that given all of the information before it, and for all the reasons outlined above, it would not be appropriate to revoke the current order or to allow it to lapse, as this would not protect the public nor would it be in the public interest The Committee next considered whether a period of conditional registration would be appropriate in this case. The Committee was mindful that any conditions imposed must be proportionate, measurable and workable. The Committee was aware that in order for conditions to be appropriate and workable there would need to be some measure of positive consistent engagement from Miss Onceriu, which is noticeably absent in this case. Further, the information before the Committee from Miss Onceriu suggested that she no longer wanted to work as a dentist in the United Kingdom and had chosen not to pay her annual retention fee. Given the above, the Committee concluded that replacing the suspension order with a conditions of practice order would not be appropriate or workable at this stage. The Committee concluded that in all the circumstances of this case a further period of suspension on Miss Onceriu s registration would protect the public, uphold the public interest and give Miss Onceriu a further opportunity to address the identified misconduct, the shortcomings in her practice and to effectively re-engage in the GDC process. The Committee concluded that for these reasons the appropriate order is that of suspension for 12 months, with a review. The panel considered that in view of Miss Onceriu s limited engagement a further period of 12 months was required as a lesser period would not enable ONCERIU, M D Professional Conduct Committee August 2015 August 2017 Page -15/20-

16 her to properly address the identified misconduct by way of demonstrable insight and remediation. The Committee therefore directs that Miss Onceriu s registration be suspended for a period of 12 months pursuant to Section 27C(1)(b) of the Act. Section 33(3) of the Act comes into operation to cover any period between the expiry of the current suspension and the date when the direction ordered by this Committee comes into force. As outlined by the previous PCC, this Committee was in agreement that the next reviewing Committee would be assisted by evidence from Miss Onceriu of: Evidence of reflection as to what she has learnt about her behaviour and the issues identified in this case. Steps she has taken to address the issues identified in this case. Independent evidence that Ms Onceriu has undertaken appropriate professional development courses in relation to the shortcomings identified in this case. Testimonials from any employer for whom she has worked, or is working. That concludes this hearing. On 16 August 2017 at a review hearing, the Chairman announced the determination as follows: Service of Notice of Hearing This is the resumed Professional Conduct Committee (PCC) hearing of Ms Onceriu s case. The hearing is being convened pursuant to Section 27C of the Dentists Act 1984 (as amended) (the Act) to review the current suspension order. Ms Onceriu is neither present nor represented today. In her absence, the Committee first considered whether the Notification of Hearing had been served on Ms Onceriu at her registered address in accordance with Rules 28 and 65 of the General Dental Council (GDC) (Fitness to Practise) Rules Order of Council 2006 (the Rules). The Committee has received a bundle of documents which contains a copy of the Notification of Hearing letter dated 19 July 2017 which was sent by international tracked mail to Ms Onceriu s registered address. The Committee is satisfied that the Notification of Hearing letter contains the information required in accordance with Rule 28. The Royal Mail track and trace receipts confirms that the Notification of Hearing was delivered to Ms Onceriu s registered address on 27 July 2017, in accordance with the Rules. Furthermore, the Committee notes that the Notification of Hearing letter was ed to Ms Onceriu on 19 July 2017 and was downloaded on 20 July Finally, in her to the GDC dated 3 August 2017, Ms Onceriu acknowledged receipt of the documents relating to today s hearing. The Committee, having heard the Legal Adviser s advice, is satisfied that the GDC has complied with Rules 28 and 65 and that due service of the Notification of Hearing has been effected. Proceeding in the absence of Ms Onceriu: The Committee went on to consider whether to proceed in the absence of Ms Onceriu, in accordance with Rule 54. Mr Ahmed, on behalf of the GDC, invited the Committee to do so and addressed the Committee on a number of matters in support of that application. ONCERIU, M D Professional Conduct Committee August 2015 August 2017 Page -16/20-