HEARING HEARD IN PUBLIC NOTTA, Gurpreet Singh Registration ...

NOTTA G S Professional Conduct Committee – March 2021 Page -1/26-

HEARING HEARD IN PUBLIC

NOTTA, Gurpreet Singh Registration No: 150378

PROFESSIONAL CONDUCT COMMITTEE MARCH 2021

Outcome: Adjourned Part-Heard

NOTTA, Gurpreet Singh, a dentist, BDS University of Birmingham 2008, was summoned to appear before the Professional Conduct Committee on 22 March 2021 for an inquiry into the following charge: Charge (as amended)

“That, being a registered dentist: At all material times you were working at the practice referred to in the schedule1 and provided treatment to the patients listed within the allegations below. Patient A 1. During appointments on or around the following dates you failed to inform Patient A

that she would be provided with NHS quality dentures:

a) 15 February 2017 b) 5 September 2017 c) WITHDRAWN d) 6 February 2018

e) 26 March 2018 f) 5 June 2018 g) WITHDRAWN h) WITHDRAWN

2. WITHDRAWN a) WITHDRAWN b) WITHDRAWN c) WITHDRAWN

d) WITHDRAWN e) WITHDRAWN f) WITHDRAWN

1 All Schedules are private documents which cannot be disclosed.


g) WITHDRAWN

h) WITHDRAWN 3. Your conduct at paragraph 1 above was:

a) Misleading b) Dishonest in that you knew Patient A believed she would receive dentures of a

higher quality 4. Your standard of clinical record keeping was inadequate, in that:

a) On or around 15 February 2017 you failed to record, adequately or at all, Patient A's agreement to the proposed treatment

b) On or around 19 September 2017 you failed to record adequately the notation of extracted teeth

Patient B 5. During appointments on or around the following dates you failed to inform Patient B

that she would be provided with NHS quality dentures: a) WITHDRAWN b) 12 May 2018

c) 20 August 2018 6. You failed to obtain valid consent for the provision of dentures to Patient B on the

following dates: a) WITHDRAWN

b) 12 May 2018 c) 20 August 2018

7. Your conduct at paragraph 5 above was: a) Misleading b) Dishonest in that you knew Patient B believed she would receive dentures of a

higher quality 8. WITHDRAWN 9. Your standard of clinical record keeping was inadequate, in that:

a) On or around 10 May 2018 you failed to record, adequately or at all: i. any discussion with Patient B about the risks and benefits of the planned

extractions ii. any discussion with Patient B about the quality of dentures she would

receive b) On or around 4 June 2018 you failed to record, adequately or at all:

i. WITHDRAWN ii. A report on a periapical radiograph


iii. WITHDRAWN

Patient D 10. During appointments on or around the following dates you failed to inform Patient D

that he would be provided with NHS quality dentures:

a) 26 July 2018 b) WITHDRAWN c) WITHDRAWN

11. You failed to obtain valid consent for the provision of dentures to Patient D on the following dates: a) 26 July 2018 b) WITHDRAWN c) WITHDRAWN

12. Your conduct at paragraph 10 above was: a) Misleading b) Dishonest in that you knew Patient D believed she would receive dentures of a

higher quality 13. Your standard of clinical record keeping was inadequate, in that on or around 26 July

2018 you failed to record, adequately or at all, any discussion with Patient D regarding the quality of dentures to be provided

Patient E 14. You failed to consult with Patient E's general practitioner or haematologist regarding

his medication prior to an appointment on 3 January 2017 15. You failed to provide Patient E with any adequate written costs estimate prior to

implant placement

16. At an appointment on or around 3 January 2017 you failed to: a) WITHDRAWN b) Quality grade radiographs

17. Your standard of clinical record keeping was inadequate in that at an appointment on or around 3 January 2017 you failed to record, adequately or at all: a) WITHDRAWN b) Any repair to the left maxillary antrum

Patient F 18. At an appointment with Patient F on or around 25 September 2018 you failed to update

and/record an update of Patient F's medical history Patient G 19. During appointments on or around the following dates you failed to inform Patient G

that she would be provided with NHS quality dentures:


a) 11 June 2018

b) WITHDRAWN c) 22 October 2018 d) WITHDRAWN

20. WITHDRAWN a) WITHDRAWN b) WITHDRAWN c) WITHDRAWN

d) WITHDRAWN 21. Your conduct at paragraph 19 above was:

a) Misleading b) Dishonest in that you knew Patient G believed she would receive dentures of a

higher quality 22. Your standard of clinical record keeping was inadequate in that on or around 11 June

2018 you failed to record, adequately or at all: a) any discussion with Patient G about the quality of dentures she would receive

b) any discussion with Patient G about the risks and benefits of treatment Patient H 23. At an appointment with Patient H on or around 19 March 2015 you failed to:

a) WITHDRAWN

b) Carry out an adequate extra-oral examination c) WITHDRAWN

24. WITHDRAWN a) WITHDRAWN

b) WITHDRAWN c) WITHDRAWN

25. At an appointment with Patient H on or around 7 April 2016 you failed to: a) Report on radiographs

b) Quality grade radiographs 26. At an appointment with Patient H on or around 7 December 2016 you:

a) Failed to report on radiographs b) Failed to quality grade radiographs

c) Failed to conduct a vitality test on the LR6, adequately or at all d) Failed to assess the level of supporting bone in the region of the LR6, adequately

or at all


e) Inappropriately prescribed a crown for the LR6

f) Failed to adequately discuss treatment options with Patient H g) Failed to adequately discuss the risks and benefits of treatment with Patient H h) WITHDRAWN

