Privy Council Appeal No. 63 of 2000
David Preiss Appellant v.
The General Dental Council Respondent
THE PROFESSIONAL CONDUCT COMMITTEE
OF THE GENERAL DENTAL COUNCIL
JUDGMENT OF THE LORDS OF THE JUDICIAL
COMMITTEE OF THE PRIVY COUNCIL,
Delivered the 17th July 2001
Present at the hearing:-
Lord Bingham of Cornhill
Lord Cooke of Thorndon
[Delivered by Lord Cooke of Thorndon]
"The Appellant accepted in evidence, and it is acknowledged on his behalf, that his concern to fulfil this patient's passionate desire for restoration of her teeth overrode in this isolated case his professional judgment. In the result it is accepted on his behalf that his performance fell short of the highest standards to which he aspired, and to which hitherto he has always adhered. Neither the course of treatment nor its ultimate outcome conformed with his original goal, or that of his patient."
"That being a registered dentist:
In relation to the treatment you provided to Mrs [H] between January 1992 and March 1997 you failed to provide the high standard of care to which a patient is entitled and thereby neglected your professional responsibilities to this patient in that:
(a) you failed … adequately to control tooth decay after December 1994 [admitted], when the health of the patient's remaining teeth and gums should have been your first priority. [It is not clear whether this last limb was either admitted or found proved; but on the evidence it was clearly made out.] As a result of this failure you did not ensure that the patient's oral environment was appropriate for the placement of complex crown and bridge restorations;
(b) you diverged significantly from your original written treatment plan of 30th January 1992, without obtaining the patient's consent, in an inappropriate manner in that:
(i) you failed to ensure that adequate plaque control was maintained with regular treatment by your hygienist prior to providing crown and bridge work; [admitted]
(ii) you failed to ensure that investigation into the root canal status of upper right 3, 2 and 7 was carried out by an endodontist;
[As to (ii), the foregoing is the appellant's interpretation of the relevant finding of the PCC after an amendment to the charge during the hearing. The Board does not understand this interpretation to be challenged by the respondent.]
(iii) you provided bridge work to upper and lower jaws at the same time; and
(iv) you failed to investigate the condition of the nerves in the patient's lower teeth;
(c) you failed to allow a sufficient interval between providing temporary crowns and bridges and permanent units;
(d) you provided linked crowns to the patient's lower teeth of inappropriate design."
"The Committee has directed the Registrar to suspend the registration in the Dentists Register of Mr David Preiss for a period of twelve months. The effect of the foregoing direction is that, unless you exercise your right of appeal, your registration will be suspended from the Dentists' Register 28 days from this date for a period of twelve months. The Committee has been particularly concerned by a number of issues in this case, in particular:
- the failure to ensure that the state of the patient's oral health was appropriate in view of the ambitious treatment plan;
- the failure to explain the divergences from the original plan, to a patient who was frequently sedated, which resulted in an absence of consent, whether informed or not, on the part of the patient;
- the delay in referring the patient to another practitioner when it was apparent that significant problems had developed.
The Committee considers that because of the gravity of the facts found proved in this case, particularly those involving standard of care, consent and duty to refer, it is necessary in the public interest to suspend the name of Mr David Preiss from the Dentists Register."
"85. When the Strasbourg jurisprudence is taken into account, we believe that a modest adjustment of the test in R v Gough is called for, … The Court must first ascertain all the circumstances which have a bearing on the suggestion that the Judge was biased. It must then ask whether those circumstances would lead a fair-minded and informed observer to conclude that there was a real possibility, or a real danger, the two being the same, that the tribunal was biased."
A breach of the Procedural Rules
"Where in a case relating to conduct the Committee have found that the facts or any of them alleged in any charge have been proved to their satisfaction (and have not on those facts recorded a finding of not guilty) the Chairman shall invite the complainant or the Solicitor, as the case may be, to address the Committee, and to adduce evidence as to the circumstances leading up to the facts in question, the extent to which such facts are indicative of serious professional misconduct on the part of the respondent, and as to the character and previous history of the respondent. The Chairman shall then invite the respondent to address the Committee by way of mitigation and to adduce evidence as aforesaid. The Committee shall forthwith consider and determine whether in relation to the facts found proved as aforesaid the respondent has been guilty of serious professional misconduct. If they determine that the respondent has not been guilty of such misconduct in relation to some or any of such facts they shall record a finding to that effect."
The Privy Council's assessment of the facts
"That for every professional man whose career spans, as this appellant's has, many years and many clients, there is likely to be at least one case in which for reasons good and bad everything goes wrong – and that this was his, with no suggestion that it was in any way representative of his otherwise unblemished record."