HEARING HEARD IN PUBLIC

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Jerome Marshall
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1 HEARING HEARD IN PUBLIC JAMALI, Nisreen Registration No: PROFESSIONAL CONDUCT COMMITTEE September 2014 Outcome: Erased with immediate suspension. Nisreen JAMALI, BDS Karachi 2002, Statutory Exam 2005, was summoned to appear before the Professional Conduct Committee on 15 September 2014 for an inquiry into the following charge: Charge (as amended on 15 September 2014) That, being a registered dentist: 1. On or around 28 October 2011 you prescribed excessive quantities of sodium fluoride toothpaste and ibuprofen ('the prescription') to Patient 1 (as described in Schedule A) 1 ; 2. You did not make a contemporaneous record of the prescription; 3. You prescribed sodium fluoride toothpaste to Patient 1 in the absence of a clearly formulated and contemporaneously recorded treatment plan; 4. You did not make any record of the prescription until 7 November 2011, after having been asked about it by J E; 5. You denied knowing Patient 1 at a meeting on or around i) 8 November 2011; ii) 13 February WITHRAWN 7. Your actions in respect to charge 5 (i) (8 November 2011) were deliberately misleading; 8. Your actions in respect to charge 5 (i) (8 November 2011) were dishonest; 9. Your actions in respect to charge 5 (ii) (13 February 2012) were deliberately misleading; 10. Your actions in respect to charge 5(ii) (13 February 2012) were dishonest; And that by reason of the facts alleged your fitness to practise as a dentist is impaired by reason of your Misconduct." 1 Please note that Schedule A is a private document and cannot be disclosed. Jamali, N Professional Conduct Committee Sep 2014 Page -1/6-

2 On 15 September 2014 Mr Dyal made a submission under Rule 19(3) on behalf of Ms JAMALI. The Chairman made the following response: Mr Dyal, Mr Beeby has formally concluded the case for the General Dental Council ( GDC ) on the facts. You, on Ms Jamali s behalf made a submission under Rule 19(3) of the GDC (Fitness to Practise) Rules 2006 that there is no case to answer in respect of the heads of charges: 1 and 3. You submitted that the burden of proof is on the prosecution. The prosecution case is such that the Committee could not safely conclude on the balance of probabilities that these charges are found proved. With reference to Head of Charge 1, the GDC has not provided possible reasons why Ms Jamali had prescribed sodium fluoride toothpaste to Patient 1. You submitted that the principle evidence of C D could not recall quantity and the date of the prescription which doesn t assist the case for the prosecution. You stated that although C D was suspicious of the prescription being redeemed in Newcastle under Lyme rather than Tunstall, this is not a proper basis to rely on her judgement. Finally Ms E did not see the prescription, she also gives hearsay evidence of a telephone conversation, and therefore her evidence could not be relied upon. You submitted that Head of Charge 3 is specifically about sodium fluoride toothpaste. There is no reference to any fillings that may be required. An adequate justification for prescribing fluoride was contained in Patient 1 s clinical records which confirms a clinical justification and a recommended review period of 6 months. You referred to Mr Scott s (GDC expert witness) report, which stated that the standard had been met. You therefore submitted that there was insufficient evidence on which the Committee could find the charges proved. Mr Beeby on behalf of the GDC stated that the Committee should determine whether these charges could be found proven. Mr Beeby states that your application failed because of the reliability of the evidence of Ms D, Ms E and the expert witness, Mr Scott, and therefore these charges are capable of being proven. The Committee considered the detailed submissions made by you and by Mr Beeby. It has accepted the advice of the Legal Adviser and has had regard to the principles to be applied to a submission of no case as set out in the case of R v Galbraith [1981] 1 WLR The Committee has reached the following decisions: Head of Charge 1 The Committee determines that there is evidence upon which this charge could be found proved. Accordingly the Committee rejects your submission in relation to this charge. Head of Charge 3 The Committee, having considered all of the evidence in the round, is satisfied that it could reach a finding that this charge could also be found proved. The Committee therefore rejects your submission. On 16 September 2014 the Chairman made the following statement regarding the finding of facts: Jamali, N Professional Conduct Committee Sep 2014 Page -2/6-