27. Your standard of clinical record keeping was inadequate, in that: a) On or around 19 March 2015 you failed to record, adequately or at all:

i. Details of any intra-oral examination ii. Details of any extra-oral examination

b) On or around 23 September 2015 you failed to record, adequately or at all: i. Details of any intra-oral examination ii. Details of any extra-oral examination

c) On or around 7 December 2016 you failed to record, adequately or at all:

i. Details of any intra-oral examination ii. Details of any extra-oral examination iii. WITHDRAWN iv. Details of the supporting bone in the region of the LR6

v. Any discussion with Patient H of treatment options vi. WITHDRAWN

Patient I 28. At an appointment on or around 28 January 2018 you failed to:

a) WITHDRAWN b) WITHDRAWN c) WITHDRAWN d) WITHDRAWN

e) Adequately discuss the risks and benefits of treatment with Patient I 29. At an appointment on or around 14 February 2018 you:

a) WITHDRAWN b) Utilised a chairside assistant whose scope of practice did not permit him to

undertake that role c) In respect of your conduct at paragraph 29b) above, you knew that the chairside

assistant's scope of practice did not permit him to carry out that role d) After treating Patient I you failed to:

i. Ensure all surfaces were adequately decontaminated ii. Ensure all single-use instruments were appropriately disposed of iii. Ensure all instruments were sterilised or prepared for sterilising


iv. Ensure all clinical waste was appropriate disposed of

30. Your standard of clinical note keeping was inadequate, in that: a) WITHDRAWN

i. WITHDRAWN

ii. WITHDRAWN iii. WITHDRAWN iv. WITHDRAWN

b) On or around 14 February 2018 you failed to keep contemporaneous notes c) In respect of the appointment on or around 14 February 2018 you failed to

record, adequately or at all: i. The type of bone used for a bone graft ii. WITHDRAWN

31. You practised dentistry without any or any adequate indemnity cover on dates unknown in:

a) December 2016 b) February 2017

32. You permitted or caused to be published an advertisement for the practice referred in Robin Hood Dental Practice which was published in the Solihull Observer on or around 19 May 2016 which stated, "In partnership with Mark Cleary Dental Laboratory Strumann Platinum accredited >25 years' experience”.

33. The statement at paragraph 32 above was: a) misleading, in that it represented that you had more than 25 years' experience in

carrying out dental implant work, when this was not accurate. b) Your conduct at paragraph 32 above was dishonest, in that you knew it induced

a reader to believe that you had more than 25 years' experience in carrying out dental implant work when this was not accurate.

34. You permitted or caused to be published an advertisement for the "Robin Hood Dental Practice" which was published in the Solihull Observer on or around 19 May 2016 which stated, "Success rates > 99%"

35. The statement at paragraph 34 above was: a) misleading, in that it represented that dental implant treatment provided to

patients by you had a successful outcome in more than 99% of cases, when this was not accurate.

b) dishonest, in that you knew it induced a reader to believe that that dental implant treatment provided to patients by you had a successful outcome in more than 99% of cases, when this was not accurate.

36. You permitted or caused to be published an advertisement in or around April 2016 representing that you had the benefit of "onsite lab work".

37. Your conduct at paragraph 36 above was:


a) Misleading, in that you had no onsite laboratory.

b) Dishonest, in that you knew you had no onsite laboratory. AND by reason of the facts stated above, your fitness to practise is impaired by reason of misconduct.”

Between 22 – 26 March 2021, the Chairman made the following statements regarding preliminary matters. On 30 March 2021 the Chairman made the following statement regarding the finding of facts:

“Mr Notta

Preliminary applications made by the GDC Ms Vanstone on behalf of the GDC over three submissions on 22, 23 and 24 March 2021 made an application under Rule 18 of the Rules, to withdraw heads of charges 1(c), 1(g), 1(h), head of charge 2 in its entirety, 5(a), 6(a), 8, 9(b)(i), 9(b)(iii), 10(b), 10(c), 11(b), 11(c), 16(a), 17(a), 19(b), 19(d), 20(a), 20(b),20(c), 20(d), 22(a), 23(c), 24(a), 24(b), 24(c), 26(d), 26(e), 26(h), 27(c)(iii), 27(c)(vi), 28(a), 28(b), 28(c), 28(d), 28(e), 29(a), 30(a)(i), 30(a)(ii), 30(a)(iii), 30(a)(iv), 30(c)(ii). This application is made following the receipt of the joint expert report and concessions made by the GDC expert in cross examination.

There was no objection by Ms O’Rourke on your behalf. Ms Vanstone also made to an application under Rule 18 of the Rules, to amend head of charge 18 to remove the words ‘update/and’. The proposed amended head of charge will now read as follows: 18. At an appointment with Patient F on or around 25 September 2018 you failed to

record an update of Patient F's medical history.

She submitted that no injustice would be caused to either party by this amendment. The Committee accepted the advice of the Legal Adviser. The Committee noted that there was no objection made by defence. In considering the applications, it had regard to the merits of the case and the fairness of the proceedings, and it was content that the proposed withdrawals and amendment could be made without causing injustice to you. The heads of charge 1(c), 1(g), 1(h), head of charge 2 in its entirety, 5(a), 6(a), 8, 9(b)(i), 9 (b)(iii), 10(b), 10(c), 11(b), 11(c), 16(a), 17(a), 19(b), 19(d), 20(a), 20(b), 20(c), 20(d), 22(a), 23(c), 24(a), 24(b), 24(c), 26(d), 26(e), 26(h), 27(c)(iii), 27(c)(vi), 28(a), 28(b), 28(c), 28(d), 28(e), 29(a), 30(a)(i), 30(a)(ii), 30(a)(iii), 30(a)(iv), 30(c)(ii) are withdrawn accordingly. Head of charge 18 is amended accordingly. Ms Vanstone made a further application on 26 March 2021 under Rule 18 to amend head of charge 3 in light of the evidence of Patient A, as the GDC will not be pursuing heads of charge 1(a) and 1(b). The amended head of charge is to read;

Your conduct at paragraph 1 (d), (e) and/or (f) above was: The Committee accepted the advice of the Legal Adviser. The Committee noted that there was no objection made by defence. In considering the applications, it had regard to the merits of the case and the fairness of the proceedings, and it was content that the proposed withdrawals and amendment could be made without causing injustice to you.


