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					                                GENERAL DENTAL COUNCIL
                         PROFESSIONAL CONDUCT COMMITTEE
                                       April to May 2010
                                    Johnstone, Stuart Elliott
                                    Registration No: 48357

Charge
Stuart Elliott Johnstone registered as of Crabtree Drive Dental Practice, Chelmsley Wood Primary
Care Centre, Chelmsley Wood, BIRMINGHAM, B37 5BU; BDS Birm 1974, was summoned to
appear before the Professional Conduct Committee on 12 April 2010 for inquiry into the following
charge:
                         Amended with the agreement of both parties
That, being a Registered Dentist:

1      At all material times you were a registered dental practitioner providing general dental
       services from Crabtree Drive Dental Practice (formerly 14, Crabtree Drive), Chelmsley
       Wood, Birmingham.

Patient B.A.D.

2      Between the 11th April 2005 and the 20th June 2007 you provided dental treatment to Miss
       B.A.D.

3      On the following dates you fitted veneers to Miss B.A.D.’s UR1 -

       a)     31.5.05

       b)     2.9.05

       c)     3.10.06

       d)     14.12.06

       e)     19.6.07

4      On the following dates you fitted veneers to Miss B.A.D.’s UL1 -

       a)     31.5.05

       b)     5.4.07

5      You failed to take a radiograph of the UL1 throughout the period of your dental treatment.

6      a)     You failed to apply adequate care and attention to the preparation and fitting of the
              veneers to the UR1 and UL1.

       b)     You failed to consider alternative treatment in the light of the repeated failure of the
              veneers.
       c)      You did not act in the best interest of your patient.

7      The provision of veneers to this patient was -

       a)      Not the most appropriate treatment

       b)      Inappropriate

       c)      Not in the patient’s best interest.

       d)      Motivated primarily by financial gain

       e)      Dishonest

       f)      Without her or her mother’s informed consent.

8      Your patient records in relation to this patient are inadequate.

Patient J.M.

9      Between the 31st January 2005 and the 2nd February 2007 you provided dental treatment to
       Miss J.M.

10     a)      On the 14th February 2005 you took a panoral radiograph that showed caries on the
               LR7 and LL6.

       b)      You failed to provide any or any adequate treatment to the caries on the LR7 and
               LL6 throughout the period of your dental treatment.

       c)      The absence of treatment was not in the best interests of the patient.

       d)      In consequence the LL6 was extracted in October 2007.

11     a)      On the 16th January 2006 you fitted a veneer to the UR2.

       b)      In the circumstances you should have sought a specialist orthodontic opinion prior
               to the decision to provide a veneer.

12     a)      On the 13th April 2006 you took an impression of the LR2 for a veneer.

       b)      You ordered a veneer from Maurice Hood Dental Laboratory Limited in April 2006.

       c)      WITHDRAWN

13     The provision of a veneer to this patient was -

       a)      Not the most appropriate treatment option

       b)      Inappropriate

       c)      Not in the patient’s best interest.

       d)      Motivated primarily by financial gain
       e)      Dishonest

14     Your patient records in relation to this patient are inadequate.

Patient C.R.

15     Between the 10th November 2002 and 18th November 2006 you provided dental treatment
       to Miss C.R.

16     Throughout the period of dental treatment you failed to -

       a)      Take any bitewing radiographs

       b)      Take a periapical radiograph of the UR2 area.

17     a)      On the 17th November 2006 you fitted a veneer to the UR1.

       b)      At the time of fitting the veneer the URb was still in place.

       c)      Fitting a veneer when the adjacent tooth had not been exfoliated was-

               i) Inappropriate

               ii) Not in the patient’s best interest.

18     The provision of a veneer to this patient was -

       a)      Not the most appropriate treatment option

       b)      Inappropriate

       c)      Not in the patient’s best interest.

       d)      Motivated primarily by financial gain

       e)      Dishonest

19     In providing a veneer you failed -

       a)      To discuss the treatment options with Miss C.R. adequately or at all.

       b)      To obtain informed consent to the fitting of a veneer.

20     Your patient records in relation to this patient are inadequate.


Patient K.T.


21     Between the 21st October 2004 and the 28th March 2007 you provided dental treatment to
       Miss K.T.
22     a)      On the 22nd October 2004 you noted that the patient required a restoration to the
               UR6.

       b)      You failed to take bitewing and / or periapical radiographs.

       c)      On the 22nd October 2004 you dressed the UR6.

       d)      On the 27th March 2007 you extracted the UR6.

       e)      Despite seeing the patient on a number of occasions between the 22nd October
               2004 and the 27th March 2007 you failed to provide definitive treatment to the UR6.

23     a)      On the 25th May 2006 you fitted a veneer to the UL2.

       b)      You failed to take a periapical radiograph of the UL2 on the 19th April 2006.

       c)      The provision of a veneer to this patient was -

               i)     Not the most appropriate treatment option

               ii)    Inappropriate

               iii)   Not in the patient’s best interest.

               iv)    Motivated primarily by financial gain

               v)     Dishonest

24     a)      On the 10th October 2006 you fitted a veneer to the UR2.

       b)      The provision of a veneer to this patient was -

               i)     Not the most appropriate treatment option

               ii)    Inappropriate

               iii)   Not in the patient’s best interest.

               iv)    Motivated primarily by financial gain

               v)     Dishonest

25     Your patient records in relation to this patient are inadequate.

Patient S.C.

26     Between the 3rd October 1996 and the 16th March 2007 you provided dental treatment to
       Miss S.C.

27     a)      In June 2001 you referred Miss S.C. to the Children’s Department at Birmingham
               Dental Hospital for generalised enamel hypoplasia.
     b)     In August 2001 Dr. Linda Shaw, Consultant in Paediatric Dentistry at the above
            Hospital saw Miss S.C. and wrote a letter to you stating that it was “far too early to
            consider making veneers” for Miss S.C.

     c)     On the 9th August 2006 you took impressions of the UR2 and the UL2 for the
            provision of veneers.

     d)     On the 13th September 2006 you fitted a veneer to the UL2.

     e)     On the 27th November 2006 you fitted a veneer to the UR2.

28   The provision of veneers to this patient was -

            i)      Not the most appropriate treatment option

            ii)     Inappropriate

            iii)    Not in the patient’s best interest.

            iv)     Motivated primarily by financial gain

            v)      Dishonest

29   On the 13th September 2006 you failed to take a radiograph of the UR2.

30   a)     On the 4th January 2007 Miss S.C. attended at your practice and you recorded that
            she had fractured her UL1.

     b)     You took impressions for veneers to the UL1 and UR1.

     c)     You failed to take a radiograph of the UL1.

     d)     On a date after the 4th January 2007 you fitted veneers to the UL1 and UR1.

     e)     The provision of veneers to this patient was -

            i)      Not the most appropriate treatment option

            ii)     Inappropriate

            iii)    Not in the patient’s best interest.

            iv)     Motivated primarily by financial gain

            v)      Dishonest

31   a)     On about three occasions between the 19th October 2004 and the 9th August 2006
            you treated the LR7.

     b)     You failed to provide any definitive treatment in a timely manner.

     c)     You failed to take any bitewing radiographs.
32     Your patient records in relation to this patient are inadequate.



Patient T.C.

33     Between the 21st November 2002 and the 8th November 2006 you provided dental
       treatment to Master T.C.

34     a)      On the 30th December 2003 you fitted a bridge onto LR1 and LR3.

       b)      On the 27th May 2004 you re-cemented the bridge.

       c)      On the 24th June 2004 you fitted a new replacement bridge.

       d)      On the 21st September 2004 you re-cemented the bridge.

       e)      On the 9th February 2005 you fitted a new replacement bridge.

       f)      In the light of the repeated failure of the bridge you failed to consider alternative
               treatment options.

       g)      You did not act in the best interest of your patient.

35     a)      On the 15th April 2004 you fitted veneers to the UR2, UR1, UL1 and the UL2.

       b)      On the 24th June 2004 you noted that the UL1 veneer had fractured.

       c)      On the 29th July 2004 you fitted veneers to the UR3 and UL3.

       d)      On the 22nd November 2004 you noted that the UL1 veneer had fractured.

       e)      On the 16th December 2004 you fitted a new veneer to the UL1.

       f)      On the 12th May 2006 you noted that the UL2 veneer had fractured.

       g)      On the 7th November 2006 you fitted a new veneer to the UL2.

36     The provision of veneers to this patient was -

               i)        Not the most appropriate treatment option

               ii)       Inappropriate

               iii)      Not in the patient’s best interest.

               iv)       Motivated primarily by financial gain

               v)        Dishonest

37     You failed to -

       a)      Take radiographs
       b)      To discuss the treatment options in relation to veneers with Master T.C. adequately
               or at all.

       c)      To obtain informed consent to the fitting of veneers.

38     Your patient records in relation to this patient are inadequate.

Patient V.D.

39     Between the 1st February 1998 and the 17th October 2006 you provided dental treatment to
       Miss V.D.

40     Between the 25th January 2004 and the 17th October 2006 you failed to treat adequately or
       at all the UL6.

41     Between the 2nd November 2003 and the 17th October 2006 you failed to treat adequately
       or at all the LR6.

42     a)      On the 8th July 2005 you fitted veneers to the UR2 and UL2.

       b)      On the 5th September 2005 you fitted veneers to the UR1 and UL1.

       c)      The provision of veneers to this patient was -

               i)     Not the most appropriate treatment option

               ii)    Inappropriate

               iii)   Not in the patient’s best interest.

               iv)    Motivated primarily by financial gain

               v)     Dishonest

43     a)      On the 22nd December 2005 you noted that the veneer to the UR1 was fractured
               and on the 27th January 2006 you fitted a new veneer to the UR1.

       b)      On the 4th September 2006 you noted that the veneer to the UR1 was fractured
               again and on the 16th October 2006 you fitted a new veneer to the UR1.

       c)      You failed to apply adequate care and attention to the preparation and fitting of the
               veneers to the UR1.

       d)      You failed to consider alternative treatment in the light of the repeated failure of the
               veneers.

       e)      You did not act in the best interest of your patient.

44     Throughout the period of dental treatment you failed to -

       a)      Take any or any adequate radiographs

       b)      Take any bitewing radiographs.
45     In providing veneers you failed -

       a)      To discuss the treatment options with Miss V.D. adequately or at all.

       b)      To obtain informed consent to the fitting of a veneer.

46     Your patient records in relation to this patient are inadequate.

Patient J.W.

47     Between the 23rd February 1995 and the 12th May 2007 you provided dental treatment to
       Miss J.W.

48     a)      On the 10th November 2003 you fitted veneers to the UL2 and UL3.

       b)      On the 22nd January 2004 you fitted veneers to the UR2 and the UR3.

       c)      On the 14th February 2005 you fitted veneers to the UR1 and the UL1.

       d)      On a date after the 8th November 2005 you fitted replacement veneers to the UR2
               and UL2.

       e)      On the 31st October 2006 you fitted a veneer to the UL4.

       f)      On the 11th May 2007 you fitted a replacement veneer to the UL2.

       g)      The provision of veneers to this patient was -

               i)     Not the most appropriate treatment option

               ii)    Inappropriate

               iii)   Not in the patient’s best interest.

               iv)    Motivated primarily by financial gain

               v)     Dishonest

49     In providing veneers you failed -

       a)      To discuss the treatment options with Miss J.W. adequately or at all.

       b)      To obtain informed consent to the fitting of a veneer.

