Ivanova v General Dental Council
| Jurisdiction | England & Wales |
| Judge | Mrs Justice Jefford |
| Judgment Date | 06 July 2017 |
| Neutral Citation | [2017] EWHC 1992 (Admin) |
| Date | 06 July 2017 |
| Court | Queen's Bench Division (Administrative Court) |
| Docket Number | CO/759/2017 |
[2017] EWHC 1992 (Admin)
IN THE HIGH COURT OF JUSTICE
QUEEN'S BENCH DIVISION
THE ADMINISTRATIVE COURT
Royal Courts of Justice
Strand
London WC2A 2LL
Mrs Justice Jefford
CO/759/2017
The Appellant appeared in person
Mr Sandesh Singh (instructed by the General Dental Council) appeared on behalf of the Respondent
The appellant, Ivelina Ivanova, is a dentist. She appeals against a decision of the Professional Conduct Committee of the General Dental Council to impose conditions on her registration for 12 months. That decision was made on 20 January 2017. The General Dental Council (the "GDC") acts for the protection of the public.
Section 1ZA and section 1ZB of the Dentists Act 1984 as amended, provide as follows:
"(1ZA) The over-arching objective of the Council in exercising their functions under this Act is the protection of the public.
(1ZB) The pursuit by the Council of their over-arching objective involves the pursuit of the following objectives —
(a) to protect, promote and maintain the health, safety and well-being of the public;
(b) to promote and maintain public confidence in the professions regulated under this Act; and
(c) to promote and maintain proper professional standards and conduct for members of those professions."
Those obligations and functions therefore put front and centre the protection of the public.
This particular matter has a slightly lengthy history. In March 2013 interim conditions on her registration were imposed on Ms Ivanova. A full hearing was held in December 2013, when she represented herself. The hearing was not concluded and the matter came back before the Professional Conduct Committee on 9 July 2014, when Ms Ivanova was not present. The Council made findings of misconduct and impairment. I read from those findings. They were as follows:
"The Committee considered that Ms Ivanova's behaviour as stated above and the associated breaches of Standards for Dental Professionals represents a serious falling short from acceptable standards. The Committee has identified, in respect of Ms Ivanova's treatment of the four patients whose treatment is the subject of the charges, failures in examination, assessment, diagnosis, treatment planning, prescribing and record keeping. The Committee notes that these took place in a very short period of time and constituted departures from basic standards in dentistry. The Committee considers that these failings could have resulted in serious adverse outcomes for the patients involved. In the circumstances, the Committee determined that the facts found proved against Ms Ivanova amounted to misconduct.
The Committee next went on to consider whether Ms Ivanova's fitness to practise is currently impaired by reason of her misconduct. It was of the view that, although serious and occurring over a short period of time, the lapses were capable of remediation. Nevertheless, the evidence before the Committee of remedial action taken by Ms Ivanova is unsatisfactory."
They then set out what they regarded as the unsatisfactory steps taken to remedy that impairment. They added that the Committee considered that Ms Ivanova did not have any real insight into her failings. They then said this:
"The combination of a failure to remediate her failings properly and a woeful lack of insight led the Committee to conclude that there is a high risk that Ms Ivanova will repeat her misconduct.
Taking all of this into account, the Committee considers that Ms Ivanova's fitness to practise is currently impaired by reason of her misconduct."
The Council imposed the sanction of suspension for a 12-month period. There were further resumed hearings on 10 July 2015, 19 January 2016 and 22 January 2016. On each occasion the suspension was continued for a further period of six months. Ms Ivanova did not appeal against the findings made in July 2014 or the sanction imposed, nor has she made any appeal against the outcomes of the resumed hearings.
There was then a further hearing on 20 January 2017. The Committee was invited to continue the suspension but decided instead to impose the lesser sanction of conditions on Ms Ivanova's registration.