Background and summary of the charge At all material times you were a registered General Dental Practitioner. At the time of the allegations, you were in an expense sharing arrangement at the Robin Hood Dental Practice with two other colleagues. You did not hold an NHS contract and provided treatment on a private only basis. Concerns were raised by your colleagues in relation to your treatment of patients and of probity in relation to the provision of dentures resulting in a complaint to the GDC. The referrals relate to the treatment you provided to patients A, B, D, E, F, G, H, I, over the 3-year period at the practice. The allegations arising from these referrals include alleged failings in examinations and assessment, informed consent, radiography, the provision of treatment including dentures, discussing treatment options and risk and benefits, and record keeping. There are also allegations relating to your probity, associated with your treatment of four of the patients, and utilising a chairside assistant who was working outside of their scope of practice. The remaining concerns relate to you practising without having indemnity insurance, and also the use of advertising for your practice. It is alleged that these adverts were misleading and dishonest. You made a number of admissions to the heads of charge. The Committee noted your admissions but deferred making any findings of fact until all the evidence had been heard. Evidence The Committee received a substantial amount of documentary evidence which included your clinical records and radiographs in respect of patients A, B and D to I, and the records of other treating practitioners. The Committee had been provided with advertisements that you had authorised. The Committee was also provided with witness statements from a number of witnesses, including Patients A, B, E, F, and H. There were also witness statements from Witness NC, the Practice Principal dated 24 November 2019, Witness CR, the Practice Principal dated 24 November 2019, and Witness ZT, a Dental Nurse dated 26 November 2019. The Committee also received expert evidence from both expert witnesses. Dr Levine, was called by the GDC. He produced an expert report dated 18 December 2019 and he also gave oral evidence. Dr Firestone was called by your defence. She produced an expert report dated 19 March 2021 and she also gave oral evidence. Both experts produced a joint expert report dated 19 March 2021 and also two addendum expert reports dated 21 and 22 March 2021. The Committee’s assessments of the witnesses who gave oral evidence at the hearing The Committee received oral evidence from witnesses called on behalf of the GDC, the expert Dr Levine and Patient B. The defence called four oral witnesses: yourself, Dr Firestone your expert, Patient A and Patient E. The Committee considered the oral evidence Patient B, and found her to be a reliable, credible and honest witness. Dr Levine was clear in giving his evidence and it found him to be knowledgeable on the clinical matters in this case. However, he stated that he has not worked in private practice, and the Committee found some of his evidence less reliable when discussing the expectation of private patients. The Committee was satisfied he considered alternative


arguments before reaching his conclusions. It also noted that on occasions, took time to seek clarification on certain matters and determined that he gave measured evidence and was prepared to change his opinion. The Committee found your oral evidence to be at times evasive, guarded and inconsistent. The Committee next heard oral evidence from your expert, Dr Firestone, and found her evidence to be clear, balanced and reliable particularly on matters relating to private dentistry where she had more direct knowledge. She was prepared on occasions to change her opinion. The Committee also heard oral evidence from Patient A, and found her to be straight forward, credible and reliable. She gave clear evidence and notified the Committee when she couldn’t recall certain events. Finally, it heard oral evidence from Patient E and the Committee found him to be credible and reliable. He stated that he was happy with the clinical treatment you provided”. The Committee’s Findings of Fact The burden is on the GDC to prove each allegation on the balance of probabilities. The Committee considered all the evidence presented to it. It took account of the closing submissions made by Ms Vanstone on behalf of the GDC and those from Ms O’Rourke on your behalf. It accepted the advice of the Legal Adviser. In accordance with that advice, it 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 facts are proved on the balance of probabilities. A number of the heads of charges relate to the provision of ‘NHS quality’ dentures to your private patients. Both experts agreed that there is no formal definition of what an ‘NHS quality’ denture is, although both gave examples of what some of the quality differences might be. The Committee notes that there is a conflict of expert opinion about the expectations of private patients and therefore how you should have explained this to your patients. Dr Levine considers that you ought to have used the term “NHS quality”; Dr Firestone’s opinion is that it is sufficient that the patient understood that the denture was of lesser or lower quality. The Committee prefers the evidence of Dr Firestone, because she has more direct experience of the expectations of private patients whilst Dr Levine confirmed that he did not have significant direct experience of treating private patients. The Committee, based on the expert evidence of Dr Firestone, determined that when providing dentures, that all patients must be informed as to whether they are temporary or permanent dentures, and understand the quality of the appliance that they are receiving. The Committee is satisfied that a temporary denture may be of lower quality because it is only expected to last a few months. Providing the patients understand this, the Committee does not consider that it is necessary to specifically say “NHS quality”. Taking all the above into account, the Committee’s findings in relation to each head of charge are as follows: I will now announce the Committee’s findings in relation to each head of charge:

Patient A 1. During appointments on or around the following dates you failed to


inform Patient A that she would be provided with NHS quality dentures:

1. a) 15 February 2017 – Partially Admitted in respect of the word used – Not proved. Head of charges 1(a) and 1(b) relate to the provision of temporary dentures. The Committee accepts that, as a matter of fact, you did not use the words “NHS quality”. The Committee accepts your evidence that these were made to a lower standard because they were to be thrown away after a few months. The Committee notes that there is a conflict of expert opinion. Dr Levine considers that you ought to have used the term “NHS quality”; Dr Firestone’s opinion that it is sufficient that the patient understood that the denture was of lesser or lower quality. The Committee prefers the evidence of Dr Firestone, because she has more direct experience of the expectations of private patients. It therefore considers that your responsibility was to ensure that the patient was told and understood that the denture she was receiving were of lesser or lower quality. It is clear from Patient A’s evidence that she knew this at the time. The Committee has determined that it was not necessary for you to have used the specific words “NHS quality” in this situation. Given that you did not have an obligation to say those words, the Committee finds this head of charge not proved.