50     a)      Between the 11th January 2005 and the 12th May 2007 you wrongly prioritised the
               provision of veneers over timely treatment to Miss J.W’s pressing oral health needs.

       b)      You did not act in the best interest of your patient.

51     You failed to take any or a sufficient number of –

       a)      radiographs
       b)      bitewing radiographs.

52     Your patient records in relation to this patient are inadequate.

Patient S.S.

53     Between the 28th April 1994 and the 3rd July 2007 you provided dental treatment to Miss
       S.S.

54     a)      Between the 17th October 2000 and the 29th May 2007 you fitted 16 new or
               replacement veneers as set out in the attached schedule marked „A‟.

       b)      The provision of veneers to this patient was -

               i)     Not the most appropriate treatment option

               ii)    Inappropriate

               iii)   Not in the patient’s best interest.

               iv)    Motivated primarily by financial gain

               v)     Dishonest

       c)      You wrongly prioritised the provision of veneers over timely treatment to Miss S.S’s
               pressing oral health needs.

       d)      You did not act in the best interest of your patient.

       e)      Each veneer you fitted was later replaced by a new veneer.

       f)      You failed to apply adequate care and attention to the preparation and fitting of the
               veneers.

       g)      You failed to consider alternative treatment in the light of the repeated failure of the
               veneers.

       h)      You did not act in the best interest of your patient.

55     You failed to take any or a sufficient number of –

       a)      radiographs

       b)      bitewing radiographs.

56     Your patient records in relation to this patient are inadequate.

Patient W.B.

57     Between the 29th November 2001 and the 16th January 2007 you provided dental treatment
       to Master W.B.

58     a)      On the 1st June 2005 you fitted veneers to the UR2, UR1 and the UL2.
       b)      The provision of veneers to this patient was -

               i)     Not the most appropriate treatment option

               ii)    Inappropriate

               iii)   Not in the patient’s best interest.

               iv)    Motivated primarily by financial gain

               v)     Dishonest

       c)      On the 30th September 2005 the UR2 was recemented.

       d)      On the 25th October 2005 you noted that the UR2 veneer was fractured.

       e)      On the 29th November 2005 you fitted a new veneer to the UR2.

       f)      On the 6th October 2006 you noted that the UL2 was fractured.

       g)      On the 15th January 2007 you fitted a new veneer to the UL2.

       h)      You failed to apply adequate care and attention to the preparation and fitting of the
               veneers.

       i)      You failed to consider alternative treatment in the light of the repeated failure of the
               veneers.

       j)      You did not act in the best interest of your patient.

59     You failed to take any or any adequate –

       a)      radiographs

       b)      bitewing radiographs

60     Your patient records in relation to this patient are inadequate.

Patient J.D.

61     Between the 8th April 2001 and the 3rd February 2007 you provided dental treatment to
       Miss J.D.

62     a)      On the 22nd December 2003 you fitted veneers to the UR2 and UL2.

       b)      On the 22nd November 2004 you fitted veneers to the UR1 and UL1.

       c)      On the 3rd June 2005 you took impressions for new veneers to the UR1 and UL1.

       d)      On the 4th July 2005 you fitted a new veneer to the UR1.

       e)      On the 2nd September 2005 you fitted a new veneer to the UL1.
       f)      On the 23rd November 2006 you took an impression for a new veneer to the UL2.

       g)      On the 21st or 23rd December 2006 you fitted a new veneer to the UL2.

       h)      The provision of veneers to this patient was -

               i)        Not the most appropriate treatment option

               ii)       Inappropriate

               iii)      Not in the patient’s best interest.

               iv)       Motivated primarily by financial gain

               v)        Dishonest

       i)      You failed to apply adequate care and attention to the preparation and fitting of the
               veneers.

       j)      You failed to consider alternative treatment in the light of the failure of the veneers.

       k)      You did not act in the best interest of your patient.

63     You failed to -

       a)      Take radiographs

       b)      To discuss the treatment options in relation to veneers with Miss J.D. adequately or
               at all.

        c)     To obtain informed consent to the fitting of veneers.

64     Your patient records in relation to this patient are inadequate.

Patient A.W.

65     Between the 23rd August 2001 and the 6th June 2007 you provided dental treatment to
       Master A.W.

66     a)      On the 6th April 2004 you took impressions for the provision of veneers to the UR1
               and UL1.

       b)      On the 5th June 2006 you took further impressions for the provision of veneers to
               the UR1 and UL1.

       c)      On the 17th July 2006 you fitted veneers to the UR1 and UL1.

       d)      The provision of veneers to this patient was -

               i)        Not the most appropriate treatment option

               ii)       Inappropriate
               iii)   Not in the patient’s best interest.

               iv)    Motivated primarily by financial gain

               v)     Dishonest

       e)      You failed to apply adequate care and attention to the preparation and fitting of the
               veneers.

       f)      You failed to discuss the treatment options in relation to veneers with Master A.W.
               adequately or at all.

       g)      You failed to obtain informed consent to the fitting of veneers.

       h)      You did not act in the best interest of your patient.

67     You failed to take any or a sufficient number of –

       a)      radiographs

       b)      bitewings.

68     Your patient records in relation to this patient are inadequate.

Patient R.B.

69     Between the 23rd May 2006 and the 27th September 2006 you provided dental treatment to
       Master R.B.

70     a)      On the 26th September 2006 you fitted a veneer to the palatal (rather than the
               buccal) aspect of the UL1.

       b)      The provision of a veneer to this patient was -

               i)     Not the most appropriate treatment option

               ii)    Inappropriate

               iii)   Not in the patient’s best interest.

               iv)    Motivated primarily by financial gain

               v)     Dishonest

       c)      The fitting of a veneer to the palatal aspect of the UL1 was inappropriate.

71     You failed to take any or a sufficient number of –

       a)      radiographs

       b)      bitewing radiographs.

72     Your patient records in relation to this patient are inadequate.
Patient R.A.

73     Between the 24th January 1975 and the 19th June 2007 you provided dental treatment to
       Mrs R.A.

74     a)      Between the 19th November 1999 and the 20th June 2006 you fitted about 18
               veneers to the UR123 and the UL123 (as set out in the schedule marked B).

       b)      You failed to apply adequate care and attention to the preparation and fitting of the
               veneers.

       c)      You failed to consider alternative treatment in the light of the repeated failures of
               the veneers.

       d)      You did not act in the best interest of your patient.

75     You failed to take any or any adequate –

       a)      radiographs

       b)      bitewing radiographs

76     Your patient records in relation to this patient are inadequate.

Patient N.S.

77     Between the 3rd December 2003 and the 11th May 2007 you provided dental treatment to
       Ms N.S.

78     a)      On six occasions between the 11th July 2005 and the 2nd December 2005 Ms N.S.
               presented to you with an infection in the LL78 region.

       b)      You failed to –

               i)     adequately attempt to diagnose the cause of the infection

               ii)    prevent the patient from unnecessary pain

               iii)   refer the patient for emergency treatment in a timely fashion.

       c)      As a consequence -

               i)     the LL7 had to be extracted

               ii)    you did not act in the best interest of your patient.

79     You failed to take any or any adequate –

       a)      radiographs

       b)      bitewing radiographs
80     Your patient records in relation to this patient are inadequate.

Patient E.C.

81     Between the 3rd October 1996 and the 27th June 2007 you provided dental treatment to
       Miss E.C.

82     a)      On the following dates you fitted veneers to Miss E.C.’s UL1 -

               i)     after the 17th October 2002

               ii)    19th October 2004

               iii)   13th September 2005

               iv)    20th September (re-cemented)

               v)     18th October 2005.

       b)      On the following dates you fitted veneers to Miss E.C.’s UR1 -

               i)     after the 17th October 2002

               ii)    19th October 2004

               iii)   13th September 2005.

       c)      On the following dates you fitted veneers to Miss E.C.’s UL2 -

               i)     12th October 2004

               ii)    18th January 2007

       d)      The provision of veneers to this patient was -

               i)     Not the most appropriate treatment option

               ii)    Inappropriate

               iii)   Not in the patient’s best interest.

               iv)    Motivated primarily by financial gain

               v)     Dishonest

       e)      You failed to apply adequate care and attention to the preparation and fitting of the
               veneers.

       f)      You failed to discuss the treatment options in relation to veneers with Miss E.C.
               adequately or at all.

       g)      You failed to obtain informed consent to the fitting of veneers.
83     You failed to take any or any adequate –

       a)       radiographs

       b)       bitewing radiographs

84     Your patient records in relation to this patient are inadequate.

       Patient J.C.

85     a) Between 3rd March and 25th November 2005 you took impressions and fitted veneers to
       the UL2 and 3, UR1 and UL1 of Mr JC.

       b) You failed to treat the patient’s presenting pain

       c) You failed to obtain informed consent to the fitting of the veneers

       d) The fitting of veneers to this patient was –

                i) Motivated primarily by financial gain

                ii) Dishonest.

86     On unknown dates prior to the 5th July 2007 you fitted veneers on top of existing veneers to
       some of your patients.

87     The patient records relating to the 39 patients set out in the attached schedule marked C -

       a)       are inadequate, as set out in the Supplementary Report of Mr Roger Turner dated
                31st August 2009.

       b)       show failures of veneers

       c)       contain an absence of radiographs when such radiographs ought to have been
                taken.

And in relation to the facts set out your fitness to practise is impaired by virtue of your misconduct
and/or deficient professional performance.”

Findings of fact

On 4 May 2010 the Chairman made the following statement regarding the finding of facts:
“Mr Johnstone

At the start of the hearing Mr Stern, on behalf of the General Dental Council (the Council), invited
the Committee to amend the heads of charge. That application was not opposed and accordingly
the following paragraphs were amended:

Paragraph 10 (d) by replacement of the words “had to be” with “was”.
Paragraph 26 by replacement of “the 1st June 1992” with the “3rd October 1996”.
Paragraph 35 (f) by replacement of “2005” with “2006”.
Paragraph 48 (b) by replacement of “21st” with “22nd”.
Paragraph 48 (c) by replacement of “4th” with “14th”.
Paragraph 53 by replacement of “September” with “April”.
Paragraph 58 (a) by deletion of UL1.
Paragraph 62 (f) by replacement of “16th” with “23rd”.
Paragraph 62 (g) by replacement of “27th” with “21st or 23rd”.
Paragraph 78 (b) (i) by addition of the word “adequately” before the word “attempt”.
Paragraph 82 (a) (iii) by replacement of “14th” with “13th”.
Paragraph 82 (b) (iii) by replacement of “14th” with “13th”.
Paragraph 82 (c) (ii) by replacement of “2006” with “2007”.
Paragraph 85 (a) so as to read “Between the 3rd March and 25th November 2005 you took
impressions and fitted veneers to the UR1, UL1, UL2 and UL3.
Paragraph 87 (a) by deletion of the words “reports by the Dental Reference Officer Mr Richard
Birkin, dated the 30th April 2007 and the 27th July 2007 and the”.

