GENERAL DENTAL COUNCIL PROFESSIONAL CONDUCT COMMITTEE JUNE 2011 BLAND, Christopher John Registration No: 51363 Christopher John Bland registered as of 18 Southend Ave, DARLINGTON, Co Durham DL3 7HL; BDS Ncle 1977; was summoned to appear before the Professional Conduct Committee on 20 June 2011 for inquiry into the following charge: Amended with the agreement of both parties That, being a registered dentist: 1 At all material times you practised as a dentist from 18 Southend Avenue, Darlington, Co Durham DL3 7HL; Professional Indemnity Insurance 2 (a) From 1997 you were a member of the Denplan scheme, operated by Denplan Ltd ( Denplan ), (b) Amended to read: Between approximately July and September 2008 representatives of Denplan requested on a number of occasions that you provide evidence of your then current policy of indemnity insurance, (c) Amended to read: Between July and September 2008 you did not provide Denplan with evidence that you held a policy of indemnity insurance, (d) Denplan terminated your membership of the Denplan scheme on or around 19 September 2008 (with effect from 30 September 2008) because of issues surrounding your apparent lack of professional indemnity insurance, (e) On or around 24 September 2008 you informed a representative of Denplan that your indemnity insurance policy had lapsed but that you were not sure for how long (or words to that effect); 3 (a) Ms Caroline Carson, a caseworker at the General Dental Council ( GDC ), requested evidence of your then current policy of indemnity insurance on two occasions between October and December 2008, (b) On 13 January 2009 you informed Ms Carson that your policy of indemnity insurance had lapsed for a period of time due to a failure in banking details (or words to that effect), (c) On 14 January 2009 you informed Ms Carson by email that I had always paid by direct debit and for some reason they had stopped. The Dental Protection Society did not inform me that they had ceased to receive payments (this is not an excuse), (d) On 23 January 2009 you informed Ms Carson that you were not currently indemnified and had stopped practising dentistry (or words to that effect), (e) On a date in March 2009 you provided the GDC with a Certificate of Membership from Dental Protection Ltd showing membership from 22 January 2009 to 21 January 2010; BLAND, C J Professional Conduct Committee June 2011 Page 1 of 11
4 Amended to read: You practised dentistry without holding a policy of professional indemnity insurance on various dates between approximately: (a) 1 February 1996 to 8 April 2001, (b) 9 April 2002 to 5 November 2002, (c) 6 November 2003 to 21 January 2009; 5 Your actions at Head of Charge 4 above were: Patient A (a) Inappropriate, (b) Irresponsible, (c) Not in the best interests of your patients; 6 Between approximately 2000 and 2008 you provided dental treatment to Patient A (identified in Schedule A); 7 Patient A last attended for a dental appointment with you on or around 25 June 2008; 8 You failed to take adequate steps to diagnose and/or treat caries at Patient A s (a) UL5, (b) LL5, (c) Amended to read: LL7, (d) LR5, (e) LR7; 9 You failed to provide Patient A with any, or adequate: (a) Oral hygiene advice, (b) Dietary advice; 10 (a) On a date after 12 December 2009 Patient A complained to you in writing about the standard of treatment you had provided, Patient B (b) You failed to respond to Patient A s complaint at any stage; 11 Between approximately 1982 and 2008 you provided dental treatment to Patient B (identified in Schedule A); 12 Patient B last attended for a dental appointment with you in around January 2008; 13 (a) Amended to read: You provided Patient B with bridges encompassing LR7654 and LL1234567 on a date in 2004 or 2005, (b) It was inappropriate to treat Patient B in the way set out at Head of Charge 13(a) above because: (i) (ii) His oral hygiene was poor, In respect of the left side, LL5 and the lower central incisor were unsuitable bridge abutments for the span of teeth to be replaced; 14 In providing the bridges you failed to assess adequately, or at all: BLAND, C J Professional Conduct Committee June 2011 Page 2 of 11