3 Ms Jamali The Committee has taken into account all the agreed documentary evidence presented to it. It has accepted the advice of the Legal Adviser. In accordance with that advice it has considered each head of charge separately. The Committee has borne in mind that the burden of proof lies entirely on the General Dental Council (GDC) to prove the facts alleged and that the standard of proof is the civil standard. The Committee noted your initial admissions from the outset. The Committee heard oral evidence from you. The Committee also heard oral evidence from Ms C D, Dispenser at Boots and also Ms J E, Senior Dental Officer at Trent Partnership Trust, both of whom the Committee found to be credible. The Committee was assisted by expert witness reports by Mr Scott, on behalf of the GDC and also Mr Pal on your behalf. I will now announce the Committee s findings in relation to each head of charge: 1. Proved. The Committee finds that Ms C D would not have rung the Practice unless the prescription had been for an excessive amount of sodium fluoride toothpaste and ibuprofen. The evidence of other witnesses supported her recollection of events. On the balance of probabilities the Committee therefore finds that you did prescribe excessive quantities of sodium fluoride and ibuprofen to Patient Admitted and found proved. 3. Proved. The Committee considers that based on the balance of probabilities you failed to formulate a clear treatment plan and neither was it contemporaneous. The clinical records do not show a treatment plan for Patient Admitted and found proved. 5.(i) 5.(ii) 6. Withdrawn Admitted and found proved. Admitted and found proved. 7. Admitted and found proved. 8. Admitted and found proved. 9. Admitted and found proved. 10. Admitted and found proved. We move to Stage Two. On 17 September the Chairman announced the determination as follows: Dr Jamali Jamali, N Professional Conduct Committee Sep 2014 Page -3/6-

4 The Committee has heard submissions from Mr Beeby on behalf of the General Dental Council and from Mr Dyal on your behalf. The Committee has heard and accepted the advice of the Legal Adviser. You have admitted the majority of the heads of charge. The Committee have found all the facts proved. This case involved a number of serious failings by you in respect of Patient 1. You failed to provide a good standard of care in relation to Patient 1 by prescribing sodium fluoride toothpaste and ibuprofen in excessive quantities. You failed to maintain appropriate standards of record keeping by not recording these prescriptions contemporaneously or providing clinical justification for them in a clearly formulated treatment plan. During an investigation by your employer, the then Staffordshire and Stoke on Trent Partnership NHS Trust (the Trust), you acted dishonestly by stating that you did not know Patient 1 personally despite later, when confronted with the facts, admitting that she was your sister. The Committee has seen documentary evidence with regard to your previous appearance before a GDC Professional Conduct Committee between March 2009 and March Mr Beeby highlighted to the Committee that that Committee had found that you had deliberately misled patients for financial gain. The Committee also had regard to your oral evidence at this stage and received a bundle of supporting documentary evidence of 285 pages which detailed your work on remediation. This included: Personal Development Plans (PDP) Care Quality Commission (CQC) report Correspondence of meetings with your Postgraduate Associate Dean Correspondence and reports following meetings with your mentor Practice audits Reflective logs Continuing Professional Development Attendance Certificates (CPD) Misconduct The Committee has had regard to the GDC's guidance in place at the time, Standards for Dental Professionals, the ethical guidance issued by the GDC for dental professionals. The Committee is in no doubt that your dishonest conduct amounts to a serious breach of the standards expected of a registered dentist. Fellow professionals would regard this conduct as deplorable. The Committee is satisfied that your conduct, which was repeated over a sustained period of time, fell far below the standards expected of a general dental practitioner. The Committee is satisfied that the facts found proved amount to misconduct. Impairment Jamali, N Professional Conduct Committee Sep 2014 Page -4/6-

