HEARING HEARD IN PUBLIC. HOLT, Paul Ruben Registration No: PROFESSIONAL CONDUCT COMMITTEE JUNE 2016 Outcome: Erased with Immediate Suspension

Transcription

1 HEARING HEARD IN PUBLIC HOLT, Paul Ruben Registration No: PROFESSIONAL CONDUCT COMMITTEE JUNE 2016 Outcome: Erased with Immediate Suspension Paul Ruben HOLT, a dentist, United Kingdom; BDS Lond 1985, was summoned to appear before the Professional Conduct Committee on 6 June 2016 for an inquiry into the following charge: Charge (as amended on 6 June 2016) That being a registered dental professional: 1. At all material times you were practising as a dentist at: a. The White House Dental Practice, Ivy Mill Lane, Godstone, Surrey, RH9 8NH. b. Cobham Dental Practice, High Street, Cobham, Surrey, KT11 3DP. 2. From on or around 14 March 2009 until 22 May 2014: a. You did not have any and/or any adequate indemnity cover. b. You provided dental services whilst you did not have any and/or any adequate indemnity cover. 3. On or around March 2014 to May 2014: a. You forged an indemnity certificate. b. You provided a copy of the document, outlined at 3a above, to the White House Dental Practice as proof of you having any and/or any adequate indemnity cover. 4. Your conduct in relation to 3a and/or 3b above was: a. Misleading. b. Dishonest. AND, that by reason of the above, your fitness to practise is impaired by reason of your misconduct. On 7 June 2016 the Chairman made the following statement regarding the finding of facts: Mr Holt, The matters in this case relate to your professional indemnity insurance. At all material times you were practising as a dentist at The White House Dental Practice, Godstone, Surrey ( the White House Practice ) and at Cobham Dental Practice, Cobham, Surrey. HOLT, P R Professional Conduct Committee June 2016 Page -1/8-

2 Amendment to the charge At the outset of the hearing, Mr Mills, Presenting Officer for the General Dental Council (GDC), made an application to amend the charge against you, pursuant to Rule 18 of the GDC (Fitness to Practise) Rules Order of Council He applied to change the wording of head of charge 3 from On or around early 2014 to On or around March 2014 to May Mr Mills told the Committee that the purpose of the proposed amendment was to clarify the timeframe within which the GDC allege the relevant actions occurred. You raised no objection to Mr Mills application. Following advice from the Legal Adviser, the Committee granted the application and amended the charge accordingly. It was satisfied, having had regard to the merits of the case and the fairness of the proceedings, that the amendment could be made without causing injustice. Admissions You admitted the following heads of the amended charge: 1a, 1b, 2a and 2b. The Committee noted your admissions, but deferred any findings until all of the evidence had been adduced. Evidence The Committee received documentary evidence which comprised the following: the witness statement of Witness A, who at the material time was employed at the White House Practice; the witness statement of Witness B, who is also associated with the White House Practice; the witness statement of Witness C, Dental Contract Lead at NHS England; and the witness statement of Witness D, employee of the Medical and Dental Defence Union of Scotland (MDDUS). The Committee considered the witness statements to be clear and self-explanatory. It noted that they were accepted by both parties and were unchallenged. Also seen by the Committee was a copy of the indemnity certificate referred to in the charge and a copy of your letter to the GDC s Investigating Committee ( the IC ), dated 11 August You did not give evidence during the fact-finding stage, which is your right, and the Committee has drawn no adverse inferences. You did, however, make submissions as part of your defence, during which you drew the Committee s attention to your comments in the letter you sent to the IC. The Committee s findings of fact The Committee has considered all of the evidence presented to it. It has taken into account the submissions made by Mr Mills on behalf of the GDC and your submissions. The Committee has accepted the advice of the Legal Adviser. It has considered each head of charge separately, bearing in mind that the burden of proof rests with the GDC and that the standard of proof is the civil standard, that is, whether the alleged matters are proved on the balance of probabilities. I will now announce the Committee s findings in relation to each head of charge: 1. a) Admitted and proved. 1. b) Admitted and proved. 2. a) Admitted and proved. HOLT, P R Professional Conduct Committee June 2016 Page -2/8-

