HEARING HEARD IN PUBLIC

Transcription

1 HEARING HEARD IN PUBLIC PHILLIPS, Florence Adepeju Yewande Registration No: PROFESSIONAL CONDUCT COMMITTEE APRIL APRIL 2017 Most recent outcome: Suspension extended for 12 months (with a review) *See page 11 for the latest determination. Florence Adepeju Yewande PHILLIPS, a dentist, Statutory Exam 2004,BDS Lagos 1997, was summoned to appear before the Professional Conduct Committee on 20 April 2017 for an inquiry into the following charge: CHARGE (as AMENDED on 4 April 2016 and 6 April 2016) That being registered under the Dentists Act 1984: 1) At all material times you were a United Kingdom registered Dental Practitioner in practise at [address redacted] 2) You did not provide Patient A with an adequate standard of care on 24 June 2014 by: a. failing to inform him that at least one RaCe file had fractured and had remained in the LR7 during the appointment; or b. failing to realise that at least one RaCe file had fractured and had remained in the LR7 during the appointment. 3) You did not provide Patient A with an adequate standard of care on or around 1July 2014 by: a. failing to inform him of the fractured RaCe file or files that remained in the LR7; b. failing to inform him that the retained RaCe file or files were part of the reason for your referral of him to a specialist. 4) You failed to provide an adequate cost estimate to Patient A for the course of treatment commenced in June ) You did not respond to Patient A's written complaint dated 30 October 2014 in a timely manner or at all. 6) You prescribed antibiotics to Patient A on or around 20 June 2014 and/or on or around 1 July 2014 without clinical justification. 7) On or around 24 June 2014 and 1 July 2014, or thereafter, you recorded that you informed Patient A of the fractured RaCe file or files-when in fact you did not do so. 8) On or around 1 July 2014, or thereafter, you recorded that you informed Patient A that part of the reason for a referral to a specialist was for the fractured RaCe file or files to be removed when in fact you did not do so. PHILLIPS, F A Y Professional Conduct Committee Apr 2017 Page -1/14-

2 9) Your conduct in relation to paragraphs 7 and 8, both individually and collectively, was: a. misleading b. dishonest. and that therefore your fitness to practise as a dentist is impaired by reason of misconduct. On 7 April 2016 the Chairman made the following statement regarding the finding of facts: Ms Phillips, This case relates to matters surrounding your treatment of, and conduct towards Patient A, between June and October At the outset of the hearing, Mr Corrie, who represents the General Dental Council (GDC), made an application to amend the charge against you, pursuant to Rule 18 of the GDC (Fitness to Practise) Rules 2006 ( the Rules ). He applied to add the words and/or on or around 1 July 2014 to head of charge 6, so that the allegation would read: You prescribed antibiotics to Patient A on or around 20 June 2014 and/or on or around 1 July Mr Corrie submitted that no prejudice would be caused by this proposed amendment, as you had previously admitted in a letter, written on your behalf to the GDC, that you had prescribed antibiotics to Patient A on or around the dates in question. You raised no objection to Mr Corrie s application. Nor did you object to the Committee receiving a copy of the MDU letter in which you made the admission, dated 13 May Following advice from the Legal Adviser, the Committee accepted Mr Corrie s application and the charge was amended. The Committee was satisfied that the amendment could be made without causing any injustice. After this preliminary matter, you admitted heads of charge 1, 4 and 5 and denied all the other heads of charge. In addition to the letter of 13 May 2015, the Committee received a GDC hearing bundle which comprised your dental records for Patient A, excerpts from your day sheets and appointments diary, the dental records made by Witness C, the dentist who treated Patient A subsequently, and the dental records made by Witness D, the specialist in endodontics to whom you referred Patient A. Also included in the bundle was your witness statement, the witness statements of Patient A and Witness B, who is Patient A s wife, and those of Witness C and Witness D. In addition to the factual evidence, the Committee received a report from, and heard the evidence of, Mr David Kramer, the expert witness called by the GDC. The Committee found Mr Kramer s evidence of assistance in reaching its findings in this case. The Committee heard oral evidence from you and from all of the aforementioned witnesses. It found Patient A to be a credible witness. It considered that he was honest in telling the Committee what he did and did not remember. Whilst there were some inconsistencies in his evidence about his appointments with Witness C, the Committee considered that this did not detract from his general credibility. His recollection was quite clear on the salient issues in this case. The evidence of Witness B corroborated that of Patient A and the Committee had no reason to doubt her truthfulness, but noted that she was not present for any of the appointments. The Committee found Witness C s evidence to be very reliable and noted that PHILLIPS, F A Y Professional Conduct Committee Apr 2017 Page -2/14-