5 The Committee next considered whether, as a result of the misconduct found, your fitness to practise is impaired. The Committee has seen evidence of improvements in your practice and the knowledge you have gained through attendance at a number of courses. The Committee notes that since your failings in 2011 you have made improvements to your work as a dentist. However, the Committee considers that your dishonest conduct is serious and you have breached one of the fundamental tenets of the profession. It has borne in mind that you have behaved dishonestly on more than one occasion. You had numerous opportunities to be honest with the Trust or the GDC, but you failed to do so. Although you have expressed remorse to the Committee, it remains concerned by your limited insight into your failings. The Committee considered that the limitations on your insight were apparent in both the written evidence provided on your behalf and in your oral evidence. You have also failed to reassure the Committee, particularly given the history, that the conduct is unlikely to be repeated. The Committee is not convinced that you have shown an appropriate level of remediation or insight into your deficiencies. The Committee is concerned that your pattern of dishonest behaviour, conducted over a sustained period of time, severely impacts upon the reputation of the dental profession and the public interest. Taking all of the circumstances into account, and the need to protect the public interest by maintaining confidence in the profession, the Committee has determined that your fitness to practise is currently impaired by reason of your misconduct. Sanction The Committee went on to consider what sanction, if any, to impose on your registration. In so doing, it has taken into account the submissions made by both parties. It is mindful that the purpose of a sanction is not to be punitive, but to protect patients and the wider public interest, although it may have a punitive effect. The Committee has considered all the evidence before it. It has taken into account the Guidance for the Professional Conduct Committee (November 2009) (the Guidance). Throughout its deliberations the Committee has applied the principle of proportionality, weighing the public interest with your own interests. The public interest includes not only the protection of patients but also the maintenance of public confidence in the profession and the declaring and upholding of proper standards of conduct and behaviour. The Committee first considered whether to conclude this case without taking any action in respect of your registration. In view of the very serious nature of your dishonesty, the Committee is satisfied that such a course of action would not be sufficient, proportionate, or in the public interest. For the same reasons, the Committee has concluded that it would be inappropriate to conclude this case with a reprimand. The Committee next considered whether to impose conditions on your registration. Any conditions imposed would need to be appropriate, proportionate, workable and measurable. Given your history of lack of probity and the Committee s finding of dishonesty, the Committee has concluded that it would not be possible to formulate any conditions to address this conduct. In any event, the Committee is satisfied that conditions would not be sufficient to protect the reputation of the profession and to declare and uphold proper standards of conduct and behaviour. Jamali, N Professional Conduct Committee Sep 2014 Page -5/6-

6 The Committee went on to consider the sanction of suspension. In so doing, it has borne in mind the serious nature of the dishonesty in this case, combined with your previous fitness to practise history. The Committee has grave concerns regarding your limited insight into your dishonesty. In these circumstances, the Committee is not satisfied that suspending your registration would be sufficient or would serve any purpose in addressing your dishonest conduct. The Committee had regard to the Guidance, which states at paragraph 40: The ability to erase exists because certain behaviours are so damaging to a registrant s fitness to practise and to public confidence in dental professionals that removal of their professional status is the appropriate outcome. Further, at paragraph 42(e) it states: Patients, employers, colleagues and others have a right to rely on registrants integrity. Important choices about treatment options and significant financial decisions can be made on the basis not only of registrants skill but also of their honesty. Dishonesty, particularly when associated with professional practice, is highly damaging to a registrant s fitness to practise and to public confidence in dental professionals. The Guidance suggests following a finding of dishonesty a decision not to erase would require careful justification. The Committee could find no justification to depart from the guidelines in the circumstances of this case. The Committee was concerned that throughout these proceedings you have failed to sufficiently demonstrate that your actions will not be repeated again. Taking into account your dishonesty, and your limited insight, the Committee has determined that the only appropriate and proportionate sanction to protect patients and maintain public confidence in the dental profession, is to direct that your name be erased from the Dentists Register. The Committee now invites submissions as to whether your registration should be suspended immediately. In all the circumstances, the Committee has determined that it is necessary for the protection of the public and is otherwise in the public interest to impose an order for the immediate suspension of your registration. The Committee has imposed the highest possible sanction in this case and has therefore decided that it would be inconsistent to allow you the opportunity to continue to practise during the intervening appeal period. The effect of the foregoing determination and this immediate order is that your registration will be suspended from today. Unless you exercise your right of appeal, your name, Nisreen Jamali will be erased from the Dentists Register 28 days from today. 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 of conditions on your registration is hereby revoked in accordance with Section 27B(9) of the Dentists Act That concludes this case. Jamali, N Professional Conduct Committee Sep 2014 Page -6/6-

HEARING HEARD IN PUBLIC

HEARING HEARD IN PUBLIC LIMBU, Dino Registration No: 246153 PROFESSIONAL CONDUCT COMMITTEE AUGUST 2015 Outcome: Fitness to practise impaired; erasure with an immediate suspension order Dinu LIMBU, a dental