HEARING PARTLY HEARD IN PRIVATE SEMP, Barrie Lee Registration No: 122203 PROFESSIONAL CONDUCT COMMITTEE JUNE 2017 - FEBRUARY 2018 Outcome: Erased with immediate suspension Barrie Lee SEMP, a Clinical Dental Technician, Dip Clin Dent Tech RCS Eng 2007, was summoned to appear before the Professional Conduct Committee on 5 June 2017 for an inquiry into the following charge: Charge (as amended) That, being a registered Clinical Dental Technician: Patient A 1. You failed to provide a good standard of care to Patient A by not carrying out a full assessment of the patient; 2. AMENDED TO READ: You failed to maintain an appropriate standard of record keeping, by not recording full clinical notes of your appointments with Patient A; 3. You claimed to be a 'specialist denturist' in a brochure provided to patients when no such specialism exists; 4. Your conduct in relation to paragraph 3 was: (a) (b) misleading; dishonest; 5. You failed appropriately to respond to a complaint made by Patient A's daughter, Ms X in that you: (a) (b) Patient B AMENDED TO READ: on or around 28 February 2013 instructed or allowed a receptionist to continue to request payment following a telephone call between you and Ms X within which she complained about the fee; AMENDED TO READ: On or around 11 March 2013 allowed Hitachi Finance Ltd, a finance company through whom Patient A had funded the purchase of her dentures, to instruct solicitors, Addlestone Keane Solicitors, to continue to request the outstanding balance of 3021.23 following a letter of complaint being received from Ms X, dated 11 March 2013. 6. You failed to provide Patient B with a good standard of care, including by: (a) not carrying out a full assessment of the patient; SEMP, B L Professional Conduct Committee June 2017-Feb 2018 Page -1/24-
(b) (c) not performing a fitting of the lower denture; not ensuring that the patient was satisfied with: (i) (ii) (iii) the fit of the dentures; the regularity of the dentures; the colour of the dentures; 7. You failed to maintain an appropriate standard of record keeping, by not recording full clinical notes of your appointments with Patient B; 8. You failed appropriately to respond to Patient B's complaint, including by telling her she was "being silly"; 9. In an undated cover letter sent to Patient B with a denture information pamphlet, you claimed that your clinic was the "most advanced Denture clinic in all of Manchester", without any legitimate basis for making this claim; 10. Your conduct in relation to paragraph 9 was: (a) (b) misleading; dishonest; 11. In your letter to the GDC dated 29 August 2013 you stated that Patient B had informed you that "her children did not like the appearance of the dentures", when she had not so informed you; 12. Your conduct in relation to paragraph 11 was: (a) (b) Patient C misleading; dishonest. 13. Between August 2013 and January 2014 you were the practising Principal at [address redacted] 14. You provided care and treatment to Patient C under private contract including the provision of upper and lower partial dentures. Communication & Consent 15. You failed to provide Patient C with adequate information on proposed treatment and possible costs in that: (a) (b) (c) (d) you quoted a discounted fee of 4,743.75, if paid at the first consultation, without adequately explaining to Patient C what the dentures would be made of; you subsequently quoted an additional fee of 400 for the upper denture to be made of cobalt chrome; you failed to discuss alternative options including risks and benefits; you failed to provide Patient C with a written treatment plan at the first or subsequent consultations. SEMP, B L Professional Conduct Committee June 2017-Feb 2018 Page -2/24-
Substandard Treatment 16. You failed to provide a further try in following the appointment dated 23 October 2013. 17. You provided: (a) (b) upper dentures which were substandard in terms of aesthetics; lower and/or upper dentures which were substandard in terms of fit. 18. You failed to offer to re-make the upper denture prior to Patient C's complaint on 4 December 2013. Record Keeping 19. You failed to keep adequate records in that: (a) (b) you did not adequately record: (i) (ii) (iii) (iv) (v) dental and denture history; diagnosis; treatment planning; consent including discussion of alternative options, risks and benefits; oral hygiene and/or denture care instructions; you did not record the taking of primary impressions; (c) you did not record a further try-in following the consultation of 23 October 2013. Complaints Handling 20. You failed to provide Patient C promptly with an agreed refund. Patient D 21. Between 14 March 2013 and 19 September 2014 you were the practising Principal at [address redacted] 22. You provided care and treatment to Patient D under private contract. Consent & Payment 23. You purported to agree a treatment plan or plans in March 2013 with Patient D prior to a treatment plan or plans having been determined by a dentist and discussed by the dentist with the patient in respect of: (a) (b) extractions and immediate upper and lower dentures; implant retained upper and lower dentures. 24. You took payment of 2,000 from Patient D on 19 March 2013 prior to a treatment plan or plans having been determined by a dentist and discussed by the dentist with the patient. Acting outside scope of practice 25. You acted outside your scope of practice in that: SEMP, B L Professional Conduct Committee June 2017-Feb 2018 Page -3/24-
(a) you commenced provision of immediate dentures in March and/or April 2013 without a prescription from a dentist; (b) you arranged for a CBCT scan to be taken on 21 May 2013; (c) you commenced the provision of implant supported dentures, including on 15 April 2014, without a prescription from a dentist. Treatment Estimates 26. On 19 March 2013 you provided Patient D with a treatment estimate containing the phrase During my consultation with the Dentist and the CDT we discussed all treatment options. 27. You conduct as set out above at 26 was misleading in that no such discussions with a dentist regarding implants or other options had taken place. Record Keeping 28. You failed to record or adequately record: (a) (b) (c) (d) your referrals to other practitioners; a prescription for the provision of a full upper and lower immediate dentures from a dentist; a prescription for the provision of implant supported dentures from a dentist; discussions with Patient D regarding treatment plans formulated for him regarding: (i) (ii) Complaints Handling extractions and immediate dentures; implant based dentures. 29. AMENDED TO READ: You failed to ensure that Patient D s complaint was appropriately handled in that via your receptionist the patient was offered a refund which was conditional on withdrawing his complaint about you to the GDC. Patient E 30. Between 18 November 2015 and 12 May 2016 you were the practising Principal at the [address redacted] 31. You provided care and treatment to Patient E under private contract. Consent & Payment 32. In November 2015, prior to a treatment plan having been determined by a dentist and discussed by the dentist with the patient: (a) you purported to agree a treatment plan with Patient E; (b) via your employees Sophie and/or Ronnie you encouraged Patient E to take out finance for the proposed treatment; (c) you took payment of 2,136 from Patient E. SEMP, B L Professional Conduct Committee June 2017-Feb 2018 Page -4/24-
