HEARING HEARD IN PUBLIC
HERMANN, Hari Cristofor
Registration No: 191813
PROFESSIONAL CONDUCT COMMITTEE
JULY 2015-JULY 2016
Most recent outcome: Suspension revoked and conditions imposed for 12 months
(with a review)*
* See page 14 for the latest determination.
Hari Cristofor HERMANN, a dentist, registered as of 40 Hartslade, LICHFIELD, Staffordshire
WS14 9RH; DMD Arad 2003; was summoned to appear before the Professional Conduct
Committee on 29 June 2015 for an inquiry into the following charge:
Charge (as amended)
“That, being a registered dentist:
1.
At all material times you were in practise at “the Clinic”.
2.
Patient CB, consulted you variously between May 2013 and December 2013 initially on
17 June presenting with pain in her lower right quarter.
3.
Between May 2013 and December 2013 you failed variously to carry out sufficient
diagnostic assessments including:
i)
Basic periodontal examinations;
ii)
The cause of presenting pain on the 27th August 2013;
iii)
An evaluation of the presenting symptoms on 27th August 2013.
4.
Between May 2013 and December 2013 you failed to treat Patient CB’s periodontal
disease.
5.
Between May 2013 and December 2013 you failed variously to provide sufficient
smoking cessation advice including:
i)
Not providing cessation advice upon her initial consultation;
ii)
On 19th June 2013 taking Patient CB outside in order to allow her to smoke;
iii)
On 7th October 2013 suggesting that she should not smoke for 2 hours.
6.
Between May 2013 and December 2013 you failed to carry out sufficient treatment
planning including by failing to identify that Patient CB’s loss of bone support was
substantially due to periodontal disease.
7.
Between May 2013 and December 2013 you failed to carry out sufficient pre-treatment
investigations including:
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8.
i)
assessing the suitability of the teeth for crowns by the use of periapical
radiographs.
ii)
the use of a facebow record to assess Patient CB’s occlusion.
Between May 2013 and December 2013 you provided treatment that was not clinically
indicated, including:
i)
Providing crowns to un-restored teeth, namely:
i) UR3;
ii) UR2;
iii) AMENDED BY DELETION AND RENUMBERING. (Now 8ii)viii).
iv) AMENDED BY DELETION AND RENUMBERING. (Now 8ii)ix).
v) AMENDED BY DELETION AND RENUMBERING. (Now 8ii)x).
vi) LL4;
vii) LL3;
viii) LL2;
ix) LL1;
x) LR1;
xi) LR2;
xii) LR3;
xiii) LR4.
ii)
Providing crowns to minimally restored teeth, namely:
i) UR7;
ii) UR6;
iii) UL4;
iv) UL5;
v) LR5;
vi) LR6;
vii) LR7.
viii) UR1;
ix) UL1;
x) UL2;
9.
On 27th August 2013 you failed to identify and/or treat gingival inflammation in
circumstances where you identified the gum starting to cover the tooth as “good” rather
than as a sign of underlying periodontal disease.
10.
Between the 18th June 2013 and 5th December 2013 you extracted Patient CB’s tooth
UR5 in circumstances where you failed:
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11.
12.
13.
14.
i)
To make any note or other record of the extraction;
ii)
To record the clinical justification for the extraction;
iii)
To record the instruments used;
iv)
To record the post-operative care provided;
v)
To record the post-operative instructions given.
Between the 18th June 2013 and 5th December 2013 you extracted Patient CB’s tooth
LR5 in circumstances where you failed:
i)
To make any note or other record of the extraction;
ii)
To record the clinical justification for the extraction;
iii)
To record the instruments used;
iv)
To record the post-operative care provided;
v)
To record the post-operative instructions given.
In or around August 2013 you provided root treatment to Patient CB’s UL2 in
circumstances where you failed:
i)
To make any note or other record of the treatment provided;
ii)
To record the clinical justification for the work provided;
iii)
To record the anaesthetic used;
iv)
To record the filling material used;
v)
To record the cement used;
vi)
To record the post-operative care provided;
vii)
To record the post-operative instructions given.
Between May 2013 and December 2013 you failed variously to keep and/or maintain
adequate dental records as regards:
i)
Basic Periodontal Examinations;
ii)
The evaluation of presenting symptoms;
iii)
The cause of presenting pain following restorative work;
iv)
Smoking cessation advice;
v)
The treatment of periodontal disease;
vi)
The suitability of teeth for crowns;
vii)
The clinical indication for providing crowns to un-restored teeth;
viii)
The clinical indication for providing crowns to minimally restored teeth;
ix)
The clinical justification for prescribing antibiotics.
You did not maintain adequate standards of clinical practise, including by:
i)
HENMANN, H C
Not possessing an intra-oral x-ray machine in order to carry out radiographic
examinations.
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15.
You failed variously to communicate with Patient CB in a professional manner,
including:
i)
On the 29th November 2013 you told Patient CB that ‘the hospital are talking
rubbish’ or words to that effect;
ii)
On the 29th November 2013 you threatened Patient CB against visiting another
dentist;
iii)
By failing to contact Patient CB in order to cancel an appointment arranged for
the 2nd October 2013;
iv)
By failing to inform Patient CB why she had been referred to Birmingham hospital
on the 27th November 2013.
And that as a result your fitness to practise in impaired by reason of your misconduct.”
On 2 July 2015 the Chairman made the following statement regarding the finding of facts:
“Mr Hermann,
This case concerns your care and treatment of one patient, Patient CB, from June to
