HEARING HEARD IN PUBLIC POPE, Robin Maxwell Registration No: 60620 PROFESSIONAL CONDUCT COMMITTEE FEBRUARY JULY 2014 Outcome: Erased with immediate suspension Robin Maxwell POPE, BDS Birm 1985, was summoned to appear before the Professional Conduct Committee on 24 February 2014 for an inquiry into the following charge: Charge 1 (as amended) That being a registered dentist under The Dentists Act 1984: 1. Between 1998 and 2012, a. You were the Principal Dentist at the NAME REDACTED Dental Surgery, ADDRESS REDACTED; b. You held a Dental Services Contract with Shropshire County Primary Care Trust pursuant to which you provided NHS dental services. 2. Between 1 January 2010 and 31 March 2012, your treatment of Patient A was not of a standard to be expected in that: a. You failed to complete charts of Patient A's dentition; b. In relation to Patient A's medical history: i. You did not obtain sufficient detail initially; ii. You did not update the medical history adequately; c. You failed to undertake a comprehensive examination of Patient A; d. There is no record of a comprehensive examination; e. Your notes of treatment generally are inadequate; f. Your clinical notes are barely legible; g. You failed to undertake a Basic Periodontal Examination ["BPE"]; h. You did not record sufficient detail in relation to your soft tissue examination; i. You failed to take appropriate diagnostic radiographs; j. On 13 April 2010 you extracted Patient A's two lower third molars notwithstanding an indication given by Patient A that extractions in his case should only be undertaken in a hospital setting; 1 Please note Schedules A K are private documents which cannot be disclosed. POPE, R M Professional Conduct Committee February July 2014 Page -1/33-
k. You ground down Patient A's incisor tooth without explanation; I. Your treatment was such that Patient A was left with an unacceptable gap in his front teeth for a period of several months; m. On 24 June 2011 you extracted Patient A's LL1 and LR1 notwithstanding a letter from the patient's GP which indicated that extractions in Patient A's case were not straightforward; n. You failed to make an adequate note of the extractions of Patient A's LL1 and LR1; o. In relation to the denture treatment provided to Patient A: i. You failed to make a note of the justification for an upper denture; ii. On 31 October 2011, Patient A left your surgery with an ill-fitting lower denture; iii. You provided upper and lower dentures separately rather than arranging for them to be made together; iv. You did not provide all the treatment required; v. The set of dentures you provided for Patient A were not fit for purpose; vi. WITHDRAWN p. You failed to treat Patient A's lower left canine appropriately when it fractured; q. You inappropriately ground down Patient A's lower right canine; r. You failed to make a note of any treatment plan for Patient A; s. The relevant completed FP17DC forms were not in your records. 3. Your conduct towards Patient A was unprofessional in that: a. When Patient A queried your decision to extract his teeth you told him "you either let me extract them or your treatment with me ends here" or words to that effect; b. You made repeated derogatory references to "you people" in relation to your NHS patients; c. On 30 January 2012 when Patient A stated that his denture was too loose you told him "that's all your getting" or words to that effect; d. You behaved aggressively towards Patient A; e. You threw Patient A's old denture at him; f. You told Patient A "that's all you're getting and "you people are never satisfied or words to that effect. 4. Your claims relating to treatment of Patient A (as listed at Schedule A) were: a. WITHDRAWN b. Inappropriate c. Dishonest POPE, R M Professional Conduct Committee February July 2014 Page -2/33-
5. Between 1 January 2010 and 31 March 2012, your treatment of Patient B was not of a standard to be expected in that: a. You failed to complete up to date charts of Patient B's dentition; b. You did not update Patient B's medical history adequately; c. You failed to undertake a comprehensive examination of Patient B; d. There is no record of a comprehensive examination; e. Your notes of treatment generally are inadequate; f. Your clinical notes are barely legible; g. You failed to undertake a Basic Periodontal Examination ["BPE"]; h. You did not record sufficient detail in relation to your soft tissue examination; i. You failed to provide an appropriate restoration for Patient B's LR7; j. You did not record sufficient detail in relation to Patient B's gingivitis; k. You failed to diagnose gingival calculus in Patient B's case; I. You failed to investigate properly Patient B's gingival swelling on the lingual aspect; m. You inappropriately advised Patient B that she should seek a referral for investigation of the gingival swelling on the lingual aspect from her GP rather than carry out the investigations or arrange the referral yourself; n. You failed to provide appropriate periodontal treatment; o. You failed to provide appropriate advice to Patient B in relation to her periodontal condition; p. You failed to take appropriate diagnostic radiographs; q. You failed to identify a cavity at Patient B's LR5; r. You failed to make a note of any treatment plan for Patient B; s. You failed to provide Patient B with a written treatment plan. 6. Between 1 January 2010 and 31 March 2012, your treatment of Patient C was not of a standard to be expected in that: a. You failed to complete up to date charts of Patient C's dentition; b. You did not update Patient C's medical history adequately; c. You failed to undertake a comprehensive examination of Patient C; d. There is no record of a comprehensive examination of Patient C; e. Your notes of treatment generally are inadequate; f. Your clinical notes are barely legible; g. You failed to undertake a BPE; h. You did not record sufficient detail in relation to your soft tissue examination; POPE, R M Professional Conduct Committee February July 2014 Page -3/33-