Acting outside scope of practice 33. You acted outside your scope of practice in that: (a) (b) on 18 and 30 November 2015 notwithstanding that Patient E had not been examined by a dentist you purported to advise her of her treatment options, including: (i) (ii) (iii) Treatment Estimates her unsuitably for suction dentures; her unsuitability for a hybrid bridge ; her suitability for an implant retained denture or dentures; you caused or allowed treatment to commence for the provision of a lower partial denture and an implant retained upper over denture without a prescription from a dentist. 34. On 18 November 2015 you provided Patient E with treatment estimates containing the phrase During my consultation we discussed all treatment options available to me. 35. You conduct as set out above at 5 was misleading in that no appropriate examination had been conducted by a dentist and the options were not known. Record Keeping 36. You failed to record or adequately record your discussions with Patient E regarding proposed treatment. Complaints Handling 37. You failed to ensure that Patient E s request for a refund was dealt with politely and/or promptly. 38. You failed to ensure that Patient E s request for the finance loan to be cancelled was dealt with politely and/or promptly. Indemnity 39. You failed to hold indemnity cover or insurance between 31 March 2015 and 18 June 2015. And that, by reason of the facts alleged, your fitness to practise is impaired by reason of misconduct. On 20 February 2018 the Chairman made the following statement regarding the finding of facts: Mr Semp, The matters in this case concern your alleged failings in practice in relation to the standard of care you provided to 5 patients, A-E. Specific failings are alleged in relation to your assessments, record-keeping, complaints handling and patient communication. It is also alleged that you made dishonest and misleading claims in the material that you provided to patients. SEMP, B L Professional Conduct Committee June 2017-Feb 2018 Page -5/24-
There are also allegations relating to your failure to have indemnity cover or insurance between 31 March 2015 and 18 June 2015. Miss Barnfather, of Counsel, appeared for the General Dental Council (GDC). Mr Morris, of Counsel, instructed by your solicitors RadcliffesLeBrasseur, represented you in respect of charges 1 to 29. You applied for Mr Rose, a family friend, to act as your lay representative in respect of the remaining charges 30 to 39, which related to Patient E and to your alleged lack of indemnity cover or insurance for the period in 2015. In deciding whether to accede to your application, the Committee took account of the submissions made by Miss Barnfather and those made by you. It accepted the advice of the Legal Adviser. The Committee considered the factors set out in rule 52(2) and rule 55(5) of the General Dental Council (Fitness to Practise) Rules 2006 (the Rules). The Committee was mindful that there is no requirement under the Rules for a representative to be legally qualified. The Committee noted that the GDC does not intend to call Mr Rose as a witness. You are not calling Mr Rose to give evidence. The Committee further considered that Mr Rose is directed to represent you in relation to Patient E and your indemnity insurance only, where it has not been alleged by the GDC that there has been any inappropriate conduct from someone purporting to be your legal adviser, as suggested with Patients D and A. The Committee concluded that it was fair to allow Mr Rose to represent you. As such the Committee accedes to the application to allow Mr Rose to represent you in respect of charges 30 39, Patient E and indemnity insurance. The Committee heard evidence from Ms X, Patient A s daughter; and from Patients B-E. The Committee also heard evidence from the Dentist TT, Dentist D, Dentist DR and Mr MB, a Clinical Dental Technician (CDT). The Committee also heard your evidence. The Committee heard expert opinion evidence from Mr James and Professor Brook, both instructed by the GDC. The Committee heard the submissions of both Counsel and of Mr Rose. The Committee accepted the advice of the Legal Adviser. The burden is on the GDC to prove each charge on the balance of probabilities. The Committee found Ms X to be a reliable and credible witness. She was also well informed, as she is a dental practice manager. The Committee also found each of the Patient witnesses to be honest and credible. They gave a straight account to the best of their recollection, making clear where they were uncertain or could not recall a matter. Dentists D and DR were credible witnesses who gave clear evidence before this Committee. The Committee found the evidence of Dentist TT to be less reliable and to some extent evasive. Mr MB was generally thought to be credible. However, his credibility was undermined to some extent on cross examination. As such, extra care was taken when considering his evidence regarding his treatment of Patient D. Mr Morris made a submission on your behalf that Mr James was not suitable to be an expert witness. This followed disclosure of correspondence between Mr James and the GDC expressing concern about his competence in other cases. The Committee accepted the advice of the Legal Adviser that it should decide, first, whether Mr James has sufficient expertise to be an expert witness and, second, whether the evidence he gave was credible. SEMP, B L Professional Conduct Committee June 2017-Feb 2018 Page -6/24-