December 2013. During that time, Patient CB attended a number of appointments with you
in connection with dental treatment you were providing to her. It is alleged by the General
Dental Council (GDC) that the standard of your care, assessment, treatment and record
keeping in relation to Patient CB, was inadequate in a number of respects.
During the course of stage one of these proceedings, you admitted a number of the
allegations made against you.
The Committee received the witness statements of Patient CB as her evidence in chief as
well as hearing oral evidence from her. It heard evidence from you about the factual matters
in this case. It also received a witness statement from one of your dental nurses, Ms AG,
and it heard oral evidence from her. The Committee received a witness statement from the
Managing Director of the dental laboratory that you usually used when treating Patient CB.
By way of expert evidence, the Committee received reports from and heard the evidence of,
Mr Roger Turner, called on behalf of the GDC.
The Committee has considered all the evidence presented to it. It has taken into account the
closing submissions made by Mr Wakerley on behalf of the GDC, and those made by Mr
Brassington on your behalf. The Committee has accepted the advice of the Legal Adviser.
It has considered each head of charge separately, bearing in mind that the burden of proof
rests with the GDC. The standard of proof is the civil standard, that is, whether the
allegations are proved on the balance of probabilities. This means that the Committee has
had to decide whether it was more likely than not that the alleged matters occurred.
I will now announce the Committee’s findings in relation to each head of charge:
1.
Admitted and proved.
2.
Admitted and proved.
3.i)
Admitted and proved.
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3.ii)
Admitted and proved.
3.iii)
Admitted and proved.
4.
Admitted and proved.
5.i)
Not proved.
Patient CB had her initial consultation with you on 17 June 2013.
In Patient CB’s statement, she stated that you had told her that the crowns you
proposed providing her with, would last for 7 years as opposed to 10 years,
because she was a smoker. However she said elsewhere in her statement that
no smoking cessation advice was given by you.
The Committee has had regard to Exhibit 5, part of your contemporaneous
record of Patient CB’s appointment on 17 June 2013, which states that
smoking cessation advice was given during the appointment.
In your evidence, you indicated that you had stopped smoking during the time
that you were treating Patient CB and that you were in the habit of trying to
persuade other smokers to do the same.
In light of all the evidence it heard on this point, the Committee took the view
that it was more likely than not that you gave Patient CB sufficient smoking
cessation advice at her initial consultation.
5.ii)
Not proved.
Patient CB’s evidence to the Committee was that during the appointment of 19
June 2013 you took her outside and smoked with her after administering a
local anaesthetic. You deny having done so.
The Committee finds that, having given Patient CB smoking cessation advice
two days prior to this appointment, it was very unlikely that you would take her
outside during this appointment so that she could have a cigarette.
5.iii)
Not proved.
Patient CB’s evidence to the Committee was that you told her that patients are
officially advised not to smoke for 48 hours following the treatment she had just
undergone, but that she could smoke after two hours. She stated that she did
not smoke for 24 hours.
Your evidence to the Committee was that you told Patient CB not to smoke for
48 hours.
The Committee notes that both you and Patient CB are in agreement that you
told her that the official guidance was that she should not smoke for 48 hours.
The Committee is not satisfied to the requisite standard that you told Patient
CB that she could smoke after two hours.
6.
Admitted and proved.
7.i)
Admitted and proved.
7.ii)
Admitted and proved.
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8.i)i)
Admitted and proved.
8.i)ii)
Admitted and proved.
8.i)iii)
AMENDED BY DELETION AND RENUMBERING. (Now 8ii)viii).
8.i)iv)
AMENDED BY DELETION AND RENUMBERING. (Now 8ii)ix).
8.i)v)
AMENDED BY DELETION AND RENUMBERING. Now 8ii)x).
8.i)vi)
Proved.
In relation to the lower arch bridge and crowns, Patient CB’s evidence to the
Committee was that you provided this treatment in early July 2013. The
Committee found her evidence on this issue to be both credible and reliable
and consistent with the documentary evidence.
Your note of the first consultation on 17 June 2013 states that one option for
Patient CB was to treat the upper teeth and then the lower.
In addition according to your note of 1 July 2013 in Patient CB’s records, it was
your intention to commence ‘lower bridge prep when ready’.
The Committee notes that Patient CB withdrew £2300 cash two days prior this,
on 29 June 2013, in order to pay for this treatment. Patient CB stated in her
statement that you had offered her a deal if she paid for this treatment in cash.
The Committee took account of Patient CB’s notes from Cannock Chase
Hospital dated 10 October 2013, in which upper and lower crowns are noted as
being present in her mouth. It also took account of the notes of Patient CB’s
subsequent treating dentist. His note of 5 December 2013 in Patient CB’s
record states that she advised him that upper and lower crowns were provided
to her at your dental practice, with the upper crowns provided in June and the
lower crowns provided in July.