Paragraph 12 was deleted.

The burden of proof remains throughout on the Council. An allegation will only be proved if the
Council have satisfied the Committee on a balance of probability that the allegation is true.

The Committee heard evidence from the following witnesses who were called on behalf of the
Council:

Patients BD, CR, TC, EC, VD, JW and JC. Four parents gave evidence namely TH, the mother of
BD, MR, the mother of CR, EC the mother of EC, and MW the father of JW. Mr Tobin, a dentist,
who had treated your patients after your suspension by the Primary Care Trust, also gave
evidence.

In addition the Committee heard the expert evidence of Mr Turner and read the report of Dr Harley
on behalf of the Council. That report was not agreed in its entirety.

The following witnesses were unable to attend the hearing: patient JD and her mother MG, and
patient AW. Each provided witness statements which were read.

Their evidence was not agreed. The Committee has taken into account that their evidence was not
agreed and the witnesses would have been cross examined had they been able to attend the
hearing. The Committee has not been able to observe these witnesses and assess their credibility.
It has therefore treated their evidence with some caution. In considering their evidence the
Committee has looked to see if support for their evidence can be found in the documents put
before the Committee. It has also taken into account those admissions relevant to their evidence.

The following witnesses did not attend the hearing because their evidence was agreed and their
statements were read:

The Dental Reference Officers, Mr Birkin, Mr Billingham and Mr Hardie.

The Committee accepts their evidence in full.

You gave evidence. The Committee has treated your evidence in the same way that it has treated
the evidence of the other witnesses.
In addition you called five witnesses who gave evidence of your character and integrity. You also
provided the Committee with the expert report of Mr Harrison. You called further expert evidence
which was given by Mr Kramer.

A bundle of testimonials was also provided to the Committee as evidence of your good character,
probity and reputation.

On the first day of the hearing Mr Horne, on your behalf, provided the Committee with a detailed
schedule listing the admissions you wished to make to the allegations and the basis upon which
those admissions were made. The Committee has considered that schedule. It has also taken into
account the evidence of patients and of their parents, the patient notes and the evidence of Mr
Turner, Mr Tobin and yourself and finds proved all the admitted allegations which appear in that
schedule.

Partial admissions were made in respect of the following paragraphs:

7 (c), 34 (g), 62 (h) (ii) and (iii), 63 (b) and (c).

Mr Stern accepted that those admissions were appropriate and did not invite the Committee to
enquire further into those paragraphs, which are therefore found proved.

The schedule of admissions makes admissions in relation to some of the 39 patients referred to in
paragraph 87. Appendix A to the schedule lists the basis on which those admissions were made.
Mr Stern agreed that it was not necessary for the Committee to go on to consider each of the
patients separately and he invited the Committee to find paragraph 87 proved only in so far as it
was admitted by you. The Committee has adopted that suggestion and finds paragraph 87 proved
subject to the qualifications and denials contained in Appendix A. The Committee therefore finds
that these patient records were inadequate, showed failures of veneers on more than one
occasion and showed an absence of radiographs in cases where the tooth was damaged.

Paragraph 87 is therefore proved to the extent that it was admitted.

Save where is indicated to the contrary the Committee found the evidence of the witnesses called
by the Council to be largely credible, accurate and reliable. The evidence of the patients, and of
any parents, was affected by the passage of time and the difficulty the witnesses had in recalling
events and conversations years later. This was of particular relevance to the evidence of patients
who were children when treatment occurred.

The Committee has taken into account that you had little or no recall of the treatment of the
patients who gave evidence. When you did have any recollection, that recollection is likely to have
been even more impaired by the passage of time than the evidence of patients and parents who
are likely to have had more reason to remember the dental treatment they or their children had
than you would have of treatment carried out by you some years earlier.

The Committee has been assisted by examining the patient records. However, these are not easy
to read and do not always record the reasons veneers were fitted or the explanation given to
patients or patients’ parents for the provision of veneers. Having regard to the passage of time and
the brevity of the notes, Mr Horne’s cross examination of witnesses and your own evidence was
largely based on what you believed your usual practice would have been rather than your own
recall of events.
In addition the Committee finds that there were similarities in the evidence of the patients about
the lack of information you provided about your treatment and about your fitting of veneers. The
Committee has taken into account that there is no suggestion by the Defence that the witnesses
colluded with one another.

In these circumstances the Committee finds that it prefers the evidence given by the patients and
parents about your treatment of them to your own evidence.

The Committee has taken into account the evidence of your good character and has read all the
testimonials which were submitted. It finds that you have a very good reputation and are well
respected by friends and fellow professional people. However, the Committee accepts that your
good character and reputation does not exclude the possibility that your motivation in providing
veneers was a financial one or that you were dishonest in doing so.

The Committee has considered whether you were a credible and reliable witness. In several
respects it found that your evidence was contradictory and implausible.

   -   Your claim that you were isolated from other dental professionals was contradicted by the
       fact that until 2000 you were in partnership with Mr Horton who continued to attend the
       practice part time until 2005. You were also in contact with fellow dentists in your area
       socially and at CPD events.
   -   Your claim, in your evidence in chief, that you did not undertake organised continuing
       professional development was contradicted by the bundle of documents you had produced
       at an interim orders hearing showing frequent attendance at seminars and training events.
   -   You claimed that you were unaware that the provision of veneers for children was
       inappropriate until after you were suspended by the PCT and started your retraining with
       Mr Fairbrother in about April 2008. However in August 2001 you received a letter from Dr
       Shaw, a consultant to whom you had referred a child patient, and she advised you that it
       was far too early to consider placing veneers on that patient’s teeth. The Committee also
       notes that in February 2008 in a letter written on your behalf by your solicitors in response
       to the complaint of the mother of EC, they stated, on your instructions, that EC’s teeth were
       still growing when the veneers were fitted [in October 2002] and she had outgrown them.
   -   All the dentists who gave evidence in this case, including Mr Harrison and one of the
       character witnesses, Mr Henderson agreed that it was only on rare occasions that veneers
       were appropriate for children. The Committee did not find it credible that you were unaware
       of the unsuitability of veneers for children when that was common knowledge within the
       profession.
   -   You also claimed that you first used veneers on adult patients after reading of this
       treatment in dental literature. The Committee did not accept that you did not read any
       guidance on this, whether in the SDR or elsewhere, or make use of your general
       knowledge of the growth of juvenile dentition.
   -   Your claim that you were unaware of the large amount of money paid to you which was
       derived from claims for treatment with veneers is not credible. You had no practice
       manager and completed all claim forms yourself. On your own evidence you said that you
       had been the treasurer of a tennis club with a large membership and a turnover of £2.5m.
       You had successfully negotiated the lease of new premises for your surgery and had
       acquired expensive equipment. You had taken out loans in connection with the practice.
       The Committee infers from this evidence that you are someone with financial ability and
       that, on a balance of probability, it is unlikely that you would have been unaware of the
       financial details of the income of your practice.
The oral evidence of the witnesses is of particular importance to the issue of whether you
discussed with the patients the treatment options adequately or at all and obtained their informed
consent. You admitted that you did not obtain informed consent for the provision of veneers in that
you recommended veneers believing them to be the most appropriate form of treatment, but you
only later discovered that they were not. The Committee was invited to consider whether that
admission was sufficient or whether the failure to obtain informed consent went further than the
admission. It finds on the evidence put before it that some discussions took place between you
and your patients about your proposed treatment with veneers, but the discussions were brief,
incomplete, lacking in detail and inadequate and failed to enable patients and their parents to
make a considered decision on appropriate treatment armed with reasonable and accurate
information.

The Committee has considered each allegation separately together with the evidence of the
patients themselves and of the parents concerned and the DROs. In addition it has taken account
of your evidence on this issue.

The Committee has noted that it is a consistent feature of the evidence of the patients and the
parents that you failed to provide detailed information about veneers or about the reasons you
considered this to be appropriate treatment.

The following paragraphs of the Heads of Charge allege that you did not discuss the
treatment options with the patients adequately or at all.

Paragraphs 19 (a), 37 (b), 45 (a), 49 (a), 63 (b), 66 (f), 82 (f)

For the reasons given above and in the accompanying schedule the Committee finds it proved that
you did not discuss treatment options adequately but that some discussions about treatment
occurred and therefore the words “or at all” are found not proved. The Committee finds that
discussions about treatment options were brief and lacking in detail and insufficient to enable a
parent, or a child old enough to consent with enough information to assess the suitability of the
treatment with veneers.

The following paragraphs alleged that your treatment was motivated primarily by financial
gain.

Paragraphs 7 (d), 13 (d), 18 (d), 23 (c) (iv), 24 (b) (iv), 28 (iv), 30 (e) (iv), 36 (iv), 42 (c) (iv), 48 (g)
(iv), 54 (b) (iv), 58 (b) (iv), 62 (h) (iv), 66 (d) (iv), 70 (b) (iv), 82 (d) (iv), 85 (d) (i).

In considering this issue the Committee has asked itself whether in treating your patients you were
doing your incompetent best with their interests in mind or whether your motivation was financial. It
has taken into account the following matters:

    (i)     the exceptionally large number of veneers you provided for patients and the
            comparative unit cost of veneers compared with other treatment options. It has noted
            the uncontested evidence contained volume C 3 in the form of charts and graphs
            showing the extent of your claims to the Dental Practice Board for fees for the provision
            of veneers. It does not accept the submission of Mr Horne that the fees payable to you
            for veneers would have been as profitable to you as those paid for fillings.
    (ii)    For the reasons given above it finds that you knew that the provision of veneers for
            children was inappropriate. You also knew that veneers fitted by you failed frequently.
            The Committee has taken into account the short length of the appointments during
               which you took impressions and later fitted veneers. Your usual practice was to fit
               veneers without preparing the tooth beforehand. You claimed that you were extremely
               busy and under great pressure after your partner at the practice retired. The Committee
               finds that you must have been aware that the fitting of veneers entitled you to greater
               payment than other forms of restorative treatment and you were able to provide this
               treatment quickly giving you more time to see other patients. You must also have been
               aware of the risk of failure of veneers fitted to children, which would involve you in
               further treatment and further claims. It does not accept your explanation that you were
               unaware of the income you derived from this treatment. That part of your evidence was
               not credible in that you were making the claims for payment yourself, without
               assistance from a practice manager. It must have been obvious to you that a
               substantial part of the income of your practice was derived from the provision of
               veneers. The Committee also takes into account that the evidence showed that on
               various occasions you had neglected to treat caries or other pressing dental problems
               and that you fitted veneers instead. All these factors have driven the Committee to the
               conclusion that your primary motivation for the provision of veneers was financial gain.
    (iii)      Although the Committee finds that you knew that the fitting of veneers on children was
               inappropriate, unless recommended by specialist opinion, it has considered whether in
               respect of any of the patients the interests of the patients justified or might have
               justified treatment with veneers.

