GENERAL DENTAL COUNCIL PROFESSIONAL CONDUCT COMMITTEE MARCH 2012 ALLAN, John Charles Urquhart Registration No: 55394 John Charles Urquhart Allan registered as of 20 Exford Ave, Harefield, Southampton, Hampshire SO18 5DJ; BDS Edin 1981; was summoned to appear before the Professional Conduct Committee on 12 March 2012 for inquiry into the following charge: That being a registered dentist: 1. At the material times you were a United Kingdom registered Dental Practitioner in practice at Dental Surgery, 20 Exford Avenue, Harefield, Southampton; Patient 1 2. By letter of 4 November 2008 you were notified by The Dental Law Partnership [DLP] of a potential claim [ the complaint ] against you and you were requested to provide 1 s dental records; 3. As regards Patient 1 s complaint: a) you failed to respond to letters from DLP dated 18 November 2008, 3 December 2008 and a voice- mail message 17 December 2008, other than to answer a telephone call made to you by DLP on 5 January 2009; b) from 27 January 2009 to 16 November 2009 you failed to respond to letters and a telephone call to you by DLP other than on 27 February 2009 to inform DLP that your insurers were Towergate MIA; c) other than the period 16 November 2009 to 9 February 2010 when solicitors were purportedly acting on your behalf, you from 12 February 2010 to 19 April 2010 and onwards failed to: i) respond to letters from DLP; ii) respond to telephone calls from DLP; iii) maintain an adequate telephone answering service at your Practice; 4. As a consequence of paragraphs 3 (a), (b) and (c) above you thereby Patient 2 a) failed to cooperate with DLP in relation to a Patient complaint; b) failed to manage appropriately Patient 1 s complaint; 5. By letters dated 14 May 2010, 8 June 2010, 6 July 2010, 13 July 2010 DLP wrote to you concerning a complaint by Patient 2 [ the complaint ] and requesting 2 s Dental Records, to which you made no reply; 6. You were telephoned by DLP on 27 July 2010 and stated that you were indemnified by Towergate MIA ( Towergate ), as regards whom: a) DLP was thereafter informed by Towergate that you could not be traced; ALLAN, JCU Professional Conduct Committee March 2012 Page -1/9-
b) DLP wrote to you informing you that Towergate were unable to trace your details and asked you to instruct Towergate as a matter of urgency, to which you made no reply; 7. As a consequence of paragraphs 4 and 5 above you thereby: a) failed to demonstrate that you had adequate indemnity cover; b) failed to provide copies of Patient 2 s records when requested; c) failed to cooperate with DLP in relation to a Patient complaint; d) failed to manage appropriately Patient 2 s complaint; Practice premises 8. In the period March 2010 until 18 October 2010 you no longer attended your Practice premises on a regular, reliable basis or at all, such that: a) Patients were left without any continued or emergency care; b) Patient records were left unattended; c) Prescription pads were left unattended; d) Controlled Drugs were left unattended; 9. As a consequence of paragraph 8 above you thereby neglected your responsibilities as regards: a) Patient care; b) Patient confidentiality; c) safe and secure storage of Controlled Drugs; d) safe and secure storage of Prescription pads; And, by reason of the facts alleged, your fitness to practice as a dentist is impaired by reason of your misconduct. As Mr Allan did not attend and was not represented at the hearing, the Chairman made the following statement regarding proof of service. He addressed this to the Counsel for the GDC: Mr Hurst, Mr Allan is neither present nor represented at this hearing. On behalf of the General Dental Council (GDC) you made an application pursuant to Rule 54 of the General Dental Council (Fitness to Practise) Rules 2006 (the Rules), for the Committee to proceed with the hearing in his absence. The Committee has considered all the evidence that has been presented to it. It has accepted the advice of the Legal Adviser. The Committee first considered whether notification of this hearing had been duly sent to Mr Allan in accordance with Rules 13 and 65 of the Rules. The Committee had regard to the Notice of Hearing dated 11 January 2012, which was sent to Mr Allan at both his registered and home addresses. It noted the Royal Mail Track and Trace receipt confirming that the Notice was signed for by Mr Allan at his home. It also noted the evidence in the service bundle showing that a Process Server had attended on Mr Allan at his home address and confirmed that he was at home to receive delivery of hearing papers. On the ALLAN, JCU Professional Conduct Committee March 2012 Page -2/9-