You told the Committee during your evidence that you did not provide Patient
CB with her lower arch bridge and crowns. You also stated that you were not
aware of their presence during the time that you treated her. The Committee
rejects that account. The Committee does not accept that it is possible that you
were not aware of Patient CB’s lower crowns and considers that your evidence
on this lacked credibility.
In Patient CB’s records until 7 October, you noted that you carried out four intra
oral examinations (IOE) after 1 July 2013, one of which was on 27 August 2013
when you conducted an intraoral examination when Patient CB was
complaining of pain in the lower right quadrant. You said that you did not at any
point note that any lower restorations had been fitted. It is highly improbable
that you would not have noticed the extensive crowns on her lower arch during
these examinations, especially in the light of your own stated intention to crown
them in July.
The Committee rejects as wholly implausible the possibility that the lower
crowns and bridge were fitted by another dentist between 7 and 10 October
2013 when Patient CB first attended Cannock Chase Hospital. It therefore finds
that the lower crowns were fitted by you in July 2013.
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The Committee has noted the lab dockets provided on your behalf as evidence
that you did not provide Patient CB’s lower arch bridge and crowns. However it
notes that the docket is not complete even in relation to the work you admit you
carried out on CB’s upper teeth. The Committee therefore cannot rely on the
information provided by the laboratory in support of your claim that you did not
crown Patient CB’s lower arch.
8.i)vii)
Proved.
8.i)viii)
Proved.
8.i)ix)
Proved.
8.i)x)
Proved.
8.i)xi)
Proved.
8.i)xii)
Proved.
8.i)xiii)
Proved.
8.ii)i)
Admitted and proved.
8.ii)ii)
Admitted and proved.
8.ii)iii)
Admitted and proved.
8.ii)iv)
Admitted and proved.
8.ii)v)
Tooth not present. Not proved.
8.ii)vi)
Proved
8.ii)vii)
Proved.
8.ii)viii)
ADDED BY AMENDMENT.
Admitted and proved.
8.ii)ix)
ADDED BY AMENDMENT.
Admitted and proved.
8.ii)x)
ADDED BY AMENDMENT.
Admitted and proved.
9.
Admitted and proved.
10.i)
Admitted and proved.
10.ii)
Admitted and proved.
10.iii)
Admitted and proved.
10.iv)
Admitted and proved.
10.v)
Admitted and proved.
11.i)
Proved.
There is no record of your extraction of Patient CB’s LR5 within her patient
notes. However Patient CB stated in her evidence that you carried out this
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extraction.
The Committee notes from the radiographs that the LR5 was present on 18
June 2013, but it was no longer present on 27 November 2013.
The tooth would have needed to be removed as part of the preparation for
Patient CB’s lower bridge as it was grade 2 mobile as of 23 April 2013.The
Committee is therefore satisfied that the tooth was absent when the lower
bridge was fitted by you.
You admitted carrying out work on Patient CB’s top teeth, including necessary
extractions. The Committee has found that you provided the lower arch crowns
and bridge. It is therefore satisfied on a balance of probabilities that you carried
out the extraction of LR5 prior to the provision of the lower bridge.
You did not make a note or record of the extraction.
11.ii)
Proved.
You did not record the clinical justification for the extraction.
11.iii)
Proved.
You did not record the instruments used.
11.iv)
Proved.
You did not record the post-operative care provided.
11.v)
Proved.
You did not record the post-operative instructions given.
12.i)
Proved.
Patient CB stated that you carried out root treatment on her upper left incisor in
August.
According to the available radiographs, the root treatment had been carried out
by November 2013.
Furthermore Patient CB’s clinical notes by her subsequent treating dentist of 5
December 2013 state ‘rct UL2, AS can see occ fill has come away and gp is
evident.’ The root canal treatment is attributed to your dental practice.
12.ii)
Proved.
12.iii)
Proved.
12.iv)
Proved.
12.v)
Proved.
12.vi)
Proved.
12.vii)
Proved.
13.i)
Not proved.
The Committee notes the Basic Periodontal Examination (BPE) scoring in your
note of 17 June 2013 within Patient CB’s records.
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13.ii)
Proved.
The Committee has noted that on various occasions, you failed to evaluate
CB’s presenting symptoms. For example on 17 June, 27 August and 14
November 2013 your evaluations were brief and lacking in detail.
13.iii)
Admitted and proved.
13.iv)
Admitted and proved.
13.v)
Admitted and proved.
13.vi)
Admitted and proved.
13.vii)
Admitted and proved.
13.viii)
Admitted and proved.
13.ix)
Admitted and proved.
14.i)
Admitted and proved.
15.i)
Not proved.
Patient CB’s evidence to the Committee was that when she told you what she
had been told at the hospital, you responded that ‘the hospital are talking
rubbish’. You deny having said this and your dental nurse, AG also stated that
you did not say this.
At the time of this alleged exchange, you had not yet seen the letter from the
hospital, you had only heard Patient CB’s account of what had been said to
her.
The Committee has been unable to determine to the requisite standard what
you said.
15.ii)
Not proved.
The Committee has seen evidence of your referrals of Patient CB to the
hospital. In the light of your willingness to send her for evaluation elsewhere,
the Committee is not satisfied that you threatened her against visiting another
dentist.
15.iii)
Proved.
You deny that Patient CB had an appointment on 2 October 2013.