3 it was fully supported by his computerised dental records for Patient A. Witness D s evidence was unchallenged and the Committee considered it to be reliable. The Committee found that you were not a reliable and credible witness either in your answers on certain issues, or when you were challenged in cross-examination, or in answer to the Committee s questions. For example, you gave a number of different reasons for the delay in referring Patient A to the endodontic specialist some of which were not in your witness statement. In addition, you stated on oath that you did not attempt treatment on 30 June or 1 July 2014 because your local anaesthetic had failed. When asked to explain why this local anaesthetic was not recorded in your notes or mentioned in your witness statement you said that you had forgotten it by the time you wrote them, but you remembered it clearly now. The Committee found your reasons for the omissions and inconsistencies to be unsatisfactory. Furthermore, there were significant issues of reliability relating to your dental records for Patient A. You produced to the Committee a bundle of documents and, although the majority of the bundle was not relevant to the fact-finding stage, the Committee has taken into account the documents which refer to your honesty and integrity. Mr Corrie wished to refer in cross-examination to a NHS England Meeting Note, dated 15 March 2016, which detailed discussions between you and the Associate Dean. The same Meeting Note referred to a prior meeting you had with the Dental Defence Union, in which you said you had admitted some of the charges i.e. altering the records before she sent them to the GDC. The Committee was advised that the Meeting Note was not subject to legal privilege, nor litigation privilege, nor was it a confidential communication intended to be privileged. However, even if it had been privileged, it had been disclosed by you and there was no unfairness in it being the subject of cross-examination. In the light of this new evidence, the Committee approved a further application made by Mr Corrie under Rule 18 of the Rules. The charge was amended to insert the words or thereafter after the dates in heads of charge 7 and 8. The Committee took into account your objection to the amendments, but your objection did not disclose prejudice, lack of fairness or injustice and it was thus satisfied that the amendments could be made without unfairness. In the Committee s view, the essence of the allegations remained the same. Furthermore, the Committee considered that the amendments would enable it to make fully informed decisions on the allegations in question. The Committee has taken into account that there is no specific allegation in this present case that you altered Patient A s dental records. However, in light of the evidence contained in the Meeting Note of 15 March 2016 and the lack of any clarity about which records may have been altered, the Committee has concluded that your dental records for Patient A cannot be relied upon where there is other evidence to contradict them. Given the Committee s opinion of your testimony and the unreliability of your notes, it decided that, where it was contradicted by other evidence, it was unlikely to accept your evidence without corroboration. The Committee has considered all the evidence presented to it, both oral and documentary. It has taken into account the submissions made by Mr Corrie and your submissions. The Committee has accepted the advice of the Legal Adviser. It considered each head of charge separately, bearing in mind that the burden of proof rests with the GDC and that the standard of proof is the civil standard, that is, whether the allegations are proved on the balance of probabilities. PHILLIPS, F A Y Professional Conduct Committee Apr 2017 Page -3/14-