The Committee finds all the allegations relating to your motivation proved save for paragraphs 13
(d), 28 (iv), 30 (e) (iv), 62 (h) (iv), 70 (b) (iv) and 85 (d) (i) in part

The following paragraphs allege that your provision of veneers was dishonest.

Paragraphs 7 (e), 13 (e), 18 (e), 23 (c) (v), 24 (b) (v), 28 (v), 30 (e) (v), 36 (v), 42 (c) (v), 48 (g) (v),
54 (b) (v), 58 (b) (v), 62 (h) (v), 66 (d) (v), 70 (b) (v), 82 (d) (v), 85 (d) (ii).

Where the Committee has found that your motivation was not primarily for financial gain the
allegations of dishonesty have been found not proved. Where it has been proved that your
motivation was financial gain the Committee has gone to consider in each case whether you were
also dishonest.

It has also taken into account and accepts the advice of the Legal Adviser on the meaning in law
of dishonesty.

The Committee has taken into account that you knew that the provision of veneers to children was
inappropriate and that you were motivated primarily by financial gain rather than by the interests of
patients. The Council’s case that you were acting dishonestly is also supported by:

    -       The lack of detailed information you gave to patients and parents about this form of
            treatment.
    -       The fact that this treatment was failing frequently and that you did not investigate the
            causes of the failures.
    -       Your continued use of this treatment between 1999 and 2007, which prioritised the
            provision of veneers to children who were under 12, was combined with your neglect of
            more pressing and more serious dental health issues and of basic matters such as proper
            examination, diagnosis and treatment planning.
    -   Your acceptance in your solicitors’ letter in August 2008 that EC had outgrown her veneers
        demonstrates your awareness at the time these veneers were fitted that EC’s teeth were
        still growing and therefore that ledges might develop.
    -   Your acceptance in cross examination that you knew that children provided with veneers
        would outgrow them.

All these factors lead the Committee to the conclusion that your provision of these veneers and
your claims for payment were dishonest by ordinary standards and that you must have realised
that these claims would be regarded as being dishonest by the ordinary standards of reasonable
and honest people.

The Committee has considered each paragraph separately. For the reasons given above it finds
that each allegation of dishonesty is found proved save for the following paragraphs which were
found not proved: 13 (e), 28 (v), 30 (e) (v), 62 (h) (v), 70 (b) (v) and 85(d) (ii) in part.

The following paragraphs of the Heads of Charge raised discrete issues.

The Committee’s findings of fact and reasons in respect of these paragraphs appear in the
accompanying schedule.

Paragraph 11 (b)
Admitted and proved

Paragraph 29
Not proved

Paragraph 62 (j)
Proved as amended

Paragraphs 63 (b) and (c)
These paragraphs were admitted in respect of teeth UR 1 and UL 1 but denied in respect of UR 2
and UL 2.
Mr Stern invited the Committee to find these paragraphs proved to the extent admitted by the
Defence. The Committee accepted that submission.

Paragraphs 85 (b)
Not proved

85 (c)
Admitted and Proved in relation to UL2 and UL3.



The reasons for the Committee‟s decision appear in the schedule below.

                                                       Admitted and proved
1       At all material times you were a registered
        dental practitioner providing general dental
        services from Crabtree Drive Dental
        Practice (formerly 14, Crabtree Drive),
        Chelmsley Wood, Birmingham.
Patient B.A.D.

                                                    Admitted and proved
2     Between the 11th April 2005 and the 20th
      June 2007 you provided dental treatment
      to Miss B.A.D.

                                                    Admitted and proved
3     On the following dates you fitted veneers
      to Miss B.A.D.’s UR1 -

      a)     31.5.05

                                                    Admitted and proved
      b)     2.9.05

                                                    Admitted and proved
      c)     3.10.06

                                                    Admitted and proved
      d)     14.12.06

                                                    Admitted and proved
      e)     19.6.07

                                                    Admitted and proved
4     On the following dates you fitted veneers
      to Miss B.A.D.’s UL1 -

      a)     31.5.05

                                                    Admitted and proved
      b)     5.4.07

                                                    Admitted and proved
5     You failed to take a radiograph of the UL1
      throughout the period of your dental
      treatment.

                                                    Admitted and proved
6     a)     You failed to apply adequate care
             and attention to the preparation
             and fitting of the veneers to the
             UR1 and UL1.
                                                    Admitted and proved
      b)     You failed to consider alternative
             treatment in the light of the
             repeated failure of the veneers.

                                                    Admitted only in respect of 5 and 6a and
      c)     You did not act in the best interest   b.
               of your patient.

                                                     Admitted and proved
7      The provision of veneers to this patient
       was -

       a)      Not the most appropriate treatment


                                                     Admitted and proved that you acted
       b)      Inappropriate                         inappropriately.

                                                     Admitted and proved
       c)      Not in the patient’s best interest.

                                                     Proved
       d)      Motivated primarily by financial      The patient was 10yrs old and had a class
               gain                                  2 occlusion. Veneers were totally
                                                     inappropriate in a child of this age. The
                                                     patient attended with a trauma to her
                                                     tooth. There was no investigation or
                                                     diagnosis by you. There was no clinical
                                                     basis for treating the trauma with a
                                                     veneer. The placing of a veneer on the
                                                     adjacent tooth for matching purposes
                                                     made the appearance of the class 2
                                                     occlusion more pronounced. There was
                                                     no clinical or aesthetic benefit to the
                                                     patient. The Committee concludes that
                                                     your only motivation was financial gain.
                                                     Proved
       e)      Dishonest

                                                     Admitted and proved
       f)      Without her or her mother’s
               informed consent.

                                                     Admitted and proved
8      Your patient records in relation to this
       patient are inadequate.


Patient J.M.

                                                     Admitted and proved
9      Between the 31st January 2005 and the 2nd
       February 2007 you provided dental
       treatment to Miss J.M.

                                                     Admitted and proved
                         th
10     a)      On the 14 February 2005 you took
               a panoral radiograph that showed
            caries on the LR7 and LL6.
                                                Admitted and proved that you failed to
     b)     You failed to provide any or any    provide any treatment to the caries on LR7
            adequate treatment to the caries on and failed to provide any adequate
            the LR7 and LL6 throughout the      treatment to the caries on LL6.
            period of your dental treatment.

                                                    Admitted and proved
     c)     The absence of treatment was not
            in the best interests of the patient.

                                                    Admitted and proved
     d)     In consequence the LL6 was
            extracted in October 2007.

                                                    Admitted and proved
11   a)     On the 16th January 2006 you fitted
            a veneer to the UR2.

                                                    Proved.
     b)     In the circumstances you should         The Committee took into account the
            have sought a specialist                evidence of Dr Harley and your
            orthodontic opinion prior to the        acceptance in evidence of this allegation.
            decision to provide a veneer.

                                                    Admitted and proved
12   a)     On the 13th April 2006 you took an
            impression of the LR2 for a veneer.

                                                    Admitted and proved
     b)     You ordered a veneer from Maurice
            Hood Dental Laboratory Limited in
            April 2006.

                                                    Admitted and proved
13   The provision of a veneer to this patient
     was -

     a)     Not the most appropriate treatment
            option

                                                    Admitted and proved
     b)     Inappropriate

                                                    Admitted and proved
     c)     Not in the patient’s best interest.
                                                    Denied and not proved.
     d)     Motivated primarily by financial        The patient was nearly 16 at the time the
            gain                                    veneer was fitted. The Committee
                                                    accepted that your initial treatment was
                                                    appropriate. Veneering an instanding
                                                         tooth was inappropriate before an
                                                         orthodontic referral. However it was
                                                         questionable whether the patient would
                                                         have accepted orthodontic treatment and
                                                         therefore it was not outside the scope of
                                                         what a dentist might honestly, but
                                                         mistakenly, do.
                                                         Denied and not proved.
       e)      Dishonest

                                                         Admitted and proved
14     Your patient records in relation to this
       patient are inadequate.

Patient C.R.

                                                         Admitted and proved
15     Between the 10th November 2002 and 18th
       November 2006 you provided dental
       treatment to Miss C.R.

                                                         Admitted and proved
16     Throughout the period of dental treatment
       you failed to -

       a)      Take any bitewing radiographs

                                                         Admitted and proved
       b)      Take a periapical radiograph of the
               UR2 area.
                                                         Admitted and proved
17     a)      On the 17th November 2006 you
               fitted a veneer to the UR1.

                                                         Admitted and proved
       b)      At the time of fitting the veneer the
               URb was still in place.

                                                         Admitted and proved
       c)      Fitting a veneer when the adjacent
               tooth had not been exfoliated was-

               i) Inappropriate

                                                         Admitted and proved
               ii) Not in the patient’s best interest.

                                                         Admitted and proved
18     The provision of a veneer to this patient
       was -

       a)      Not the most appropriate treatment
               option

                                                      Admitted and proved
       b)      Inappropriate

                                                      Admitted and proved
       c)      Not in the patient’s best interest.

                                                      Denied and proved.
       d)      Motivated primarily by financial       The Committee found patient CR to be
               gain                                   credible. The patient had enquired about a
                                                      brace but you had said that a veneer
                                                      would be preferable and orthodontic
                                                      treatment was deferred until the patient
                                                      could no longer obtain it on the NHS from
                                                      the orthodontist to whom you sent
                                                      referrals. The Committee was unable to
                                                      identify any advantage to the patient in the
                                                      treatment which was provided before a
                                                      referral and accepted that there was
                                                      financial advantage to you in the provision
                                                      of a veneer.
                                                      Denied and proved.
       e)      Dishonest

                                                      Admitted and proved in relation to
19     In providing a veneer you failed -             „adequately‟ as amended to refer to one
                                                      veneer.
       a)      To discuss the treatment options       The Committee found that some
               with Miss C.R. adequately or at all.   discussion occurred and therefore the
                                                      words “or at all” are not proved. The
                                                      discussion was inadequate in that you
                                                      should have informed CR of her need for
                                                      orthodontic treatment.
                                                      Admitted and proved that you
       b)      To obtain informed consent to the      recommended a porcelain veneer as the
               fitting of a veneer.                   most appropriate option when it was not.

                                                      Admitted and proved
20     Your patient records in relation to this
       patient are inadequate.


Patient K.T.

                                                      Admitted and proved
21     Between the 21st October 2004 and the
       28th March 2007 you provided dental
       treatment to Miss K.T.
                                                 Admitted and proved
22   a)   On the 22nd October 2004 you
          noted that the patient required a
          restoration to the UR6.

                                                 Admitted and proved
     b)   You failed to take bitewing and / or
          periapical radiographs.