basis of the evidence before it, the Committee was satisfied that service had been properly effected in accordance with the Rules. The Committee next considered whether to proceed with the case in Mr Allan s absence. It approached this issue with the utmost care and caution, having regard to the criteria approved by the House of Lords in R v Jones [2003] 1 AC 1HL. The Committee considered the issue of fairness to the GDC and to Mr Allan, as well as its duty to protect the public interest by ensuring the expeditious disposal of this case. The Committee is in no doubt that Mr Allan is fully aware of this hearing and the formal allegations against him. It has noted the letters that have been sent to him regarding these proceedings and the proof of their delivery. It has also noted the GDC s attempts to correspond with him by email. The Committee has had regard to the information it received in private session regarding Mr Allan s possible state of health. It noted that there is no evidence before it to indicate that an adjournment would make Mr Allan s attendance any more likely at a later date. On the contrary, he has not responded to any of the correspondence sent to him in relation to this case. Taking all these matters into account the Committee has concluded that Mr Allan has voluntarily absented himself from these proceedings. In all the circumstances the Committee has determined that it is in the interests of justice to proceed with the hearing. In reaching this decision, the Committee has reminded itself that it must not draw any adverse inferences from Mr Allan s absence. Mr Allan was not present and was not represented. On 13 March 2012 the Chairman announced the findings of fact to the Counsel for the GDC: Mr Hurst, At the material times Mr Allan was a registered dental practitioner in practice at a dental surgery (the Practice) in Harefield, Southampton. The charge against him alleges that he neglected his professional responsibilities to his patients and the Practice. These include his failure to: appropriately manage patient complaints; fulfil his responsibilities for patient care; and ensure the safe and secure storage of patient records, prescription pads and Controlled Drugs within the Practice premises. The Committee heard oral evidence from 10 witnesses of fact called by the General Dental Council (GDC), including Patient 1, one of the patients referred to in the charge. One of these witnesses gave evidence to the Committee over the telephone. The Committee received the witness statement of the second patient referred to in the charge, Patient 2. It took into account that Patient 2 s evidence was not given under oath or subject to questions from the Committee and it had regard to these factors when assessing what weight to attach to that it. Further, the Committee had before it documentary evidence including copies of the correspondence between Mr Allan, his representatives and The Dental Law Partnership, who acted on behalf of Patients 1 and 2 in their complaints against him. The Committee also received copies of correspondence from various other agencies involved in the ALLAN, JCU Professional Conduct Committee March 2012 Page -3/9-
management of NHS dental services in the Southampton area and the operation of the Practice premises. The Committee has taken into account all the evidence presented to it. It has accepted the advice of the Legal Adviser. The Committee considered each head of charge separately and reminded itself that the burden of proof lies with the GDC and that the standard of proof is the civil standard, namely the balance of probabilities. The Committee remained mindful that Mr Allan s absence added nothing to the GDC s case and no adverse inference could be drawn from it. I will now announce the Committee s findings in relation to each head of charge: 1. Proved. 2. Proved. 3. a) Proved. 3. b) Proved. 3. c) i. Proved. 3. c) ii. Proved. 3. c) iii. Proved. 4. a) Proved. 4. b) Proved. 5. Proved. 6. a) Proved. 6. b) Proved. 7. a) Proved. 7. b) Proved. 7. c) Proved. 7. d) Proved. 8. a) Proved. 8. b) Proved. 8. c) Proved. 8. d) Proved. 9. a) Proved. The Committee finds that the telephone answering service at Mr Allan s practice was not adequate in the circumstances. In view of his prolonged and on-going absence, the Committee considered that the answering service did not contain sufficient details for his regular and emergency patients, as to how and where they could contact another dentist. It is clear from the evidence that Mr Allan failed to cooperate with The Dental Law Partnership s requests for information. ALLAN, JCU Professional Conduct Committee March 2012 Page -4/9-
9. b) Proved. 9. c) Proved. 9. d) Proved. We move to Stage Two. On 14 March 2012 the Chairman announced the determination as follows: Mr Hurst, The Committee has considered all the evidence presented to it and it has taken into account your submissions made on behalf of the General Dental Council (GDC). It has accepted the advice of the Legal Adviser. The background to this case is that, in June 2008, Patient 1 instructed The Dental Law Partnership (DLP) to act on her behalf to pursue a claim against Mr Allan in respect of his management of an attempted extraction of one of her teeth in March 2008. DLP s first contact with Mr Allan was by way of a letter dated 4 November 2008, in which they notified him of Patient 1 s potential claim and requested her dental records. Mr Allan failed to respond to this letter. He also failed to respond to two further letters from DLP dated 18 November 2008 and 3 December 2008, and a voicemail message left for him on 17 December 2008. Ms Jenny Wyatt, Solicitor, DLP, contacted Mr Allan again by telephone on 5 January 2009. He confirmed that he had received the correspondence regarding Patient 1 s claim and that he had sent her dental records to DLP, although these were not received. He agreed to resend them. Patient 1 s dental records were received by DLP on 12 January 2009, but were incomplete, as they did not contain her x-rays. DLP sent Mr Allan two further letters, dated 27 January 2009 and 9 February 2009, and also telephoned him on 24 February 2009 to request