4 I will now announce the Committee s findings in relation to each head of charge: 1. Admitted and proved. 2.a Not proved, for the reasons noted in 2b below. 2.b Proved. 3.a Proved. In reaching its findings in respect of heads of charge 2a and 2b, the Committee first considered the allegation at 2b, that is, whether you had realised at the appointment on 24 June 2014, that at least one RaCe file had fractured and remained in the LR7. The evidence shows that, following your inability to complete the root canal treatment on the LR7 on 24 June 2014, you recalled Patient A for a further appointment on 30 June or 1 July At that appointment you made another unsuccessful attempt to complete the root canal treatment on the LR7. You then scheduled a further appointment with Patient A, with the intention of carrying out a third attempt at the treatment. The Committee concluded that, keeping Patient A under review in this way, would have made no sense clinically, had you been aware that a RaCe file had fractured and remained in the tooth on 24 June 2014, and that specialist assistance was required to remove it. The Committee therefore decided that it was more likely that you had not realised on the date in question that the file had fractured. It accepted the evidence of Mr Kramer that you should have realised the file had fractured and, as such, this was a failing on your part. In light of the Committee s decision in respect of head 2b, it follows that head 2a is not proved. A dental practitioner cannot have a duty to inform a patient of something that they do not know. The Committee was satisfied, on the basis of the evidence, that shortly after your appointment with Patient A on 30 June or 1 July 2014, you realised that there was at least one fractured RaCe file in the LR7. Patient A describes this appointment in his statement as Appointment No. 3 at which you again attempted root canal treatment and again had to stop as it was too painful. The Committee considers it is highly probable that it was on this occasion that the second file fractured and it was this fracture of which you became aware, either immediately or shortly afterwards, when clearing away your instruments. If your claim that you knew of only one broken file is true, this is the only sequence which makes sense because if both files had broken on the same appointment, it is the Committee s view that you could not possibly have been unaware of that, since you would have had to use a new file to start work on the second root. Patient A describes his next appointment as Appointment No. 4, this being an appointment after the 30 June or 1 July He stated that it was at this fourth appointment that you told him that you were not going to continue the root canal treatment yourself, but instead refer him for specialist treatment. He also stated that you did not undertake an oral examination at this appointment. In the Committee s view, your actions in referring Patient A to a specialist on this particular occasion, without oral examination, suggests that by this time you were aware of the broken file and realised the matter was beyond your expertise to PHILLIPS, F A Y Professional Conduct Committee Apr 2017 Page -4/14-

5 resolve. It was Patient A s evidence that you did not inform him about the fractured file at all, which the Committee accepts. 3.b Proved (as amended). There was a typographical error in this head of charge, which the Committee amended of its own volition under Rule 18. The Committee has replaced the word her with the word your, so that the head of charge now reads: failing to inform him that the retained RaCe file or files were part of the reason for your referral of him to a specialist The Committee accepts the evidence of Patient A that you did not inform him that part of the reason for referring him to the specialist was because of the retained RaCe file or files. 4. Admitted and proved. In finding this head of charge proved, the Committee took into account your evidence that it was your usual practice to discuss costs with your patients. Whilst the Committee accepts that may have been the case, it was clear from Patient A s testimony that he was unclear about the costs in this case. The Committee therefore concluded that any discussion you had with him about the estimated costs of his treatment was not adequate and in any event you should have provided a written estimate. 5. Admitted and proved. 6. Proved (as amended) in relation to on or around 20 June 2014, but not proved in relation to on or around 1 July In his evidence, Patient A was very clear that you had prescribed him with antibiotics at his first appointment with you. This was an urgent appointment on 20 June In your evidence, you conceded that Patient A was probably right about this matter. The Committee accepted the opinion of Mr Kramer that your prescription for antibiotics on this occasion was not clinically justified. In his report, Mr Kramer stated that Patient A did not have the type of infection during the period in question that warranted the administration of antibiotics. As far as any later prescription is concerned, Patient A was adamant that you gave him only one prescription and the Committee did not consider your note to the contrary was sufficiently reliable to outweigh his evidence. 7. Proved (as amended). There is a note in the dental records purporting to relate to 24 June 2014, which states that you informed Patient A about the fractured RaCe file or files in the LR7. However, the Committee has found that you had not realised as at 24 June 2014 that the RaCe file had fractured and so you could not have informed the patient. In addition, it accepted Patient A s evidence that you had not informed him. There is no clear evidence as to when this record was made, but it must have been added on a subsequent date, probably at some stage after being confronted by Patient A or after his complaint was made to the GDC. PHILLIPS, F A Y Professional Conduct Committee Apr 2017 Page -5/14-