i. You failed to take appropriate diagnostic radiographs; j. You failed to provide appropriate treatment for Patient C's periodontal condition; k. You failed to record any justification for the radiograph taken on 29 September 2011; I. You failed to report on the radiograph taken on 29 September 2011; m. You failed to evaluate the radiograph properly; n. You failed to identify all of potential carious lesions in Patient C's teeth on 29 September 2011; o. You failed to complete charting in relation to the potential carious lesions p. You failed to plan and provide appropriate treatment for Patient C's caries; q. You failed to make a note of any treatment plan for Patient C; r. The relevant completed FP17DC forms were not in your records. 7. Your claims relating to treatment of Patient C (as listed at Schedule C) were: a. WITHDRAWN b. Inappropriate; c. Dishonest. 8. Between 1 January 2010 and 31 March 2012, your treatment of Patient D was not of a standard to be expected in that: a. You failed to complete up to date charts of Patient D's dentition; b. You did not update Patient D's medical history adequately; c. You failed to undertake a comprehensive examination of Patient D; d. There is no record of a comprehensive examination of Patient D; e. Your notes of treatment generally are inadequate; f. Your clinical notes are barely legible; g. You failed to undertake a BPE; h. You did not record sufficient detail in relation to your soft tissue examination; i. You failed to take appropriate diagnostic radiographs; j. You failed to store radiographs appropriately; k. You failed to provide appropriate periodontal treatment; I. You failed to record your discussions with Patient D; m. You failed to record diagnoses for Patient D; n. You failed to record a justification for the crown at Patient D's UR3; o. You failed to make a note of any treatment plan for Patient D; p. The relevant completed FP17DC forms were not in your records. POPE, R M Professional Conduct Committee February July 2014 Page -4/33-
9. Your claims relating to treatment of Patient D (as listed at Schedule D) were: a. WITHDRAWN b. Inappropriate; c. Dishonest. 10. Between 1 January 2010 and 31 March 2012, your treatment of Patient E was not of a standard to be expected in that: a. You failed to complete up to date charts of Patient E's dentition at any time; b. You did not update Patient E's medical history adequately; c. You failed to undertake a comprehensive examination of Patient E; d. There is no record of a comprehensive examination of Patient E; e. Your notes of treatment are inadequate i. Generally; ii. ln relation to Patient E's denture construction; f. Your clinical notes are barely legible; g. You failed to undertake a BPE; h. You did not record sufficient detail in relation to your soft tissue examination; i. You failed to take appropriate diagnostic radiographs; j. WITHDRAWN k. You failed to record diagnoses for Patient E; I. You failed to make a note of any treatment plan for Patient E; m. Your records did not include i. The relevant FPDC17 forms; ii. The relevant laboratory documents. 11. Your claims relating to treatment of Patient E (as listed at Schedule E) were: a. WITHDRAWN b. Inappropriate; c. Dishonest. 12. Between 1 January 2010 and 31 March 2012, your treatment of Patient F was not of a standard to be expected in that: a. You failed to complete up to dale charts of Patient F's dentition; b. You did not update Patient F's medical history adequately; c. You failed to undertake a comprehensive examination of Patient F; d. There is no record of a comprehensive examination of Patient F; e. Your notes of treatment generally are inadequate; POPE, R M Professional Conduct Committee February July 2014 Page -5/33-
f. Your clinical notes are barely legible; g. You failed to undertake a BPE; h. You did not record sufficient detail in relation to your soft tissue examination; i. You prescribed antibiotics i. Without justification; ii. Without consulting with Patient F yourself; j. You failed to take appropriate diagnostic radiographs: i. Generally; ii. Before preparing the UR3 for a crown; k. You failed to record any justification for the crown at UR3; I. You failed to keep the laboratory docket in relation to the crown provided; m. You failed to make a note of any treatment plan for Patient F; n. The relevant completed FP17DC forms were not in your records. 13. Your claims relating to treatment of Patient F (as listed at Schedule F) were: a. WITHDRAWN; b. Inappropriate; c. Dishonest. 14. Between 1 January 2010 and 31 March 2012, your treatment of Patient G was not of a standard to be expected in that: a. You failed to complete up to date charts of Patient G's dentition; b. You did not update Patient G's medical history adequately; c. You failed to undertake a comprehensive examination of Patient G; d. There is no record of a comprehensive examination of Patient G; e. Your notes of treatment generally are inadequate; f. Your clinical notes i. Are barely legible; ii. Contain incorrect tooth annotation; g. You failed to undertake a BPE; h. You did not record sufficient detail in relation to your soft tissue examination; i. You failed to keep the laboratory docket in relation to the Crown provided; j. The relevant completed FP17DC forms were not in your records. 15. Your claims relating to treatment of Patient G (as listed at Schedule G) were: a. WITHDRAWN b. Inappropriate; POPE, R M Professional Conduct Committee February July 2014 Page -6/33-
c. Dishonest. 16. Between 1 January 2010 and 31 March 2012, your treatment of Patient H was not of a standard to be expected in that: a. You failed to complete up to date charts of Patient H's dentition; b. You did not update Patient H's medical history adequately; c. You failed to undertake a comprehensive examination of Patient H; d. There is no record of a comprehensive examination of Patient H; e. Your notes of treatment generally are inadequate; f. Your clinical notes are barely legible; g. You failed to undertake a BPE h. You did not record sufficient detail in relation to your soft tissue examination; i. You failed to take appropriate diagnostic radiographs; j. You prescribed antibiotics i. Without recording the justification; ii. Without updating the patient's medical history; k. You failed to make a note of any treatment plan for Patient H; I. The relevant completed FP17DC forms were not in your records. 17. Your claims relating to treatment of Patient H (as listed at Schedule H) were: a. WITHDRAWN b. Inappropriate; c. Dishonest. 18. Between 1 January 2010 and 31 March 2012, your treatment of Patient I was not of a standard to be expected in that: a. You failed to complete up to date charts of Patient l's dentition; b. You failed to keep a proper record of Patient l's medical history; c. You failed to undertake a comprehensive examination of Patient I; d. There is no record of a comprehensive examination of Patient I; e. Your notes of treatment generally are inadequate; f. Your clinical notes are barely legible; g. You failed to undertake a BPE; h. You did not record sufficient detail in relation to your soft tissue examination; i. You did not take appropriate radiographs; j. Between 21 December 2010 and 24 March 2011 POPE, R M Professional Conduct Committee February July 2014 Page -7/33-
