HEARING PARTLY HEARD IN PRIVATE* *The Committee has made a determination in this case that includes some private information. That information has been omitted from this text. GRAHAM, Lisa Marie Registration No: 197048 PROFESSIONAL CONDUCT COMMITTEE OCTOBER 2018 Outcome: Erased with Immediate Suspension Lisa Marie GRAHAM, a dental nurse, NVQ L3 Dental Nursing & VRQ L3 Dental Nursing City & Guilds 2010 was summoned to appear before the Professional Conduct Committee on 19 October 2018 for an inquiry into the following charge: Charge That being a registered dental care professional: 1. On 12 September 2017, at Crownhill Police Station, you received a police caution for theft of a credit card. 2. You failed to immediately inform the GDC that you were cautioned for theft, as per Charge 1 above. 3. Your actions in relation to Charge 2 were: a. Misleading; b. Dishonest 4. From 15 November 2017 until 16 April 2018, you failed to co-operate with an investigation conducted by the GDC into your fitness to practise, including by not providing the GDC with: a. any evidence of indemnity; b. confirmation of your employer s details. 5. From 1 December 2017 to 13 February 2018, you worked as a dental nurse at The Smile Centre, Liskeard, whilst suspended from the GDC s Dental Care Professionals Register. 6. Your actions in relation to Charge 5 were: a. Misleading; b. Dishonest. 7. Between 1 December 2017 and 13 February 2018, you failed to inform your employer, The Smile Centre, Liskeard, that you were suspended from the GDC s Dental Care Professionals Register. 8. Your actions in relation to Charge 7 were: a. Misleading Graham, L M Professional Conduct Committee Oct 2018 Page -1/8-
b. Dishonest; By reason of the matters alleged, your fitness to practise is impaired by reason of your caution in respect of Charge 1 and/or misconduct in respect of Charges 2 to 8. On 19 October 2018 the Chairman made the following statement regarding the finding of facts: Miss Graham You are participating in this hearing of the Professional Conduct Committee (PCC) via Skype. You are not represented. Mr Tom Middleton of the General Dental Council s (GDC s) Legal Team appears for the Council. Background to the case and summary of allegations The facts giving rise to this case relate to your police caution for an offence of theft. The circumstances of the offence for which you were later cautioned relate to an incident that is understood to have taken place whilst you were employed by MyDentist at The Crescent Specialist Dental Centre in Plymouth, Devon, in the capacity of dental nurse. It is understood that you stole a credit card from your colleague and that on 3 August 2017 you used the credit card to make two separate contactless purchases from two different shops between the hours of 1300 and 1400, which coincided with your lunch break. The two transactions were in the sums of 24.00 and 29.98. Following an investigation your employers at MyDentist reported the matter to the police, and you were arrested on 6 September 2017. You were dismissed from your post with MyDentist following a disciplinary hearing on 31 August 2017. Following your arrest on 6 September 2017 you attended Crownhill Police Station on the morning of 12 September 2017 and, having admitted to the offence, you were cautioned by the police for an offence of theft contrary to section 1 (1) and section (7) of the Theft Act 1968. It is further alleged that you failed to immediately inform the GDC of the fact of your caution, and that such conduct was misleading and dishonest. The Council also alleges that from 15 November 2017 to 16 April 2018 you failed to co-operate with its investigation into your fitness to practise, more particularly by not providing evidence of your indemnity arrangements and details of your employers. You also face allegations that you worked as a dental nurse at The Smile Centre in Liskeard, Cornwall, from 1 December 2017 to 13 February 2018 contrary to the Interim Orders Committee s direction that your name be suspended from the register, and without having informed your employer that you were in fact suspended. It is further alleged that such conduct was misleading and dishonest. Evidence The Committee has been provided with documentary material in relation to the allegations that you face. These documents include a copy of the Certificate of Adult Simple Caution relating to the caution for an offence of theft, the witness statement and documentary exhibits of the Practice Manager of MyDentist, the witness statement and documentary exhibits of the lead dentist at your subsequent employer, namely the Smile Centre, the witness statement and documentary exhibits of the GDC s caseworker with conduct of the Council s investigation, and the witness statement and documentary exhibits of a Registrations Manager in the GDC s Registrations Department. Graham, L M Professional Conduct Committee Oct 2018 Page -2/8-