                                                 Admitted and proved
     c)   On the 22nd October 2004 you
          dressed the UR6.

                                                 Admitted and proved
     d)   On the 27th March 2007 you
          extracted the UR6.

                                                 Admitted and proved
     e)   Despite seeing the patient on a
          number of occasions between the
          22nd October 2004 and the 27th
          March 2007 you failed to provide
          definitive treatment to the UR6.


                                                 Admitted and proved
23   a)   On the 25th May 2006 you fitted a
          veneer to the UL2.

                                                 Admitted and proved
     b)   You failed to take a periapical
          radiograph of the UL2 on the 19th
          April 2006.

                                                 Admitted and proved
     c)   The provision of a veneer to this
          patient was -

          i)     Not the most appropriate
                 treatment option

                                                 Admitted and proved
          ii)    Inappropriate

                                                 Admitted and proved
          iii)   Not in the patient’s best
                 interest.

                                                 Denied and proved
          iv)    Motivated primarily by          The Committee found that the chip on UL2
                 financial gain                  was minimal and not urgent and not a
                                                 sufficient justification for provision of a
                                                     veneer. You also neglected other pressing
                                                     issues in preference to the veneer
                                                     treatment. You were also able to claim 12
                                                     UDAs for this treatment. The only
                                                     inference the Committee could draw on
                                                     the evidence was that your primary
                                                     motivation was financial.
                                                     Denied and proved
               v)     Dishonest

                                                     Admitted and proved
24     a)      On the 10th October 2006 you fitted
               a veneer to the UR2.

                                                     Admitted and proved
       b)      The provision of a veneer to this
               patient was -

               i)     Not the most appropriate
                      treatment option

                                                     Admitted and proved
               ii)    Inappropriate

                                                     Admitted and proved
               iii)   Not in the patient’s best
                      interest.

                                                     Denied and proved
               iv)    Motivated primarily by         The patient records did not refer to any
                      financial gain                 reason for treatment to this tooth nor to
                                                     any concern about matching. The tooth
                                                     was not adjacent to UL2 on which the
                                                     earlier veneer had been fitted. You were
                                                     able to claim a further 12 UDAs whereas if
                                                     all the treatment had been undertaken at
                                                     the same time you would only have been
                                                     able to claim 12 UDAs in total. The
                                                     Committee therefore found no sufficient
                                                     clinical justification for this treatment and
                                                     a financial advantage to you.
                                                     Denied and proved
               v)     Dishonest
                                                     Admitted and proved
25     Your patient records in relation to this
       patient are inadequate.

Patient S.C.

                                                     Admitted and proved
26     Between the 3rd October 1996 and the 16th
     March 2007 you provided dental treatment
     to Miss S.C.

                                                    Admitted and proved
27   a)     In June 2001 you referred Miss
            S.C. to the Children’s Department
            at Birmingham Dental Hospital for
            generalised enamel hypoplasia.

                                                    Admitted and proved
     b)     In August 2001 Dr. Linda Shaw,
            Consultant in Paediatric Dentistry
            at the above Hospital saw Miss
            S.C. and wrote a letter to you
            stating that it was “far too early to
            consider making veneers” for Miss
            S.C.

                                                    Admitted and proved
     c)     On the 9th August 2006 you took
            impressions of the UR2 and the
            UL2 for the provision of veneers.

                                                    Admitted and proved
     d)     On the 13th September 2006 you
            fitted a veneer to the UL2.

                                                    Admitted and proved
     e)     On the 27th November 2006 you
            fitted a veneer to the UR2.

                                                    Admitted and proved
28   The provision of veneers to this patient
     was -

            i)      Not the most appropriate
                    treatment option

                                                    Admitted and proved
            ii)     Inappropriate

                                                    Admitted and proved
            iii)    Not in the patient’s best
                    interest.
                                                    Not proved.
            iv)     Motivated primarily by          The Committee accepted that the patient‟s
                    financial gain                  enamel hypoplasia was severe and that
                                                    she had reached an age at which a dentist
                                                    might honestly, but mistakenly, place
                                                    veneers.
                                                  Not proved.
            v)     Dishonest

                                                  Not proved.
29   On the 13th September 2006 you failed to     The Committee accepts that you did not
     take a radiograph of the UR2.                take a radiograph but no criticism arises
                                                  from this. The Committee accepted that
                                                  only the veneer was fractured.
                                                  Admitted and proved
30   a)     On the 4th January 2007 Miss S.C.
            attended at your practice and you
            recorded that she had fractured her
            UL1.

                                                  Admitted and proved
     b)    You took impressions for veneers
           to the UL1 and UR1.

                                                  Admitted and proved
     c)     You failed to take a radiograph of
            the UL1.

                                                  Admitted and proved
     d)     On a date after the 4th January
            2007 you fitted veneers to the UL1
            and UR1.

                                                  Admitted and proved
     e)     The provision of veneers to this
            patient was -

            i)     Not the most appropriate
                   treatment option

                                                  Admitted and proved
            ii)    Inappropriate

                                                  Admitted and proved
            iii)   Not in the patient’s best
                   interest.

                                                  Not proved.
            iv)    Motivated primarily by         The Committee noted the recording of the
                   financial gain                 fracture of the patient‟s hypoplastic tooth
                                                  on the notes and that she had reached an
                                                  age at which a dentist might honestly but
                                                  mistakenly place veneers.
                                                  Not proved
            v)     Dishonest
                                                         Admitted and proved
31     a)      On about three occasions between
               the 19th October 2004 and the 9th
               August 2006 you treated the LR7.

                                                         Admitted and proved on the basis that
       b)      You failed to provide any definitive      you should have provided definitive
               treatment in a timely manner.             treatment in January 2005.

                                                         Admitted and proved
       c)      You failed to take any bitewing
               radiographs.

                                                         Admitted and proved
32     Your patient records in relation to this
       patient are inadequate.


Patient T.C.

                                                         Admitted and proved
33     Between the 21st November 2002 and the
       8th November 2006 you provided dental
       treatment to Master T.C.

                                                         Admitted and proved
34     a)      On the 30th December 2003 you
               fitted a bridge onto LR1 and LR3.

                                                         Admitted and proved
       b)      On the 27th May 2004 you re-
               cemented the bridge.

                                                         Admitted and proved
       c)      On the 24th June 2004 you fitted a
               new replacement bridge.

                                                         Admitted and proved
       d)      On the 21st September 2004 you
               re-cemented the bridge.

                                                         Admitted and proved

       e)      On the 9th February 2005 you fitted
               a new replacement bridge.

                                                         Admitted and proved on the basis that
       f)      In the light of the repeated failure of   you should have fitted a one-winged
               the bridge you failed to consider         adhesive bridge June 2004.
               alternative treatment options.
                                                   Admitted and proved in respect of the
     g)     You did not act in the best interest   admissions to paragraphs 34 (c) to (f)
            of your patient.

                                                   Admitted and proved
                          th
35   a)     On the 15 April 2004 you fitted
            veneers to the UR2, UR1, UL1 and
            the UL2.

                                                   Admitted and proved
     b)     On the 24th June 2004 you noted
            that the UL1 veneer had fractured.

                                                   Admitted and proved
     c)     On the 29th July 2004 you fitted
            veneers to the UR3 and UL3.

                                                   Admitted and proved
                          nd
     d)     On the 22 November 2004 you
            noted that the UL1 veneer had
            fractured.

                                                   Admitted and proved
     e)     On the 16th December 2004 you
            fitted a new veneer to the UL1.

                                                   Admitted and proved
     f)     On the 12th May 2006 you noted
            that the UL2 veneer had fractured.

                                                   Admitted and proved
                     th
     g)     On the 7 November 2006 you
            fitted a new veneer to the UL2.

                                                   Admitted and proved
36   The provision of veneers to this patient
     was -

            i)      Not the most appropriate
                    treatment option
                                                   Admitted and proved
            ii)     Inappropriate

                                                   Admitted and proved
            iii)    Not in the patient’s best
                    interest.

                                                   Proved. The Committee preferred the
            iv)     Motivated primarily by         evidence of the patient to your evidence.
                    financial gain                 There was no clinical need for the
                                                   provision of veneers and the patient did
                                                   not request them.
                                                    Proved
               v)        Dishonest

                                                    Admitted and proved in that a periapical
37     You failed to -                              radiograph ought to have been taken
                                                    before providing the bridge in the
       a)      Take radiographs                     quadrant LR Q

                                                    Admitted and proved in relation to
       b)      To discuss the treatment options in „adequately‟.
               relation to veneers with Master T.C. The Committee finds that there was some
               adequately or at all.                limited discussion and therefore it does
                                                    not find the words “or at all” proved.
                                                    Admitted and proved in that you
       c)      To obtain informed consent to the    recommended porcelain veneers as the
               fitting of veneers.                  most appropriate treatment option when it
                                                    was not.
                                                    Admitted and proved
38     Your patient records in relation to this
       patient are inadequate.


Patient V.D.

                                                    Admitted and proved
39     Between the 1st February 1998 and the
       17th October 2006 you provided dental
       treatment to Miss V.D.

                                                    Admitted and proved on the basis that
                         th
40     Between the 25 January 2004 and the          you failed to treat the tooth adequately by
       17th October 2006 you failed to treat        the summer of 2005
       adequately or at all the UL6.

                                                    Admitted and proved on the basis that
41     Between the 2nd November 2003 and the        you failed to treat the tooth adequately by
       17th October 2006 you failed to treat        the summer of 2005
       adequately or at all the LR6.

                                                    Admitted and proved
42     a)      On the 8th July 2005 you fitted
               veneers to the UR2 and UL2.

                                                    Admitted and proved
       b)      On the 5th September 2005 you
               fitted veneers to the UR1 and UL1.
                                                    Admitted and proved
       c)      The provision of veneers to this
               patient was -

               i)        Not the most appropriate
                         treatment option
                                                   Admitted and proved
            ii)    Inappropriate

                                                   Admitted and proved
            iii)   Not in the patient’s best
                   interest.

                                                   Denied and proved.
            iv)    Motivated primarily by          You extracted a healthy but misaligned
                   financial gain                  canine tooth and then placed veneers
                                                   before advising the patient of possible
                                                   orthodontic treatment which would have
                                                   resolved the patient‟s problem.
                                                   Denied and proved.
            v)     Dishonest

                                                   Admitted and proved
43   a)     On the 22nd December 2005 you
            noted that the veneer to the UR1
            was fractured and on the 27th
            January 2006 you fitted a new
            veneer to the UR1.

                                                   Admitted and proved
     b)     On the 4th September 2006 you
            noted that the veneer to the UR1
            was fractured again and on the 16th
            October 2006 you fitted a new
            veneer to the UR1.

                                                   Admitted and proved
     c)     You failed to apply adequate care
            and attention to the preparation
            and fitting of the veneers to the
            UR1.

                                                   Admitted and proved in relation to 4/9/06
     d)     You failed to consider alternative     and UR1 only
            treatment in the light of the
            repeated failure of the veneers.