i. You failed to undertake proper investigation in relation to the patient's presenting complaints; ii. You failed to take appropriate radiographs to investigate the LR6 and LL6; iii. You failed to record a diagnosis; iv. You failed to record treatment options; v. You failed to discuss treatment options with Patient I; vi. You failed to make a note of any treatment plans; k. You failed to record full details of local anaesthetic given; I. You prescribed antibiotics i Without recording the justification; ii Without updating the patient's medical history; m. You failed to make a note of any treatment plan for Patient I; n. The relevant completed FP17DC forms were not in your records. 19. Your claims relating to treatment of Patient I (as listed at Schedule I) were: a. WITHDRAWN b. Inappropriate; c. Dishonest. 20. Between 1 January 2010 and 31 March 2012, your treatment of Patient J was not of a standard to be expected in that: a. You failed to complete up to date charts of Patient J's dentition; b. You did not update Patient J's medical history adequately; c. You failed to undertake a comprehensive examination of Patient J; d. There is no record of a comprehensive examination of Patient J; e. Your notes of treatment generally are inadequate; f. Your clinical notes are barely legible; g. You failed to undertake a BPE; h. You did not record sufficient detail in relation to your soft tissue examination; i. You prescribed antibiotics without consulting with Patient J yourself; j. You did not follow up adequately the episode of swelling that required the prescription of antibiotics; k. You failed to take appropriate diagnostic radiographs i. Generally; ii. To investigate the possible cause of swelling at UL1; I. You failed to make a note of any treatment plan for Patient J. POPE, R M Professional Conduct Committee February July 2014 Page -8/33-
m. The relevant completed FP17DC forms were not in your records. 21. Your claims relating to treatment of Patient J (as listed at Schedule J) were: a. WITHDRAWN b. Inappropriate; c. Dishonest. 22. Between 1 January 2010 and 31 March 2012, your treatment of Patient K was not of a standard to be expected in that: a. You failed to complete up to date charts of Patient K's dentition; b. You did not update Patient K's medical history adequately; c. You failed to undertake a comprehensive examination of Patient K; d. There is no record of a comprehensive examination of Patient K; e. Your notes of treatment generally are inadequate; f. Your clinical notes are barely legible; g. You failed to undertake a BPE; h. You did not record sufficient detail in relation to your soft tissue examination; i. Between 14 February 2011 and 4 July 2011 i. You failed to undertake proper investigation the patient s recurring problems at her UL6; ii. You failed to provide appropriate treatment for the patient's UL6; j. You failed to take appropriate diagnostic radiographs either i. Generally; ii. To investigate the possible cause of the problems at the UL6; 23. Your claims relating to treatment of Patient K (as listed at Schedule K) were: a. WITHDRAWN; b. Inappropriate; c. Dishonest. AND, by reason of the facts stated, your fitness to practise as a Dentist is impaired by reason of your Misconduct. On 7 March 2014 the Chairman made the following statement regarding the finding of facts: Mr Pope, The Committee has taken into account all the evidence presented to it. It has accepted the advice of the Legal Adviser. When considering allegations of dishonesty, the Committee on each occasion adopted the two stage test set out in the case of R v Ghosh 1982 QB 1053. POPE, R M Professional Conduct Committee February July 2014 Page -9/33-
I will now announce the Committee s findings in relation to each head of charge: 1a. 1b. 2a. 2bi. 2bii. Not proved. The Committee noted that the period 1 January 2010 to 31 March 2012 does not include the date of Patient A s first visit to you. It noted that a medical history form was completed on 11 July 2011 and that two undated lists of medications were included in the patient s records that may have been obtained in 2010 to 2011. In the light of this, the Committee determined that this head of charge was not made out. 2c. Proved. Patient A was a patient of pensionable age with a history of problems with his dentition. In relation to this patient, you gave CPITN scores of 1. In the light of the consistent CPITN scorings of 1 given to many other patients, including those with longstanding periodontal problems, mobile teeth and poor oral health, the Committee was not satisfied that the scoring was accurate in this patient s case or in relation to other patients. Regarding this patient, CPITN scores were noted for the patient s upper arch despite the patient having no teeth in that area. This notation was subsequently crossed out as the patient as the patient wore a full upper denture. This suggests a tick box approach to the CPITN scoring. Your evidence was that you routinely examined your patients and that though you did not record the outcome of those examinations, you relied upon your memory. The Committee did not find this credible. You admitted that you did not palpate your patients as part of the extraoral examination process. You also admitted that you did not take radiographs. The Committee accepts that some type of examination occurred but in the light of the lack of reliable CPITN scoring, palpation and radiographs it was not satisfied that your examination of this patient was comprehensive. 2d. 2e. 2f. 2g. 2h. 2i. 2j. Proved. The Committee accepts the evidence of Patient A that he told you that any POPE, R M Professional Conduct Committee February July 2014 Page -10/33-
