Uncertainty and terror: a tale of fitness to practise
In many ways, Eddie Scher is exceptional.
He is a visiting professor at Temple University Philadelphia. He is a past president, founder, and life member of the Association of Dental Implantology. He comes from a long line of successful dentists, counting deans of dental schools in his family heritage.
But in other ways, he is less remarkable. He loves his patients. He thrives on working with colleagues, on providing an exceptional end result, and on practising evidence-based dentistry.
And he is not immune to the gaze of the General Dental Council’s fitness to practise (FtP) processes.
One morning, Eddie received the ‘private and confidential’ letter that every dentist dreads – informing him that the GDC had received a complaint about him, and that FtP proceedings had begun.
‘I was horrified,’ admits Eddie. ‘It felt like the sky was falling on me. It appeared totally out of the blue. I felt frightened. I felt ashamed, even though I knew I had done nothing wrong.’
He would go on to be totally exonerated of the charges, but not before going all the way to a hearing, and enduring two years of uncertainty and terror.
Against the backdrop of the GDC’s very public recent difficulties, his personal story presents a fascinating insight into how these problems impact on the profession it regulates – and the patients it is supposed to protect.
Wheels in motion
For anyone unfamiliar with the vagaries of the FtP process, perhaps the most concerning aspect of his case is how it evolved over time.
The initial complaint came from a patient who claimed to be suffering from acute pain, ostensibly an allergic reaction to the metal used in her temporary restoration.
The metal in question is an alloy specifically recommended for use in patients with a nickel allergy. There have been 125 million uses of it without an allergy complaint; there is even a $5 million insurance policy in place (cited on the manufacturer’s website) that claims to cover any dentist or technician using it against an allergy developing.
The patient started experiencing pain shortly after the website mentioning the insurance policy was discussed with her.
After the patient’s provisional bridgework had been changed to plastic, she stopped attending the practice, and registered her complaint directly with the GDC.
‘The GDC letter arrived while we were still sending her recall letters, which was the only indicator we had that she had a problem with us,’ Eddie recalls.
A second letter arrived soon after the first, though this was nothing to do with the GDC. Instead, it was a letter from the patient, directly demanding compensation – just under £100,000 as a bill for the ‘pain and suffering caused by the allergic response’. Paying this was out of the question, of course – but by that point it was already too late. The wheels were in motion.
The claim was passed to Dental Protection, which dealt with the patient directly, denying liability on Eddie’s behalf.
Twists and turns
After the complaint was registered, and the initial caseworker decided it warranted further investigation, it was sent to a National Clinical Assessment Service (NCAS) dentist for a clinical review of the complaint and the records submitted by Eddie.
In spite of the very low level concerns identified by the NCAS clinical reviewer, Eddie’s case was referred by the Investigating Committee for a full hearing in front of the Professional Conduct Committee.
The patient was interviewed by the GDC’s solicitors tasked with preparing the case, and the patient gave a witness statement. Following that, a new allegation – of not obtaining valid consent – emerged.
But now the allegations went even further: if consent had been obtained, it was obtained after the patient had been given intravenous sedation. The patient claimed not to remember signing the form, but did claim to have been asked to sign something just after the anaesthetist began administering the sedation.
There was a dark irony in that the patient, who attended Eddie’s implant practice seeking a replacement for her ‘hated’ denture, was now at the centre of a consent case because she had not been offered dentures as a treatment option.
Things had turned from allegations that Eddie and the team at Dental Protection knew were straightforward to deal with, as there was no evidence to support them, to something far more serious than they first anticipated.
It had become a different case, and the stakes had risen terrifyingly high.
‘It’s a severe accusation,’ Eddie acknowledges. ‘Placing implants under sedation without consent; you could, and perhaps should, be struck off for that.
‘And not only that – acquiring her signature in that manner would have been disgusting. It would be a totally despicable way of practising. If I had done it I would completely agree with being struck off; it’s a really awful accusation.
‘When the case changed in that way it completely pulled the rug out from under my feet. Especially when I had a treatment plan, signed…I had everything. I had consent, and she was saying none of it ever happened.’
Yet at the hearing, the charges completely fell apart. A day and a half into the five-day hearing, the case was dismissed with ‘no case to answer’.
The panel accepted that the patient’s evidence in the hearing itself – that consent was in fact dealt with before the sedation – was correct, and contrary to the written evidence submitted during the two-year investigation. That helped cement the unreliability of the prosecution’s case.
In effect, the case was thrown out of court before the defence had to give its argument.
Weathering the storm
Ignore, for a moment, the impact that cases like this have on the dental professional who goes through them.
For many observers, the fact that a case can make it so far through the FtP process only to be summarily dismissed raises equally serious questions about how far the GDC is succeeding in its oft-quoted aim of protecting patients.
Because despite the heartache, the worry, and the sleepless nights, Eddie still worries about what the ordeal was like for his erstwhile patient.
‘I actually feel sorry for her,’ Eddie says. ‘By the time we got to the hearing, everything about nickel allergy had been dropped from the GDC’s allegations. But not for the patient – that was still her issue. She was confused; even when she testified she found it difficult not to bring it up.’
The charges had evolved so far from the patient’s original complaint that it seemed to undermine the whole case, particularly when it came to the hearing.