Ms Ivanova submits, firstly, that the Committee was wrong to impose any sanction because she had carried out such remediation as it had in mind and had, she must therefore say, remedied any impairment of her fitness to practise. She relies on the documents put before the court, particularly relating to her Personal Development Plan and her contact with NHS East Midlands. In this respect, Ms Ivanova bore a "persuasive burden", that is, she had to persuade the Committee that she had remedied any impairment ( Bamgbelu v GDC [2013] EWHC 1169 (Admin), paragraphs 13 to 14 being relevant). The Committee was not so satisfied and it reached the following conclusions:
"The Committee carefully examined the documents provided to it and your oral statement. The Committee considered whether or not these adequately addressed the matters raised in the helpful suggestions made by the previous PCC on 29 July 2016.
You have produced a Personal Development Plan … which focused on areas such as, diagnosis and treatment of caries, dental treatment and drug prescribing, periodontal treatment, record keeping, and radiography. You have produced some evidence of CPD. You have provided written reflective pieces, together with copies of various audits on your record keeping. The Committee noted that you provided a written supervisors report which confirms that there are no concerns with your dental practice, diagnosis, treatment planning and record-keeping in relation to your work in Bulgaria."
I pause to say that so far that report was supportive of Ms Ivanova. However, it went on:
"The Committee noted that since the last review hearing there has been sporadic engagement with Health Education East Midlands NHS Trust, which you ended in May 2016. The Committee also noted that you have not produced verified and up to date audits. You have produced sparse evidence of your current practice. The Committee considers that you could have done more to demonstrate full remediation.
The Committee further noted that several CPD certificates you have submitted relate to discrete areas of dentistry, some of which were placed before the previous reviewing Committee. The Committee had some concerns that your CPD did not demonstrate any reflection in respect of your day-to-day practice. The Committee noted a similar concern identified by the previous Committee, regarding a lack of evidence confirming how your learning has been embedded in your current practice. Attending courses or undertaking other training activities is a starting point, but the Committee would need to see evidence of improvements in your practice in the light of your training to be satisfied that your remediation is sufficiently developed to avoid the risk of repetition. The Committee noted your intention to remedy the deficiencies identified in your practice. The Committee acknowledges that you have made some improvements, albeit slow, and are engaging with three deaneries to improve your learning and clinical skills."
The Committee then noted that the focus of the GDC regulatory process was, as I have said, to protect patients and the public interest. It concluded that although Ms Ivanova had begun to improve her remediation and insight into her failings there was some way to go, and they repeated that she had not yet demonstrated how her current learning had been properly embedded in her day-to-day practice. The Committee therefore concluded that her fitness to practise remained impaired.
In his careful submissions to the court, Mr Singh has provided what appears to me to be an accurate analysis of the documentation that was relied on by the Committee to reach those conclusions. Some of the documents and the matters relied upon had been before the Committee at the previous hearing. Of those that had not, Mr Singh on behalf of the respondent said this. Firstly there was correspondence between the GDC and Health Education East Midlands in December 2016 which suggested that there had been little/no engagement with Ms Ivanova recently. A report was available dated 20 December 2016 which confirmed that Ms Ivanova initially engaged but had 'not responded to recent attempts to contact her to continue the remediation process.'
There was evidence that the appellant had engaged with Health Education Northeast and attended various meetings resulting in her producing a Personal Development Plan. However, Mr Singh submitted, she had produced no evidence from Health Education Northeast to establish the level of her insight or improvement as a result of this contact.
Of her CPD certificates that had not previously been produced, they demonstrated that the CPD undertaken was limited and the reflective writing produced as a result essentially listed what had been read rather than going further in terms of reflection on what had been learnt. That written submission was expanded upon orally by reference to the CPD which it is expected a dentist would take, amounting to 250 hours over a period of five years, compared with which there was verified CPD undertaken by Ms Ivanova in the course of the year of a little over 11 hours.
Orally before me she has explained further the CPD that she undertook, including reading a book — at least one book, if not more — recommended as part of her Personal Development Plan. However, that does not seem substantially to affect the thrust of the submission made...
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