extractions should occur in a hospital setting. You were aware that Patient A was on Bisphosphonates, which put him at risk of osteonecrosis of the jaw. Guidance indicates clearly that in such cases, care should be taken when treating patients. You told the Committee that there were merely fragments of roots in the patients soft tissue that you flicked out. The Committee is unable to determine whether you extracted roots only or entire teeth. The Committee further notes that there were no radiographs available which would indicate the status of the teeth. However it is satisfied that you carried out extractions on 13 April 2010 and 2 June 2010. The potential consequences for the patient of your lack of awareness of the state of his teeth and roots could have been very serious particularly in the light of the risk of osteonecrosis. You did not refer Patient A to the hospital or seek their advice, nor did you take any further steps to minimise the risks. The Committee is satisfied that an extraction under these circumstances was inappropriate. 2k. Not proved Your notes indicate that you smoothed down Patient A s incisor tooth. However you told the Committee that you did explain what you were about to do and why. By Patient A s own account, he asked for a cap and you explained to him why you were unable to provide a cap. The Committee is therefore satisfied that some discussion must have occurred. The Committee finds it unlikely that you ground down the tooth without saying anything at all to Patient A. The Committee additionally notes that in many of the testimonials you are described as a practitioner who consistently explains treatment before carrying it out. 2l. Not proved Patient A was inevitably going to have a gap in his teeth for a period of time following the treatment to his incisor tooth by you at the emergency appointment. There was a further appointment arranged two months following that emergency appointment. In the light of this, the Committee is not satisfied to the required standard that it was incumbent upon you to expedite the filling of the gap. 2m. Proved. You admitted carrying out the extractions. You told the Committee that they were straight forward, uncomplicated and only involved roots in soft tissue. However the Committee is satisfied that in the light of the patient s medical history and the correspondence from his GP, there were clearly risks involved. You should have been more cognisant of the risks and taken greater care to safeguard against them. You referred Patient A to the local oral and maxillofacial hospital department, but proceeded with the extraction of his two lower incisor teeth before the patient had been seen by the consultant. POPE, R M Professional Conduct Committee February July 2014 Page -11/33-
The Committee further notes that there were no radiographs available to you, nor did you carry any out that could have shown clearly that the state of the teeth and roots were as you described. 2n. 2oi. 2oii. 2oiii. 2oiv. Not proved. In Patient A s witness statement he stated that his lower denture was ill fitting and uncomfortable and that he suffered ulcers and cuts to the inside of his mouth. The Committee noted that Mr Grainger, a dentist that treated Patient A on 14 March 2013, noted in Patient A s clinical records that the lower partial denture was poorly fitting. In his witness statement dated 6 January 2014 he stated that he saw ulceration and trauma to the inside of Patient A s mouth around the lower denture. However, he acknowledged that he did not record this in clinical notes of 14 March 2013. The Committee noted that Patient A s appointment with Mr Grainger occurred some 17 months following the fitting of the lower denture and that the upper denture had been replaced since that fitting. Mr MacBean, an oral and maxillofacial surgeon, saw Patient A on 14 January 2013. He made no mention of ulceration around the lower denture. The Committee also noted that he extracted Patient A s lower right canine, which would have affected the fit of the lower denture and is a possible explanation for any subsequent ulceration. The Committee does not find it credible that the fit was as bad as was described by Patient A. It noted that there was a try-in stage of the lower denture. It finds it inherently improbable that you would proceed to the fit stage if the try in denture had been as bad as described by the patient. The Committee further notes that where the upper denture was unsatsifactory, it was immediately replaced by you. The Committee accepts your evidence that the lower partial denture was acceptable. Not proved. You accept that you provided the upper and lower dentures separately but you do not accept that your failure to provide them together was culpable. You told the Committee that you did not initially plan on making the upper denture at the time of making the lower denture. The Committee does not find your failure to provide both dentures together to be culpable. There is nothing inherently wrong with doing dentures separately unless both are planned at the outset. The new upper full denture must have been discussed at some point during the fit of the lower partial denture, as appointments for the upper full denture were planned; but there is no evidence that both were planned together. Not proved. POPE, R M Professional Conduct Committee February July 2014 Page -12/33-