1. b) 5 September 2017– Partially admitted in respect of the word used – Not proved for the reasons given in head of charge 1(a).

1. c) WITHDRAWN 1. d) 6 February 2018 - Admitted and found proved.

Heads of charge 1(d), 1(e) and 1(f) relate to the provision of permanent dentures. The Committee accepts that, as a matter of fact, you did not use the words “NHS quality”. You did not explain to the patient that lower quality materials would be used for the permanent denture. The Committee considers you ought to have told the patient that the permanent denture you would be providing was of the same, lesser, quality as the temporary denture. You did not do so, either using the words “NHS quality” or any other reasonable wording. Accordingly, this charge is found proved.

1. e) 26 March 2018- Admitted and found proved for the reasons given in head of charge 1(d)

1. f) 5 June 2018- Admitted and found proved for the reasons given in head of charge 1(d)

1. g) WITHDRAWN 1. h) WITHDRAWN 2. WITHDRAWN 2. a) WITHDRAWN


2. b) WITHDRAWN 2. c) WITHDRAWN 2. d) WITHDRAWN 2. e) WITHDRAWN

2. f) WITHDRAWN 2. g) WITHDRAWN 2. h) WITHDRAWN 3. Your conduct at paragraph 1 (d), (e) and/or (f) above was:

3. a) Misleading; - Admitted in respect of head of charge 1(d), 1(e) and 1(f) – Proved. The Committee notes that you told this patient that the temporary denture would be of a lower quality, provided for a lower fee, because it was to be discarded. The patient would therefore have expected that the permanent denture would have been of a higher quality. She was quoted and then charged a higher fee for this permanent denture. It has been found proved that you provided a denture that was of a lower quality to what Patient A was told to expect. The Committee is satisfied that Patient A was misled because she was expecting a permanent denture that was of a better quality than the temporary denture, and you did not provide this higher quality denture. The Committee is satisfied that you failed to inform her that the permanent dentures that you had provided were of lower quality than had been planned. This is misleading. Accordingly, the Committee finds this head of charge proved.

3. b) Dishonest in that you knew Patient A believed she would receive dentures of a higher quality – Admitted in respect of head of charge 1(d), 1(e) and 1(f) – Proved. The Committee applied the test of dishonesty as set out in Ivey v Genting Casinos (UK) limited [2017] 3WLR p1212. Accordingly, it first sought to ascertain, as far as it was able to on the information before it, your actual state of knowledge or belief as to the facts. During your oral evidence you apologised for your miscommunication and in hindsight recognise that you should have been clearer to the patient. You thought that Patient A had understood this meaning. You stated that the reasons you did this was to avoid any patient complaints. The Committee does not accept that this was a miscommunication. You knew that the patient was expecting a higher quality permanent denture, because you had told her this. You also knew that the denture you supplied was of the lower, ‘NHS-equivalent’ quality. You knew that you had not told her that the permanent denture was of lower quality than had originally been planned. You knew that she had been quoted for and had subsequently paid for a higher quality of denture than you


provided. The Committee is satisfied that an objective person would consider supplying a product of lower quality materials to a patient who was reasonably expecting and had paid for better quality materials was dishonest. It has no hesitation that this would be considered dishonest by the objective standards of ordinary decent people.

4. Your standard of clinical record keeping was inadequate, in that:

4. a) On or around 15 February 2017 you failed to record, adequately or at all, Patient A's agreement to the proposed treatment

Admitted and found proved. 4. b) On or around 19 September 2017 you failed to record adequately the

notation of extracted teeth

Admitted and found proved. Patient B 5. During appointments on or around the following dates you failed to

inform Patient B that she would be provided with NHS quality dentures:

5. a) WITHDRAWN 5. b) 12 May 2018 – Partially admitted and found not proved.

This head of charge relates to the provision of temporary dentures. The Committee accepts that, as a matter of fact, you did not use the words “NHS quality”. The Committee accepts your evidence that these were made to a lower standard because they were to be thrown away after a few months. The Committee notes that there is a conflict of expert opinion. Dr Levine considers that you ought to have used the term “NHS quality”; Dr Firestone’s opinion that it is sufficient that the patient understood that the denture was of lesser or lower quality. The Committee prefers the evidence of Dr Firestone, because she has more direct experience of the expectations of private patients. It therefore considers that your responsibility was to ensure that the patient was told and understood that the denture she was receiving were of lesser or lower quality. It is clear from Patient B’s evidence that she knew this at the time. The Committee has determined that it was not necessary for you to have used the specific words “NHS quality” in this situation. Given that you did not have an obligation to say those words, the Committee finds this head of charge not proved.

5. c) 20 August 2018 – Partially admitted and found proved. This head of charge relates to the provision of permanent dentures. The Committee accepts that, as a matter of fact, you did not use the words “NHS quality”. You did not explain to the patient that lower quality materials would be used for the permanent denture. The Committee considers you ought to have told the patient that the


permanent denture you would be providing was of the same, lesser, quality as the temporary denture. You did not do so, either using the words “NHS quality” or any other reasonable wording. Accordingly, this charge is found proved.

6. You failed to obtain valid consent for the provision of dentures to Patient B on the following dates:

6. a) WITHDRAWN 6. b) 12 May 2018 - Not proved.

The Committee, for the reasons as given above, is satisfied that informing Patient B that her temporary denture was of a lower quality is sufficient. The Committee is satisfied Patient B was informed by you that her temporary denture was of a lesser quality, and that you had obtained Patient B’s informed consent. The Committee therefore finds this head of charge not proved.

6. c) 20 August 2018 - Admitted and found proved Patient B was under the impression that she was receiving a higher quality permanent denture. However, you provided her with a lower quality permanent denture and failed to inform her of this. The Committee is satisfied that Patient B was not in full possession of all of the facts, and therefore you did not obtain valid informed consent from Patient B. The Committee finds this head of charge proved.