(a) Patient B s occlusion, (b) The suitability of the proposed left side bridge abutment teeth; 15 The left side bridge you provided was inadequate in that: (a) The occlusion was poor, (b) The bridge abutment at the lower central incisor was too large and leant both sideways and slightly anteriorly, (c) The bridge arched forwards anteriorly and buccally out of line with Patient B s other teeth; 16 The right side bridge you provided was inadequate in that the occlusion was poor; 17 As a result of the construction of the bridges Patient B: (a) Experienced difficulty in chewing and biting, (b) Had restorations which were of poor aesthetic appearance; 18 You failed to take adequate steps to diagnose and/or treat caries at Patient B s (a) LL7, (b) LR7, (c) UL3; 19 You failed to provide remedial treatment for: (a) A ledge on a filling at UL6, (b) Buccal and lingual overhangs on a crown at LR2, (c) A ledge on the margin of the lower central incisor bridge abutment; 20 You failed to provide Patient B with adequate oral hygiene advice; 21 (a) Patient B presented to you with infections in his mouth on multiple occasions between approximately 2005 and 2008, (b) During that period you prescribed multiple courses of antibiotics without adequately investigating the cause of Patient B s presenting symptoms, (c) Your conduct at Head of Charge 21(b) above was: (i) Inappropriate, (ii) Not in the best interests of Patient B; 22 (a) Patient B presented to you in or around September/October 2007 with a discharging sinus ( white spot ) in the region of UR5, (b) You failed to take adequate steps to investigate the cause of the discharging sinus at any stage after September/October 2007, (c) You failed to provide definitive treatment for the discharging sinus at any stage after September/October 2007; 23 (a) In or around 2007 you provided Patient B with a crown at LR3, (b) Following placement of the crown Patient B presented to you complaining of pain on the lower right side of his face, BLAND, C J Professional Conduct Committee June 2011 Page 3 of 11
(c) In or around late 2007 you commenced root canal treatment on LR3 but left the tooth open to drain for a period of weeks, (d) Your conduct in leaving LR3 open to drain for a period of weeks was: (i) Inappropriate, (ii) Not in the best interests of Patient B; 24 As a result of your failures to provide adequate care and treatment to Patient B set out above, Patient B required extensive remedial treatment; Failure to respond to requests for information 25 (a) On or around 9 February 2009 a representative of Meikles Solicitors (solicitors for Patient B) requested in writing that you provide them with a copy of Patient B s dental records, (b) Amended to read: Following a hearing at Darlington County Court on 7 August 2009, you were ordered by Deputy District Judge Read to, provide Patient B s solicitors with a copy of his dental records by 12 August 2009, (c) Amended to read: You failed to respond to Patient B s solicitors in respect of Patient B s dental records at any stage after 9 February 2009; 26 (a) A representative of Meikles Solicitors requested in writing that you provide contact details for your insurers on a number of occasions between November 2 008 and February 2009, (b) Amended to read: Following a hearing at Darlington County Court on 7 August 2009, you were ordered by Deputy District Judge Read to provide Patient B s solicitors with a copy of your professional indemnity or indemnity policy, (c) Amended to read: You failed to respond to Patient B s solicitors in respect of your professional indemnity insurance position at any stage after November 2008; 27 Your actions at Heads of Charge 25(c) and 26 (c) were: (a) Inadequate, (b) Uncooperative, (c) Not in the best interests of Patient B; And that, in consequence of the matters set out above, your fitness to practise as a dentist is impaired by reason of your misconduct. On 27 June 2011 the Chairman made the following statement regarding the finding of facts: Mr Singh, The Committee has taken into account all the oral and documentary evidence presented to it. It has considered your submissions on behalf of the General Dental Council (GDC) and it has accepted the advice of the Legal Adviser. The Committee has drawn no adverse inferences from Mr Bland s absence, his not giving evidence or producing dental records. I will now announce the Committee s findings in relation to each head of charge: BLAND, C J Professional Conduct Committee June 2011 Page 4 of 11