the x- rays and details of his defence organisation. He eventually sent a letter, dated 25 February 2009 to DLP with the x-rays enclosed and provided the details of his defence organisation, Towergate MIA. In the absence of any contact from Mr Allan or Towergate MIA from May to October 2009, DLP, issued a Claim Letter on behalf of Patient 1, dated 30 October 2009 directly to Mr Allan. Subsequently, from 12 February 2010 to 19 April 2010 and onwards, Mr Allan failed to cooperate with DLP in relation to Patient 1 s complaint or manage her complaint appropriately. In her evidence to the Committee, Patient 1 stated that she had been very disappointed and angry about the nature of Mr Allan s contact with DLP. She told the Committee that she had since won an award of compensation, but had not received any payment from Mr Allan as yet. In 2010, a second patient, Patient 2, also instructed DLP to act on his behalf to pursue a claim, as he had been unhappy with the way in which Mr Allan had undertaken the removal of his cemented bridge in February of that year. Similarly, Mr Allan failed to respond to letters from DLP dated 14 May 2010, 8 June 2010, 6 July 2010, 13 July 2010, in which they requested Patient 2 s dental records. ALLAN, JCU Professional Conduct Committee March 2012 Page -5/9-
In a telephone conversation with an employee of DLP on 27 July 2010, Mr Allan reiterated that he was indemnified by Towergate MIA. He made no reply to a further letter from DLP dated 17 August 2010, and as such failed to: Demonstrate that he had adequate indemnity cover; Provide copies of Patient 2 s records when requested; Co-operate with DLP in relation to his complaint; Manage Patient 2 s complaint appropriately. In his witness statement, Patient 2 stated that he had returned to visit Mr Allan in March 2010 to have permanent bridge fitted, but he found the practice closed. In fact, in the period March 2010 until 18 October 2010, a period of seven months, Mr Allan failed to attend the practice premises on a regular, reliable basis or at all, such that: Patients were left without any continued or emergency care; Patient records were left unattended; Prescription pads were left unattended; and Controlled Drugs were left unattended. The Committee heard and received written evidence from a number of employees from the Hampshire Dental Helpline, which took a number of calls from Mr Allan s patients and dealt with arranging alternative dental services for Mr Allan s regular patients and emergency appointments. In relation to the practice premises, the Committee heard that it was situated in an area of Southampton that was due to undergo regeneration and as a result was scheduled to be demolished. The Committee also heard that the area in question also experienced some anti-social behaviour. In the circumstances, Southampton City Primary Care Trust raised concerns about the increased potential of the abandoned premises being broken into, particularly in light of the presence of controlled drugs, prescription pads and patient records which were kept in the practice. By abandoning the practice, Mr Allan neglected his responsibilities as regards: Patient care; Confidential patient records; Safe and secure storage of Controlled Drugs; and Safe and secure storage of prescription pads. The practice was repossessed by Southampton City Council on 15 October 2010 and the contents removed by the appropriate officials. On behalf of the GDC, you submitted that misconduct is plainly made out in this case. You submitted that this case concerns a wide range of basic matters such as communication, engagement, the care of patients, patient confidentiality and the security of Controlled Drugs and prescription pads. You referred the Committee to the relevant standards guidance for dental professionals and stated that Mr Allan has fallen seriously short of the standards set by his regulatory body. You submitted that, in view of Mr Allan s misconduct, which was serious, and in the absence of any evidence from Mr Allan, his fitness to practise could not be anything other than currently impaired. In reaching its decisions the Committee exercised its own independent judgement. It reminded itself of its primary duty to consider the public interest, which includes the ALLAN, JCU Professional Conduct Committee March 2012 Page -6/9-
protection of patients, the maintenance of public confidence in the profession and the declaring and upholding of proper standards of conduct and behaviour. The Committee first considered whether the facts found proved in this case amount to misconduct. It was extremely concerned about the way in which Mr Allan had behaved towards his patients and indeed colleagues in abandoning the practice, leaving it vulnerable. The confidential records of patients, prescription pads and Controlled Drugs, would have been readily available to for anyone to appropriate and misuse, had the property been broken into. The Committee had regard to the GDC s publication, Standards for Dental Professionals (May 2005) and noted that Mr Allan s actions and omissions clearly breached the principles of practice in dentistry, which state that a dental professional must: 1. Put patients interests first and act to protect them. 2. Respect patients dignity and choices. 3. Protect the confidentiality of patients information. 