On this basis the Committee considered Mr James had a good understanding of the role of a CDT, although he has limited experience of being a CDT to fully qualify him as an expert in that field. Overall his evidence was straightforward and of assistance to the Committee. The Committee were greatly assisted by the clarity, fullness and transparency of the opinion evidence given by Professor Brook. The Committee found your evidence to be evasive, inconsistent and unreliable. Further, the Committee could find no basis to support your claim that these proceedings are part of a GDC witch hunt against you where patients were encouraged to complain about you as part of these fitness to practise proceedings. Indeed, it is clear from the evidence that in some cases, patients who contacted the GDC to complain about you were initially advised by the GDC to simply put their complaint in writing to you in the first instance. I will now announce the Committee s findings in relation to each head of charge: Patient A 1. You failed to provide a good standard of care to Patient A by not carrying out a full assessment of the patient; Patient A, then aged 80, first attended you on 13 December 2012 for the provision of a new set of dentures at a cost of 5,000.00, which she funded by entering into a credit agreement arranged through your practice with Hitachi Finance Ltd. The total amount payable under the agreement was 5,933.12 and Patient A made an advance payment of approximately 2000.00 towards that amount. She passed away in February 2013, before the treatment was completed. Patient A was dentate by reason of a dental implant and you could therefore only treat her under the prescription of a dentist. There is no record of you carrying out a full assessment of her, including no record of her previous dental history. Indeed, you failed to maintain any records at all for her consultations, save for a ledger listing the dates of the appointments. You could only explain to the Committee how you would normally assess a patient. The Committee found this to be insufficient to establish that you carried out a full assessment of Patient A, whose case was more complex than that of edentulous patients. You have only a limited recollection of what was done at the appointments which took place some five years ago. Had you carried out a full assessment the Committee would expect to see, especially in view of the retained implant, there to be some record. There are no records whatsoever. 2. AMENDED TO READ: You failed to maintain an appropriate standard of record keeping, by not recording full clinical notes of your appointments with Patient A; 3. You claimed to be a 'specialist denturist' in a brochure provided to patients when no such specialism exists; SEMP, B L Professional Conduct Committee June 2017-Feb 2018 Page -7/24-
4. Your conduct in relation to paragraph 3 was: 4.(a) 4.(b) misleading; dishonest; Not proved. It was not in dispute that the brochure you supplied to patients, including to Patient A, referred to you as Barrie Semp, specialist Denturist when no such specialism existed. Your conduct was therefore misleading. On 6 May 2008 the Investigating Committee (IC) issued you with a written warning: ensure that you work within your competence as a clinical dental technician and that you make your remit clear to the public. Following that warning you overhauled your website but failed to also remove the title specialist Denturist from the brochure. This, you stated in evidence, was an inadvertent oversight, as you had overlooked the fact that the brochure contained that title. Having regard to the totality of the evidence, the Committee determined that the GDC has not proved you knowingly and deliberately continued to use the title specialist Denturist in your brochure. You had taken down your website to completely remove from it anything which inferred specialist status. It is more likely that you were negligent in failing to also revise your printed brochure. Negligence, rather than dishonesty, is consistent with the broad brush and careless attitude you took to other basic professional standards, such as record keeping. Although you were not acting dishonestly, there remains a high level of culpability in respect of heads of charge 3 and 4(a) above. Notwithstanding the warning from the IC, you continued to use a title which misleadingly held you out as having specialist status as a CDT, when no corresponding specialism existed and when there was nothing which could justify you being regarded as a specialist in your field of practice. 5. You failed appropriately to respond to a complaint made by Patient A's daughter, Ms X in that you: 5.(a) AMENDED TO READ: on or around 28 February 2013 instructed or allowed a receptionist to continue to request payment following a telephone call between you and Ms X within which she complained about the fee; Ms X informed your practice on 15 February 2013 that Patient A was in hospital and would therefore be unable to attend appointments in the foreseeable future. Patient A subsequently died. On or around 25 February 2013, Ms X, who had been given power of attorney, contacted Hitachi to cancel the credit agreement. On or around 27 February 2013, Ms X phoned your practice to advise you of SEMP, B L Professional Conduct Committee June 2017-Feb 2018 Page -8/24-
5.(b) Patient A s death. She was asked by the receptionist to bring in a copy of the death certificate, which she did the following day. You were not at the practice when she attended but she spoke with you over the phone. Ms X s evidence was that the receptionist then advised her that the dentures were finished and that you had put a lot of work into them for which you should be paid. Ms X s evidence was that this contradicted what the receptionist had previously advised her on 15 February 2013, when she stated that they were at the try-in stage. In the ledger notes for 4 March 2013 you recorded a clear intention that you would refund the money. However, you continued to allow your receptionist to try to retain as much money in respect of Patient A as possible. The Committee accepted Ms X s evidence that the receptionist told her that further payment was due on the account. The actions of your receptionist in respect of this matter were your responsibility. AMENDED TO READ: On or around 11 March 2013 allowed Hitachi Finance Ltd, a finance company through whom Patient A had funded the purchase of her dentures, to instruct solicitors, Addlestone Keane Solicitors, to continue to request the outstanding balance of 3021.23 following a letter of complaint being received from Ms X, dated 11 March 2013. You stated in evidence that you informed Ms X that you would sort it on the telephone, and that this was to provide a refund. On Monday 4 March 2013 you sent instruction to Hitachi to pursue the claim. You could not remember what subsequently caused you to change your mind and provide a refund, albeit there was a record of Ms X leaving a message on your system on Friday 8 March 2013. There is no written record to show you cancelling the claim. Your only record is your letter replying to Ms X s letter of complaint, dated 11 March 2013. On the balance of probabilities the Committee finds the allegation proved. Patient B 6. You failed to provide Patient B with a good standard of care, including by: 6.