7. a) Misleading

Admitted in respect of head of charge 5(c) and found proved in respect of head of charge 5(c) The Committee notes that you told this patient that the temporary denture would be of a lower quality, provided for a lower fee, because it was to be discarded. The patient would therefore have expected that the permanent denture would have been of a higher quality. She was quoted and then charged a higher fee for this permanent denture. It has been found proved that you provided a denture that was of a lower quality to what Patient B was told to expect. The Committee is satisfied that Patient B was misled because she was expecting a permanent denture that was of a better quality than the temporary denture, and you did not provide this higher quality denture. The Committee is satisfied that you failed to inform her that the permanent dentures that you had provided were of lower quality than had been planned. This is misleading. Accordingly, the Committee finds this head of charge proved.

7. b) Dishonest in that you knew Patient B believed she would receive


dentures of a higher quality

Admitted in respect of head of charge 5(c) and found proved in respect of head of charge 5(c) The Committee applied the test of dishonesty as set out in Ivey v Genting Casinos (UK) limited [2017] 3WLR p1212. Accordingly, it first sought to ascertain, as far as it was able to on the information before it, your actual state of knowledge or belief as to the facts. In your oral evidence you apologised for your miscommunication and in hindsight recognise that you should have been clearer to the patient. You thought that Patient B had understood this meaning. You stated that the reasons you did this was to avoid any patient complaints. The Committee does not accept that this was a miscommunication. You knew that the patient was expecting a higher quality permanent denture, because you had told her this. You also knew that the denture you supplied was of the lower, ‘NHS-equivalent’ quality. You knew that you had not told her that the permanent denture was of lower quality than had originally been planned. You knew that she had been quoted for and had subsequently paid for a higher quality of denture than you provided. The Committee is satisfied that an objective person would consider supplying a product of lower quality materials to a patient who was reasonably expecting and had paid for better quality materials was dishonest. It has no hesitation that this would be considered dishonest by the objective standards of ordinary decent people.

8. WITHDRAWN 9. Your standard of clinical record keeping was inadequate, in that;

9.a) On or around 10 May 2018 you failed to record, adequately or at all:

9. a) i.

any discussion with Patient B about the risks and benefits of the planned extractions

Admitted and found proved. 9. a) ii.

any discussion with Patient B about the quality of dentures she would receive

Admitted and found proved. 9.b) On or around 4 June 2018 you failed to record, adequately or at all:

9. b) i.

WITHDRAWN

9. b) ii.

A report on a periapical radiograph

Admitted and found proved. 9. b) iii.

WITHDRAWN


Patient D 10. During appointments on or around the following dates you failed to

inform Patient D that he would be provided with NHS quality dentures:

10. a) 26 July 2018 - Admitted and found not proved. This head of charge relates to the provision of temporary dentures. The Committee accepts that, as a matter of fact, you did not use the words “NHS quality”. The Committee accepts your evidence that these were made to a lower standard because they were to be thrown away after a few months. Your standard practice of using the expression “lower quality” is supported by the evidence of Patient A and B. The Committee notes that there is a conflict of expert opinion. Dr Levine considers that you ought to have used the term “NHS quality”; Dr Firestone’s opinion that it is sufficient that the patient understood that the denture was of lesser or lower quality. The Committee prefers the evidence of Dr Firestone, because she has more direct experience of the expectations of private patients. It therefore considers that your responsibility was to ensure that the patient was told and understood that the denture he was receiving were of lesser or lower quality. The Committee has not heard from Patient D but has no reason to suppose that he was not aware of this. The Committee has determined that it was not necessary for you to have used the specific words “NHS quality” in this situation. Given that you did not have an obligation to say those words, the Committee finds this head of charge not proved.

10. b) WITHDRAWN 10. c) WITHDRAWN 11. You failed to obtain valid consent for the provision of dentures to Patient

D on the following dates:

11. a) 26 July 2018 - not proved The Committee, for the reasons given above, is satisfied that informing Patient D that his temporary denture was of a lower quality is sufficient. The Committee is satisfied Patient D was informed by you that his temporary denture was of a lesser quality, and that you had obtained Patient D’s informed consent. The Committee therefore finds this head of charge not proved.

11. b) WITHDRAWN 11. c) WITHDRAWN 12. Your conduct at paragraph 10 above was:

12. a) Misleading; - Not proved having found head of charge 10(a) not proved.

12. b) Dishonest in that you knew Patient D believed she would receive


dentures of a higher quality – Not proved having found head of charge 10(a) not proved.

13. Your standard of clinical record keeping was inadequate, in that on or around 26 July 2018 you failed to record, adequately or at all, any discussion with Patient D regarding the quality of dentures to be provided

Admitted and found proved. Patient E 14. You failed to consult with Patient E's general practitioner or

haematologist regarding his medication prior to an appointment on 3 January 2017

Admitted and found proved. 15. You failed to provide Patient E with any adequate written costs estimate

prior to implant placement

Admitted and found proved. 16. At an appointment on or around 3 January 2017 you failed to:

16. a) WITHDRAWN 16. b) Quality grade radiographs - Proved.

You stated in oral evidence that either yourself or your Dental Nurse quality graded radiographs. This was recorded in a processing log for assessment purposes. The Committee has not been provided with this. You have quality graded radiographs taken on other occasions in the clinical notes of other patients. Given this the Committee does not accept your evidence that your normal practice was to grade on the processing log and not in the clinical notes. The clinical notes show that a radiograph was taken on this date. The Committee considers that you had a duty to assess the quality of your radiographs and has no evidence that you have done so. Therefore, the Committee is satisfied on the balance of probabilities that you had failed to quality grade radiographs on 3 January 2017 and finds this head of charge proved.

17. Your standard of clinical record keeping was inadequate in that at an appointment on or around 3 January 2017 you failed to record, adequately or at all:

17. a) WITHDRAWN 17. b) Any repair to the left maxillary antrum - Admitted and found proved. Patient F 18. At an appointment with Patient F on or around 25 September 2018 you

failed to update and/record an update of Patient F's medical history – Admitted and found proved.