Committee s findings of fact The Committee has taken into account all the evidence presented to it. The Committee has considered the submissions made by Mr Middleton on behalf of the GDC. The Committee noted that you chose not to make any submissions, other than to confirm that you agreed with the evidence that had been presented. The Committee has accepted the advice of the Legal Adviser. The Committee is mindful that the burden of proof lies with the GDC, and has considered the heads of charge against the civil standard of proof, that is to say, the balance of probabilities. In relation to heads of charge 3 (b), 6 (b) and 8 (b), the Committee applied the test set out in Ivey v Genting Casinos (UK) Ltd. t/a Crockfords [2017] UKSC 67. The test is that the Committee must decide subjectively the actual state of your knowledge or belief as to the facts, and must then apply the objective standards of ordinary and decent people as to whether your conduct is dishonest by those standards. The Committee has heard that you accept this test and it has therefore approached its consideration of heads of charge 3 (b), 6 (b) and 8 (b) accordingly. The Committee has considered each head of charge separately, although its findings will be announced together. I will now announce the Committee s findings in relation to each head of charge: 1. Admitted and proved The Committee finds the allegations at head of charge 1 proved on the basis of your admission. In reaching this finding the Committee has also had regard to the documentary evidence placed before it which provides further proof of the facts. The Committee also finds the facts alleged at the remaining heads of charge proved on the basis of your respective admissions, and that those facts are also supported by the documentary evidence presented to it. 2. Admitted and proved 3. (a) Admitted and proved 3. (b) Admitted and proved 4. (a) Admitted and proved 4. (b) Admitted and proved 5. Admitted and proved 6. (a) Admitted and proved 6. (b) Admitted and proved 7. Admitted and proved 8. (a) Admitted and proved 8. (b) Admitted and proved We move to stage two. On 19 October 2018 the Chairman announced the determination as follows: Ms Graham Graham, L M Professional Conduct Committee Oct 2018 Page -3/8-
Proceedings at stage two The Committee has considered all the evidence presented to it, both written and oral. The Committee has been provided with a copy of a letter that you have written about the matters giving rise to these proceedings, and has heard oral evidence from you. It has taken into account the submissions made by Mr Middleton on behalf of the General Dental Council (GDC), and those made by you. In its deliberations the Committee has had regard to the GDC s Guidance for the Practice Committees, including Indicative Sanctions Guidance (October 2016). The Committee has accepted the advice of the Legal Adviser. Application to hear part of the case in private Following the announcement of the Committee s findings of fact, and at the outset of stage two, the Committee announced that it would hear part of the hearing in private in accordance with Rule 53 (2) of the General Dental Council (Fitness to Practise) Rules 2006 ( the Rules ) given that your evidence would mention your personal life and your health. The hearing thereafter continued partly in private session as indicated below. IN PRIVATE Application to adjourn [text omitted]. IN PUBLIC The Committee therefore decided not to adjourn its consideration of this case. Fitness to practise history Mr Middleton addressed the Committee in accordance with Rule 20 (1) (a) of the Rules. He confirmed that you have no fitness to practise history with the GDC. Misconduct The Committee first considered whether the facts that it has found proved at heads of charge 2, 3, 4, 5, 6, 7 and 8 constitute misconduct. In considering this matter, the Committee has exercised its own independent judgement. In its deliberations the Committee has had regard to the following paragraphs of the GDC s Standards for the Dental Team (September 2013) in place at the time of the incidents giving rise to the facts that it has found proved at those heads of charge. These paragraphs state that as a dental care professional you must: 1.3 Be honest and act with integrity. 1.3.1 [ ] justify the trust that patients, the public and your colleagues place in you by always acting honestly and fairly in your dealings with them [ ]. 1.3.2 [ ] make sure you do not bring the profession into disrepute. 9 Make sure your personal behaviour maintains patients confidence in you and the dental profession. 9.1 Ensure that your conduct, both at work and in your personal life, justifies patients trust in you and the public s trust in the dental profession. 9.4 Co-operate with any relevant formal or informal inquiry and give full and truthful information. Graham, L M Professional Conduct Committee Oct 2018 Page -4/8-
9.4.1 If you receive a letter from the GDC in connection with concerns about your fitness to practise, you must respond fully within the time specified in the letter. You should also seek advice from your indemnity provider or professional association. In light of the findings of fact that it has made, the Committee has concluded that your conduct, and in particular your dishonest acts and omissions, fell far short of the standards reasonably expected of a dental care professional. The Committee has made a number of findings which amount to serious departures from acceptable standards of conduct and behaviour. The Committee has found that you were cautioned by the police for an offence of theft. The offence related to the theft of your dental colleague s credit card from her handbag at the premises at which you were working. You then failed to inform the GDC of the fact that you had been cautioned, which the Committee has found was misleading and dishonest. You thereafter failed to co-operate for a period with the GDC s investigation of the caution after it had been notified by other means. After being suspended by the Interim Orders Committee on an interim basis in connection with these matters, you continued to work as a dental nurse. You worked in this capacity for an employer from whom you withheld the fact of your suspension. The Committee has found that such conduct was, again, misleading and dishonest. The Committee finds that this conduct would be considered by your fellow practitioners to be deplorable, and that