6 8. Proved (as amended). There is a note in the dental records dated 1 July 2014 which states that you informed Patient A that part of the reason for his referral to see a specialist was because of the fractured file or files. However, the Committee has accepted the evidence of Patient A that you did not inform him that this was the case and, indeed, that the first time that you acknowledged to him the existence of the broken files was when he confronted you on or after 23 July Again this note must have been added at a later date. 9.a Proved in respect of both heads 7 and 8. The Committee was satisfied that the records in the dental notes are untrue, and as such are clearly misleading as they give the impression that you did something that you did not. 9.b Proved in respect of both heads 7 and 8. The Committee went on to consider whether your action in making such records would be considered dishonest by the standards of ordinary, reasonable and honest people. The Committee was in no doubt that your conduct would be considered dishonest by those standards. The Committee was also satisfied that you knew that your conduct would have been considered dishonest by the standards of ordinary reasonable and honest people. We move to Stage Two. On 8 April 2016 the Chairman announced the determination as follows: Ms Phillips, The Committee has considered all the evidence presented to it, both at this stage and at the fact-finding stage. It has taken into account the submissions made by Mr Corrie, on behalf of the General Dental Council (GDC) and your submissions. The Committee has accepted the advice of the Legal Adviser. At all material times you were in practice at Mathura Dental Practice in Coventry ( the Practice ), where you had recently become the Practice principal. The facts found proved in this case concern your treatment of, and conduct towards Patient A, between June and October There were a number of failings on your part. In particular: failing to provide the patient with a cost estimate; prescribing antibiotics to the patient without clinical justification; failing to realise that a RaCe file had fractured in the LR7; failing to inform the patient that at least one RaCe file had fractured in the LR7, when you became aware of the issue; failing to inform the patient that the retained RaCe file was part of your reason for your referral of him to a specialist; failing to respond to the patient s written complaint. PHILLIPS, F A Y Professional Conduct Committee Apr 2017 Page -6/14-

7 In addition, the Committee has found that you behaved in a misleading and dishonest manner by retrospectively recording information in Patient A s dental records that was untrue. Misconduct The Committee considered whether the facts found proved amount to misconduct. It noted that a finding of misconduct in this regulatory context requires a serious falling short of the standards to be expected of a registered dental professional. The Committee had regard to the GDC s Standards for the Dental Team (September 2013), in particular, the following paragraphs: 1.31 You must justify the trust that patients, the public and your colleagues place in you by always acting honestly and fairly in your dealings with them. This applies to any business or education activities in which you are involved as well as to your professional dealings You must make sure you do not bring the profession into disrepute You must always put your patients interests before any financial, personal or other gain. 2.1 Communicate effectively with patients listen to them, give them time to consider information and take their individual views and communication needs into account. 2.4 You must give patients clear information about costs You must provide patients with sufficient information and give them a reasonable amount of time to consider that information in order to make a decision. 4.1 Make and keep contemporaneous, complete and accurate patient records. 5.1 You must make sure that there is an effective complaints procedure readily available for patients to use, and follow that procedure at all times. 5.3 You must give patients who complain a prompt and constructive response 9.1 You must ensure that your conduct, both at work and in your personal life, justifies patients trust in you and the public s trust in the dental profession. 9.4 You must co-operate with any relevant formal or informal inquiry and give full and truthful information. The Committee first considered your actions and omissions in this case individually. In doing so, it took into account the conclusions of Mr David Kramer, the expert witness called by the GDC. It was Mr Kramer s opinion that each of your shortcomings, as identified in this case, fell far below the standards expected of a registered dental practitioner. The Committee accepted his opinion. Your clinical failings, namely: your inappropriate prescribing of antibiotics; your failure to provide the patient with an adequate cost estimate; the issue of the fractured files; and your failure to inform the patient of important information, were clearly not in his best interests. In fact, the Committee considered that some of your failings put the patient at risk of harm. The Committee was also satisfied that your failure to respond to the patient s written complaint was a serious breach of the standards. It was further satisfied that your dishonest conduct represented a very grave departure from what was expected from you as a dentist. PHILLIPS, F A Y Professional Conduct Committee Apr 2017 Page -7/14-