2ov. 2ovi. You provided Patient A with upper and lower dentures. On 30 January 2013 you provided treatment to Patient A for the last time. According to the evidence the Committee has heard, the relationship between you and Patient A had broken down by that time. You offered Patient A further appointments for the purposes of addressing his concerns, but he declined to attend. Your offer followed Patient A s complaint to the PCT. In relation to the denture treatment, both dentures had been provided. In the light of this and of the subheads of charge above that the Committee found not proved the Committee is not satisfied on a balance of probabilities that there was a failure regarding this subhead of charge. Not proved Patient A complained about the fit of the upper denture when you first fitted it on 12 December 2011. You replaced it with a new upper denture on 30 January 2012, but the patient remained unsatisfied. You recorded Patient A s dissatisfaction in the notes. When Mr Grainger saw Patient A in March 2013, he noted in Patient A s clinical notes that the full upper and partial lower dentures were poor fitting. In his witness statement of January 2014 he stated that he noticed that the upper and lower dentures were not particularly well fitted and that upon biting, the back teeth did not meet. The criticism regarding the occlusion was not reflected in his clinical notes. The Committee notes that Patient A did not seek to replace his dentures for 17 months until he saw Mr Grainger. The Committee was not satisfied on a balance of probabilities that the set of dentures was not fit for purpose. WITHDRAWN 2p. Proved. Patient A s lower left canine was a root filled tooth that fractured during the time that he was under your care. Patient A maintains that you did not treat it. You told the Committee that you recollect a fractured tooth and that you smoothed it down. The Committee noted the expert evidence of Mr Bradley that merely smoothing down the tooth in the manner that you say you did was not adequate. The Committee agrees with this view. 2q. Not proved. Patient A s evidence was that his lower right canine protruded above the level of the denture and that you ground it down to the degree that it was painful. You told the Committee that you did not treat this tooth and the Committee notes that there is no mention of it in your notes. The Committee finds it not credible that you would have ground down this tooth in the way described by Patient A. 2r. 2s. POPE, R M Professional Conduct Committee February July 2014 Page -13/33-
3a. Not proved The only evidence in support of this is the witness statement of Patient A. You have denied this head of charge. Neither you nor the Committee were in a position to question Patient A on this point and observe his demeanour. The Committee takes the view that it is inherently improbable that a dentist would speak to their patient in the way alleged in this head of charge. In the absence of any corroborative evidence it is not satisfied on a balance of probabilities that this was said by you to Patient A. 3b. Not proved. The only evidence in support of this is the witness statement of Patient A. You have denied this head of charge. Neither you nor the Committee were in a position to question Patient A on this point and observe his demeanour. The Committee was told that the vast majority of your patients are NHS patients. The Committee takes the view that it would be illogical for you to refer to NHS patients as you people in the light of the majority of your patients being such. Further, it takes the view that it is inherently improbable that a dentist would speak to their patient in the way alleged in this head of charge. In the absence of any corroborative evidence the Committee is not satisfied on a balance of probabilities that this was said by you to Patient A. 3c. Not proved. It is apparent from the unusually extensive clinical notes you made in Patient A s records on 30 January 2012, the subsequent letter of complaint written by the patient, and your response, that a breakdown had occurred in your relationship with the patient. In the light of the tenor and nature of the exchanges between you and Patient A, the Committee takes the view that an incident occurred on 30 January 2012. However the Committee concluded that there was insufficient evidence upon which it could determine that you said words to that effect and that your conduct was unprofessional. 3d. Not proved. In the light of the tenor and nature of the exchanges between you and Patient A, the Committee takes the view that by 30 January 2012 your relationship with Patient A had broken down. However the Committee concluded that there was insufficient evidence upon which it could determine that you acted aggressively. 3e. Not proved The only evidence in support of this is the witness statement of Patient A. You have denied this head of charge. Neither you nor the Committee were in a position to question Patient A on this point and observe his demeanour. The Committee takes the view that it is inherently improbable that a dentist would treat their patient in the way alleged in this head of charge. In the absence of any corroborative evidence it is not satisfied on a balance of POPE, R M Professional Conduct Committee February July 2014 Page -14/33-
probabilities that you threw Patient A s denture at him. 3f. Not proved In the light of the Committee s finding at subheads of charge 3b and c above the Committee finds this subhead of charge not proved. 4a. WITHDRAWN 4b. Schedule A Claim 1 Admitted and proved Schedule A Claim 2 Not proved. You carried out extractions and then made additions to Patient A s denture the Committee is satisfied that this was a completed Band 2 treatment and the claim was appropriate. Schedule A Claim 3 Proved. The Committee is satisfied that you planned to provide the upper denture whilst you were in the process of providing the lower denture and noted that appointments were scheduled for the upper denture. Following completion of the lower partial denture, there is no indication that Patient A contacted the surgery to arrange for an upper denture. The notes indicate that dates were set three weeks later for four appointments to make the upper denture. On the balance of probabilities, in those circumstances, it is more likely than not that the decision to provide an upper denture had already been taken at the time of the provision of the lower denture. The consequence of this is that when Claim 3 was made it was inappropriate because further treatment was contemplated. Schedule A Claim 4 Proved. This claim was inappropriate because it was part of the continuing course of treatment initiated at Claim 3. The Committee acknowledges that you were entitled to one Band 3 Claim for the provision of this set of dentures. 4c. Proved. In relation to Claim 1 you were clearly planning on providing additional treatment to the patient, however you closed that course of treatment and then claimed a Band one fee to which you were not entitled. When the patient returned for further treatment, you claimed again. In relation to the provision of the upper and lower dentures, Claims 3 and 4, to Patient A as separate courses of treatment, the Committee takes the view that in the light of your intention to provide an upper denture at the time that you were providing the lower denture, your splitting of the course of treatment was done with the intention of claiming a greater number of UDAs. The regulations are clear on this particular issue, and you yourself did not claim to be confused about them in this regard. You sought to persuade the Committee that you did not intend to provide the upper denture at the same time as providing the lower denture. The Committee did not accept this. POPE, R M Professional Conduct Committee February July 2014 Page -15/33-
