Jagdev Singh Wasu v The General Dental Council
| Jurisdiction | England & Wales |
| Judge | Mr Justice Haddon-Cave |
| Judgment Date | 03 December 2013 |
| Neutral Citation | [2013] EWHC 3782 (Admin) |
| Docket Number | Case No: CO/4773/2013 |
| Court | Queen's Bench Division (Administrative Court) |
| Date | 03 December 2013 |
[2013] EWHC 3782 (Admin)
Mr Justice Haddon-Cave
Case No: CO/4773/2013
IN THE HIGH COURT OF JUSTICE
QUEEN'S BENCH DIVISION
ADMINISTRATIVE COURT
Royal Courts of Justice
Strand, London, WC2A 2LL
Ian Winter QC instructed by and for the Claimant
Ian Stern QC and Sandesh Singh (instructed by Capsticks Solicitors) for the Defendant
INTRODUCTION
This is an appeal by Jagdev Singh Wasu ("the Appellant"), against an order of the General Dental Council ("GDC") dated 28 th March 2013 finding him guilty of professional misconduct such that his fitness to practise dentistry was impaired and ordering his erasure from the Register of Dentists and immediate suspension from practice, pursuant to s. 27B and s. 30 Dentists Act 1984.
The Appellant brings this appeal as of right against the Decision pursuant to s.29(1B) of the Dentists Act 1984. The Appellant contends that (i) the substantive decision made by the Disciplinary Committee of the GDC ( i.e. that the Appellant was guilty of professional misconduct such that his fitness to practise was impaired) was (a) wrong, (b) contrary to the evidence and (c) a decision which no reasonable Disciplinary Committee could have reached; and (ii) the decision as to penalty made by the Disciplinary Committee of the GDC ( i.e. that the Appellant should be erased from the Register of Dentists) was (a) wrong, (b) disproportionate to the Appellant's conduct and (c) a decision which no reasonable Disciplinary Committee could have reached.
The Defendant submits that the Appellant's grounds have no merit and invites the Court to dismiss the appeal with costs.
THE CHARGES
The charges brought by the GDC against the Appellant can be divided into three categories:
(1) GENERAL CHARGES: Charges 3–7 relating to a series of allegations arising from a review of the Appellant's record cards between 2008 and 2011 carried out by NHS Kingston, with whom he held a contract to provide NHS dental services.
(2) CHARGES RELATING TO PATIENT A: Charges 8–18 related to a series of allegations regarding the Appellant's treatment of a 75-year-old lady called Patient A who was treated by the Appellant at the Aspire dental practice in Surbiton between July 2009 and May 2010.
(3) CHARGES RELATING TO PATIENT B: Charges 19–24 related to another female patient, called Patient B, who attended appointments with the Appellant at the Aspire dental practice in Southampton in 2009 and 2010.
The category (1) charges were admitted. This appeal relates to categories (2) and (3).
(1) GENERAL CHARGES: Charges 3–7
Under Charges 3–7, the GDC alleged that the Appellant's clinical treatment and record-keeping in respect of 14 patients was inadequate in a number of respects over a period of about 3 years between 2008 and 2011 in that he (i) failed to keep adequate records of treatment provided, (ii) failed to take all necessary radiographs and (iii) failed to adequately manage the periodontal condition (gum health) of his patients.
The Appellant admitted all of the allegations under Charges 3–7 (save for Charge 3(o)(iii) which was withdrawn). Charges 3(b), 3(d) and 3(e) were admitted on the basis that inadequate records were kept, rather than no records at all. The GDC Disciplinary Committee formally found Charges 3–7"Admitted and Proved". No issue on appeal arises in respect of these General Charges.
(2) CHARGES RELATING TO PATIENT A: Charges 8–18
Charges 8–18 related to the Appellant's clinical treatment of Patient A as follows:
"PATIENT A
8. Between approximately July 2009 and May 2010 you provided dental treatment to Patient A (who is identified in Schedule 3).
9. On or around 21 July 2009 you agreed a treatment plan, which was signed by yourself and Patient A, which included the placement of 6 implants in the upper anterior region and restoration of those implants with all ceramic crowns.
10. On 29 October 2009 you:
(a) extracted UR4, UR2, UL1, UL2, UL4;
(b) placed implants at UR4, UR1, UL1 and UL4;
(c) provided Patient A with temporary bridge.
11. At appointments between approximately 16 th February 2010 and 20 th April 2010 you, with a view to providing Patient A with a 12 unit permanent bridge:
(a) extracted UL3 and UR3;
(b) placed an implant at UL3;
(c) extracted UL5 and UR5;
(d) provided Patient A with a 12 unit temporary bridge.