8 Therefore, taking all of these matters cumulatively, the Committee was in no doubt that the facts found proved in this case amount to misconduct. Impairment The Committee went on to consider whether your fitness to practise is currently impaired by reason of your misconduct. In reaching its decision, the Committee exercised its independent judgement. It remained mindful of its duty to consider the public interest, which includes the protection of patients, the maintenance of public confidence in the profession, and the declaring and upholding of proper standards of conduct and behaviour. It was clear to the Committee that your fitness to practise as a dentist was impaired at the time of the events in question. In determining whether your fitness to practise remains impaired today, the Committee considered the nature of your misconduct and whether it is capable of being remedied, whether it has in fact been remedied and whether it is likely to be repeated. The Committee was satisfied that the clinical issues that have been highlighted in this case are capable of being remedied. The concerns about your practice are not so significant that they could not be properly addressed by appropriate remediation. The Committee had regard to the evidence of remediation you have provided, including: your Personal Development Plan, which you have formulated with the assistance of the Postgraduate Dental Deanery; the audit of your antimicrobial prescribing; the evidence of your Continuing Professional Development and attendance on courses; and the evidence of your reflection on some of the matters in this case. The Committee also took into account your oral evidence on the changes you have made to your practice and within the Practice. You told the Committee about the changes you have made in the way you record your notes and make specialist referrals. You also told the Committee about the complaints policy that you now have in place, although you did not bring a copy of it with you to this hearing. You also told the Committee of your intention to write to Patient A to apologise for what has happened. You told the Committee of personal matters that had affected you at the time of the incidents in this case. However, you assured the Committee that you have sought help from mentors and from the Deanery to improve your clinical, communication and management skills to prevent a recurrence of the circumstances in Patient A s case. With regard to the clinical matters in this case, the Committee was satisfied from the evidence that you have started the process of remediation. However, even by your own admission, this is still a work in progress. Other than the audit, which shows that you still have some issues with antimicrobial prescribing, the Committee has seen very little verifiable evidence of how you have embedded your learning into your clinical practice. It has therefore concluded that the clinical issues identified must still remain and that there is a risk that you could repeat the mistakes you made with Patient A. A finding of impairment is therefore necessary to protect patients. The Committee then considered the issue of your dishonesty. Your decision to deny the charges against you has aggravated the dishonesty involved in the charges themselves and has clearly precluded you from having been able to show any real insight into that aspect of your misconduct. The remorse you displayed, and the apology you offered after the Committee s findings, have come at such a late stage that they can carry little weight. In the view of the Committee, dishonesty is misconduct in relation to which it is always difficult, PHILLIPS, F A Y Professional Conduct Committee Apr 2017 Page -8/14-

9 although not impossible, to demonstrate remediation. In respect of your dishonesty, the Committee has seen little or no insight and has concluded that it could not be confident that, if placed in similar circumstances, you would not repeat such dishonest conduct. The Committee also considered the wider public interest in this case. Given the nature of your misconduct, particularly your dishonesty, your limited remediation in respect of all the issues in this case and your lack of insight into your behaviour, the Committee decided that public confidence in the dental profession would be undermined, if a finding of impairment were not made. In all the circumstances of this case, the Committee has determined that your fitness to practise is currently impaired. Sanction The Committee considered what sanction, if any, to impose on your registration. 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. In reaching its decision, the Committee took into account the Guidance for the Practice Committees including Indicative Sanctions Guidance (effective from October 2015). It considered the range of sanctions available to it, starting with the least serious. The Committee applied the principle of proportionality, balancing the public interest with your own interests. In view of its serious findings, which highlight a need to protect patients and maintain the public s confidence in the dental profession, the Committee has determined that it would be inappropriate to conclude this case without taking any action in respect of your registration. It reached the same conclusion in respect of a reprimand. These courses of action would not serve to protect the patients from potential harm, nor would they satisfy the wider public interest. The Committee considered whether to impose conditions on your registration. Whilst it considered your clinical failings could possibly be addressed by conditions, it decided that, in the circumstances of this case, it was not possible to identify any conditions that could adequately address the issue of your dishonesty. Given the serious nature of the matters in this case, the Committee spent some time considering whether the suspension of your registration would be appropriate and proportionate in the circumstances. It noted that there are a number of aggravating features in this case, these being: the risk of harm posed to the patient by some of your clinical failings, not least the delay in his treatment; the multiple opportunities that you had to put the situation right; your attempt to cover up your wrongdoing; and your dishonesty continued over a sustained period of time. The Committee weighed these matters against the mitigation in your favour. In particular it considered: your previous good character; your difficult personal circumstances at the time, which put you under a lot of pressure; PHILLIPS, F A Y Professional Conduct Committee Apr 2017 Page -9/14-