(a) 6.(b) not carrying out a full assessment of the patient; There are no records at all of any full assessment of the patient. The appointment log shows that the appointment only lasted 15 minutes during which a treatment estimate was produced and payment taken. not performing a fitting of the lower denture; Not proved. The Committee accepted your evidence, which was consistent with the opinion of Mr James, that you would have taken a bite to fit the lower denture. The dentures could not have fitted so closely without a bite having been taken. SEMP, B L Professional Conduct Committee June 2017-Feb 2018 Page -9/24-
6.(c) 6.(c)(i) 6.(c)(ii) 6.(c)(iii) not ensuring that the patient was satisfied with: the fit of the dentures; the regularity of the dentures; the colour of the dentures; The Committee accepted Patient B s evidence. Her account was clear and consistent throughout. She was not satisfied with the fit and appearance of the dentures from the very outset. The gaps between the teeth were also too large. She immediately voiced concerns with the receptionist about the dentures and was directed to use the mirror in the lavatory in the practice. She wanted to go back into the consultation room to see you but you were unable to see her. 7. You failed to maintain an appropriate standard of record keeping, by not recording full clinical notes of your appointments with Patient B; 8. You failed appropriately to respond to Patient B's complaint, including by telling her she was "being silly"; Not proved. The Committee found this head of charge not proved on the basis that you had offered to remake the dentures and to provide the patient with a full refund plus 100.00 as a gesture of goodwill if she still was not satisfied with the dentures. At face value this was a good offer and amounted to an appropriate and adequate response to Patient B s complaint. Patient B initially accepted the offer, albeit she subsequently changed her mind. Your response, even if the term silly was used, was acceptable in all the circumstances. 9. In an undated cover letter sent to Patient B with a denture information pamphlet, you claimed that your clinic was the "most advanced Denture clinic in all of Manchester", without any legitimate basis for making this claim; Admitted and found proved 10. Your conduct in relation to paragraph 9 was: 10.(a) 10.(b) misleading; dishonest; There was no rational or objective justification for the misleading claim that your clinic was the most advanced denture clinic in all of Manchester. In evidence, you stated that you considered your work to be of a higher standard than that of other CDTs practising in Manchester, having judged SEMP, B L Professional Conduct Committee June 2017-Feb 2018 Page -10/24-
the quality of their work from the patients who attended your practice dissatisfied with the dentures which had been manufactured for them. However, that was an entirely subjective perspective. Further, you were not likely to have assessed a fair sample of the work produced by other CDTs in the area: you were judging the work done in cases where something had gone wrong or was unsatisfactory to the patient, for that was the reason those patients were attending your clinic. You had already received a warning from the IC relating to the importance of accuracy in your advertising. You acted on that warning by changing your website: you were conscious of your professional responsibilities in respect of advertising and of the need to ensure that the statements you made were objectively true and not misleading. On your own account, you devote much skill and attention to advertising your services. You stated that in your business you heavily depend on effective and persuasive advertising in order to get patients. In the Committee s judgment, your misleading statement was not made carelessly or with any legitimate belief in its truth. You deliberately made that statement in your promotional literature, knowing that there was no legitimate basis to what you were stating. Your conduct was therefore dishonest. 11. In your letter to the GDC dated 29 August 2013 you stated that Patient B had informed you that "her children did not like the appearance of the dentures", when she had not so informed you; 12. Your conduct in relation to paragraph 11 was: 12.(a) 12.(b) misleading; dishonest. This was a deeply concerning attempt to undermine Patient B and her complaint against you as part of the GDC s investigation. As a matter of fact, Patient B did not have children. She was unhappy with the dentures from the outset and had immediately conveyed this at the practice. You knew that she had not informed you that her children did not like the appearance of the dentures. What you were doing was making up a version of events that Patient B was initially happy with the dentures but had subsequently become dissatisfied and that she exaggerated her dissatisfaction. Patient C 13. Between August 2013 and January 2014 you were the practising Principal at SEMP, B L Professional Conduct Committee June 2017-Feb 2018 Page -11/24-