1. 2(a). 2(b). 2(c). 2(d). 2(e). 3(a). 3(b). 3(c). 3(d). 3(e). 4(a). 4(b). 4(c). 5(a). 5(b). 5(c). Proof of indemnity was requested of Mr Bland on several occasions but was not provided for the relevant periods. 6. 7. 8(a). 8(b). 8(c). 8(d). 8(e). 9(a). 9(b). The GDC Standards require every registrant to hold a policy of professional indemnity insurance or equivalent in order to carry out the business of dentistry. Proved The Committee considers that Patient A was a credible witness. The extensive caries identified by the subsequent treating dentist indicates that Mr Bland took no steps to suitably diagnose and treat the caries. The Committee accepts the evidence of Patient A that he was neither given oral hygiene advice nor dietary advice. BLAND, C J Professional Conduct Committee June 2011 Page 5 of 11
10(a). 10(b). 11. 12. 13(a). 13(b)(i). 13(b)(ii). 14(a). 14(b). 15(a). 15(b). 15(c). The Committee accepts the evidence of the expert witness, Mrs Roberts- Harry. 16. 17(a). 17(b). 18(a). 18(b). 18(c). 19(a). 19(b). 19(c). The Committee accepts the evidence of Mr Allum, Implantologist and the expert witness. The Committee accepts the evidence of Mr Allum and Mr Andrews, Denplan assessor that Patient B s occlusion was poor. The Committee accepts Patient B s evidence that he couldn t chew properly and has seen photographic evidence of his mouth. Not The Committee was not satisfied that the caries would have been present in the UL3 at the time Mr Bland was treating Patient B. 20. The Committee accepts the radiographic evidence and that of the expert witness. This was confirmed by clinical examination. The Committee accepts the evidence of Patient B that he did not receive adequate oral hygiene advice. BLAND, C J Professional Conduct Committee June 2011 Page 6 of 11
21(a). 21(b). 21(c)(i). 21(c)(ii). 22(a). 22(b). 22(c). 23(a). 23(b). 23(c). 23(d)(i). 23(d)(ii). The Committee accepts the evidence of Patient B. Proved Proved Proved The Committee accepts the evidence of Patient B that Mr Bland only prescribed antibiotics and stated that it would go away. The tooth was left on open drainage. Mr Henley, Patient B s subsequent treating dentist confirmed that the tooth was still open on 25 February 2008. 24. 25(a). 25(b). 25(c). 26(a). 26(b). 26(c). 27(a). 27(b). 27(c). The expert evidence was that a tooth should be left on open drainage in exceptional circumstances, for a maximum of 24 hours, before review. The evidence of Mr Henley and Mr Allum indicates that Patient B required extensive remedial treatment. We move to Stage Two. On 28 June 2011 the Chairman announced the determination as follows: Mr Singh, BLAND, C J Professional Conduct Committee June 2011 Page 7 of 11
The Committee has considered your submissions on behalf of the General Dental Council (GDC). Mr Bland was neither present nor represented at this hearing. It has accepted the advice of the Legal Adviser. Mr Bland was a single handed practitioner working in Darlington, Co Durham. He joined a scheme operated by Denplan Limited in 1997 and both Patients A and B were treated under that scheme. Patient A received treatment from Mr Bland between 2000 and 2008 and Patient B received treatment between 1982 and 2008. In 2008 Patient B made a complaint to Denplan Limited about the treatment he had received from Mr Bland. On several occasions, Denplan Limited requested evidence of Mr Bland s Professional Indemnity Insurance (PII). As no evidence was provided to them, Denplan Limited terminated Mr Bland s membership from 30 September 2008 and informed the GDC of their concerns. Patient B subsequently engaged a firm of solicitors in February 2009 with a view to taking legal action against Mr Bland relating to his dental treatment. Patient A made a direct complaint to Mr Bland in December 2009. The Committee found both Patients A and B to be credible witnesses, although there were areas where their recollection was not entirely clear due to the passage of time and the absence of patient records. However the Committee was satisfied that it could rely upon their evidence. The Committee heard from Patient A s subsequent treating dentist, Mrs Skipsey. It also heard from Patient B s subsequent treating dentist Mr Henley, Mr Andrews, a Denplan assessor and Mr Allum, an Implantologist, who all examined him. The Committee saw the patient records, radiographs and, where relevant, reports written by these clinicians. It was assisted by the expert evidence given by Mrs Roberts-Harry. There was considerable written evidence put before the Committee relating to indemnity and requests for information. The Committee has found proved a number of clinical failings in relation to