3 2. b) Admitted and proved. 3. a) Proved (as amended). The Committee accepted the evidence of Witness D, as set out in his witness statement. He stated that he was certain that the indemnity certificate in question was not issued by the MDDUS. It was Witness D s opinion that the certificate had been created using an old certificate of membership. The Committee also took into account your submissions in relation to this head of charge. Whilst you did not make a formal admission in respect of forging the indemnity certificate in question, you did state that you had crudely modified the document. The Committee noted the context in which you stated that this modification had occurred, but concluded that this information was not relevant to its fact-finding task. It was satisfied on the evidence before it, that you did forge the indemnity certificate. 3. b) Proved (as amended). You confirmed during your submissions that you did provide a copy of the purported indemnity certificate to the White House Practice. The Committee also saw evidence proving that it had been received by Witness A and subsequently Witness B at some point during the material dates. In an attempt to demonstrate that you had professional indemnity cover, you forged an indemnity certificate which stated that you were indemnified. You then submitted it, following several requests for your indemnity certificate from Witness A. The Committee concluded that it was difficult to reach any other conclusion in the circumstances, other than you intended the forged document to be accepted as proof of your indemnity cover. 4. a) Proved in relation to heads of charge 3a and 3b. Your conduct, as found proved at heads of charge 3a and 3b, is clearly misleading. 4. b) Proved in relation to heads of charge 3a and 3b. We move to Stage Two. In the Committee s opinion, your conduct, as found proved at heads of charge 3a and 3b, was dishonest. It was satisfied that this conduct was dishonest by the ordinary standards of reasonable and honest people. It was also satisfied that you must have realised that what you did was obviously dishonest by those standards. On 7 June 2016 the Chairman announced the determination as follows: Mr Holt, The Committee has considered all of the evidence presented to it. It has taken into account the submissions made by Mr Mills on behalf of the General Dental Council (GDC) and your submissions. The Committee has accepted the advice of the Legal Adviser. HOLT, P R Professional Conduct Committee June 2016 Page -3/8-

4 Facts found proved At all material times you were practising as a dentist at The White House Dental Practice, Godstone, Surrey ( the White House Practice ) and at Cobham Dental Practice, Cobham, Surrey. From on or around 14 March 2009 until 22 May 2014, you provided dental services whilst you did not have any indemnity. On or around March 2014 to May 2014, following a number of requests for you to provide your indemnity certificate, you forged an indemnity certificate and provided a copy of it to the White House Practice as proof that you were indemnified. The Committee has found that your conduct in this respect was clearly misleading and dishonest. Misconduct The Committee considered whether the facts found proved amount to misconduct. It noted that a finding of misconduct in this regulatory context requires a serious falling short of the standards expected of a registered dental professional. In relation to your failure to have indemnity from 2009 to 2014, the Committee had regard to the GDC s Standards for Dental Professionals (May 2005), which were the applicable standards for the majority of this period. In particular, the following paragraphs: 1.1 Put patients interests before your own or those of any colleague, organisation or business. 1.6 Make sure your patients are able to claim any compensation they may be entitled to by making sure you are protected against claims at all times, including past periods of practice. In relation to your dishonest conduct, which occurred in 2014, the Committee had regard to the relevant standards as set out in Standards for the Dental Team (September 2013), namely: 1.3 You must be honest and act with integrity You must justify the trust that patients, the public and your colleagues place in you by always acting honestly and fairly in your dealings with them. This applies to any business or education activities in which you are involved as well as to your professional dealings You must make sure you do not bring the profession into disrepute. 1.7 You must put patients interests before your own or those of any colleague, business or organisation. 1.8 Have appropriate arrangements in place for patients to seek compensation if they suffer harm You must have appropriate insurance or indemnity in place to make sure your patients can claim any compensation to which they may be entitled. The Committee also considered the further guidance set out in the document Guidance on Indemnity published by the GDC in September The Committee has taken into account that you were practising without professional indemnity for a sustained period of time. As an experienced dentist, the Committee was satisfied that you would have been well aware that professional indemnity is a fundamental HOLT, P R Professional Conduct Committee June 2016 Page -4/8-