                                                   Admitted and proved in respect of
     e)     You did not act in the best interest   paragraphs 40, 41, 42a, c(ii) and (iii)
            of your patient.

                                                   Admitted and proved in that you failed to
44   Throughout the period of dental treatment     take any adequate radiograph.
     you failed to -

     a)     Take any or any adequate
               radiographs

                                                      Admitted and proved
       b)      Take any bitewing radiographs.

                                                      Admitted and proved in relation to
45     In providing veneers you failed -              „adequately‟.
                                                      The Committee accepts that there was
       a)      To discuss the treatment options       discussion but that it was brief and
               with Miss V.D. adequately or at all.   inadequate and failed to explain the
                                                      reasons for extracting a sound upper
                                                      canine tooth. There is no note of such
                                                      discussions in the patient‟s records. The
                                                      words “or at all” are not proved.
                                                      Admitted and proved on the basis that
       b)      To obtain informed consent to the      you recommended porcelain veneers as
               fitting of a veneer.                   the most appropriate treatment option
                                                      when they were not.
                                                      Admitted and proved
46     Your patient records in relation to this
       patient are inadequate.


Patient J.W.

                                                      Admitted and proved
47     Between the 23rd February 1995 and the
       12th May 2007 you provided dental
       treatment to Miss J.W.

                                                      Admitted and proved
48     a)      On the 10th November 2003 you
               fitted veneers to the UL2 and UL3.
                                                      Admitted and proved
       b)      On the 22nd January 2004 you fitted
               veneers to the UR2 and the UR3.

                                                      Admitted and proved
       c)      On the 14th February 2005 you
               fitted veneers to the UR1 and the
               UL1.

                                                      Admitted and proved
       d)      On a date after the 8th November
               2005 you fitted replacement
               veneers to the UR2 and UL2.
                                                      Admitted and proved
       e)      On the 31st October 2006 you fitted    Amended to read UL 4. The allegation
               a veneer to the UL4                    appears to refer in error to the UR4
                                                      instead of the UL4.
                                                   Admitted and proved
     f)     On the 11th May 2007 you fitted a
            replacement veneer to the UL2.

                                                   Admitted and proved
     g)     The provision of veneers to this
            patient was -

            i)      Not the most appropriate
                    treatment option

                                                   Admitted and proved
            ii)     Inappropriate
                                                   Admitted and proved
                    iii)    Not in the patient’s
                    best interest.

                                                   Denied and proved.
            iv)     Motivated primarily by         The Committee finds that the patient was
                    financial gain                 credible and finds that there was no
                                                   clinical reason for the treatment. Veneers
                                                   were placed on top of undiagnosed and
                                                   untreated caries and would not protect
                                                   teeth from acid erosion. Other carious
                                                   teeth were untreated. There was no
                                                   clinical justification for the treatment. The
                                                   Committee infers that the only reason for
                                                   the treatment was for financial gain.
                                                   Denied and proved.
            v)      Dishonest

                                                   Admitted and proved in relation to
49   In providing veneers you failed -             „adequately‟.
                                                   The Committee further finds that there
     a)     To discuss the treatment options       was some limited and brief discussion
            with Miss J.W. adequately or at all.   about her treatment and the words “or at
                                                   all” are not proved.
                                                   Admitted and proved on the basis that you
     b)     To obtain informed consent to the      recommended porcelain veneers as the
            fitting of a veneer.                   most appropriate treatment option when
                                                   they were not.
                                                   Admitted and proved
50   a)     Between the 11th January 2005 and
            the 12th May 2007 you wrongly
            prioritised the provision of veneers
            over timely treatment to Miss J.W’s
            pressing oral health needs.
                                                   Admitted and proved in respect of
     b)     You did not act in the best interest   paragraphs 48a to g(iii) and 50a.
            of your patient.
                                                    Admitted and proved
51     You failed to take any or a sufficient
       number of –

       a)      radiographs

                                                    Admitted and proved that you failed to
       b)      bitewing radiographs.                take a sufficient number of radiographs.


                                                    Admitted and proved
52     Your patient records in relation to this
       patient are inadequate.


Patient S.S.

                                                    Admitted and proved
53     Between the 28th April 1994 and the 3rd
       July 2007 you provided dental treatment to
       Miss S.S.

                                                    Admitted and proved
54     a)      Between the 17th October 2000 and
               the 29th May 2007 you fitted 16
               new or replacement veneers as set
               out in the attached schedule
               marked „A‟.

                                                    Admitted and proved
       b)      The provision of veneers to this
               patient was -

               i)     Not the most appropriate
                      treatment option

                                                    Admitted and proved
               ii)    Inappropriate

                                                    Admitted and proved
               iii)   Not in the patient’s best
                      interest.

                                                    Denied and proved.
               iv)    Motivated primarily by        The Committee finds that the provision of
                      financial gain                veneers started when the patient was 8
                                                    years old. Veneers were placed on canine
                                                    teeth within a short period after their
                                                    eruption at a time when her dentition was
                                                    developing. The Committee was unable to
                                                    identify any other motivation for the
                                                    provision of veneers than a financial one.
                                                      Denied and proved.
               v)     Dishonest

                                                      Admitted and proved from the period
       c)      You wrongly prioritised the            1/12/05 onwards.
               provision of veneers over timely
               treatment to Miss S.S’s pressing
               oral health needs.

                                                      Admitted and proved in relation to
       d)      You did not act in the best interest   paragraphs 54a to b(iii) and 54c
               of your patient.

                                                      Admitted and proved
      e)       Each veneer you fitted was later
               replaced by a new veneer.

                                                      Admitted and proved
       f)      You failed to apply adequate care
               and attention to the preparation
               and fitting of the veneers.

                                                      Admitted and proved from February 2005
       g)      You failed to consider alternative
               treatment in the light of the
               repeated failure of the veneers.

                                                      Admitted and proved in the respects set
       h)      You did not act in the best interest   out in 54e to g.
               of your patient.

                                                      Admitted and proved
55     You failed to take any or a sufficient
       number of –

       a)      radiographs

                                                      Admitted and proved
       b)      bitewing radiographs.

                                                      Admitted and proved
56     Your patient records in relation to this
       patient are inadequate.

Patient W.B.

                                                      Admitted and proved
57     Between the 29th November 2001 and the
       16th January 2007 you provided dental
       treatment to Master W.B.
                                              Admitted and proved
58   a)   On the 1st June 2005 you fitted
          veneers to the UR2, UR1 and the
          UL2.

                                              Admitted and proved
     b)   The provision of veneers to this
          patient was -

          i)     Not the most appropriate
                 treatment option

                                              Admitted and proved
          ii)    Inappropriate

                                              Admitted and proved
          iii)   Not in the patient’s best
                 interest.

                                              Denied and proved.
          iv)    Motivated primarily by       The Committee has considered carefully
                 financial gain               what the motivation was for placing
                                              veneers on this patient. No attempt was
                                              made to examine the trauma to the
                                              patient‟s teeth. The Committee has
                                              considered the veneer working model and
                                              all other information relating to this
                                              treatment. At the time the impressions
                                              were taken permanent teeth were erupting
                                              and the mouth could change even before
                                              the fitting of the veneers. Although the
                                              provision of a veneer on the UR2 may
                                              have been justified the treatment to the
                                              upper centrals was not.
                                              Denied and proved.
          v)     Dishonest

                                              Admitted and proved
     c)   On the 30th September 2005 the
          UR2 was recemented.

                                              Admitted and proved
     d)   On the 25th October 2005 you
          noted that the UR2 veneer was
          fractured.

                                              Admitted and proved
     e)   On the 29th November 2005 you
          fitted a new veneer to the UR2.

                                              Admitted and proved
     f)   On the 6th October 2006 you noted
               that the UL2 was fractured.

                                                      Admitted and proved
       g)      On the 15th January 2007 you fitted
               a new veneer to the UL2.

                                                      Admitted and proved
       h)      You failed to apply adequate care
               and attention to the preparation
               and fitting of the veneers.

                                                      Admitted and proved in respect of UR2
       i)      You failed to consider alternative     only
               treatment in the light of the
               repeated failure of the veneers.

                                                      Admitted and proved in respect of
       j)      You did not act in the best interest   paragraphs 58a to b(iii) and h to i.
               of your patient.

                                                      Admitted and proved
59     You failed to take any or any adequate –

       a)      radiographs

                                                      Admitted and proved
       b)      bitewing radiographs
                                                      Admitted and proved
60     Your patient records in relation to this
       patient are inadequate.



Patient J.D.

                                                      Admitted and proved
61     Between the 8th April 2001 and the 3rd
       February 2007 you provided dental
       treatment to Miss J.D.

                                                      Admitted and proved
62     a)      On the 22nd December 2003 you
               fitted veneers to the UR2 and UL2.

                                                      Admitted and proved
       b)      On the 22nd November 2004 you
               fitted veneers to the UR1 and UL1.

                                                      Admitted and proved
       c)      On the 3rd June 2005 you took
               impressions for new veneers to the
               UR1 and UL1.
                                           Admitted and proved
d)   On the 4th July 2005 you fitted a
     new veneer to the UR1.

                                           Admitted and proved
e)   On the 2nd September 2005 you
     fitted a new veneer to the UL1.

                                           Admitted and proved
f)   On the 23rd November 2006 you
     took an impression for a new
     veneer to the UL2.

                                           Admitted and proved
g)   On the 21st or 23rd December 2006
     you fitted a new veneer to the UL2.


                                           Admitted and proved
h)   The provision of veneers to this
     patient was -

     i)     Not the most appropriate
            treatment option

                                           Admitted and proved in respect of UR1
     ii)    Inappropriate                  and UL1.
                                           You admitted that the treatment to UR 2
                                           and UL 2 was also inappropriate in the
                                           course of your evidence.
                                           Admitted and proved in respect of UR1
     iii)   Not in the patient’s best      and UL1.
            interest.                      See 62 (h) (ii) above

                                           Denied and not proved.
     iv)    Motivated primarily by         There may have been justification for the
            financial gain                 placing of veneers on the UR 2 and UL 2.
                                           The Committee was not satisfied to the
                                           necessary standard that you were
                                           motivated primarily by financial gain in
                                           relation to the veneers placed on the UR1
                                           and UL1.
                                           Denied and not proved.
     v)     Dishonest

                                           Admitted and proved
i)   You failed to apply adequate care
     and attention to the preparation
     and fitting of the veneers.
                                                       The Committee amended the allegation by
       j)      You failed to consider alternative      deletion of the word “repeated” and found
               treatment in the light of the failure   the charge proved.
               of the veneers.

                                                       Admitted and proved in respect of
       k)      You did not act in the best interest    paragraph 62i
               of your patient.
                                                       Admitted and proved
63     You failed to -

       a)      Take radiographs

                                                       Admitted and proved regarding UR1 and
       b)      To discuss the treatment options in     UL1.
               relation to veneers on UR1 and
               UL1 and with Miss J.D. adequately
               or at all.