In all of the circumstances the Committee is satisfied that in relation to Claims 1, 3 and 4, you knowingly and dishonestly acted with the intention of claiming UDAs to which you were not entitled. 5a. 5b. 5c. Proved You took no radiographs and you undertook no extraoral palpation. In relation to this patient, you gave CPITN scores of 1 on all but one occasion. In the light of the consistent CPITN scorings of 1 given to many other patients, including those with longstanding periodontal problems, mobile teeth and poor oral health, the Committee was not satisfied that the scoring was accurate in this patient s case or in relation to other patients. Your evidence was that you routinely examined your patients and that though you did not record the outcome of those examinations, you relied upon your memory. The Committee did not find this credible. 5d. 5e. 5f. 5g. 5h. 5i. Not proved. The Committee noted that both yourself and your colleague Mr Knox provided restorative work to Patient B s LR7. The patient was seen on four occasions. You provided a filling on 20 June 2011 and Mr Knox provided a filling on 13 July 2011 and 1 August 2011. You saw the patient again on 20 July 2011. However the notes are unclear about what happened on that occasion. In the light of treatment having been provided to Patient B by another dentist as well as by yourself, and in the light of the lack of clarity as to which of you held ultimate responsibility for this treatment, the Committee determined that there was insufficient evidence upon which it could find this head of charge proved. 5j. 5k. Proved. The Committee noted that you recorded one score of 2 in Patient B s CPITN scoring on 12 December 2011. On that basis you therefore diagnosed calculus in one area. However the Committee noted the hospital hygienist s clinical notes dated 28 February 2012 which diagnosed very large sub gingival calculus all areas. Calculus would not have built up to such a degree in such a short space of time. Your diagnosis was therefore incomplete and inadequate. 5l. 5m. Not proved. POPE, R M Professional Conduct Committee February July 2014 Page -16/33-
The Committee accepts your evidence that there was no reason for you to refer Patient B. It noted that Patient B had been advised by you to inform her GP about her adverse reaction to antibiotics. She thereafter went to see her GP. It was satisfied that you would be unlikely to refer her to her General Practitioner for onward referral to an oral and maxillofacial surgeon. 5n. 5o. 5p. 5q. 5r. 5s. 6a. 6b. 6c. Proved Patient C had Parkinsons disease and was therefore struggling significantly with his oral hygiene. You noted the patient s oral hygiene problems on 29 September 2011, however only one CPITN score was undertaken by you on 4 January 2011. Your evidence was that your extra oral examinations never included palpation. In the light of these factors the Committee was satisfied that your examination of the patient was inadequate. 6d. 6e. 6f. 6g. 6h. 6i. Admitted and proved regarding the LL3 on 17 May 2011. Proved in its entirety. The Committee noted that apart from an OPG taken on 29 September 2011, you took no other radiographs. You have told the Committee that your failure to take diagnostic radiographs in this instance was due to Patient C s medical condition. However in view of your general habit of failing to take radiographs, the Committee was not persuaded by this explanation. It further took the view that radiographs could be taken of a patient with Parkinsons disease. 6j. 6k. 6l. POPE, R M Professional Conduct Committee February July 2014 Page -17/33-
6m. 6n. 6o. 6p. 6q. 6r. 7a. WITHDRAWN 7b. Schedule C Claim 1 Admitted and proved Schedule C Claim 2 Not proved The Committee takes the view that this was not an inappropriate claim. The Committee does not accept that the 25 charge that the patient paid was for private treatment. Schedule C Claim 3 Schedule C Claim 4 Not proved. Mr Birkin was of the view that this was an inappropriate claim because no examination was carried out. However Mr Kramer told the Committee that an examination of sorts must have occurred in order for the treatment to be provided. On balance the Committee is satisfied that an examination of sorts must have occurred. This claim was therefore not inappropriate. Schedule C Claim 5 Not proved. You carried out treatment by recementing a crown. The Committee is satisfied that this was not an inappropriate claim. Schedule C Claim 6 7c. Not proved. In relation to these inappropriate claims, in the light of the ambiguity of the regulations in this area, the Committee was not satisfied that the requirements of either stage one or stage two of Ghosh were met. 8a. 8b. 8c. Proved. You took no radiographs and you did not undertake any extraoral palpation. In all of the circumstances the Committee is satisfied that this head of charge is proved. 8d. 8e. 8f. POPE, R M Professional Conduct Committee February July 2014 Page -18/33-