Mr Bland s treatment. In relation to Patient A these failings include: Failing to take adequate steps to diagnose and/or treat caries in five teeth; Failing to provide adequate oral hygiene and dietary advice. In relation to Patient B these failings include: Failing to take adequate steps to diagnose and/or treat caries in the LL7 and LR7; Providing inadequate and inappropriate bridgework; Failing to provide remedial treatment for a number of ledges and overhangs on various teeth; Failing to provide oral health advice; Prescribing multiple courses of antibiotics without adequately investigating the cause of the symptoms; Failing to take adequate steps to investigate and treat the discharging sinus from the UR5; Leaving a tooth on open drainage for an inappropriate length of time. Additionally the Committee found that between 2003 and 2009, Mr Bland practised without PII, as well as on a number of other occasions. Mr Bland failed to respond to Patient A s complaint or Patient B s solicitors request for details of his indemnity insurance and copies of his dental records. Mr Bland also failed to comply with a court order that he should BLAND, C J Professional Conduct Committee June 2011 Page 8 of 11
provide Patient B s solicitors with a copy of his professional indemnity or indemnity policy and a copy of his dental records. You first addressed the Committee on Mr Bland s history. You stated that he had no previous complaints against him and no previous history of misconduct or impaired fitness to practise. You provided a chronology of the fitness to practise processes in Mr Bland s case following the receipt of the complaints from Patients A and B. You submitted that the facts found proved by the Committee readily cross the threshold from mere negligence to misconduct. You also submitted that Mr Bland s failings in relation to Patient B were most serious because it was over a significant period of time and resulted in dire consequences for Patient B. You further submitted that it is a major duty on dentists to have adequate insurance. Mr Bland was seemingly unindemnified over an extended period of time during which he provided treatment to Patients A and B. His attitude towards his duties to his patients was reckless. You referred the Committee to the relevant case law and you submitted that Mr Bland s fitness to practise is currently impaired. In considering whether or not the failings found proved amounted to misconduct, the Committee took into account the GDC s Standards Guidance, May 2005: Principle 1: Putting patients interest first and acting to protect them and in particular sub-paragraphs 1.1, 1.2, 1.3, 1.4, 1.5, and 1.6 Principle 6: Be trustworthy and in particular sub-paragraph 6.3 The Committee also took into account the GDC s Principles of Complaint Handling, May 2006: Principle 1: Respecting the patient s right to complain and in particular sub-paragraphs 1.1 and 1.3 Principle 4: Process of handling complaints and in particular sub-paragraph 4.4 Principle 5: Dealing with a complaint and in particular sub-paragraph 5.2 The Committee considers that Mr Bland s failings breached the above standards and that the cumulative effect of his conduct was extremely serious falling far below the standards expected of a registered dental practitioner and would be regarded as deplorable by fellow practitioners. Consequently the Committee finds that Mr Bland s failings amount to misconduct. The Committee then went on to consider whether Mr Bland s fitness to practise is currently impaired. The Committee had regard to the public interest including the maintenance of public confidence in the profession, upholding proper standards of conduct and behaviour as well as protection of the public / patients. It also took account of the case of CHRE v NMC and Paula GRANT 2011 which lists a number of criteria. The Committee considers the following to be relevant in this case: a. has in the past acted and/or is liable in the future to act so as to put a patient or patients at unwarranted risk of harm; and/or b. has in the past brought and/or is liable in the future to bring the medical profession into disrepute; and/or c. has in the past breached and/or is liable in the future to breach one of the fundamental tenets of the profession;. BLAND, C J Professional Conduct Committee June 2011 Page 9 of 11