[address redacted] 14. You provided care and treatment to Patient C under private contract including the provision of upper and lower partial dentures. Communication & Consent 15. You failed to provide Patient C with adequate information on proposed treatment and possible costs in that: 15.(a) 15.(b) 15.(c) 15.(d) you quoted a discounted fee of 4,743.75, if paid at the first consultation, without adequately explaining to Patient C what the dentures would be made of; Your treatment estimate outlined two different denture types, one of which was to be made of cobalt chrome. The patient understood that both would be made of metal. You accepted in your evidence that you had not fully explained the difference between the two dentures. you subsequently quoted an additional fee of 400 for the upper denture to be made of cobalt chrome; You accepted this in your oral evidence. you failed to discuss alternative options including risks and benefits; The Committee accepted Mr James evidence that there were alternative options in this case. You did not discuss these with the patient. You only discussed the options you could provide at your clinic and provided a costs estimate. In respect of implant treatment, you stated that you simply did not discuss this because you assumed that the patient would not be able to afford it, but that was not a decision for you to make. You also did not discuss the option of NHS dentures, which would have been far cheaper than the prices you quoted to the patient. you failed to provide Patient C with a written treatment plan at the first or subsequent consultations. You provided a costs estimate that did not contain details of what the treatment involved. You accepted in hindsight that this does not amount to a written treatment plan. You stated that Patient C was fully aware of the treatment plan from her discussion with you. What is alleged under this head of charge is that you failed to provide a written treatment plan. You were under a duty to provide one and as a matter of fact you did not. Substandard Treatment SEMP, B L Professional Conduct Committee June 2017-Feb 2018 Page -12/24-
16. You failed to provide a further try in following the appointment dated 23 October 2013. Not proved. As a matter of fact you did not provide a further try in. However, the Committee concluded that, although one would have been desirable and wise, you were not required to provide a further try in. In those circumstances you had not failed in a corresponding duty. 17. You provided: 17.(a) 17.(b) upper dentures which were substandard in terms of aesthetics; The aesthetics of a denture must be judged according to the reasonable perspective of the patient, for it is their teeth and appearance. The Committee accepted the patient s evidence, which related to the aesthetics. You made a number of alterations as she was unhappy which failed to remedy the problems and left them with a poor bite. lower and/or upper dentures which were substandard in terms of fit. Not proved. It is clear that there are issues regarding the bite. This head of charge is not proved because it pleads only the fit as being substandard, in respect of which there was only anecdotal evidence before the Committee. There is a subtle but important distinction between the bite and the fit. Had the charge pleaded the bite to be sub-standard then that would have been found proved. 18. You failed to offer to re-make the upper denture prior to Patient C's complaint on 4 December 2013. Not proved. The denture was fitted on 13 November 2013 and the complaint was made on 4 December 2013, following which you offered to re-make the denture. The Committee could not identify from the evidence that you were under any duty to offer to re-make the upper denture prior to the complaint being made. It might have been desirable for you to have done so but the evidence does not establish that there was a corresponding duty on you and that you therefore failed in that duty. Record Keeping 19. You failed to keep adequate records in that: 19.(a) you did not adequately record: (i) (ii) (iii) dental and denture history; diagnosis; treatment planning; SEMP, B L Professional Conduct Committee June 2017-Feb 2018 Page -13/24-
19.(b) 19.(c) (iv) (v) consent including discussion of alternative options, risks and benefits; oral hygiene and/or denture care instructions; you did not record the taking of primary impressions; you did not record a further try-in following the consultation of 23 October 2013. Complaints Handling 20. You failed to provide Patient C promptly with an agreed refund. Patient C asked for a 50% refund as she did not believe you would refund her the full amount. You agreed to refund the 50% by return of her dentures and the refund was made on 30 January 2014, a few weeks after the return of the dentures. The Committee accepted Patient C s evidence of the repeated attempts she had to make to chase the refund of what was a substantial sum of money which had been promised to her by return of her dentures. She posted them to you on 3 January 2015. It is accepted that they had not arrived on 6 January 2015 when your staff contacted her. However, the Committee felt that there was an excessive delay in providing a refund that had been promised by return. Patient D 21. Between 14 March 2013 and 19 September 2014 you were the practising Principal at [address redacted] 22. You provided care and treatment to Patient D under private contract. Consent & Payment 23. You purported to agree a treatment plan or plans in March 2013 with Patient D prior to a treatment plan or plans having been determined by a dentist and discussed by the dentist with the patient in respect of: 23.(a) extractions and immediate upper and lower dentures; Proved The Committee accepted Patient D s evidence that he first saw you for impressions before having his teeth extracted by Dentist D. Patient D gave clear and consistent evidence. The appointments would also have been particularly memorable for him due to his phobia of dentists. It is also highly unlikely that he would have had the teeth extracted first and then SEMP, B L Professional Conduct Committee June 2017-Feb 2018 Page -14/24-
23.(b) impressions taken, as it can be difficult to take impressions with 9 bleeding sockets. Further, if Patient D had seen Dentist D first, then there is no reason why the treatment estimate you provided him with for treatment costing 17,000.00 would have the cost of the extractions written on to it, as those costs would have been paid separately to Dentist D. The fact that they were written onto the treatment estimate is consistent with Patient D seeing you first before being referred to Dentist D for the extractions. Patient D also discussed with you the possibility of having the work done on the NHS, which would have been a moot point had he already attended Dentist D for the extractions. The Committee accepted Professor Brook s evidence that you were acting as the lead clinician. implant retained upper and lower dentures. 24. You took payment of 2,000 from Patient D on 19 March 2013 prior to a treatment plan or plans having been determined by a dentist and discussed by the dentist with the patient. Acting outside scope of practice 25. You acted outside your scope of practice in that: 25.