8g. 8h. 8i. 8j. 8k. Not proved. The GDC expert Mr Bradley took the view that you failed to provide oral hygiene instruction due to your lack of notation in the patient s records. You did not note that you gave the patient any oral hygiene instruction. However you told the Committee that you always gave it. The Committee was not satisfied that the GDC had made out its case to the required standard of proof. 8l. 8m. 8n. 8o. 8p. 9a. WITHDRAWN. 9b. Schedule D Claim 1 Schedule D Claim 2 Not proved. Mr Birkin s view was that the treatment of 30 June 2011 was the beginning of a course of treatment which was carried on into 12 August 2011, 1 November 2011, and 24 January 2012. He did not accept that a Band 4 course of treatment could stand alone as claimed in this instance. Mr Kramer took the view that the treatment of 12 August 2011 was a stand alone Band 4 treatment. The patient came in as an emergency. The Committee has considered the regulations and takes the view that a Band 4 treatment can stand alone in the way that you claimed in this instance and that this was therefore an appropriate claim. In reaching its decision, the Committee paid particular attention to Regulation 6 (3) of the National Health Service (General Dental Services Contracts) Regulations 2005. Schedule D Claim 3 Schedule D Claim 4 Proved This claim should have been a component of Claim 3 and is therefore inappropriate. However the Committee acknowledges that you were entitled to claim one Band 3 payment for the provision of these crowns. 9c. Proved. In relation to these claims you were clearly planning on providing additional treatment to the patient at the start, however you inappropriately and repeatedly closed courses of treatment and then claimed fees to which you were not entitled; POPE, R M Professional Conduct Committee February July 2014 Page -19/33-
starting a new course of treatment when the patient returned for further treatment. In all of the circumstances the Committee is satisfied that in relation to these claims, you knowingly and dishonestly acted with the intention of claiming UDA s to which you were not entitled. 10a. 10b. 10c. Proved. In relation to this patient, you gave CPITN scores of 1. In the light of the consistent CPITN scorings of 1 given to other patients, including those with longstanding periodontal problems, mobile teeth and poor oral health, the Committee was not satisfied that the scoring was accurate in this patient s case or in relation to other patients. You admitted that you did not extraorally palpate your patients as part of the examination process. You also admitted that you did not take radiographs. The Committee accepts that some type of examination occurred but in the light of the lack of reliable CPITN scoring, palpation and radiographs it was not satisfied that your examination of this patient was comprehensive. 10d. 10ei. 10eii. 10f. 10g. 10h. 10i. 10j. WITHDRAWN 10k. 10l. 10mi. 10mii. 11a. WITHDRAWN 11b. Schedule E Claim 1 Schedule E Claim 2 Proved. The Committee is satisfied that as the previous course of treatment had been inappropriately closed, this claim, which should have been a part of Claim 1, was also inappropriate. Schedule E Claim 3 Proved. The Committee is satisfied that as the Claim 1 course of treatment had been POPE, R M Professional Conduct Committee February July 2014 Page -20/33-
inappropriately closed, this claim was also inappropriate. However the Committee is satisfied that you were entitled to one Band 3 payment for Claims 1 to 3. Schedule E Claim 4 Schedule E Claim 5 Proved The Committee is satisfied that as the previous course of treatment had been inappropriately closed, this claim was also inappropriate. 11c. Proved. However the Committee is satisfied that you were entitled to one Band 2 payment. As reflected in the Committee s findings above, you were entitled to claim for two courses of treatment. In relation to these claims you were clearly planning on providing additional treatment to the patient when you began each course of treatment, but you chose to inappropriately split them into five courses of treatment. In the Committee s view the regulations are clear on this particular issue. In all of the circumstances the Committee is satisfied that in relation to these claims, you knowingly and dishonestly acted with the intention of claiming UDAs to which you were not entitled. 12a. 12b. 12c. Proved. In relation to this patient, you gave CPITN scores of 1. In the light of the consistent CPITN scorings of 1 given to other patients, including those with longstanding periodontal problems, mobile teeth and poor oral health, the Committee was not satisfied that the scoring was accurate in this patient s case or in relation to other patients. You admitted that you did not extraorally palpate your patients as part of the examination process. You also admitted that you did not take radiographs. The Committee accepts that some type of examination occurred but in the light of the lack of reliable CPITN scoring, palpation and radiographs it was not satisfied that your examination of this patient was comprehensive. 12d. 12e. 12f. 12g. 12h. 12i.i. 12i.ii. POPE, R M Professional Conduct Committee February July 2014 Page -21/33-
12ji. 12jii. 12k. 12l. 12m. 12n. 13a. WITHDRAWN 13b. Schedule F Claim 1 Schedule F Claim 2 Schedule F Claim 3 Not proved. The Committee is satisfied that this was an emergency stand alone Band 4 treatment and was therefore not inappropriate. Schedule F Claim 4 Schedule F Claim 5 Proved. On 11 August 2011 you inappropriately claimed for Band 1 treatment. The treatment provided on 14 October 2011 was a part of that course of treatment. This claim was therefore inappropriate. 13c. Proved. However the Committee acknowledges that you were entitled to one Band 3 claim. The Committee is satisfied that the treatment associated with Claim 2 was a clinical failing and that associated with Claim 4 was a note keeping failing. However in relation to Claims 1 and 5, you were entitled to claim for one course of treatment. At the time of Claim 1 you were clearly planning on providing additional treatment to the patient, but you chose to inappropriately split it into two courses of treatment. In the Committee s view the regulations are clear on this particular issue. In all of the circumstances the Committee is satisfied that in relation to these claims, you knowingly and dishonestly acted with the intention of claiming UDAs to which you were not entitled. 14a. 14b. 14c. Proved. You admitted that you did not extraorally palpate your patients as part of the examination process. You also admitted that you did not take radiographs. The Committee accepts that some type of examination occurred but in the light of the lack of palpation and radiographs it was not satisfied that your examination of this patient was comprehensive. POPE, R M Professional Conduct Committee February July 2014 Page -22/33-