Patient G 19. During appointments on or around the following dates you failed to

inform Patient G that she would be provided with NHS quality dentures:

19. a) 11 June 2018 – Partially admitted and found not proved. This head of charge relates to the provision of temporary dentures. The Committee accepts that, as a matter of fact, you did not use the words “NHS quality”. The Committee accepts your evidence that these were made to a lower standard because they were to be thrown away after a few months. Your standard practice of using the expression “lower quality” is supported by the evidence of Patient A and B. The Committee notes that there is a conflict of expert opinion. Dr Levine considers that you ought to have used the term “NHS quality”; Dr Firestone’s opinion that it is sufficient that the patient understood that the denture was of lesser or lower quality. The Committee prefers the evidence of Dr Firestone, because she has more direct experience of the expectations of private patients. It therefore considers that your responsibility was to ensure that the patient was told and understood that the denture she was receiving were of lesser or lower quality. The Committee has not heard from Patient G but has no reason to suppose that she was not aware of this. The Committee has determined that it was not necessary for you to have used the specific words “NHS quality” in this situation. Given that you did not have an obligation to say those words, the Committee finds this head of charge not proved.

19. b) WITHDRAWN 19. c) 22 October 2018 – Partially admitted and found proved.

This head of charge relates to the provision of permanent dentures. The Committee accepts that, as a matter of fact, you did not use the words “NHS quality”. You did not explain to the patient that lower quality materials would be used for the permanent denture. The Committee considers you ought to have told the patient that the permanent denture you would be providing was of the same, lesser, quality as the temporary denture. You did not do so, either using the words “NHS quality” or any other reasonable wording. Accordingly, this charge is found proved.

19. d) WITHDRAWN 20. You failed to obtain valid consent for the provision of dentures to Patient

G on the following dates:

20. a) WITHDRAWN

20. b) WITHDRAWN

20. c) 22 October 2018 – Admitted and found proved. Patient G was under the impression that she was receiving a higher


quality permanent denture. However, you provided her with a lower quality permanent denture and failed to inform her of this. The Committee is satisfied that Patient G was not in full possession of all of the facts, and therefore you did not obtain valid informed consent from Patient G. The Committee finds this head of charge proved.

20. d) 24 November 2018 - Admitted and found proved for the reasons found in head of charge 20(c)


21. a) Misleading: Admitted in respect of head of charge 19(c) and found proved. Not proved in respect of head of charge 19(a) having found it not proved. It has been found proved that you provided a permanent denture that was of a lower quality to what Patient G was told to expect. The Committee is satisfied that Patient G was misled when she was expecting at that stage a permanent denture that was of a better quality than the temporary denture. Patient G was expecting a permanent denture that was of a higher quality for which she had paid for. The Committee is satisfied that by failed to inform her of this, that your actions are misleading and finds this head of charge proved.

21. b) Dishonest in that you knew Patient G believed she would receive dentures of a higher quality

Admitted in respect of head of charge 19(c) and found proved. Not proved in respect of head of charge 19(a) having found it not proved. The Committee applied the test of dishonesty as set out in Ivey v Genting Casinos (UK) limited [2017] 3WLR p1212. Accordingly, it first sought to ascertain, as far as it was able to on the information before it, your actual state of knowledge or belief as to the facts. In your oral evidence you apologised for your miscommunication and in hindsight recognise that you should have been clearer to the patient. You thought that Patient G had understood this meaning. You stated that the reasons you did this was to avoid any patient complaints. The Committee does not accept that this was a miscommunication. You knew that the patient was expecting a higher quality permanent denture, because you had told her this. You also knew that the denture you supplied was of the lower, ‘NHS-equivalent’ quality. You knew that you had not told her that the permanent denture was of lower quality than had originally been planned. You knew that she had been quoted for and had subsequently paid for a higher quality of denture than you provided. The Committee is satisfied that an objective person would consider


supplying a product of lower quality materials to a patient who was reasonably expecting and had paid for better quality materials was dishonest. It has no hesitation that this would be considered dishonest by the objective standards of ordinary decent people.

22. Your standard of clinical record keeping was inadequate in that on or around 11 June 2018 you failed to record, adequately or at all:

22. a) WITHDRAWN

22. b) any discussion with Patient G about the risks and benefits of treatment

Admitted and found proved. Patient H 23. At an appointment with Patient H on or around 19 March 2015 you

failed to:

23. a) Carry out an adequate intra-oral examination – Not proved. You stated in oral evidence that this was a record keeping failure rather than a clinical failure. You guided the Committee to a further date that shows that it is your usual practice to carry out an intra-oral and extra-oral examinations. You accept the records don’t detail any of these for this date. The Committee noted that you state that it is your standard practice to perform an intra-oral and extra-oral examinations. Patient H stated that during your examination you were far more thorough than her previous dentist and you had called everything out to your Dental Nurse. Having taken all of this into account, the Committee considers that on the balance of probabilities that you did this and finds this head of charge not proved.

23. b) Carry out an adequate extra-oral examination - Not proved for the reasons in head of charge 23(a)

23. c) WITHDRAWN 24. At an appointment with Patient H on or around 23 September 2015 you

failed to:

24. a) WITHDRAWN 24. b) WITHDRAWN 24. c) WITHDRAWN 25. At an appointment with Patient H on or around 7 April 2016 you failed

to:

25. a) Report on radiographs

Admitted and found proved. 25. b) Quality grade radiographs – Proved.

You stated in oral evidence that either yourself or your dental nurse quality graded radiographs. This was recorded in a processing log for


assessment purposes. The Committee has not been provided with this. You have quality graded radiographs taken on other occasions in the clinical notes of other patients. Given this the Committee does not accept your evidence that your normal practice was to grade on the processing log and not in the clinical notes. The clinical notes show that bitewing radiographs were taken on this date. The Committee considers that you had a duty to assess the quality of your radiographs, and has no evidence that you have done so. Therefore, the Committee is satisfied on the balance of probabilities that you had failed to quality grade radiographs on or around 7 April 2016 and finds this head of charge proved.