(a) you commenced provision of immediate dentures in March and/or April 2013 without a prescription from a dentist; The Committee found as fact that Patient D attended you before he attended Dentist D when you took a down payment and impressions were taken. Providing immediate dentures without the prescription of a dentist was outside your scope of practice, as Patient D was dentate. 25.(b) you arranged for a CBCT scan to be taken on 21 May 2013; 25.(c) Arranging for a CBCT scan was beyond your scope of practice as a CDT. Dentist TT allowed the scan to go ahead without having seen Patient D and without examining the notes: the first time he saw the Patient was when you booked him in for the implant surgery without his sockets having healed. On balance, you were the practitioner who arranged the CBCT scan for Patient D and not Dentist TT. The scan was arranged prematurely, before the Patient had healed. Dentist TT would have understood the need to wait 3 months to allow for full healing before arranging the scan. By contrast, you did not understand that Patient D needed to wait 3 months before having the CBCT scan. you commenced the provision of implant supported dentures, including on SEMP, B L Professional Conduct Committee June 2017-Feb 2018 Page -15/24-
15 April 2014, without a prescription from a dentist. Treatment Estimates 26. On 19 March 2013 you provided Patient D with a treatment estimate containing the phrase During my consultation with the Dentist and the CDT we discussed all treatment options. 27. You conduct as set out above at 26 was misleading in that no such discussions with a dentist regarding implants or other options had taken place. Record Keeping 28. You failed to record or adequately record: (e) (f) (g) (h) your referrals to other practitioners; a prescription for the provision of a full upper and lower immediate dentures from a dentist; a prescription for the provision of implant supported dentures from a dentist; discussions with Patient D regarding treatment plans formulated for him regarding: (iii) extractions and immediate dentures; (iv) implant based dentures. Complaints Handling 29. AMENDED TO READ: You failed to ensure that Patient D s complaint was appropriately handled in that via your receptionist the patient was offered a refund which was conditional on withdrawing his complaint about you to the GDC. It is abundantly clear from the documentary evidence that your intention was that the refund would be conditional on the patient withdrawing his complaint to the GDC. This was wholly inappropriate conduct, albeit it only lasted 24-48 hours. You stated in evidence that it was Dentist TT who initiated the requirement. Whether it was you or Dentist TT is a moot point in the Committee s judgment. You adopted the role of lead clinician and shared responsibility for the terms on which the refund was offered to your patient. Patient E 30. Between 18 November 2015 and 12 May 2016 you were the practising SEMP, B L Professional Conduct Committee June 2017-Feb 2018 Page -16/24-
Principal at the [address redacted] 31. You provided care and treatment to Patient E under private contract. The issue under this head of charge was whether you provided care and treatment. The Committee found that you did provide care and treatment to Patient E, from at least when you provided treatment options and took payment from her. Consent & Payment 32. In November 2015, prior to a treatment plan having been determined by a dentist and discussed by the dentist with the patient: 32.(a) you purported to agree a treatment plan with Patient E; 32.(b) via your employees Sophie and/or Ronnie you encouraged Patient E to take out finance for the proposed treatment; There was clear evidence that your employees encouraged Patient E to take out finance for the proposed treatment. They would have done so under your direction and not of their own volition. In any event, their actions were your ultimate responsibility. 32.(c) you took payment of 2,136 from Patient E. You accepted this in the course of your evidence. The sum was paid on 30 November 2015. Acting outside scope of practice 33. You acted outside your scope of practice in that: 33.(a) 33.(a)(i) 33.(a)(ii) on 18 and 30 November 2015 notwithstanding that Patient E had not been examined by a dentist you purported to advise her of her treatment options, including: her unsuitably [sic] for suction dentures; The Committee accepted the evidence of Patient E, who gave a clear account of having researched suction dentures and other forms of denture. Suction dentures were the reason she attended you. You confirmed in your evidence that you discussed suction dentures with her and advised her that she would be unsuitable. her unsuitability for a hybrid bridge ; SEMP, B L Professional Conduct Committee June 2017-Feb 2018 Page -17/24-
33.(a)(iii) 33.(b) The Committee accepted Patient E s evidence. You discussed the option of a hybrid bridge with the Patient and her unsuitability for it. her suitability for an implant retained denture or dentures; The Committee accepted Patient E s evidence. You discussed her suitability for implant retained dentures. you caused or allowed treatment to commence for the provision of a lower partial denture and an implant retained upper over denture without a prescription from a dentist. On 30 November 2015 you took payment for the treatment without a prescription from a dentist. In addition to this on 23 December 2015 a member of your staff took an impression when the treatment option had not been decided upon. That person had not even seen the patient and the patient did not know that she was a dentist. Treatment Estimates 34. On 18 November 2015 you provided Patient E with treatment estimates containing the phrase During my consultation we discussed all treatment options available to me. The document was in evidence before the Committee. 35. You conduct as set out above at 5 [sic] was misleading in that no appropriate examination had been conducted by a dentist and the options were not known. The Committee saw that 5 must be a typographical error and read this charge as referring to your conduct at 34 above. The patient had not even seen the dentist until December 2015. As no examination had taken place by the dentist, the treatment options were not known on 18 November 2015 and it was therefore misleading to provide Patient E with the treatment estimate stating that all treatment options had been discussed. Record Keeping 36. You failed to record or adequately record your discussions with Patient E regarding proposed treatment. The only record of your discussions is the treatment estimate, which is clearly not adequate. Complaints Handling 37. You failed to ensure that Patient E s request for a refund was dealt with SEMP, B L Professional Conduct Committee June 2017-Feb 2018 Page -18/24-