The Committee is persuaded by Patient CB’s detailed account of having an
appointment on that date. It notes that she needed to see a dentist at that time
and that she went to see her doctor because the practice was unexpectedly
closed.
15.iv)
Not proved.
Patient CB may not have understood the reasons for her referral, however the
Committee notes that you gave detailed reasons in your letter to the hospital.
The Committee is aware that patients do not always understand the
information they are given about their treatment. It takes the view that Patient
CB may simply not have understood what you told her.
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We move to Stage Two.”
On 2 July 2015 the Chairman announced the determination as follows:
“Mr Hermann,
Between June and December 2013, during your provision of treatment to Patient CB, you:
-
Failed to carry out sufficient diagnostic assessments;
-
Failed to treat her periodontal disease;
-
Failed to carry out sufficient treatment planning, including by not identifying that
her loss of bone support was substantially due to periodontal disease;
-
Failed to carry out sufficient pre-treatment investigations;
-
Provided treatment that was not indicated, including by providing crowns to a
number of unrestored and minimally restored upper and lower teeth;
-
Failed to identify and/or treat gingival inflammation in circumstances where you
identified the gum starting to cover a tooth as ‘good’ rather than as a sign of
underlying periodontal disease;
-
Extracted her UR5 and LR5 but made no record of having done so;
-
Provided root treatment to her UL2 but made no record of having done so;
-
Failed to keep or maintain adequate dental records;
-
Did not maintain adequate standards of clinical practise;
-
Failed to communicate with her in a professional manner.
Prior to addressing it on the issue of current impairment and sanction, Mr Wakerley informed
the Committee of your previous history. On 22 May 2014 you were issued with a warning by
the Investigating Committee for similar conduct. You treated a patient from August 2011 to
December 2012 and during that time your failings included not carrying out a full
assessment, providing poor quality crowns, not treating periodontal disease and keeping
inadequate records.
He noted that the warning related to events prior to your treatment of Patient CB and
therefore showed that this is not an isolated case.
Mr Brassington on your behalf accepted that the facts found proved amounted to misconduct
and that your fitness to practise is currently impaired.
MISCONDUCT
The Committee considered whether the facts found proved against you amounted to
misconduct. In so doing, it had regard to the publication Standards for the Dental Team. It
looked in particular at the following principles:
1.
Put patients’ interests first
2.
Communicate effectively with patients
4.
Maintain and protect patients’ information
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9.
Make sure your personal behaviour maintains patients’ confidence in you and the
dental profession
The Committee also had regard to the following paragraphs within Standards for Dental
Professionals:
1.4
Make and keep accurate and complete patient records, including a medical history, at
the time you treat them. Make sure that patients have easy access to their records.
2.4
Listen to patients and give them the information they need, in a way they can use, so
that they can make decisions.
This will include:
5.3
-
communicating effectively with patients;
-
explaining options (including risks and benefits);
-
and giving full information on proposed treatment and possible costs.
Find out about current best practice in the fields in which you work. Provide a good
standard of care based on available up-to-date evidence and reliable guidance.
Although your failings related to only one patient, the Committee is aware that this is not the
first occasion on which your clinical treatment has been subject to a complaint to the GDC.
Your conduct fell short in a number of fundamental respects and your clinical failings were
wide ranging and serious. You failed to make full assessments, treatment plan, you did not
have facilities for the taking of radiographs, you carried out unnecessary treatment in a
manner that was not in Patient CB’s best interests, and you kept inadequate records.
There is clear training and guidance regarding what is expected of a practitioner in relation to
such basic aspects of dentistry. The Committee is satisfied that your failures were a clear
departure from the standards, and fell far short of what is expected of a reasonable dentist in
a wide range of areas. Taken cumulatively, the Committee is satisfied that your failures were
serious, would be considered deplorable by fellow professionals and serve to bring the
profession into disrepute. It finds that the deficiencies in your conduct and practice amount to
misconduct.
IMPAIRMENT
In considering whether your fitness to practise is currently impaired, the Committee
reminded itself of the fundamental considerations, namely the need to protect the public and
declare and uphold proper standards of conduct and behaviour so as to maintain public
confidence in the profession.
The failings identified in this case are principally clinical in nature. The Committee therefore
considered whether they were open to remediation, whether they had been remediated and
were unlikely to be repeated.
It also considered whether and to what extent you have insight into your failings.
The Committee took the view that the clinical deficiencies in your practice could theoretically