10 that the incidents in this case arise from the treatment of one patient; that although maintained, your dishonesty was not calculated from the outset. The Committee is clear that its findings against you reveal serious breaches of your professional standards, which are unacceptable. There is no excuse for your clinical failings and your subsequent conduct. However, having considered all the evidence, the Committee has decided that this is not a case where your actions are fundamentally incompatible with being a dental professional. It was accepted by the Committee that your dishonesty arose out of what was essentially a single incident where you made a mistake and then responded, as you have said, in panic. It is not to your credit that you did not correct your dishonesty when you had had time to reflect, but the Committee is satisfied from all the evidence it has heard that you are not naturally a dishonest person. The Committee concluded that your conduct, as a professional person and an ordained minister of religion for many years, was probably out of character and thus is capable of remediation. The Committee then considered whether the sanction of erasure would be appropriate. However, in all the circumstances of this case, the Committee considered that erasure would be disproportionately punitive and furthermore, that it is not necessary, as a suspension will be quite adequate both to protect the public and to satisfy the wider public interest by marking the gravity of your behaviour without precluding the potential return to practice of an otherwise competent dentist. In terms of protection of the public it should be noted that as this suspension will be reviewed before its expiry, you will not be allowed to return to practice until a reviewing Committee is satisfied that you no longer pose a significant risk in terms of repetition of your misconduct. In all the circumstances, the Committee has determined that it is appropriate and proportionate to suspend your registration for a period of 12 months. It considered that such a period, which is the maximum available, reflects the seriousness of your misconduct and will give you time to develop the necessary level of insight into all the matters of concern in this case. A Committee will review your case at a resumed hearing to be held shortly before the end of the period of suspension. That Committee will consider what further action to take in relation to your registration. You will be informed of the date and time of that resumed hearing, which you will be expected to attend. The Committee reviewing your case may find it helpful to receive the following: Evidence of the actions you have taken to address your misconduct and its consequences, particularly your dishonesty. This evidence could usefully include a substantial piece of written reflection to show that you have developed a full understanding of the importance of absolute honesty and integrity in a dental professional. The Committee notes your intent to write to Patient A regarding these matters; a copy of this letter may be of assistance. Testimonials as to your character, from those who are aware of the subject of these GDC proceedings, in particular the issue of your dishonesty. Evidence that you have addressed the clinical issues in this case. Evidence of the strategies you have developed to avoid any repetition of your misconduct. Evidence that you have kept up to date with your CPD. PHILLIPS, F A Y Professional Conduct Committee Apr 2017 Page -10/14-