14d. 14e. 14fi. 14fii. 14g. 14h. 14i. 14j. 15a. WITHDRAWN 15b. Schedule G Claim 1 Schedule G Claim 2 Schedule G Claim 3 Proved. On 10 December 2010 you inappropriately claimed for Band 1 treatment. The treatment provided from 11 March 2011 to 5 April 2011 was a part of that course of treatment. This claim was therefore inappropriate. Schedule G Claim 4 Not proved. The Committee is not satisfied that you inappropriately claimed for Band 2 treatment on 21 July 2011. It was not satisfied that you failed to examine the patient. Schedule G Claim 5 - Schedule G Claim 6 Not proved. The Committee is not satisfied that this claim was inappropriate as the components of Band 1 appear to have been met. 15c. Proved. In relation to Claims 1,2 and 3, you were entitled to claim for one course of treatment. At the time of Claim 1 you were clearly planning on providing additional treatment to the patient, but you chose to inappropriately split it into three courses of treatment. In the Committee s view the regulations are clear on this particular issue. In all of the circumstances the Committee is satisfied that in relation to these claims, you knowingly and dishonestly acted with the intention of claiming UDAs to which you were not entitled. In relation to Claim 5, though it was inappropriate in that you should have claimed for Band 4 treatment, the Committee took the view that the evidence was not sufficiently cogent to support a finding of dishonesty. You may have mistakenly thought that a Band 2 claim was justified at the time. 16a. POPE, R M Professional Conduct Committee February July 2014 Page -23/33-
16b. 16c. Proved. You admitted that you did not extraorally palpate your patients as part of the examination process. You also admitted that you did not take radiographs. The Committee accepts that some type of examination occurred but in the light of the lack of palpation and radiographs it was not satisfied that your examination of this patient was comprehensive. Further on 20 September 2010 you failed to record a CPITN score or by use of the tick box record that you had carried out other routine examinations. 16d. 16e. 16f. 16g. 16h. 16i. 16ji. 16jii. 16k. 16l. 17a. WITHDRAWN 17b. Schedule H Claim 1 Schedule H Claim 2 Schedule H Claim 3 Not proved The Committee is satisfied that you examined and treated the patient and that a Band 2 claim was therefore appropriate. Schedule H Claim 4 WITHDRAWN Schedule H Claim 5 Schedule H Claim 6 Schedule H Claim 7 Not proved. The Committee is satisfied that you provided Band 4 treatment to the patient. Schedule H Claim 8 Not proved The Committee is not satisfied that you inappropriately claimed for Band 1 treatment. It was not satisfied that you failed to examine the patient. 17c. Proved. Claims 1, 2 and 5 were inappropriate. However the Committee took the view that POPE, R M Professional Conduct Committee February July 2014 Page -24/33-
the evidence was not sufficiently cogent to support a finding of dishonesty. The Committee is willing to accept that there may have been some confusion in your mind. In relation to Claim 6, the treatment you provided was clearly not Band 2 treatment and you must have been aware of this. It was clearly a Band 4 treatment. The Committee is satisfied that in relation to this claim, you knowingly and dishonestly acted with the intention of claiming UDAs to which you were not entitled. 18a. 18b. 18c. Proved. You admitted that you did not extraorally palpate your patients as part of the examination process. You also admitted that you did not take radiographs. The Committee accepts that some type of examination occurred but in the light of the lack of palpation and radiographs it was not satisfied that your examination of this patient was comprehensive. 18d. 18e. 18f. 18g. 18h. 18i. 18ji. 18jii. 18jiii. 18jiv 18jv. 18jvi. Not proved. On 10 February 2011 you noted in the patient records that you discussed treatment options with Patient I. 18k. 18li 18lii. Proved. The Committee noted there was no medical history recorded for Patient I. The Committee noted that you wrote on each page of the patient s records that the patient was allergic to penicillin but the Committee does not consider that to be equivalent to updating the patient s medical records. POPE, R M Professional Conduct Committee February July 2014 Page -25/33-
18m. 18n. 19a. WITHDRAWN 19b. Schedule I Claim 1 Not proved On 21 December 2010 you provided treatment to the patient s LR6. Mr Birkin took the view that the claim was inappropriate as further treatment was planned at the time. However in the light of the NHS regulations referred to above, which indicate that emergency treatment is stand alone treatment, the Committee rejects his view. Schedule I Claim 2 Not proved. Band 2 treatment was provided on 27 January 2011. The Committee is satisfied that some form of assessment must have occurred. It is therefore not satisfied that this claim was inappropriate. 19c. Proved. Schedule I Claim 3 Schedule I Claim 4 Schedule I Claim 5 In relation to Claim 3, the patient s notes indicate that you provided a prescription without seeing the patient and then claimed for a course of treatment. This was not only inappropriate but you knowingly and dishonestly acted with the intention of claiming UDAs to which you were not entitled. Claims 4 and 5 were inappropriate. However the Committee took the view that the evidence was not sufficiently cogent to support a finding of dishonesty. The Committee is willing to accept that there may have been some confusion in your mind. 20a. 20b. 20c. Proved. You admitted that you did not extraorally palpate your patients as part of the examination process. You also admitted that you did not take radiographs. The Committee accepts that some type of examination occurred but in the light of the lack of palpation and radiographs it was not satisfied that your examination of this patient was comprehensive. 20d. 20e. 20f. 20g. 20h. POPE, R M Professional Conduct Committee February July 2014 Page -26/33-