26. At an appointment with Patient H on or around 7 December 2016 you:

26. a) Failed to report on radiographs

Admitted and found proved. 26. b) Failed to quality grade radiographs - Proved.

You stated in oral evidence that either yourself or your dental nurse quality graded radiographs. This was recorded in a processing log for assessment purposes. The Committee has not been provided with this. You have quality graded radiographs taken on other occasions in the clinical notes of other patients. Given this the Committee does not accept your evidence that your normal practice was to grade on the processing log and not in the clinical notes. The clinical notes show that a radiograph was taken on this date. The Committee considers that you had a duty to assess the quality of your radiographs and has no evidence that you have done so. Therefore, the Committee is satisfied on the balance of probabilities that you had failed to quality grade radiographs on or around 7 December 2016 and finds this head of charge proved.

26. c) Failed to conduct a vitality test on the LR6, adequately or at all

Admitted and found proved. 26. d) WITHDRAWN

26. e) WITHDRAWN

26. f) Failed to adequately discuss treatment options with Patient H

Admitted and found proved. 26. g) Failed to adequately discuss the risks and benefits of treatment with

Patient H

Admitted and found proved. 26. h) WITHDRAWN 27. Your standard of clinical record keeping was inadequate, in that:


27. a) On or around 19 March 2015 you failed to record, adequately or at all:

27. a) i.

Details of any intra-oral examination

Admitted and found proved. 27. a) ii.

Details of any extra-oral examination

Admitted and found proved. 27. b) On or around 23 September 2015 you failed to record, adequately or at

all:

27. b) i.


Admitted and found proved. 27. b) ii.


Admitted and found proved. 27. c) On or around 7 December 2016 you failed to record, adequately or at

all:

27. c) i.


Admitted and found proved. 27. c) ii.


Admitted and found proved. 27. c) iii.

WITHDRAWN

27. c) iv.

Details of the supporting bone in the region of the LR6

Admitted and found not proved. The Committee noted Dr Levine, the GDC expert, conceded in cross examination that as the bone level was satisfactory, failing to record the details of the supporting bone in the region of the LR6 was not a serious failing. The Committee therefore finds this head of charge not proved.

27. c) v.

Any discussion with Patient H of treatment options

Admitted and found proved. 27. c) vi.

WITHDRAWN

Patient I 28. At an appointment on or around 28 January 2018 you failed to:

28. a) WITHDRAWN 28. b) WITHDRAWN 28. c) WITHDRAWN


28. d) WITHDRAWN

28. e) WITHDRAWN

29. At an appointment on or around 14 February 2018 you:

29. a) WITHDRAWN 29. b) Utilised a chairside assistant whose scope of practice did not permit him

to undertake that role

Admitted and found proved. 29. c) In respect of your conduct at paragraph 29b) above, you knew that the

chairside assistant's scope of practice did not permit him to carry out that role

Admitted and found proved. 29. d) After treating Patient I you failed to:

29. d) i.

Ensure all surfaces were adequately decontaminated

Admitted and found proved. 29. d) ii.

Ensure all single-use instruments were appropriately disposed of

Admitted and found proved. 29. d) iii.

Ensure all instruments were sterilised or prepared for sterilising

Admitted and found proved. 29. d) iv.

Ensure all clinical waste was appropriate disposed of

Admitted and found proved. 30. Your standard of clinical note keeping was inadequate, in that:

30.a) WITHDRAWN 30. a) i.

WITHDRAWN

30. a) ii.

WITHDRAWN

30. a) iii.

WITHDRAWN

30. a) iv.

WITHDRAWN

30. b) On or around 14 February 2018 you failed to keep contemporaneous notes

Admitted and found proved. 30.c) In respect of the appointment on or around 14 February 2018 you failed

to record, adequately or at all:

30. c) The type of bone used for a bone graft


i. Admitted and found proved. 30. c) ii.

WITHDRAWN

31. You practised dentistry without any or any adequate indemnity cover on dates unknown in:

31. a) December 2016 – Proved. The Committee took into account the exact wording of this head of charge which did not restrict the head of charge to within the borders of the UK. It also took into account Section 26(A) of the Dentist Act 1984 which states ‘A registered dentist who is practising as a dental practitioner must have in force in relation to him an indemnity arrangement which provides appropriate cover for practising as such.’

The Committee notes that there is no certificate of indemnity insurance or documentary confirmation from your indemnifier that would prove or disprove this head of charge. The Committee was aware that the burden of proof was on the GDC. The Committee took into account your oral evidence, where you stated that you had taken 4 patients to your sister practice in India where you rent a room. This accords with a screenshot of your twitter account where you advertised that you, a UK dentist, will be travelling to your sister practice in Delhi to treat UK patients for two weeks. This is also verified by the statement of Witness NC and Witness CR. In your original statement you have admitted to this head of charge stating ‘admitted. I did have indemnity in place for treatment in the UK. The treatment I performed was in India and my indemnity did not extend overseas.’ In your oral evidence you stated you had not contacted your indemnity insurers to verify if you were covered in India. You did contact the GDC, who stated it was outside their jurisdiction. You informed the Committee that providing implants is a three-stage process. The planning, consent, and signing of the contract took place in the UK. The implant placement, which is surgery, was undertaken in India by you. The final restorative work was performed in the UK. In response to Committee questions, you stated that you told these patients that the implant placement would be subject to the laws in India. You also stated that you were not required to have indemnity insurance in India, and you knew that as you had asked other practitioners in India. The Committee is satisfied that you had appropriate indemnity in the UK but that you knew you did not have adequate indemnity insurance for treatment carried out in India. The Committee is satisfied, based on your own evidence, that on the balance of probabilities you were practising as such without adequate indemnity insurance for the two dates. It therefore finds head of charge 31 proved in its entirety.