11 Unless you exercise your right of appeal, your registration will be suspended 28 days from the date when notice is deemed to have been served upon you. The Committee now invites submissions from Mr Corrie and from you, as to whether your registration should be suspended immediately, pending its substantive determination taking effect. Decision on immediate order Ms Phillips, In deciding whether to impose an immediate order on your registration, the Committee has taken into account the submissions made by Mr Corrie, on behalf of the GDC, and your submissions. It has accepted the advice of the Legal Adviser. 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 the immediate suspension of your registration. It has identified ongoing risks in this case, both in relation to patient safety and your dishonesty in falsifying records. The Committee considered that it would be inconsistent not to impose an immediate order on your registration in these circumstances. The effect of the foregoing determination and this order is that your registration is suspended immediately to cover the appeal period. If you do not appeal, the substantive direction for suspension, as already announced, will take effect 28 days from the date when notice is deemed to have been served upon you. Should you exercise your right of appeal, this immediate order for suspension will remain in place until the resolution of any appeal. That concludes this hearing. At a review hearing on 20 April 2017 the Chairman announced the determination as follows: Mr Ahmed This is the resumed Professional Conduct Committee (PCC) hearing of Ms Phillips case. Service of Notice of Hearing Ms Phillips was not in attendance nor was she represented at this review hearing today. The Committee saw a copy of the Notification of Resumed Hearing dated 22 March 2017 that was sent to Ms Phillips registered address via Special Delivery, First Class Post and . It saw a printout from the Royal Mail Track and Trace website service which stated that delivery was attempted on 23 March A card was left at this address notifying Ms Phillips of this. The Committee was satisfied that notification of the hearing had been effected in accordance with Rules 28 and 65. Proceeding in the absence of Ms Phillips PHILLIPS, F A Y Professional Conduct Committee Apr 2017 Page -11/14-

12 The Committee then considered whether to exercise its discretion to proceed in the absence of Ms Phillips under Rule 54. It bore in mind that its discretion to proceed had to be exercised with the utmost care and caution. It balanced the interests of Ms Phillips against the public interest in the expeditious disposal of this matter. It is aware that the current order will expire on 5 May The Committee noted a telephone call between Ms Phillips and the GDC on 17 January 2017 where it was revealed that a recommendation letter had been returned by Royal Mail as she had moved address. She was informed by a GDC staff member during this conversation that she must update her contact details. No communication or engagement has been received from Ms Phillips since that telephone conversation on 17 January The Committee noted that Ms Phillips had made no request for an adjournment. It was satisfied that she had been furnished with all of the relevant information to allow her to participate in the hearing. Whilst the Committee could not be certain that Ms Phillips was aware of today s hearing, she was aware that she was subject to an on-going fitness to practise case and that a review of her suspension order would take place. The Committee was therefore satisfied that she had voluntarily chosen to disengage from the process. It determined that there was a pressing public interest in proceeding, bearing in mind the imminent expiry of the order. The Committee therefore determined that it was fair and reasonable to proceed with the hearing notwithstanding Ms Phillips absence. Background The facts found proved in the case concern Ms Phillips treatment of, and conduct towards Patient A, between June and October There were a number of failings on her part. In particular: failing to provide the patient with a cost estimate; prescribing antibiotics to the patient without clinical justification; failing to realise that a RaCe file had fractured in the LR7; failing to inform the patient that at least one RaCe file had fractured in the LR7, when she became aware of the issue; failing to inform the patient that the retained RaCe file was part of her reason for her referral of him to a specialist; failing to respond to the patient s written complaint. In addition, the Committee found that Ms Phillips behaved in a misleading and dishonest manner by retrospectively recording information in Patient A s dental records that was untrue. The PCC determined that the facts found proved against Ms Phillips amounted to misconduct. That Committee found that her fitness to practise was currently impaired and suspended her registration for a period of 12 months. Mr Ahmed also informed the Committee that Ms Phillips had been made the subject of a warning issued by the Investigating Committee on 14 December This related to a PHILLIPS, F A Y Professional Conduct Committee Apr 2017 Page -12/14-