5 requirement of the dental profession. You effectively had no arrangements in place to protect patients who may have suffered harm or who had problems during or following their dental treatment. The Committee considered your failure in this regard to be a serious breach of the standards expected of you, which in itself amounts to misconduct. This misconduct was compounded by your subsequent dishonest actions in forging and submitting an indemnity certificate as proof that you were indemnified from March 2014 to March 2015, when in reality you were not. This was a clear and serious breach of the standards. Honesty and integrity are fundamental tenets of the dental profession and go to the heart of your practise as a dentist. Taking all of these matters together, the Committee was in no doubt that the facts found proved amount to misconduct. Impairment The Committee next considered whether your fitness to practise is currently impaired by reason of your misconduct. In reaching its decision, the Committee exercised its independent judgement. It remained mindful of its duty to consider the public interest, which includes the protection of patients, the maintenance of public confidence in the profession, and the declaring and upholding of proper standards of conduct and behaviour. The Committee took into account that there are no clinical concerns in this case. It also took into account that there has been no actual harm to patients. There does, however, remain an ongoing risk to the patients you treated during the five years that you had no professional indemnity. The Committee recognises that these patients may not be able to seek compensation, should any problems arise with the dental treatment you provided to them. There is also the serious issue of your subsequent dishonest conduct. The Committee considered that it would be very difficult, although not impossible, for you to remedy the misconduct found in this case, which includes a finding of dishonesty. You did not give evidence at any stage during this hearing, which is your right and the Committee has drawn no adverse inference. Nevertheless, it remains a fact that neither Mr Mills, nor this Committee has been able to question you about the steps you have taken to address the matters in this case. Nor has the Committee received any documentary evidence in this respect. However, you did make submissions to the Committee at this stage and at the factfinding stage. The Committee noted that, during your submissions you made several expressions of regret regarding your lack of professional indemnity from 2009 to You also referred to your subsequent dishonest conduct as foolish and regrettable. Nevertheless, the Committee was not persuaded that you fully grasp the seriousness of your wrongdoing. In its view, your submissions were largely focused on the effect this case has had on you, rather than the potential impact on your patients and the reputation of the dental profession. This demonstrated to the Committee that you have very little insight into your misconduct. The Committee acknowledges that you experienced some very difficult personal circumstances in 2009 and accepts that this may explain why you failed to seek indemnity following the cancellation of your previous cover. However, you provided no additional explanation for why you were without appropriate indemnity for five years. During which time, you were able to continue to practise as a dentist and undertake Continuing Professional Development. HOLT, P R Professional Conduct Committee June 2016 Page -5/8-