politely and/or promptly. You were difficult and uncooperative with Patient E when she requested a refund. You claimed to be entitled to payment of 150.00 in respect of work done but this was an arbitrary figure for which you provided no justification or breakdown to Patient E, as requested. 38. You failed to ensure that Patient E s request for the finance loan to be cancelled was dealt with politely and/or promptly. Patient E cancelled the loan in accordance with her right to do so but you were difficult and uncooperative. She had to fight every step of the way for her right to cancel the loan and ultimately went into arbitration to enforce her right of cancellation. It was plain that the substantial deposit she had paid was not intended as a non-refundable deposit but was a payment towards the balance on the account and would become refundable to her upon cancellation of the loan agreement. Indemnity 39. You failed to hold indemnity cover or insurance between 31 March 2015 and 18 June 2015. We move to Stage Two. Your membership with Dental Protection lapsed on 30 March 2015. It was your evidence that you were unaware of this at the time. When you became aware you ceased practising until you obtained cover from an alternative provider. Some 2 years later you also took out retrospective cover for the period 31 March 2015 to 18 June 2015. You stated that Dental Protection had failed to serve on you effective notice of your membership lapsing and that in those circumstances your indemnity cover continued, or should be treated as having continued. In the Committee s judgment, as a matter of fact, you failed to hold indemnity cover or insurance for the period alleged whether or not you had received notification that your membership had lapsed. On 27 February 2018 the Chairman announced the determination as follows: Mr Semp, The Committee heard the submissions made on behalf of the General Dental Council (GDC) by Miss Barnfather, and those made on your behalf by Mr Morris and Mr Rose. The Committee accepted the advice of the Legal Adviser. The Committee had regard to the Guidance for the Practice Committees, including Indicative Sanctions Guidance (October 2016). SEMP, B L Professional Conduct Committee June 2017-Feb 2018 Page -19/24-
In accordance with Rule 20(1)(a) of the General Dental Council (Fitness to Practise) Rules 2006, Miss Barnfather addressed the Committee on your history. Between 1997 and 2006 you received 4 criminal convictions for offences relating to the illegal practice of dentistry. You registered with the GDC in 2007. On 6 May 2008 the Investigating Committee (IC) issued you with a published warning for 12 months: ensure that you have [sic] work within your competence as a clinical dental technician and that you make your remit clear to the public. Please ensure that you are familiar with and understand the guidance contained in Standards for Dental Professionals and its accompanying documents. As a dental professional you are expected to apply these principles to your work and conduct at all times. This was followed by a further warning from the IC on 20 December 2012 in respect of other matters, published for a period of 18 months: In reaching this decision, the Committee has taken into account that the Registrant had been in practice for a relatively short period of time prior to receiving a formal warning from this Committee less than 4 years ago. In all the circumstances, the Committee is satisfied that it is proportionate to afford the Registrant a final opportunity to demonstrate a commitment to appropriate practice, within GDC guidelines but that in order to protect the wider public interest, it is necessary to publish a warning for a period of 18 months The Committee formally warns the Registrant that a repetition of the conduct outlined in the concerns raised will be viewed very seriously and may likely call into question the Registrant's continued fitness to practice [sic]. Further, the Committee warns the Registrant to ensure that: he works within his competencies as a clinical dental condition [sic] and does not treat dentate patients without a valid prescription from a dentist; it is not appropriate to treat a patient then subsequently obtain a prescription or referral; his advertising is clear, accurate and not misleading as to his status on the GDC Register and as a consequence, his scope of practice; and he speaks to patients in a clear and effective fashion, particularly during difficult conversations, to ensure that there is no scope for miscommunication, or for patients to feel that their concerns have not been appropriately addressed. At Stage Two of these proceedings, the Committee heard evidence from Mr Smith and from you. Mr Smith is a Clinical Dental Technician (CDT) and former Council member of the GDC who had recused himself from the Council to write a letter in support of you. The Committee found his evidence to be credible, authoritative and reasonable. The Committee found your evidence more credible at Stage Two than at Stage One. However, there were some discrepancies during cross-examination concerning the employment of a consultant to develop your business strategy. In evidence at Stage Two you acknowledged, as did your counsel in closing submissions, that the facts found proved would amount to misconduct and that your fitness to practise would be currently impaired by reason of that misconduct. Mr Morris submitted that suspension is the appropriate outcome in this case; Miss Barnfather submitted that your name should be erased from the dental care professionals register. Misconduct Misconduct connotes a serious departure from acceptable standards. It can be characterised as conduct which other members of the profession would regard as deplorable. In SEMP, B L Professional Conduct Committee June 2017-Feb 2018 Page -20/24-