12. In respect of the treatment at paragraph 11 above you failed, in the period between 29 th October 2009 and 20 th April 2010, to:
(a) explain to Patient A, adequately or at all, that you planned to provide her with a 12 unit bridge rather than individual crowns;
(b) obtain Patient A's express consent for the provision of a 12 unit bridge rather than individual crowns;
(c) provide Patient A with any, or sufficient, information in writing following the appointment on 29 th October 2009 regarding:
(i) the available treatment options in respect of her upper arch at that stage;
(ii) the costs associated with the available treatment options;
(iii) the risks and benefits associated with the available treatment options;
(iv) the type of restoration that you planned to provide for her upper arch;
(v) the further teeth that you planned to extract;
(vi) the further implants that you planned to place;
(vii) the risk factors associated with implants;
(viii) any other treatment that was required for decay and/or her periodontal condition;
(d) provide Patient A with any, or sufficient, information verbally regarding the matters at paragraph 12(c) above following the appointment on 29 th October 2009.
13. In the circumstances you failed to obtain Patient A's informed consent for the treatment at paragraph 11 above.
14. The standard of care you provided was inadequate, in that:
(a) you failed to diagnose and/or treat caries at LR6, LR4 and/or LL2;
(b) you failed to provide any, or any adequate, caries preventative advice and/or treatment;
(c) you provided a temporary bridge which was of an inadequate design, in that you provided a 12 unit temporary bridge which was retained by cement and supported by 4 implants.
15. In relation to the letter/treatment plan dated 4 August 2009 you forged, or caused to be forged, Patient's A's signature.
16. On or around 22 July 2010 you made retrospective entries in Patient A's electronic dental records relating to appointments you had conducted with her between 8 July 2009 and 19 May 2010 without recording that those entries were made retrospectively.
17. In the entries described at paragraph 16 above you inaccurately recorded that:
(a) On 21 July 2009 you had discussed an option for implant treatment with Patient A which included 'complete restoration of [her] upper arch' ('Option 2') (or words to that effect);
(b) On 4 th August 2009 you had "explained Option 2 in detail" to Patient A and that she was "happy with this" (or words to that effect);
(c) On 4 th August 2009 you had provided Patient A with a "treatment plan with [an] indication of costs" on that date (or words to that effect);
(d) On 23 rd September 2009 Patient A had "agreed to go ahead with [Option 2] implant treatment" (or words to that effect).]
18. Your conduct as set out at paragraph 15, [16 and/or 17] above was:
(a) inappropriate;
(b) intended to mislead;
(c) dishonest."
The Appellant admitted Charges 8, 9, 10, 11 and 16 but denied Charges 12, 13, 14, 15, 17 and 18. The Disciplinary Committee formally found Charges 8, 9, 10, 11 and 16"Admitted and Proved" and (save for Charge 12(d) and 14(c)) found Charges 12, 13, 14, 15, 17 and 18"Proved" on the evidence.
The Appellant appeals the Disciplinary Committee's findings against him in relation to Charges 12, 13, 14, 15, 17 and 18. Mr Winter QC, for the Appellant, helpfully identified the principal finding of fact challenged by the Appellant under each head of Charge as follows:
(1) Charge 12(a): that Dr Wasu failed adequately or at all to explain to Patient A that he intended to provide her with a 12 unit bridge (she was fully aware that she had received temporary bridges and was to receive a permanent bridge).
(2) Charge 12(b): that Dr Wasu failed to obtain Patient A's consent for such a bridge (she consented to the fitting of the bridge).
(3) Charge12(c) and (d): that Dr Wasu failed to provide Patient A with sufficient information either in writing or verbally following the appointment with Dr Hawkesford on 29 October 2009 (she received full information both on 29.10.09 and thereafter).
(4) Charge 15: that Dr Wasu forged or caused to be forged Patient A's signature on the treatment plan of 4 August 2009 (he did not forge her signature or fabricate the treatment plan).
(5) Charge 17: that Dr Wasu inaccurately recorded details in Patient A's medical records for 21.7.09; 4.8.09; and 23.9.09 (the details recorded were accurate).
(6) Charge 18(b) and (c): that Dr Wasu's conduct was intended to mislead and/or was dishonest (he was not dishonest and did not intend to mislead).
(3) CHARGES RELATING TO PATIENT B: Charges 19–24
Charges 19–24 related to the Appellant's clinical treatment of Patient B:
"PATIENT B
19. In 2009 and 2010 you provided dental treatment to Patient B (who is identified in Schedule 3).
20. Your care and treatment of Patient B was inadequate, in that you failed to:
(a) obtain Patient B's informed consent for the provision of a crown at UR6 on or around 28 th October 2009, in that you did not inform her that UR6 required or may require root canal treatment;
(b) arrange a suitable...
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