your dishonesty is likely to have brought the standing and reputation of the profession into disrepute. Your dishonest conduct, and in particular working whilst suspended, is also likely to have undermined the trust and confidence that the public places in the dental profession and in the GDC as its regulator. The Committee finds that your conduct, sustained and repeated as it was, represents a serious and sustained departure from a fundamental tenet of the profession, namely the need to act in an honest and trustworthy manner, and it therefore finds that the facts that it has found proved at heads of charge 2, 3, 4, 5, 6, 7 and 8 amount to misconduct. Impairment The Committee then went on to consider whether your fitness to practise is currently impaired by reason of your misconduct and police caution. In doing so, the Committee has again exercised its independent judgement. Throughout its deliberations, it has borne in mind that its overarching objective is to protect the public, which includes the protection of patients and the wider public, the maintenance of public confidence in the profession and in the regulatory process, and the declaring and upholding of proper standards of conduct and behaviour. The Committee considers that your fitness to practise is currently impaired by reason of your police caution. The offence for which you were cautioned was one of theft, which is a criminal offence involving a dishonest action intended to benefit you. The serious nature of this offence is highly damaging to your fitness to practise and also requires a finding of impairment in order to declare and uphold proper professional standards of conduct and behaviour and maintain public trust and confidence in the profession. The Committee also finds that your fitness to practise is currently impaired by reason of the misconduct that it has found at heads of charge 2, 3, 4, 5, 6, 7 and 8. Following on from the theft, your subsequent dishonest conduct was serious and sustained over a period of months. This sustained and repeated dishonesty involved a failure to declare your caution to the GDC, working as a dental nurse whilst suspended and a failure to inform your employer of your suspension. In each case your dishonesty only came to an end when your behaviour was discovered by others. Graham, L M Professional Conduct Committee Oct 2018 Page -5/8-
This persistent dishonesty connotes a wilful and deliberate disregard for the systems regulating the profession, which are intended to safeguard patients and the interests of the wider public. Although you have demonstrated some insight into your misconduct in your written and oral evidence, the Committee considers that this insight is not sufficiently developed to indicate that this conduct is not likely to be repeated. The Committee considers that this hearing has clearly had a salutary effect on you, and that your remorse and regret is genuine, but that the attitudinal and behavioural deficiencies that are suggested by your repeated dishonest acts are likely to be repeated in the future. The Committee finds that a finding of impairment is further, and undoubtedly, required in order to declare and uphold proper standards of conduct and behaviour, and to maintain trust and confidence in the profession and in the regulatory process. Your dishonest conduct has breached fundamental tenets of the profession such that the profession has been brought into disrepute. Public trust and confidence in the profession, and in the regulator, would be seriously undermined if a finding of impairment were not made in the particular circumstances of this case. The Committee therefore concludes that your fitness to practise is currently impaired by reason of your police caution and your misconduct. Sanction The Committee then determined what sanction, if any, would be appropriate in light of the findings of facts, misconduct and impairment that it has made. The Committee recognises that the purpose of a sanction is not to be punitive, although it may have that effect, but is instead imposed in order to protect patients and safeguard the wider public interest referred to above. In reaching its decision the Committee has again taken into account the GDC s Guidance for the Practice Committees referred to above. The Committee has applied the principle of proportionality, balancing the public interest with your own interests. The Committee heard the submissions of Mr Middleton on behalf of the GDC that the appropriate and proportionate sanction is one of erasure. The Committee also heard your submissions on the issue of sanction, and heard that you invite the Committee to consider imposing a period of suspension short of erasing your name from the register. The Committee has had regard to the mitigating and aggravating factors in this case. In terms of mitigation, the Committee has considered the difficult personal circumstances that you have described, including your health, your latter engagement with these proceedings and your cooperation at this hearing, the remorse and apology that you have offered, the admissions that you tendered, and that you are of previous good character. In terms of aggravating factors, the Committee notes that your dishonesty relates to premeditated and repeated misconduct, that you have been motivated by financial gain, and that your theft and subsequent dishonest acts and omissions, which include attempts to cover-up your wrongdoing, amount to a breach of trust. Your failure to provide the GDC with required and requested information, and your practising whilst suspended, is highly suggestive of a blatant and wilful disregard for the GDC. The Committee has considered the range of sanctions available to it, starting with the least serious. In the light of its findings of facts, misconduct and impairment, the Committee has determined that it would be wholly inappropriate to conclude this case with no action or with a reprimand. The serious nature and risk of repetition of the harmful and dishonest conduct that it has identified means that taking no action, or issuing a reprimand, would be insufficient, particularly in relation to the need to maintain public confidence and trust in the profession and in the regulatory process, and to declare and uphold proper standards of conduct and behaviour. Graham, L M Professional Conduct Committee Oct 2018 Page -6/8-