                                                       Admitted and proved regarding UR1 and
       c)      To obtain informed consent to the       UL1 and that you recommended veneers
               fitting of veneers on UR1 and UL1.      as the most appropriate treatment option
                                                       when they were not.

                                                       Admitted and proved
64     Your patient records in relation to this
       patient are inadequate.


Patient A.W.

                                                       Admitted and proved
65     Between the 23rd August 2001 and the 6th
       June 2007 you provided dental treatment
       to Master A.W.

                                                       Admitted and proved
66     a)      On the 6th April 2004 you took
               impressions for the provision of
               veneers to the UR1 and UL1.

                                                       Admitted and proved
       b)      On the 5th June 2006 you took
               further impressions for the
               provision of veneers to the UR1
               and UL1.

                                                       Admitted and proved
       c)      On the 17th July 2006 you fitted
               veneers to the UR1 and UL1.
                                                       Admitted and proved
       d)      The provision of veneers to this
            patient was -

            i)      Not the most appropriate
                    treatment option
                                                   Admitted and proved
            ii)     Inappropriate

                                                   Admitted and proved
            iii)    Not in the patient’s best
                    interest.

                                                   Denied and proved
            iv)     Motivated primarily by         The Committee found that there was no
                    financial gain                 need for veneers, or any restoration in this
                                                   case, having regard to the minimal
                                                   damage to the incisal edges. In the
                                                   circumstances the provision of veneers
                                                   was contra indicated before an
                                                   orthodontic opinion had been obtained.
                                                   Denied and found proved
            v)      Dishonest

                                                   Admitted and proved
     e)     You failed to apply adequate care
            and attention to the preparation
            and fitting of the veneers.

                                                   Admitted and proved in relation to
     f)     You failed to discuss the treatment    „adequately‟.
            options in relation to veneers with    The Committee further found that there
            Master A.W. adequately or at all.      was some discussion about veneers but it
                                                   was brief and lacking in detail and it took
                                                   place in the absence of the patient‟s
                                                   parent.
                                                   Admitted and proved in that you
     g)     You failed to obtain informed          recommended veneers as the most
            consent to the fitting of veneers.     appropriate treatment option when they
                                                   were not.
                                                   Admitted and proved in respect to the
     h)     You did not act in the best interest   admissions to paragraphs 66b, c, d(ii) and
            of your patient.                       (iii), e, f and g.

                                                   Admitted and proved
67   You failed to take any or a sufficient
     number of –

     a)     radiographs

                                                   Admitted and proved
     b)     bitewings.
                                                        Admitted and proved
68     Your patient records in relation to this
       patient are inadequate.


Patient R.B.

                                                        Admitted and proved
69     Between the 23rd May 2006 and the 27th
       September 2006 you provided dental
       treatment to Master R.B.

                                                        Admitted and proved
70     a)      On the 26th September 2006 you
               fitted a veneer to the palatal (rather
               than the buccal) aspect of the UL1.

                                                        Admitted and proved
       b)      The provision of a veneer to this
               patient was -

               i)      Not the most appropriate
                       treatment option

                                                        Admitted and proved
               ii)     Inappropriate

                                                        Admitted and proved
               iii)    Not in the patient’s best
                       interest.

                                                        Denied and not proved.
               iv)     Motivated primarily by           The Committee found that some treatment
                       financial gain                   was necessary. A previous composite
                                                        filling had failed. Although treatment
                                                        would have been appropriate the
                                                        Committee was not satisfied that your
                                                        motivation was primarily financial or that
                                                        the provision of a veneer was not outside
                                                        the scope of what a dentist might honestly
                                                        but mistakenly do.
                                                        Denied and found not proved.
               v)      Dishonest

                                                        Admitted and proved
       c)      The fitting of a veneer to the palatal
               aspect of the UL1 was
               inappropriate.

                                                        Admitted and proved
71     You failed to take any or a sufficient
       number of –
       a)      radiographs

                                                      Admitted and proved
       b)      bitewing radiographs.

                                                      Admitted and proved
72     Your patient records in relation to this
       patient are inadequate.


Patient R.A.

                                                      Admitted and proved
73     Between the 24th January 1975 and the
       19th June 2007 you provided dental
       treatment to Mrs R.A..

                                                      Admitted and proved
74     a)      Between the 19th November 1999
               and the 20th June 2006 you fitted
               about 18 veneers to the UR123
               and the UL123 (as set out in the
               schedule marked B).

                                                      Admitted and proved
       b)      You failed to apply adequate care
               and attention to the preparation
               and fitting of the veneers.


                                                      Admitted and proved from 12/5/00 with the
       c)      You failed to consider alternative     second failure of UR2
               treatment in the light of the
               repeated failures of the veneers.

                                                      Admitted and proved in respect of
       d)      You did not act in the best interest   paragraphs 74b and c
               of your patient.

                                                      Admitted and proved on the basis of the
75     You failed to take any or any adequate –       insufficient number of radiographs.

       a)      radiographs

                                                      Admitted and proved
       b)      bitewing radiographs

                                                      Admitted and proved
76     Your patient records in relation to this
       patient are inadequate.
Patient N.S.

                                                       Admitted and proved
77     Between the 3rd December 2003 and the
       11th May 2007 you provided dental
       treatment to Ms N.S.

                                                       Admitted and proved
78     a)      On six occasions between the 11th
               July 2005 and the 2nd December
               2005 Ms N.S. presented to you
               with an infection in the LL78 region.

                                                       Admitted and proved
       b)      You failed to –

               i)     adequately attempt to
                      diagnose the cause of the
                      infection

                                                       Admitted and proved
               ii)    prevent the patient from
                      unnecessary pain

                                                       Admitted and proved on the basis that a
               iii)   refer the patient for            referral should have occurred on 30/11/05
                      emergency treatment in a
                      timely fashion.

                                                       Admitted and proved
       c)      As a consequence -

               i)     the LL7 had to be extracted

                                                       Admitted and proved in respect of
               ii)    you did not act in the best      paragraphs 78b(ii) and (iii) only.
                      interest of your patient.

                                                       Admitted and proved
79     You failed to take any or any adequate –

       a)      radiographs

                                                       Admitted and proved
       b)      bitewing radiographs

                                                       Admitted and proved
80     Your patient records in relation to this
       patient are inadequate.

Patient E.C.
                                                 Admitted and proved
81   Between the 3rd October 1996 and the 27th
     June 2007 you provided dental treatment
     to Miss E.C.

                                                 Admitted and proved
82   a)    On the following dates you fitted
           veneers to Miss E.C.’s UL1 -

            i)     after the 17th October 2002

                                                 Admitted and proved
            ii)    19th October 2004

                                                 Admitted and proved
            iii)   13th September 2005

                                                 Admitted and proved
            iv)    20th September (re-
                   cemented)

                                                 Admitted and proved
            v)     18th October 2005.

                                                 Admitted and proved
     b)    On the following dates you fitted
           veneers to Miss E.C.’s UR1 -

            i)     after the 17th October 2002

                                                 Admitted and proved
            ii)    19th October 2004

                                                 Admitted and proved
            iii)   13th September 2005.

                                                 Admitted and proved
     c)    On the following dates you fitted
           veneers to Miss E.C.’s UL2 -

            i)     12th October 2004

                                                 Admitted and proved
            ii)    18th January 2007.

                                                 Admitted and proved
     d)     The provision of veneers to this
            patient was -

            i)     Not the most appropriate
                   treatment option
                                                  Admitted and proved
            ii)     Inappropriate

                                                  Admitted and proved
            iii)    Not in the patient’s best
                    interest.

                                                  Denied and proved
            iv)     Motivated primarily by        You provided veneers for this patient
                    financial gain                when she was 7 years old and you knew
                                                  she was at high risk of caries. Mottling on
                                                  her teeth was not a good reason for
                                                  veneers to such a young child. In the
                                                  absence of any clinical reason for this
                                                  treatment the Committee found that the
                                                  only motivation was financial.
                                                  Denied and proved
            v)      Dishonest

                                                  Admitted and proved
     e)     You failed to apply adequate care
            and attention to the preparation
            and fitting of the veneers.

                                                  Admitted and proved in relation to
     f)     You failed to discuss the treatment   „adequately‟.
            options in relation to veneers with   The Committee did not find the evidence
            Miss E.C. adequately or at all.       of the patient‟s mother to be reliable by
                                                  reasons of inaccuracies in her recollection
                                                  of details. The Committee finds that some
                                                  discussion of treatment options took
                                                  place.
                                                  Admitted and proved that you offered
     g)     You failed to obtain informed         veneers as the most appropriate treatment
            consent to the fitting of veneers.    option when they were not.

                                                  Admitted and proved in relation to the
83   You failed to take any or any adequate –     adequacy of the radiographs

     a)     radiographs

                                                  Admitted and proved
     b)     bitewing radiographs

                                                  Admitted and proved
84   Your patient records in relation to this
     patient are inadequate.


     Patient J.C.
                                                     Admitted and proved
85   a)     Between 3rd March and 25th
            November 2005 you took
            impressions and fitted veneers to
            the UR1, UL1, UL2 and UL3 of Mr
            JC.

                                                     Denied and not proved
      b)    You failed to treat the patient’s        The evidence shows that you did treat the
            presenting pain                          patient‟s pain

                                                     Denied and proved in respect of the UL2
      c)    You failed to obtain informed            and UL3 but not in respect of the UR1 and
            consent to the fitting of the veneers    UL1.
                                                     The Committee took note of
                                                     contradictions and vagueness in aspects
                                                     of the patient‟s evidence and has treated it
                                                     with care. Notwithstanding that, the
                                                     Committee was not satisfied that there
                                                     was sufficient justification for the
                                                     provision of veneers to the UL2 and UL3
                                                     and the patient did not return to have
                                                     them fitted. The Committee did accept the
                                                     patient‟s evidence that he did not
                                                     understand why these veneers had been
                                                     prescribed.
                                                     Denied and not proved in respect of UR 1
      d)    The fitting of veneers to this patient   and UL 1 but proved in respect of UL 2
            was –                                    and UL 3.
                                                     There was no clinical justification for the
            i)     Motivated primarily by            prescribing of veneers on UL 2 and UL 3
                   financial gain                    whereas the Committee was not satisfied
                                                     that the provision of veneers on the UR 1
                                                     and UL 1 for this adult patient was outside
                                                     the scope of what a dentist might honestly
                                                     but mistakenly do.
                                                     Denied and proved in respect of UL 2 and
            ii)    Dishonest.                        UL 3 but not in respect of UR 1 and UL 1.

                                                     Admitted and proved
86   On unknown dates prior to the 5th July
     2007 you fitted veneers on top of existing
     veneers to some of your patients.

                                                     Amended by deletion of the words
87   The patient records relating to the 39          “reports by the Dental Reference Officer
     patients set out in the attached schedule       Mr Richard Birkin, dated the 30th April
     marked C -                                      2007 and 27th July 2007 and the”
                                                     Admitted and proved to the extent as set
     a)     are inadequate, as set out in the        out in the attached Appendix A
                Supplementary Report of Mr Roger
                Turner dated 31st August 2009.