6 The Committee also took into account that you contested the dishonesty allegations in this case. You refused to accept that you had forged an indemnity certificate, instead stating that you had crudely modified it, as if to imply that this in itself was not dishonest. Furthermore, the Committee considered that you tried to excuse your dishonest conduct. You told the Committee that it had never been your intention to rely permanently on the forged certificate as proof of your indemnity. Under repeated pressure from the White House Practice, you submitted the forgery as an interim measure. You said that, at the time, you had already made an application for indemnity, but the assessment of this had been slow. Subsequently you made a further application to another indemnity provider. In any case, you were not indemnified at the time of the forgery and this was clearly misleading and dishonest. The Committee was not satisfied that you have sufficient level of understanding of the matters that have brought you before your regulatory body. Whilst it has taken into account that there are no patient safety issues in this case, it remains concerned about your judgement and sense of professional responsibility. It considers that you have shown an ongoing lack of insight into what were serious breaches of fundamental tenets of the dental profession. The Committee has to take into account the wider public interest in this case, in particular the maintenance of public confidence in the profession, and the declaring and upholding of proper standards of conduct and behaviour. In the Committee s view, the public s confidence in the dental profession and this regulatory process would be undermined, if a finding of impairment were not made in the circumstances of this case. The Committee has therefore determined that your fitness to practise is currently impaired. Sanction The Committee considered what sanction, if any, to impose on your registration. The purpose of a sanction is not to be punitive, although it may have that effect, but to protect patients and the wider public interest. In reaching its decision, the Committee took into account the Guidance for the Practice Committees including Indicative Sanctions Guidance (effective from October 2015). It considered the range of sanctions available to it, starting with the least serious. The Committee applied the principle of proportionality, balancing the public interest with your own interests. The Committee determined that it would be wholly inappropriate to conclude this case without taking any action in respect of your registration, given the serious nature of its findings and your lack of insight. It reached the same conclusion in respect of a reprimand. It considered that such a sanction would be insufficient in the circumstances of this case. The Committee next considered whether to impose conditions on your registration. It was of the view that conditions may be capable of addressing a lack of professional indemnity in certain circumstances. However, it was not satisfied that conditional registration could address dishonesty and continuing attitudinal concerns. The Committee therefore concluded that conditions would not be workable in a case such as this. The Committee went on to consider whether to suspend your registration. In doing so, the Committee considered the mitigating factors in this case. It took into account your submissions regarding your personal difficulties, but only to the extent that they explained why you had failed to seek professional indemnity in The Committee also took into account your previous good character. HOLT, P R Professional Conduct Committee June 2016 Page -6/8-

7 The Committee weighed these factors in mitigation against what it considered to be the aggravating features in this case, namely: the prolonged period of your lack of professional indemnity, for which you have offered no explanation; your financial gain from not having paid for professional indemnity for the five years in question; your subsequent premeditated act of dishonesty in forging an indemnity certificate; your serious breaches of fundamental tenets of the profession, including a breach of trust; and your ongoing lack of insight and lack of genuine contrition. Having had regard to all of these factors, the Committee concluded that the aggravating features of this case outweighed those in mitigation. In the Committee s view, the serious nature of your misconduct, together with your failure to properly acknowledge the gravity of your wrongdoing, represents behaviour that is fundamentally incompatible with continued registration. The Committee has taken into account the consequences that its determination will have for you. However, it is satisfied in the circumstances of this case that the only appropriate and proportionate sanction is one of erasure. Unless you exercise your right of appeal, your name will be erased from the Dentists Register 28 days from the date when notice is deemed to have been served upon you. The Committee now invites submissions from Mr Mills and then from you, as to whether your registration should be suspended immediately, pending the taking effect of its substantive determination of erasure. Mr Holt, In considering whether to impose an immediate order on your registration, the Committee has taken into account the submission made by Mr Mills, on behalf of the GDC, that such an order should be imposed. It has also taken into account your submission that an immediate order should not be imposed in the absence of any patient safety concerns. The Committee has accepted the advice of the Legal Adviser. The Committee has determined that it is in the public interest to impose an order for the immediate suspension of your registration. It has made serious findings and has concluded that your behaviour, as highlighted in this case, is fundamentally incompatible with continued registration. In these circumstances, the Committee considers that it would be inconsistent not to impose an immediate suspension order. The effect of the foregoing determination and this order is that your registration is suspended immediately to cover the appeal period. If you do not appeal, the substantive direction for erasure, as already announced, will take effect 28 days from the date when notice is deemed to have been served upon you. Should you exercise your right of appeal, this immediate order for suspension will remain in place until the resolution of any appeal. HOLT, P R Professional Conduct Committee June 2016 Page -7/8-

8 That concludes this hearing. HOLT, P R Professional Conduct Committee June 2016 Page -8/8-