The Committee next considered whether a period of conditional registration would be appropriate. The serious attitudinal deficiency suggested by your persistent dishonest conduct would not in the Committee s view be capable of being adequately addressed with conditions. The Committee also doubts whether you would comply with any conditions even if they could be formulated given that it has found that you practised for a considerable period of time whilst suspended. The Committee considers that a period of conditional registration would not sufficiently protect patients, declare and uphold proper professional standards or maintain trust and confidence in the profession. The Committee next considered whether to suspend your registration. After careful consideration the Committee concluded that a period of suspension would not be sufficient to address the seriousness of this particular case. Your dishonesty suggests a serious attitudinal or professional deficiency, arising as it does from repeated and serious departures from a fundamental tenet of the profession, namely the need to act in an honest and trustworthy manner. This dishonesty has been found to have been in evidence in relation to your dealings with your colleague, your employers and the GDC. The Committee considers in particular that a period of suspended registration would not sufficiently meet the wider public interest considerations referred to above. The Committee has decided that erasure from the register is the only appropriate and proportionate sanction to impose in the particularly serious circumstances of this case. The misconduct that the Committee has identified arises out of serious and sustained departures from your professional obligations. Your serious and persistent dishonest conduct relates to an abuse of trust, and is of a serious and sustained nature. The Committee has considered the devastating effect that erasure from the register is likely to have on you, but it finds that any lesser sanction than erasure would be wholly insufficient to declare and uphold proper professional standards and maintain public trust in confidence in the profession and in the regulatory process. The Committee has determined, and hereby directs, that your name be erased from the register. Absence of the registrant Prior to handing down the determination on impairment and sanction, the Committee was informed by the Committee Secretary that you were no longer contactable and that the efforts to contact you by Skype, mobile telephone and email were not successful. Mr Middleton on behalf of the GDC submitted that it would be appropriate and fair to proceed with the remainder of the hearing in your absence in accordance with Rule 54 of the Rules. The Committee accepted the advice of the Legal Adviser and determined that it would be appropriate to proceed with the case. Immediate order of suspension The Committee then invited submissions as to whether to impose an order for your immediate suspension in accordance with section 36U (1) of the Dentists Act 1984 (as amended) ( the Act ). The Committee was mindful that in accordance with Rule 22 (1) of the Rules, parties should be provided with an opportunity to make submissions on this matter. Mr Middleton submitted that it would be appropriate for the Committee to proceed to consider whether an immediate order should be imposed in your absence. The Committee accepted the advice of the Legal Adviser, and determined that it was appropriate and fair to proceed in your absence. Having directed that your registration be erased, the Committee has considered whether to impose an order for your immediate suspension in accordance with section 36U (1) of the Dentists Act 1984 (as amended). Graham, L M Professional Conduct Committee Oct 2018 Page -7/8-
The Committee has considered the submissions made by Mr Middleton on behalf of the GDC as to the necessity of an immediate order of suspension. The Committee has accepted the advice of the Legal Adviser. In 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 considers that an immediate order for suspension is consistent with the findings that the Committee has set out in its determination. The effect of the foregoing determination and this immediate order is that your registration will be suspended by virtue of this immediate order from the date on which notice of this decision is deemed served upon you. Unless you exercise your right of appeal, the substantive erasure order will be recorded in the Dental Care Professionals Register 28 days from the date of deemed service. Should you decide to exercise your right of appeal, this immediate order of suspension will remain in place until the resolution of any appeal. Existing interim order In accordance with Rule 21 (3) of the General Dental Council (Fitness to Practise) Rules 2006 the interim order of suspension in place on your registration is hereby revoked. That concludes this case. Graham, L M Professional Conduct Committee Oct 2018 Page -8/8-