Mr Bland s failings resulted in harm to both patients. Patient A required approximately 13 restorations over an extended period of time to achieve dental fitness. The bridges provided to Patient B resulted in long term distress and difficulty in chewing. There was lack of appropriate diagnosis and treatment of the recurrent infections. He subsequently needed extensive remedial treatment. There remains a high risk that patients could be harmed in the future due to the lack of any remedial action by Mr Bland. By failing to respond to the complaints, provide copies of records or comply with the court order, Mr Bland has disadvantaged both patients. This has brought the profession into disrepute. Mr Bland s behaviour is indicative of a lack of patient consideration and he has not demonstrated to the Committee any change in his attitude. By failing to maintain PII, Mr Bland has breached one of the fundamental tenets in that neither patient has the ability to obtain any financial redress. Both patients have had to fund their remedial treatment themselves. Patient B in particular is facing extensive restorative work estimated to cost many thousands of pounds. By practising over an extended period of time without indemnity Mr Bland has demonstrated his lack of consideration for the public s ability to obtain redress and the Committee has nothing before it to show that this would not occur again in the future. The Committee heard of some limited engagement with the GDC which demonstrated some insight by Mr Bland into his failings, but this was insufficient to mitigate his misconduct. In all the circumstances, the Committee has determined that Mr Bland s fitness to practise is currently impaired. Turning to the question of sanction, the Committee took into account the Guidance for the Professional Conduct Committee, November 2009 in particular paragraphs 40, 41 and 42(c), (g), (h) and (i). In determining the appropriate disposal, the Committee considered each of the sanctions available to it starting with the least serious. It reminded itself of the need to exercise proportionality and that it should balance the public interest with the interests of Mr Bland. The Committee first considered whether to conclude this case with or without a reprimand. The Committee concluded that in view of the seriousness of the failings, it would be inappropriate to do so. The Committee next considered whether to impose conditions on Mr Bland s registration. The fact that Mr Bland had not complied with conditions imposed by an interim orders committee in 2009 left this Committee with no confidence that he would comply if conditions were imposed. Additionally, having regard to the seriousness of the findings, the Committee determined that conditions would be insufficient and inappropriate. The Committee then considered whether a period of suspension would adequately address the risks it identified. The Committee determined that this sanction would not maintain public confidence in the profession nor would it be in the public interest in view of the seriousness of the findings. Mr Bland s misconduct is so damaging to his fitness to practise and to public confidence in the dental profession that the Committee has determined that the appropriate and sufficient sanction is one of erasure of his name from the Dentists Register. The Committee is minded to impose an order of immediate suspension but would first invite submissions from you before making that decision. BLAND, C J Professional Conduct Committee June 2011 Page 10 of 11
Mr Singh, The Committee has considered your submissions on behalf of the General Dental Council (GDC) and has accepted the advice of the Legal Adviser. The Committee considers that in the light of the evidence before it there is a risk of Mr Bland continuing to engage in dental practice pending when the substantive direction takes effect. As a consequence, the Committee has determined that it is necessary for the protection of the public and in the public interest to impose an order of immediate suspension of Mr Bland s registration. The effect of the foregoing direction and this order is that Mr Bland s registration will be suspended from the date when notice of this decision is deemed served on him and unless he exercises his right of appeal, his name will be erased from the Dentists Register 28 days from the date of notification. The interim order currently on Mr Bland s registration is hereby revoked. That concludes this case. BLAND, C J Professional Conduct Committee June 2011 Page 11 of 11