be addressed by engagement in targeted remedial activity. In considering whether you have
remedied the deficiencies identified in this case, the Committee had regard to the material
you submitted including evidence of your attendance on continuing professional
development (CPD) courses since these matters occurred.
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You have undertaken CPD in the following areas: superior management of plaque and
gingivitis through the use of triclosan, periodontal disease and its management and laser
periodontics.
You have also been in contact with your postgraduate dental deanery. A report from your
deanery dated 17 March 2015 states, in relation to interim conditions in place against your
registration at that time:
‘His conditions include that he is unable to work single handed, he must confine his
dental practice to posts where at least 3 members are registered as dentists and he
requires close supervision on site while he is working. Due to the circumstances of his
dental practice he has found it impossible to continue with clinical work as he is unable
to meet the conditions…’
A second report from the deanery dated 21 May 2015 states that following a variation of the
conditions, allowing you to work in a practice with one other dental registrant, but remaining
under close supervision, you remained unable to work under the conditions. It further states:
‘Dr Hermann has been very distressed each time we have met at the situation he finds
himself in as he finds it difficult to envisage how he will continue his dental career
under the current GDC conditions.’
You have not worked within dentistry since your registration was made subject to interim
conditions. You have therefore not provided the Committee with sufficient evidence of
remediation undertaken whilst practising during that time.
You have demonstrated some limited insight during this hearing, but that has been only in
relation to the matters admitted by you at the start of the proceedings. The Committee
rejected your persistent denial of having undertaken restoration work on Patient CB’s lower
arch. As a result, Patient CB was subjected to cross examination and in the course of your
evidence you went so far as to comment on her [text redacted]. You have not shown a full
understanding of the seriousness of all of your failings or the impact of these matters upon
Patient CB or on public confidence in the profession.
Your failure to treat Patient CB’s periodontal disease and your decision to embark upon
extensive crown and bridge work to her upper and lower teeth so soon after your initial
consultation with her, and in the absence of adequate assessment, planning and record
keeping, are very serious matters. The Committee is not satisfied that you fully appreciate
the extent of the inappropriateness of the work you carried out in Patient CB’s mouth.
In the Committee’s view, such serious errors of judgement relating to such basic and
fundamental aspects of dentistry are indicative of clinical and attitudinal concerns that are
not easily remedied. Furthermore, having regard to the evidence submitted on your behalf
during the second stage of these proceedings, it is apparent that they have not been fully
remedied.
In the light of these factors, and bearing in mind that you have previously been issued with a
warning in relation to similar matters, the Committee is concerned that there is a real risk of
repetition of such failings in future.
The Committee also had regard to the negative impact that your conduct would likely have
on public confidence in the profession. In the light of that, it determined that it was necessary
to make a finding that your fitness to practise is currently impaired, not just on the basis of
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the risk you pose to patients, but also so as to declare and uphold proper standards and
thereby safeguard public confidence in the profession.
SANCTION
On behalf of the GDC, Mr Wakerley submitted that in this case it would be appropriate to
impose conditions on your registration.
Mr Brassington drew the Committee’s attention to the severe impact interim conditions have
had on you. He submitted that, although the Committee had rejected important parts of your
case, that should not result in you being punished.
In considering sanction, the Committee bore in mind the principle of proportionality. It had
regard to the Guidance for the Professional Conduct Committee, including Indicative
Sanctions Guidance of 6 April 2015.
The Committee first considered whether to conclude this case with no further action, but it
determined that this would be wholly inadequate, in the light of the seriousness of your
misconduct.
The Committee next considered whether to conclude the case with a reprimand but
determined that a reprimand would not serve to protect patients or safeguard public
confidence in the profession.
The Committee next considered whether to impose conditions of practice upon your
registration for a specified period. Any conditions would need to be workable measurable
and enforceable and would need to address the wide ranging concerns found by the
Committee about your clinical practice.
The Committee took the view that conditions that would adequately protect the public and
maintain public confidence in the profession would be difficult to devise in the light of the
nature and extent of your failings. Furthermore the Committee is not satisfied that you have
demonstrated significant insight and a willingness to abide by conditions.
The seriousness and wide ranging nature of your failings means that any conditions would