13 different patient and involved issues of miscommunication and record keeping. The complaint was received by the GDC in July Decision on review Today this Committee has undertaken a review. It took account of the submissions put forward by the GDC and all of the material before it. It accepted the advice of the Legal Adviser. Impairment The Committee considered whether Ms Phillips fitness to practise remains currently impaired by reason of her misconduct. As was stated at the initial hearing, Ms Phillips conduct in inappropriately prescribing of antibiotics; failing to provide the patient with an adequate cost estimate; the issue of the fractured files; and her failure to inform the patient of important information, were clearly not in his best interests. In fact, that Committee considered that some of Ms Phillips failings put the patient at risk of harm. The Committee was also satisfied that Ms Phillips failure to respond to the patient s written complaint was a serious breach of the standards. The Committee notes that the GDC wrote to Ms Phillips on 19 April 2016 reminding her of the evidence that the initial Committee suggested she put together prior to this review in order to assist this Committee in reaching its decision. Ms Phillips did not respond to that letter. A telephone call was made by Ms Phillips to the GDC on 17 January 2017 requesting a copy of the determination of the previous hearing. This was sent to her by the GDC via secure on the same day. However, no response has been received since. The Committee took into account the separate complaint which resulted in a warning letter being sent to Ms Phillips in December 2016, but noted that this incident pre-dated the hearing in April At this review, the onus is on Ms Phillips to demonstrate that she has addressed the concerns identified. Ms Phillips has submitted no evidence of any insight into the seriousness of her misconduct or of remediation. The Committee has seen no evidence of continuing professional development, no reflective documentation, nor any evidence relating to courses or other activity in relation to ethics or professionalism. The Committee therefore takes the view that there remains a risk of repetition of Ms Phillips misconduct. The Committee has determined that Ms Phillips fitness to practise remains impaired. It has further determined that such a finding remains necessary in order to declare and uphold proper professional standards and to maintain public confidence in the profession particularly in view of the limited engagement by Ms Phillips over the last twelve months. Sanction The Committee sought to determine what action to take in relation to Ms Phillips registration. It bore in mind that the purpose of a sanction is not to be punitive, but rather to protect patients and the wider public interest. It first considered whether to revoke the order of suspension and take no further action. In the light of the seriousness of the findings made against Ms Phillips, the Committee decided PHILLIPS, F A Y Professional Conduct Committee Apr 2017 Page -13/14-

14 that it would be inappropriate to revoke the order and conclude the case with no action as this would not provide any protection to the public against the risk of repetition. The Committee considered whether to revoke the order of suspension and replace it with one of conditional registration. It noted Ms Phillips limited engagement with the GDC in relation to this matter. She has produced none of the evidence suggested by the initial Committee and has demonstrated no insight. The Committee has no confidence that Ms Phillips would be willing or able to comply with any conditions imposed on her registration. In any event, the Committee considered that no conditions could be formulated which would be sufficiently workable, practicable and measurable and which would address the identified failings in this case. In particular, no conditions could assist Ms Phillips development of full insight and reflection upon her conduct in any meaningful way given her lack of engagement in these proceedings. This can only be achieved by her own efforts. The Committee therefore determined that conditional registration would therefore not be appropriate. The Committee has determined that an extension of the order of suspension for the maximum period of 12 months is necessary for the protection of patients and will serve to safeguard public confidence in the profession and uphold standards. This period is the maximum in order to allow her the opportunity to fully engage and provide sufficient evidence of insight and remediation. The order is imposed for 12 months from the date at which the current order would otherwise expire and will be reviewed shortly before the end of that period. This Committee notes the previous recommendations have not been carried out and reiterates them below for the benefit of Ms Phillips and any subsequent reviewing Committee: Evidence of the actions you have taken to address your misconduct and its consequences, particularly your dishonesty. This evidence could usefully include a substantial piece of written reflection to show that you have developed a full understanding of the importance of absolute honesty and integrity in a dental professional. The Committee notes your intent to write to Patient A, a copy of this letter may be of assistance. Testimonials as to your character, from those who are aware of the subject of these GDC proceedings, in particular the issue of your dishonesty. Evidence that you have addressed the clinical issues in this case. Evidence of the strategies you have developed to avoid any repetition of your misconduct. Evidence that you have kept up to date with your CPD. This Committee did not have the power to impose an indefinite order of suspension, although the next reviewing Committee will have such a power. That concludes the case for today. PHILLIPS, F A Y Professional Conduct Committee Apr 2017 Page -14/14-