assessing whether the facts found proved amount to misconduct, the Committee had particular regard to the following principles from Standards for Dental Professionals (2005 to 2013): 1.1 Put patients interests before your own or those of any colleague, organisation or business. 1.3 Work within your knowledge, professional competence and physical abilities. Refer patients for a second opinion and for further advice when it is necessary, or if the patient asks. Refer patients for further treatment when it is necessary to do so. 1.4 Make and keep accurate and complete patient records, including a medical history, at the time you treat them. Make sure that patients have easy access to their records. 1.5 Give patients who make a complaint about the care or treatment they have received a helpful response at the appropriate time. Respect the patient s right to complain. Make sure that there is an effective complaints procedure where you work and follow it at all times. Co-operate with any formal inquiry into the treatment of a patient. And from Standards for the Dental Team (September 2013): 1.1 You must listen to your patients 1.1.1 You must discuss treatment options with patients and listen carefully to what they say. Give them the opportunity to have a discussion and to ask questions. 1.2 You must treat every patient with dignity and respect at all times 1.3.3 You must make sure that any advertising, promotional material or other information that you produce is accurate and not misleading, and complies with the GDC s guidance on ethical advertising. 1.7 You must put patients interests before your own or those of any colleague, business or organisation 1.7.1 You must always put your patients interests before any financial, personal or other gain. 1.8.1 You must have appropriate insurance or indemnity in place to make sure your patients can claim any compensation to which they may be entitled (See our website for further guidance on what types of insurance or indemnity the GDC considers to be appropriate). 2.3.6 You must give patients a written treatment plan, or plans, before their treatment starts and you should retain a copy in their notes. You should also ask patients to sign the treatment plan. 3.1 Obtain valid consent before starting treatment, explaining all the relevant options and the possible costs. 3.2 Make sure that patients (or their representatives) understand the decisions they are being asked to make. 4.1 You must make and keep contemporaneous, complete and accurate patient records In the Committee s judgment, the facts found proved in this case, which include findings of dishonesty and of acting beyond your Scope of Practice, clearly amount to serious breaches of the above standards. This was important, expensive and advanced treatment for 5 patients who trusted your skill, competence and integrity as a dental professional. They were paying you thousands of pounds for treatment. Your promotional literature included false and misleading claims of you being a specialist and of your clinic being the most advanced denture clinic in all of Manchester, the latter claim having been made dishonestly by you. You sought to make withdrawal of a complaint by a patient to the GDC a condition of him being reimbursed for the cost of his treatment. Your conduct fell far below that which would SEMP, B L Professional Conduct Committee June 2017-Feb 2018 Page -21/24-
reasonably be expected of a dental professional. Other members of the profession would clearly regard your conduct as deplorable. In respect of your record keeping failings, these were not isolated shortcomings but reflected your standard of practice, where you would typically make no clinical records at all for your many patients or would make very poor records for them. In respect of indemnity cover, you were unaware this had lapsed when continuing to practise for a period of some 2 months. You blamed the indemnity provider for this lapse due to the manner in which they communicated the cancellation of your policy. However, whilst the Committee had some sympathy with your position, it was plainly your responsibility to have ensured that your indemnity cover continued to be in place. You vehemently denied any responsibility for this in evidence before this Committee. It is that attitude, taken in the round, which would be regarded as deplorable by other members of the profession. The Committee finds that the facts found proved are so serious as to amount to misconduct. Impairment The Committee next considered whether your misconduct is remediable, whether it had been remedied and the risk of repetition. The Committee also had regard to the wider public interest, which includes the need to maintain public confidence in the dental profession and to uphold and declare appropriate standards of conduct and behaviour. You have shown only very limited insight into your failings. You repeatedly blamed a vendetta on the part of the GDC, the incompetence of other members of the dental team, your former indemnity provider and indeed patients in general for what were clearly your own failings for which you as a dental professional had responsibility. In respect of patients, you suggested that they tend to be litigious and financially motivated in making their complaints against you. This was not at all apparent to the Committee from the evidence before it. Ms X and Patients B to E were honest and straightforward individuals who had made genuine and legitimate complaints regarding failings in their care and treatment. What was apparent to the Committee is that you struggle to accept patients legitimately calling into question the standard of your work, the information you provide to them and your competence as a CDT. In respect of Patient B, you lied to the GDC in an attempt to undermine the seriousness of her complaint about you. You only conceded failings when, as with record keeping, the evidence against you was overwhelming. You have demonstrated no real understanding or responsibility for the basic and fundamental professional standards to which you are subject. Throughout these proceedings you treated those standards as mere obstacles to your commercial interests, which, in the Committee s judgment, you placed above the interests of both your patients and the profession. Whilst you are now putting in place changes to the structure of your business, this appears to be solely motivated by a desire to protect your own interests as part of these proceedings and not as the result of any genuine reflection and acceptance of GDC standards. You have a history of criminal offending in respect of the illegal practice of dentistry. However, the Committee attached limited weight to this. Those offences took place prior to Dental Technicians and CDTs becoming registered with the GDC and are at least more than a decade old. SEMP, B L Professional Conduct Committee June 2017-Feb 2018 Page -22/24-