have to be extensive such that they would be likely unworkable and unduly restrictive.
The Committee next considered whether to impose a period of suspension upon your
registration.
Your failings when treating Patient CB were extensive. Treating a patient in the manner that
you did, in the presence of periodontal disease is wholly unacceptable. You provided full
upper arch restorations ten days after seeing the patient for the first time. Your actions did
not occur by mistake, they were thought out and calculated. The Committee notes that it is
not looking at one or two discrete aspects of your practice that are of concern, but a very
wide range of matters. In addition the Committee considers that you have only limited insight
into your failings.
The Committee determined that although your misconduct was serious, it was not so serious
as to merit erasure. The Committee was satisfied that suspending your registration was
appropriate and proportionate in all of the circumstances of this case. It will serve to protect
the public, and declare and uphold proper standards of conduct and behaviour so as to
uphold public confidence in the profession and will provide you with an opportunity to reflect
on your failings and take such steps as you can to improve your clinical knowledge.
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For all of these reasons the Committee has concluded that suspension is the appropriate
and proportionate sanction in this case.
The suspension is imposed for a period of 12 months and will be reviewed shortly before the
end of that period. The Committee considers that this period of time will allow you sufficient
time to reflect upon these matters and develop insight. It will also mark the seriousness of
your misconduct.
The reviewing Committee will be assisted by seeing evidence that you have undertaken
study and appropriate CPD in the areas of record keeping, treatment planning, periodontal
assessment and ethics. It would also be assisted by receiving a reflective statement and a
personal development plan (PDP).
The Committee has borne in mind its findings and the reasons given for its substantive
order. It has decided that it is necessary for the protection of the public and that it is in the
public interest to impose an immediate order of suspension on your registration in the same
terms and for the same reasons as outlined in the substantive order.
The effect of the determination and this immediate order is that you will be made subject to
immediate suspension from today. Unless you exercise your right of appeal, the substantive
order of suspension will come into effect in 28 days time.
Should you exercise your right of appeal, this immediate order for suspension will remain in
place until the resolution of any appeal.
The interim order currently in place is hereby revoked.”
At a review hearing on 15 July 2016 the Chairman announced the determination as follows:
“Mr Hermann,
This is the first review of a suspension order initially imposed on your registration for a period
of 12 months, with a review, following the decision by the Professional Conduct Committee
(PCC) on 2 July 2015.
This hearing was convened pursuant to Section 27C (1) of the Act to review the current
suspension order, which is due to expire on 29 July 2016.
At the initial substantive hearing in July 2015 the PCC considered allegations relating to
whether your fitness to practice was impaired by reason of misconduct. At that hearing the
following was found:
Between June and December 2013, during your provision of treatment to Patient CB,
you:
-
Failed to carry out sufficient diagnostic assessments;
-
Failed to treat her periodontal disease;
-
Failed to carry out sufficient treatment planning, including by not identifying that
her loss of bone support was substantially due to periodontal disease;
-
Failed to carry out sufficient pre-treatment investigations;
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-
Provided treatment that was not indicated, including by providing crowns to a
number of unrestored and minimally restored upper and lower teeth;
-
Failed to identify and/or treat gingival inflammation in circumstances where you
identified the gum starting to cover a tooth as ‘good’ rather than as a sign of
underlying periodontal disease;
-
Extracted her UR5 and LR5 but made no record of having done so;
-
Provided root treatment to her UL2 but made no record of having done so;
-
Failed to keep or maintain adequate dental records;
-
Did not maintain adequate standards of clinical practise;
-
Failed to communicate with her in a professional manner.
The July 2015 Committee found that your fitness to practise was impaired by reason of
misconduct and imposed a suspension order for 12 months with a review. In making that
decision the Committee made the following recommendations for you in respect of this
review hearing:
The reviewing Committee will be assisted by seeing evidence that you have
undertaken study and appropriate CPD in the areas of record keeping, treatment
planning, periodontal assessment and ethics. It would also be assisted by receiving a
reflective statement and a personal development plan (PDP).
Today Miss Headley referred the Committee to the documentation before it. She also
referred to the material submitted by you in relation to remediation. She outlined the
background to this case and submitted that the matter of current impairment is solely for the
Committee’s judgement. However, the information before the Committee demonstrates that
you have taken only limited steps towards remediation and gaining insight.