                                                     Amended to delete the word “repeated”.
       b)       show failures of veneers             Admitted and proved to the extent as set
                                                     out in the attached Appendix A
                                                     Admitted and proved to the extent as set
       c)       contain an absence of radiographs    out in the attached Appendix A
                when such radiographs ought to
                have been taken.



Determination
Mr Johnstone,

In 2007, at the request of the Solihull NHS Care Trust (the CT), an examination was undertaken by
Dental Reference Officers (the DROs) into your patients’ clinical records and radiographs.
Following that examination serious concerns were expressed by the DROs about your treatment of
children by providing them with veneers when it was inappropriate to do so. In addition, concerns
were expressed about the poor quality of your records, your failure to take necessary radiographs,
and your lack of proper diagnosis and treatment planning. They also expressed concerns about
the poor quality of many of the porcelain veneers you provided and the frequency of failure of
them.

In July 2007 the CT suspended you from its Performers List following which, in April 2008, the CT
removed your name from the Performers List. Your appeal against that decision was allowed on
30th January 2009 by the Family Health Service Appeals Authority (the FHSAA) on terms that you
would be removed contingently, subject to conditions which were agreed between the parties. The
Committee has been provided with a copy of the determination of the FHSAA and notes that it was
agreed that at the date of your suspension from the Performers List there were serious
deficiencies in your clinical practice.

In these proceedings the General Dental Council (the GDC) has submitted that your fitness to
practice is impaired by your misconduct and by your deficient professional performance.

In the course of final submissions at the impairment stage you accepted, by Counsel, that your
actions amounted to misconduct and that your professional performance had been deficient. You
went on to accept that your fitness to practice is impaired.

Notwithstanding that frank acceptance by you, it is the responsibility of the Committee to assess
whether your fitness to practice is indeed impaired.

At this hearing the Committee heard evidence from seven of your patients and five parents. All but
one of these patients were children at the time you treated them. The Committee was also
provided with witness statements from two patients and one other parent who could not attend the
hearing and the witness statements of three Dental Reference Officers. It was provided with a
bundle of patient records and received expert evidence from Mr Turner and Dr Harley on behalf of
the Council and from Dr Harrison and Dr Kramer on your behalf.
You made many admissions into the allegations about your clinical treatment of patients. You also
admitted that you had failed to obtain informed consent for your treatment of patients in that you
provided them with inadequate information about treatment options. The Committee went further
and also found that your discussions with patients or their parents had been brief, lacking in detail
and insufficient to enable a parent, or a child old enough to consent, with enough information to
assess the suitability of treatment with veneers.

At the fact finding stage of this hearing this Committee made extensive and detailed findings about
your treatment of patients. It does not propose to repeat those findings in this determination. The
following cases are merely examples of your clinical treatment.

The evidence showed that in children under 16 years old, porcelain veneers should not normally
be provided unless specialist advice has recommended that treatment. However, in the case of
patient EC you provided veneers to a 7 year old child and you knew that she was at risk of caries.
Subsequently, you failed to respond to repeated requests of EC and her mother for the removal of
the veneers.

In the case of patient JW, a child of 12, you prescribed porcelain veneers whilst ignoring, and
consequently not providing, suitable treatment for her pressing oral health needs. You did not treat
extensive caries (in 17 teeth at the time of her subsequent examination by the DRO) nor the
repeated infections and reports of pain. The evidence revealed a very poor level of treatment of
this patient amounting to neglect of her dental health.

Your failings in respect of patient NS, an adult, were so serious that your failure to identify and
treat the patient’s infection placed her life at risk and resulted in her being admitted to hospital for
emergency treatment under general anaesthetic.

In the case of CR you provided a porcelain veneer while ignoring the orthodontic needs of a
teenager with hypodontia.

On other occasions the Committee has noted that you provided children with porcelain veneers
and neglected to treat serious caries and other urgent dental problems.

The Committee found that in eleven of the cases before it, your primary motivation for the
provision of porcelain veneers was financial gain and that you were dishonest.

In considering the issue of impairment the Committee must consider your past conduct and
professional performance and must also look forward.

The Committee has considered the evidence it has read and heard. It has concluded that your
frequent provision of veneers, knowing this to be an inappropriate form of treatment for children,
and your dishonesty, provide ample evidence of misconduct. It has also concluded that your
failures to prioritise urgent and necessary treatment in preference for short term treatment of an
aesthetic or cosmetic nature, to take necessary radiographs, to deal appropriately with consent
and to make a clear record of your treatment and of treatment plans demonstrates that your
professional performance was deficient. The Committee has also taken into account the evidence
of Professor Dunne that you are still in need of supervision in your work. He also said that you
would be safe to practise as long as you did not get yourself into pressurised situations at work.

The Committee finds that it is especially troubling that you appear to lack insight into your past
dishonest conduct.
Taking all these factors into account the Committee finds that your fitness to practice is impaired
both by your misconduct and by your deficient performance.

Sanction

The Committee went on to consider what sanction, if any, should be placed on your registration.

Mr Stern, on behalf of the GDC, submitted that your actions were so serious that no sanction other
than erasure would be appropriate.

Mr Horne, on your behalf, submitted that having regard to the very considerable evidence of your
retraining since 2007 and the good reports made about you by those who have provided you with
clinical attachments and who have assessed your progress, it would be proportionate and
appropriate to place conditions on your registration.

The Committee has heard that you commenced a period of your retraining in November 2007. In
October 2007 you contacted the Dr Davies-Slowik in the West Midlands Deanery, and with her
help a series of clinical attachments were arranged at Birmingham Dental Hospital and at Charing
Cross Hospital in London. With her assistance you also prepared a Personal Development Plan.

In December 2008 a clinical assessment was carried out by Dr Caddick (the Associate
Postgraduate Dean of the West Midlands Deanery and Dr Corke (the Postgraduate Tutor at
Birmingham Dental Hospital). This assessment was designed to address the concerns expressed
by the Dental Reference Officers.

That assessment found significant improvements in some areas but that shortcomings in other
areas of your clinical knowledge remained.

The Committee heard evidence from:

Dr Davies-Slowik
Professor Stephen Dunne, the Professor of Primary Dental Care at Kings College London Dental
Institute.
Dr Kevin Fairbrother, the Clinical Lead for Restorative Dentistry at Birmingham Dental Hospital.
Dr Tony Davies, a General Dental Practitioner

The Committee was also referred to the reports of those who have been involved in your
assessment and retraining since 2007 and an additional bundle of documents comprising practice
documentation.

The Committee has noted their evidence and finds that during your period of retraining and clinical
attachments your clinical skills in a range of areas have improved considerably.

The Committee has taken into account that until these proceedings you were a man of good
character against whom no adverse findings had been made by this Council.

It has also read and taken into account the bundle of testimonials provided by you and the
evidence of the character witnesses who appeared on your behalf.
In considering the issue of sanction the Committee has, at all times, considered the public interest
which involves the protection of patients, the maintenance of standards and the upholding of public
trust and confidence in the profession.

It has taken into account the principle of proportionality and has balanced your interests with the
public interest.

The Committee has been referred to the pre 2005 editions of Maintaining Standards and to its
successor Standards for Dental Professionals.

The Committee has had regard to the following paragraphs in Maintaining Standards:

2.1 Personal behaviour and what the public expects
3.1 Acting in the best interests of patients
3.2 Providing a high standard of care
3.3 Making a referral
3.7 Consent
4.3 Contemporaneous records
4.6 Misleading claims
4.8 Duty and expectations regarding pain and anxiety control

The Committee has also had regard to Standards for Dental Professionals, specifically principles:

1 Putting patients interests first and acting to protect them,
2 Respecting patients dignity and choices
5 Maintaining your professional knowledge and competence, and
6 Being trustworthy.

The Committee also had regard to the following paragraphs:

1.1 Putting patients interests before your own
1.3 Working within your knowledge and competence
1.4 Making and keeping accurate records
1.10 Not making claims that could mislead patients
2.4 Listening to patients and giving them the information they need
5.2 Reviewing your knowledge and skills
5.3 Finding out about best practice
6.1 Justifying the trust that the public, patients and colleagues have in you

In the judgment of the Committee, your dishonesty in this case was extremely serious. The
Committee has found that between 2002 and 2007 you subjected patients, most of whom were
children, to treatment knowing it to have been inappropriate, with the primary motivation of your
own financial gain. You thereby neglected the dental interests of these patients and failed to
provide them with the treatment they needed. You did so in order to obtain fees leading to a
greater profit from the NHS than the fees you would have received for appropriate treatment. You
were in a position of trust towards your patients and the public. You abused that trust. For all these
reasons the Committee places this case high in the scale of dishonesty.

The Committee has considered the question of sanction in ascending order sequentially. Thus it
started by considering whether to conclude this case by taking no action. It found that it would be
entirely inappropriate to do so having regard to the serious nature of the findings it has made.
It went on to consider whether any conditions could be framed which would allow you to resume
clinical practice. It has noted the submissions made on your behalf by Mr Horne that conditions
could be imposed on your registration. The Committee accepts that were it not for the issues of
dishonesty, conditions could be devised. However, there are no conditions which could be
formulated which would adequately address the issues of dishonesty in this case.

The Committee went on to consider whether to suspend your registration.

The Committee has taken into account the mitigation in this case namely:

-         your previous good character
-         the efforts made by you to retrain, which appear to have been largely successful
-         the evidence of Professor Dunne and Mr Fairbrother that, notwithstanding the findings of
fact, it would be possible for you to continue your career as a dentist and practice safely under
appropriate safeguards

Mr Horne submitted that a suspension of your registration would effectively bring to an end your
career as a dentist. The Committee does not accept that that submission is necessarily correct.
You would be able to continue your training and there would be some prospect of your being able
to resume your professional career.

However, the Committee considers that an order for suspension of your registration would not
reflect the gravity of the findings it has made about your misconduct and, in particular, about your
dishonesty. It considers that a clear message needs to be made that serious dishonesty involving
claims for inappropriate treatment cannot be dealt with by an order for suspension save in very
exceptional circumstances.

The Committee has had regard to the Guidance to the Professional Conduct Committee. It
accepts that there is no presumption in favour of erasure in a case of dishonesty and that this is
guidance only. The following parts of the guidance are of particular relevance to your case:

-      A serious abuse of a clinical relationship
-      A serious abuse of a privileged position
-      Causing serious avoidable harm to patients
-      Dishonesty
-      Failing to maintain professional knowledge in areas relevant to your practice

Having found that all other sanctions would be inappropriate in this case, the Committee was left
with no alternative but to order that your name be erased from the Dentists Register.

The Interim order currently in place is hereby revoked. Pursuant to Section **27B(10) of the
Dentists Act 1984 the revocation will take effect when the sanction takes effect, or when any
appeal is determined.”

**Please note that this reference to the legislation was corrected post hearing (having previously
incorrectly said to be 27(9)).

				
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