31. b) February 2017 – Proved for the reasons as in head of charge 31(a). 32. You permitted or caused to be published an advertisement for the

Robin Hood Dental Practice which was published in the Solihull Observer on or around 19 May 2016 which stated, "In partnership with Mark Cleary Dental Laboratory Strumann Platinum accredited >25 years' experience"

Admitted and found proved. 33. The statement at paragraph 32 above was:

33. a) misleading, in that it represented that you had more than 25 years' experience in carrying out dental implant work, when this was not accurate - Not proved. In your statement you deny this saying “on a reasonable reading, that advert does not represent that I had more than 25 years’ experience, however I accept that the wording could have been clearer.”

The Committee agrees that this advert is not clear. However, it is satisfied that a reasonable member of the public having read this advert would be more likely than not to understand that the statement "In partnership with Mark Cleary Dental Laboratory Strumann Platinum accredited >25 years' experience" applied to the lab. The Committee accepted the evidence in Mark Cleary’s letter that he had over 25 years’ experience and therefore the advert was factually true. The Committee is therefore satisfied that the advert is not misleading. It therefore finds this head of charge not proved.

33. b) Your conduct at paragraph 32 above was dishonest, in that you knew it induced a reader to believe that you had more than 25 years' experience in carrying out dental implant work when this was not accurate - Not proved. During your oral evidence you stated that you did not intend to mislead anybody. You told the Committee that the advert was designed by the newspaper, and you authorised the publication of the advert. The Committee has already found that the statement in question is factually correct and refers to the laboratory technician and not you. You knew at the time that the statement was correct and so your intention in publishing the advert was not dishonest. The Committee is therefore satisfied that the head of charge not proved.

34. You permitted or caused to be published an advertisement for the "Robin Hood Dental Practice" which was published in the Solihull Observer on or around 19 May 2016 which stated, "Success rates > 99%"

Admitted and found proved. 35. The statement at paragraph 34 above was:


35. a) misleading, in that it represented that dental implant treatment provided to patients by you had a successful outcome in more than 99% of cases, when this was not accurate.

Admitted and found proved The Committee notes that head of charge 34 is a matter of fact. The Committee considers that objectively, a reasonable patient reading this advert would believe that your success rate for implant patients was over 99%. In fact, your success rate was 95%. This success rate relates to the 20 patients you treated during your training who had only been followed up for a relatively short period of time. The Committee accepted Dr Levine’s evidence that for a success rate to be meaningful it must be measured over a defined time period. It noted his evidence that the Eastman Dental Hospital ‘gives the success rate of their specialist implant unit as 80-95% over 15 years.’ To claim that your success rate is over 99% when it is in fact at best 95%, and when this was based on a very small training sample followed for only a short period of time, is objectively misleading. This creates an inaccurate expectation for patients about the results they can expect in reality. The Committee therefore finds this head of charge proved.

35. b) dishonest, in that you knew it induced a reader to believe that that dental implant treatment provided to patients by you had a successful outcome in more than 99% of cases, when this was not accurate.

Admitted and found proved. The Committee applied the test of dishonesty as set out in Ivey v Genting Casinos (UK) limited [2017] 3WLR p1212. Accordingly, it first sought to ascertain, as far as it was able on the information before it your actual state of knowledge or belief as to the facts. You have admitted this head of charge and in your oral evidence stated that you intended to increase the business for your practice. Your claimed success rate of over 99% is based on the 20 patients you treated in training. The success rate in this training cohort was in fact 95%. The Committee accepted Dr Levine’s evidence that for a success rate to be meaningful it must be measured over a defined time period. It noted his evidence that the Eastman Dental Hospital ‘gives the success rate of their specialist implant unit as 80-95% over 15 years.’ Your figures of 99% was not based on a fair sample of your actual implant patients, and was incorrect, and therefore the 99% figure quoted is misleading and unreliable for any potential patient. You were aware that the advert was misleading, with inaccurate data, and yet you still authorised publication. The Committee is satisfied that an honest and decent person would


consider that authorising an advert which stated that you had a success rate of over 99% when you knew that was not realistic, was dishonest. The Committee determined that this conduct is dishonest by the objective standards of ordinary decent people.

36. You permitted or caused to be published an advertisement in or around April 2016 representing that you had the benefit of "onsite lab work"

Admitted and found proved. 37. Your conduct at paragraph 36 above was:

37. a) Misleading, in that you had no onsite laboratory

Admitted and found not proved. The Committee is satisfied that you did not have an onsite laboratory at the practice. The advert contains the wording ‘onsite lab work’ and not the wording ‘onsite laboratory’. The Committee is satisfied that a reasonable person would consider the wording of the advert to mean that you have access to some onsite lab work when required, and not that you have an onsite laboratory at the practice. In your evidence you verified that you had access to onsite lab work and this was confirmed by the documentary evidence of Mark Cleary. Considering the content of the advert cumulatively, the Committee was satisfied that objectively that a reasonable member of the public would not be mislead.

37. b) Dishonest, in that you knew you had no onsite laboratory – Found not proved. The Committee applied the test of dishonesty as set out in Ivey v Genting Casinos (UK) limited [2017] 3WLR p1212. Accordingly, it first sought to ascertain, as far as it was able on the information before it your actual state of knowledge or belief as to the facts. You gave evidence that the advert does not claim you had an “onsite laboratory” but could provide “onsite lab work”. This is a fact the Committee has already determined to be correct in head of charge 37(a). The Committee having found that your conduct in this respect was not misleading, is satisfied that your conduct was not dishonest. The Committee is satisfied that the wording in the advert was accurate and not intended to be dishonest. Having made this finding of fact the Committee was satisfied that your conduct was not dishonest by the objective standards of ordinary decent people and finds this head of charge not proved.

We move to Stage Two.” On 30 March 2021, the hearing was adjourned part heard.

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