Miss Headley referred the Committee to the available sanctions and invited it to consider all
the circumstances of this case. She invited the Committee to consider whether conditions
could replace the current suspension order. She provided a set of draft conditions that, in the
view of the GDC, are required in order to allow you to return to safe practice.
Mr Brassington informed the Committee that he would not be making any positive
submissions in respect of current impairment. He submitted that you accept that, given the
nature of the findings against you and your limited degree of remediation, your fitness to
practise remains impaired.
Mr Brassington submitted that conditions of practice would be proportionate and that you
would be willing to comply. He said that the proposed conditions are stringent, but that you
accept this may be necessary in order to allow you to return to practice. Mr Brassington
outlined your current financial status and the significant impact this has had on your ability to
undertake the appropriate remediation. He referred the Committee to the documentation
provided by you, including continuing professional development certificates.
The Committee accepted the advice of the Legal Adviser.
The Committee considered that although the misconduct identified was remediable, it had
not yet been fully remedied. The Committee appreciated that you have attended this hearing
and provided documentation for its consideration. The Committee acknowledged that you
have taken some steps towards remediation since the last hearing, as evidenced by the
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documentation before it which included online CPD training. You have begun the
remediation process although this is as yet incomplete. The Committee concluded that in all
the circumstances there remains a real risk of repetition and that your fitness to practise
remains currently impaired.
The Committee then considered what, if any, sanction to impose. It has the power to extend
the current order for a maximum period of 12 months. Alternatively, it could revoke the
suspension order with immediate effect, allow it to lapse on expiry or replace the order with a
conditions of practice order for up to 3 years. It is aware that it must consider the sanctions
in order starting with the least serious.
The Committee was aware that it should have regard to the principle of proportionality,
balancing the public interest against your own interests. The public interest includes the
protection of the public, the maintenance of public confidence in the profession, and
declaring and upholding standards of conduct and performance within the profession.
The Committee first considered whether it would be appropriate to allow the current order to
lapse at its expiry or to revoke it with immediate effect. The Committee concluded that given
the information before it, and for all the reasons outlined above, it would not be appropriate
to revoke the current order or to allow it to lapse, as this would not protect the public nor
would it be in the public interest. The Committee therefore determined to replace the
suspension order with a conditions of practice order.
The Committee has concluded that a conditions of practice order is the appropriate,
proportionate and sufficient sanction. Such an order would allow you to return to work and to
take further steps to remedy your failings whilst ensuring that the public are protected and
the public interest upheld.
The Committee was mindful that any conditions imposed must be proportionate, measurable
and workable. You have indicated that you would be willing to comply with conditions placed
on your registration by this Committee.
Having regard to the matters it has identified, the Committee concluded that a conditions of
practice order will mark the importance of maintaining public confidence in the profession,
and will send the public, the profession and you a clear message about the standards
required of a registered dental practitioner.
The Committee has therefore determined to terminate the existing suspension order
forthwith and replace it with a conditions of practice order.
The conditions as they will appear against your name on the Dentists Register are as
follows:
1.
He must notify the GDC promptly of any post he accepts for which GDC
registration is required and the Commissioning Body on whose Dental
Performers List he is included.
2.
If employed, he must provide contact details of his employer and allow the GDC
to exchange information with his employer or any contracting body for which he
provides dental services.
3.
He must inform the GDC of any formal disciplinary proceedings taken against
him, from the date of this determination.
4.
He must inform the GDC if he applies for dental employment outside the UK.
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5.
He must not engage in single-handed dental practice.
6.
At any time he is providing dental services, which require him to be registered
with the GDC, he must agree to the appointment of a reporter nominated by
Postgraduate Dean/ Director (or a nominated deputy). The reporter shall be a
GDC registrant.
7.
He must allow the reporter to provide reports to the GDC at intervals of not more
than 3 months and the GDC will make these reports available to any
Postgraduate Dean/Director, or workplace supervisor.
8.
He must work with a Postgraduate Dental Dean/Director (or a nominated
deputy), to formulate a Personal Development Plan, specifically designed to
address the deficiencies in the following areas of his practice:

Crowns and Bridgework,

Record keeping,

Radiography,

Treatment planning,

Clinical assessment,

Periodontal assessment and care,

Communication and referral,

Antibiotic prescribing, and

Ethics
9.
He must meet with the Postgraduate Dental Dean/Director (or a nominated
deputy), on a regular basis to discuss his progress towards achieving the aims
set out in his Personal Development Plan. The frequency of his meetings is to be
set by the Postgraduate Dental Dean/Director (or a nominated deputy).
10.
He must allow the GDC to exchange information about the standard of his
professional performance and his progress towards achieving the aims set in his
Personal Development Plan with the Postgraduate Dental Dean/Director (or a
nominated deputy) and any other person(s) involved in his retraining and
supervision.
11.
He must forward a copy of his Personal Development Plan to the GDC within
three months of the date on which these conditions become effective.
12.
He must provide to the GDC, within 3 months and prior to any review, a written
reflection focused on the specific issues identified by the initial PCC.
13.
He must continue to carry out a monthly audit of his patient records in
accordance with the advice of his Postgraduate Dean or nominated deputy
14.
He must undertake an audit of the frequency and quality of his radiographs every
3 months and submit each audit to the GDC.
15.
He must provide a copy of the full audit including the data capture sheets
referred to conditions 13 and 14 above, to the GDC on a 3 monthly basis.
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16.
At any time he is employed, or providing dental services, which require him to be
registered with the GDC, he must place himself and remain under close
supervision of the workplace supervisor nominated by his Local Dental
Committee (LDC) or his Postgraduate Dean/Director (or a nominated deputy)
and agreed by the GDC.
17.
He must allow his workplace supervisor to provide reports to the GDC at
intervals every 3 months and the GDC will make these reports available to any
Postgraduate Dean/Director.
18.
He must confine his dental practice to general practice posts as a Dentist under
the close supervision*** of a named Principal. This supervision should include
but not be limited to the following aspects:

Crowns and Bridgework,

Record keeping,

Radiography,

Treatment planning,

Clinical assessment,

Periodontal assessment and care,

Communication and referral, and

Antibiotic prescribing.
19.
He must seek a report from his supervisor, for consideration by this Committee
every six months.
20.
He must not undertake any out-of-hours work or on-call duties.
21.
He must not work as a locum or undertake any out-of-hours work or on-call
duties.
22.
He must inform within 1 week the following parties that his registration is subject
to the conditions, listed at 1 to 21, above:
23.
a.
Any organisation or person employing or contracting with him to undertake
dental work;
b.
Any prospective employer (at the time of application);
c.
The Commissioning Body in whose Dental Performers List he is included,
or seeking inclusion (at the time of application).
He must permit the GDC to disclose the above conditions to any person
requesting information about his registration status.
The period of this order is twelve months. The Committee concluded that a period of twelve
months would enable you to gain employment, to address these issues and to demonstrate
to a reviewing Committee that you are a safe practitioner with insight into your misconduct.
During the period of this order your record in the GDC register will show that you are the
subject of a conditions of practice order and anyone who enquires about your registration will
be told about the order.
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In the light of the Committee’s findings and the reasons given it has concluded that it is
necessary for the protection of the public and otherwise in the public interest to impose an
immediate order of conditions upon your registration. This order is in the same terms and for
the same reasons as in the substantive order.
The effect of this immediate order is that you would be made subject to the above conditions
forthwith. Unless you exercise your right of appeal the substantive order of conditions will
come into effect in 28 days.
Should you exercise your right of appeal, this immediate order of conditions will remain in
place until the resolution of any appeal.
Before the end of the period of the order, a Committee will hold a review hearing to see how
well you have complied with the order. At the review hearing the Committee may revoke the
order or any condition of it, it may confirm the order or vary any condition of it, or it may
replace the order with another order.”
*** For the purposes of these conditions, Close supervision is defined as “The registrant’s day to day work must be supervised by a person who is registered
with the GDC in their category of the register or above and who must be on site and
available at all times. As a minimum, the registrant’s work must be reviewed at least
twice a week by the supervisor via one to one meetings and case-based discussion.
These bi-weekly meetings must be focused on all areas of concern identified by the
conditions.”
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