4. Co-operate with other members of the dental team and other healthcare colleagues in the interests of patients. In particular, Mr Allan s failed to adhere to the following fundamental standards: 1.1 Put patients interests before your own or those of any colleague, organisation or business. 1.2 Follow these principles when handling questions and complaints from patients and in all other aspects of non-clinical professional service. 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. 1.7 If you believe that patients might be at risk because of your health, behaviour or professional performance, or that of a colleague, or because of any aspect of the clinical environment, you should take action. You can get advice from appropriate colleagues, a professional organisation or your defence organisation. If at any time you are not sure how to continue, contact us. 2.1 Treat patients politely and with respect, in recognition of their dignity and rights as individuals. 3.2 Prevent information from being accidentally revealed and prevent unauthorised access by keeping information secure at all times. 4.1 Co-operate with other team members and colleagues and respect their role in caring for patients. Mr Allan s behaviour fell seriously below that expected of a registered dental practitioner and the Committee was in no doubt that the facts found proved amount to misconduct. Mr Allan was not present at these proceedings. With regard to his current fitness to practise, the Committee considered there to be no positive evidence to suggest that he has ALLAN, JCU Professional Conduct Committee March 2012 Page -7/9-
any insight into his past misconduct or that he has undertaken any remedial action. It determined that his fitness to practise remained impaired today. The Committee next considered what sanction, if any, to impose on Mr Allan s registration. You informed the Committee that there is nothing recorded against Mr Allan and therefore he is of good character. However, on behalf of the GDC, you submitted that the appropriate sanction in this case is one of erasure. The Committee has borne in mind that the purpose of a sanction is not to be punitive, but to protect patients and the wider public interest. In deciding on the appropriate sanction the Committee applied the principle of proportionality, weighing the public interest with Mr Allan s own interests. It took into account the Guidance for the Professional Conduct Committee (November 2009) and it considered the sanctions available to it, starting with the least restrictive. In the light of the serious nature of Mr Allan s misconduct, the Committee determined that it would be wholly inappropriate to conclude this case without taking any action in relation to his registration, or with a reprimand. The Committee then considered whether to impose conditions on his registration. It reminded itself that any conditions would have to be clear, workable, measurable and enforceable. In view of Mr Allan s lack of engagement with the GDC and this regulatory process, the Committee concluded that it could not frame any workable conditions that would adequately protect patients and the public interest. Therefore, the Committee went on to consider whether to suspend Mr Allan s registration. The Committee noted that there was no evidence relating to his insight, remediation or current circumstances. It is clear from the evidence that has been presented at this hearing that Mr Allan has repeatedly failed to act professionally and responsibly towards his patients and his PCT. Furthermore, he has completely failed to engage with his regulatory body. The Committee has heard some indirect evidence about Mr Allan s current state of health. Nevertheless, in the light of its findings the Committee considers that a period of suspension would be insufficient to protect the public and the reputation of the profession. Therefore, in the Committee s view, a period of suspension would serve no meaningful purpose. The Committee concluded that Mr Allan s behaviour was so damaging to his fitness to practise and to public confidence in dental professionals that removal of his professional status is the appropriate outcome. In all the circumstances the Committee has determined to erase the name of John Charles Urquhart ALLAN from the Dentists Register. The interim order currently on Mr Allan s registration is hereby revoked. The Committee is minded to impose an immediate order for suspension on Mr Allan s registration, but first invites submissions from you as to whether it is necessary to suspend Mr Allan s registration immediately. For the reasons set out in its substantive determination, the Committee has determined that it is necessary for the protection of the public, and is otherwise in the public interest to impose an order for immediate suspension on Mr Allan s registration. ALLAN, JCU Professional Conduct Committee March 2012 Page -8/9-
The effect of the foregoing determination and this order is that Mr Allan s registration will be suspended from the Dentists Register from the date on which notice of this decision is deemed served upon him. Unless he exercises his right of appeal, his name will be erased from the Dentists Register 28 days from that date of service. Should Mr Allan exercise his right to appeal, this immediate order for suspension will remain in place until the resolution of any appeal. That concludes this hearing. ALLAN, JCU Professional Conduct Committee March 2012 Page -9/9-