‘She was caught out under questioning because she didn’t have the facts,’ Eddie explains. ‘And because of that…there’s no other way to put this: she looked confused and frustrated on the stand.
‘That is completely wrong; it was unfair to put her through that. She couldn’t own this complaint on the witness stand because it was not her complaint to begin with. So when questions were asked there were gaping holes in her testimony – she didn’t know what to answer.’
Eddie believes the strength of the determination belies the superb work done by his legal team, including the barrister Dental Protection appointed, and the support of his wife Belinda.
Without that backing, the outcome could have been very different, he explains.
‘After a detailed discussion I accepted Dental Protection’s recommendation because I realised that I needed an expert in GDC cases. They were so fair, and they deserve every credit for how they handled the case.
‘But without that choice of barrister, and without Belinda’s help, I wouldn’t have won the case. It’s as simple as that.
‘The panel at the hearing was very fair in its judgement – yes, there were record keeping issues that cropped up. You can never make enough notes! But the panel recognised that the case should never have been brought to them.
‘But would they have the chance to be that fair had the barrister not helped us show the holes in the patient’s testimony? Without all those things then the outcome could have been very different.’
Time to change
Eddie’s journey through the eye of the GDC needle has left him in no uncertainty that the regulator’s processes must change.
He continues: ‘Does my case represent the norm? I couldn’t believe that the charges changed so dramatically over the course of the proceedings. It doesn’t seem possible to me that the patient who kept returning to me for months after I had placed the implants suddenly started claiming that I did so without consent.
‘But Dental Protection weren’t surprised that this happened – they’ve seen it happen before.
‘How does this help the patient? Was my case really in the best interests of someone who feels they have a problem with their treatment?’
Despite everything, Eddie is a staunch advocate of the need for regulation – he still argues vehemently about the importance of the GDC in dentistry.
‘I’m not critical of regulation’, he says. ‘I am critical of the regulator. I am critical of the process, and of how the current regulator has been operating. The hearing itself was fair but it should never have gotten that far. I don’t believe the fact that it did was in the best interests of the patient, or me.’
Hindsight has given him ample opportunity to consider where things can be improved for the benefit of the patient and the profession.
The first item on the list is absolutely clear. Eddie explains: ‘I would like to see a senior member of the dental profession as chair of the GDC. The current chair is a layperson and I believe it should be a dentist.’
Beyond that, the suggestions get more complex but no less pressing: ‘The proposed plans for more comprehensively trained case examiners have to happen. And those individuals must be given the power to recommend arbitration – the GDC has the Dental Complaints Service and their role is to resolve complaints.’
The possibility of arbitration or mediation would also help the GDC to be much more proportionate, he argues – particularly in cases where there are record keeping issues but where the patient has come to no harm. The dental community could do more in its own way too, he believes.
‘We could do better as a profession to support our colleagues going through FtP,’ Eddie adds.
‘Not to provide legal advice, but to simply be there as a friend or mentor. So many dentists are going through similar experiences, and it is devastating. I really believe that more support could make all the difference.
‘I had a lot of support from the places you would expect – Dental Protection, the solicitor and barrister, my staff. But nobody dares tell anyone else about these things, so there’s nothing at ground level, from someone who’s been through it.
‘I only realised how important that was once the hearing was set and my name appeared on the GDC website. The moment that happened I had many calls from colleagues who simply rang to say how sorry they were that I was going through it, and wished me well. It made all the difference.
‘Patients don’t always realise how serious this is for the dentist; I don’t think they know that dentists could be struck off – it’s not just a case of a slap on the wrist. There are repercussions and I don’t think patients realise that.’
Gone but not forgotten
It is now nearly a year on from the hearing, and the sleepless night are gone, but not forgotten.
‘The investigation has left its mark on me,’ Eddie admits.
‘It took two years – two years where my life felt like it was put on hold. Once the case was finished I realised I felt like I had been holding my breath all that time.
‘When you hear of it happening to others, I used to think “there but for the grace of God”…but then it happened to me, and I learned the hard way that grace has nothing to do with it.’
It is evident that the experience has cast a long shadow but typically, for Eddie it is about moving on and trying to improve things rather than dwelling on the past.
‘I actually believe that much of what the GDC does is very good, and most of what the CQC does is very good. The CQC seems to be coming round to the idea that it initially made some mistakes, and that it needed to put those right. The GDC needs to do the same.
‘Instead of taking one in 10 dentists and putting them through a trial because of their record keeping, maybe we should be spending that money on educating dentists to do it better. Surely that’s more constructive than spending so much money on hearings?
‘I worry that there is no trust left in the relationship between dentists and their regulator, and that is not a healthy outcome for us or our patients.
‘Possibly the most annoying and disturbing aspect of this whole saga is that the GDC insisted on informing all interested parties: the three universities I work for, the journal I am editor in chief of, and so on. But did it inform them of the outcome? Of course not – which underlines the lack of respect that the GDC has for the people it regulates.’
With the case firmly behind him, Eddie is looking to the future – and trying to offer support to other dentists going through the same thing. Next month he starts lecturing about his experiences on top of his usual commitments to his practice and teaching across the globe. He is in the process of putting together a year-long series on treatment planning in his journal Implant Dentistry Today for the same reason.
But no matter where his return to normality carries him, it is safe to say that he takes his new favourite phrase with him wherever he goes: ‘No case to answer.’